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Sample records for current return-to-play guidelines

  1. Return to Play Guidelines Cannot Solve the Football-Related Concussion Problem

    Science.gov (United States)

    Johnson, L. Syd M.

    2012-01-01

    Background: High school football players are the single largest cohort of athletes playing tackle football, and account for the majority of sport-related concussions. Return to play guidelines (RTPs) have emerged as the preferred approach for addressing the problem of sport-related concussion in youth athletes. Methods: This article reviews…

  2. Return to Play Guidelines Cannot Solve the Football-Related Concussion Problem

    Science.gov (United States)

    Johnson, L. Syd M.

    2012-01-01

    Background: High school football players are the single largest cohort of athletes playing tackle football, and account for the majority of sport-related concussions. Return to play guidelines (RTPs) have emerged as the preferred approach for addressing the problem of sport-related concussion in youth athletes. Methods: This article reviews…

  3. Return-to-Play Recommendations After Cervical, Thoracic, and Lumbar Spine Injuries

    Science.gov (United States)

    Huang, Philip; Anissipour, Alireza; McGee, William; Lemak, Lawrence

    2016-01-01

    Context: Currently, there is a national focus on establishing and disseminating standardized guidelines for return to play for athletes at all levels of competition. As more data become available, protocols and guidelines are being refined and implemented to assist physicians, coaches, trainers, players, and parents in making decisions about return to play. To date, no standardized criteria for returning to play exist for injuries to the spine. Evidence Acquisition: Electronic databases including PubMed and MEDLINE and professional orthopaedic, neurosurgical, and spine organizational websites were reviewed between 1980 and 2015. Study Design: Clinical review. Level of Evidence: Level 4. Results: Although clinical guidelines have been published for return to play after spine injury, they are almost exclusively derived from expert opinion and clinical experience rather than from well-designed studies. Furthermore, recommendations differ and vary depending on anatomic location, type of sport, and surgery performed. Conclusion: Despite a lack of consensus and specific recommendations, there is universal agreement that athletes should be pain free, completely neurologically intact, and have full strength and range of motion before returning to play after spinal injury. PMID:26502187

  4. Predicting return to play after hamstring injuries

    NARCIS (Netherlands)

    M.H. Moen (Maaike); G. Reurink (Gustaaf); A. Weir (Adam); J.L. Tol (Johannes); M. Maas (Mario); G.J. Goudswaard (Gert Jan)

    2014-01-01

    markdownabstract__Abstract__ Background Previous studies on the prognostic value of clinical and MRI parameters for the time to return to play (TTRTP) in acute hamstring injuries showed only limited to moderate evidence for the various investigated parameters. Some studies had multiple methodologic

  5. Return to play in athletes with spinal cord concussion: a systematic literature review.

    Science.gov (United States)

    Nagoshi, Narihito; Tetreault, Lindsay; Nakashima, Hiroaki; Nouri, Aria; Fehlings, Michael G

    2017-02-01

    This is a systematic review. The study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI). Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial. We conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI. We identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a "long" duration of symptoms (>24 hours; 36.36%) compared with those who were problem-free (11.11%; p=.0311). There is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine

  6. Return to Play After Forearm and Hand Injuries in the National Basketball Association

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    Morse, Kyle W.; Hearns, Krystle A.; Carlson, Michelle Gerwin

    2017-01-01

    Background: Hand injuries can result in significant time away from competition for professional basketball players. Time to return to play after hand injuries in elite athletes has not been well described. Purpose: To report the return to play from metacarpal fractures, phalangeal fractures, and thumb ligament tears in National Basketball Association (NBA) players over a 5-year period. Study Design: Descriptive epidemiology study. Methods: The NBA transaction report was analyzed from January 2009 to May 2014. Players were identified if they were added to the inactive list (IL), missed games due to their injury, or underwent surgery as a result of hand injury. Number of games missed due to injury, days spent on the IL, and age at injury were calculated by injury type and location. Results: One hundred thirty-seven injuries were identified: 39 injuries to the hand and 98 injuries to the finger. Three major injury patterns were identified and analyzed: metacarpal fractures (n = 26), phalangeal fractures (n = 33), and thumb ligament tears (n = 9). The type of injury sustained affected return to play (P < .05). All thumb ligament tears required surgery and had the longest return to play of 67.5 ± 17.7 days (P < .05). The return to play for surgically treated metacarpal fractures (56.7 ± 26.3 days) was significantly greater than nonsurgically treated metacarpal fractures (26.3 ± 12.1 days; P < .01). Return to play for surgically repaired phalangeal fractures (46.2 ± 10.8 days) trended greater but was not significantly different than phalangeal fractures treated nonsurgically (33.3 ± 28.5 days; P = .21). Conclusion: Hand injuries in professional basketball players can lead to prolonged periods of time away from competition, especially after surgery. This study provides guidelines on expected return to play in the NBA after these common hand injuries. PMID:28251168

  7. Return to Play After Forearm and Hand Injuries in the National Basketball Association.

    Science.gov (United States)

    Morse, Kyle W; Hearns, Krystle A; Carlson, Michelle Gerwin

    2017-02-01

    Hand injuries can result in significant time away from competition for professional basketball players. Time to return to play after hand injuries in elite athletes has not been well described. To report the return to play from metacarpal fractures, phalangeal fractures, and thumb ligament tears in National Basketball Association (NBA) players over a 5-year period. Descriptive epidemiology study. The NBA transaction report was analyzed from January 2009 to May 2014. Players were identified if they were added to the inactive list (IL), missed games due to their injury, or underwent surgery as a result of hand injury. Number of games missed due to injury, days spent on the IL, and age at injury were calculated by injury type and location. One hundred thirty-seven injuries were identified: 39 injuries to the hand and 98 injuries to the finger. Three major injury patterns were identified and analyzed: metacarpal fractures (n = 26), phalangeal fractures (n = 33), and thumb ligament tears (n = 9). The type of injury sustained affected return to play (P basketball players can lead to prolonged periods of time away from competition, especially after surgery. This study provides guidelines on expected return to play in the NBA after these common hand injuries.

  8. Does posteromedial chondromalacia reduce rate of return to play after ulnar collateral ligament reconstruction?

    Science.gov (United States)

    Osbahr, Daryl C; Dines, Joshua S; Rosenbaum, Andrew J; Nguyen, Joseph T; Altchek, David W

    2012-06-01

    Biomechanical studies suggest ulnohumeral chondral and ligamentous overload (UCLO) explains the development of posteromedial chondromalacia (PMC) in throwing athletes with ulnar collateral ligament (UCL) insufficiency. UCL reconstruction reportedly allows 90% of baseball players to return to prior or a higher level of play; however, players with concomitant posteromedial chondromalacia may experience lower rates of return to play. The purpose of this investigation is to determine: (1) the rates of return to play of baseball players undergoing UCL reconstruction and posteromedial chondromalacia; and (2) the complications occurring after UCL reconstruction in the setting of posteromedial chondromalacia. We retrospectively reviewed 29 of 161 (18%) baseball players who were treated for the combined posteromedial chondromalacia and UCL injury. UCL reconstruction was accomplished with the docking technique, and the PMC was addressed with nothing or débridement if Grade 2 or 3 and with débridement or microfracture if Grade 4. The mean age was 19.6 years (range, 16-23 years). Most players were college athletes (76%) and pitchers (93%). We used a modified four-level scale of Conway et al. to assess return to play with 1 being the highest level (return to preinjury level of competition or performance for at least one season after UCL reconstruction). The minimum followup was 24 months (mean, 37 months; range, 24-52 months). Return to play was Level 1 in 22 patients (76%), Level 2 in four patients (14%), Level 3 in two patients (7%), and Level 4 in one (3%) patient. Our data suggest baseball players with concomitant PMC, may have lower rates of return to the same or a higher level of play compared with historical controls. Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

  9. Complete avulsion of the adductor longus in a semi-professional football player: Rapid return to play with nonoperative treatment

    Directory of Open Access Journals (Sweden)

    Vince W Lands

    2016-01-01

    Full Text Available The adductor longus has become recognized as one of the more commonly injured muscles in the medial compartment. Acute complete rupture injuries occurring at the proximal aspect of the muscle are less common. Limited data exist regarding management of the injuries in athletes required for return to play and functioning. The current data favors operative management; however, nonoperative treatment may be a viable option. Nonoperative management of avulsion injuries of the proximal adductor longus tendon may prove equal results to surgical repair in return to play and functioning. A semi-professional football player sustained a left groin injury while participating in the play. Due to continued pain, swelling, and suspicion of injury, a magnetic resonance imaging was performed diagnosing a complete tear of proximal adductor longus tendon. Physical examination, strength, and range of motion were recorded until the patient was able to function normally without strength deficit, the range of motion loss, and the return of speed. The player was treated nonoperatively and was eventually allowed to return to play. The time of return to play was 6 weeks. Strength deficit was not appreciated or loss of motion and player was able to return to baseline function. Nonoperative management of complete avulsion injuries of the proximal adductor longus tendon result in faster return to play than operative management even if significant retraction is present.

  10. 2014 female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad.

    Science.gov (United States)

    Joy, Elizabeth; De Souza, Mary Jane; Nattiv, Aurelia; Misra, Madhusmita; Williams, Nancy I; Mallinson, Rebecca J; Gibbs, Jenna C; Olmsted, Marion; Goolsby, Marci; Matheson, Gordon; Barrack, Michelle; Burke, Louise; Drinkwater, Barbara; Lebrun, Connie; Loucks, Anne B; Mountjoy, Margo; Nichols, Jeanne; Borgen, Jorunn Sundgot

    2014-01-01

    The female athlete triad is a medical condition often observed in physically active girls and women and involves three components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with one or more of the three triad components, and early intervention is essential to prevent its progression to serious end points that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement presents a set of recommendations developed following the first (San Francisco, CA) and second (Indianapolis, IN) International Symposia on the Female Athlete Triad. This consensus statement was intended to provide clinical guidelines for physicians, athletic trainers, and other health care providers for the screening, diagnosis, and treatment of the female athlete triad and to provide clear recommendations for return to play. The expert panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision making regarding sport participation, clearance, and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team, and implementation of treatment contracts.

  11. MRI observations at return to play of clinically recovered hamstring injuries

    NARCIS (Netherlands)

    G. Reurink (Gustaaf); G.J. Goudswaard (Gert Jan); J.L. Tol (Johannes); E. Almusa (Emad); M.H. Moen (Maaike); A. Weir (Adam); J.A.N. Verhaar (Jan); B. Hamilton (Bruce); M. Maas (Mario)

    2013-01-01

    textabstractBackground: Previous studies have shown that MRI of fresh hamstring injuries have diagnostic and prognostic value. The clinical relevance of MRI at return to play (RTP) has not been clarified yet. The aim of this study is to describe MRI findings of clinically recovered hamstring injurie

  12. No association between fibrosis on magnetic resonance imaging at return to play and hamstring reinjury risk.

    Science.gov (United States)

    Reurink, Gustaaf; Almusa, Emad; Goudswaard, Gert Jan; Tol, Johannes L; Hamilton, Bruce; Moen, Maarten H; Weir, Adam; Verhaar, Jan A N; Maas, Mario

    2015-05-01

    Connective tissue scar (fibrosis) is a common finding on magnetic resonance imaging (MRI) after recovery from acute hamstring injuries. Fibrosis has been suggested as a predisposing factor for reinjury, but evidence from clinical studies is lacking. The aim of this study was to examine the association between the presence of fibrosis on MRI at return to play after an acute hamstring injury and the risk of reinjury. The hypothesis was that fibrous tissue on MRI was associated with an increased reinjury risk. Cohort study; Level of evidence, 3. Magnetic resonance images were obtained from 108 consecutive athletes with modified Peetrons classification grade 1 or 2 hamstring injuries within 5 days of injury and within 7 days of return to play. The presence and extent of abnormally low signal intensity in the intramuscular tissue on MRI, suggestive of fibrosis, were assessed on both T1- and T2-weighted images. Reinjuries were recorded over a 1-year follow-up period. The association between fibrosis and reinjury risk was analyzed with a Cox proportional hazards model. The MRIs of the initial injury showed 45 (43%) grade 1 and 63 (57%) grade 2 injuries. Median time of return to play was 30 days (interquartile range [IQR], 22-42 days). At return to play, 41 athletes (38%) had fibrosis on MRI with a median longitudinal length of 5.8 cm (IQR, 3.3-12.5 cm) and a median volume of 1.5 cm3 (IQR, 1.5-3.9 cm3). In athletes with fibrosis, 24% (10/41) sustained a reinjury, and in the subjects without fibrosis, 24% (16/67) had a reinjury, resulting in a hazard ratio of 0.95 (95% CI, 0.43-2.1; P=.898). Fibrosis is commonly seen on MRI at return to play after grade 1 or 2 hamstring injuries but is not associated with reinjury risk. © 2015 The Author(s).

  13. Return to Play and Future ACL Injury Risk Following ACL Reconstruction In Soccer Athletes From the MOON Group

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    Brophy, Robert H.; Schmitz, Leah; Wright, Rick W.; Dunn, Warren R.; Parker, Richard D.; Andrish, Jack T.; McCarty, Eric C.; Spindler, Kurt P.

    2013-01-01

    Background There is limited information on outcomes and return to play (RTP) after ACL reconstruction (ACLR) in soccer athletes. Hypothesis The purpose of this study was to (i) test the hypotheses that player sex, side of injury and graft choice do not influence RTP, and (ii) define the risk for future ACL injury in soccer players after ACLR. Study design Retrospective cohort study, Level II. Methods Soccer players in a prospective cohort were contacted to determine RTP following ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant) and incidence of subsequent ACL surgery was recorded. Results Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACL reconstruction returned to soccer. At average follow up of 7.0 years, 36% were still playing, a significant decrease compared to initial RTP (preturn to play. Twelve soccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% v. 5.5%, p=0.03). Soccer athletes who underwent ACLR on their non-dominant limb had a higher future rate of contra-lateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (p=0.03). Conclusion Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer following ACLR declines over time. PMID:23002201

  14. Concussion Symptoms and Return to Play Time in Youth, High School, and College American Football Athletes.

    Science.gov (United States)

    Kerr, Zachary Y; Zuckerman, Scott L; Wasserman, Erin B; Covassin, Tracey; Djoko, Aristarque; Dompier, Thomas P

    2016-07-01

    To our knowledge, little research has examined concussion across the youth/adolescent spectrum and even less has examined concussion-related outcomes (ie, symptoms and return to play). To examine and compare sport-related concussion outcomes (symptoms and return to play) in youth, high school, and collegiate football athletes. Athletic trainers attended each practice and game during the 2012 to 2014 seasons and reported injuries. For this descriptive, epidemiological study, data were collected from youth, high school, and collegiate football teams, and the analysis of the data was conducted between July 2015 and September 2015. The Youth Football Surveillance System included more than 3000 youth football athletes aged 5 to 14 years from 118 teams, providing 310 team seasons (ie, 1 team providing 1 season of data). The National Athletic Treatment, Injury, and Outcomes Network Program included 96 secondary school football programs, providing 184 team seasons. The National Collegiate Athletic Association Injury Surveillance Program included 34 college football programs, providing 71 team seasons. We calculated the mean number of symptoms, prevalence of each symptom, and the proportion of patients with concussions that had long return-to-play time (ie, required participation restriction of at least 30 days). Generalized linear models were used to assess differences among competition levels in the mean number of reported symptoms. Logistic regression models estimated the odds of return to play at less than 24 hours and at least 30 days. Overall, 1429 sports-related concussions were reported among youth, high school, and college-level football athletes with a mean (SD) of 5.48 (3.06) symptoms. Across all levels, 15.3% resulted return to play at least 30 days after the concussion and 3.1% resulted in return to play less than 24 hours after the concussion. Compared with youth, a higher number of concussion symptoms were reported in high school athletes (β = 1.39; 95

  15. Professional Athletes' Return to Play and Performance After Operative Repair of an Achilles Tendon Rupture.

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    Trofa, David P; Miller, J Chance; Jang, Eugene S; Woode, Denzel R; Greisberg, Justin K; Vosseller, J Turner

    2017-06-01

    Most Achilles tendon ruptures are sports related. However, few studies have examined and compared the effect of surgical repair for complete ruptures on return to play (RTP), play time, and performance across multiple sports. To examine RTP and performance among professional athletes after Achilles tendon repair and compare pre- versus postoperative functional outcomes of professional athletes from different major leagues in the United States. Cohort study; Level of evidence, 3. National Basketball Association (NBA), National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) athletes who sustained a primary complete Achilles tendon rupture treated surgically between 1989 and 2013 were identified via public injury reports and press releases. Demographic information and performance-related statistics were recorded for 2 seasons before and after surgery and compared with matched controls. Statistical analyses were used to assess differences in recorded metrics. Of 86 athletes screened, 62 met inclusion criteria including 25 NBA, 32 NFL, and 5 MLB players. Nineteen (30.6%) professional athletes with an isolated Achilles tendon rupture treated surgically were unable to return to play. Among athletes who successfully returned to play, game participation averaged 75.4% ( P .05). When individual sports were compared, NBA players were most significantly affected, experiencing significant decreases in games played, play time, and performance. An Achilles tendon rupture is a devastating injury that prevents RTP for 30.6% of professional players. Athletes who do return play in fewer games, have less play time, and perform at a lower level than their preinjury status. However, these functional deficits are seen only at 1 year after surgery compared with matched controls, such that players who return to play can expect to perform at a level commensurate with uninjured controls 2 years postoperatively.

  16. Return to Play Following Shoulder Stabilization: A Systematic Review and Meta-analysis

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    Ialenti, Marc N.; Mulvihill, Jeffrey D.; Feinstein, Max; Zhang, Alan L.; Feeley, Brian T.

    2017-01-01

    Background: Anterior shoulder instability can be a disabling condition for the young athlete; however, the best surgical treatment remains controversial. Traditionally, anterior shoulder instability was treated with open stabilization. More recently, arthroscopic repair of the Bankart injury with suture anchor fixation has become an accepted technique. Hypothesis: No systematic reviews have compared the rate of return to play following arthroscopic Bankart repair with suture anchor fixation with the Bristow-Latarjet procedure and open stabilization. We hypothesized that the rate of return to play will be similar regardless of surgical technique. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a systematic review and meta-analysis focused on return to play following shoulder stabilization. Inclusion criteria included studies in English that reported on rate of return to play and clinical outcomes following primary arthroscopic Bankart repair with suture anchors, the Latarjet procedure, or open stabilization. Statistical analyses included Student t tests and analyses of variance. Results: Sixteen papers reporting on 1036 patients were included. A total of 545 patients underwent arthroscopic Bankart repair with suture anchors, 353 with the Latarjet procedure, and 138 with open repair. No significant difference was found in patient demographic data among the studies. Patients returned to sport at the same level of play (preinjury level) more consistently following arthroscopic Bankart repair (71%) or the Latarjet procedure (73%) than open stabilization (66%) (P Latarjet procedure (3.5%) than after arthroscopic Bankart repair (6.6%) or open stabilization (6.7%) (P Latarjet procedure than open stabilization. Despite this difference, >65% of all treated athletes returned to sport at their preinjury levels, with other outcome measures being similar among the treatment groups. Therefore, arthroscopic Bankart repair, the Latarjet procedure, and

  17. Concussion Assessment in California Community College Football: Athletic Trainers' Strides toward a Safer Return to Play

    Science.gov (United States)

    Chinn, Nancy Resendes

    2010-01-01

    The purpose of this mixed method study was to compare current practices of athletic trainers in the management of concussion in football at California Community Colleges (CCC) with the concussion management guidelines set forth by the National Athletic Trainers Association (NATA). The study also set out to gain understanding of why some athletic…

  18. Return to Play in National Football League Players After Operative Jones Fracture Treatment.

    Science.gov (United States)

    Lareau, Craig R; Hsu, Andrew R; Anderson, Robert B

    2016-01-01

    Jones fractures commonly occur in professional athletes and operative treatment remains the standard of care in this patient population. In our clinical experience, an aggressive postoperative rehabilitation protocol for National Football League (NFL) players with an average return to play (RTP) between 8 and 10 weeks can have successful outcomes with few complications. The purpose of this study was to quantify RTP and rate of complications, including nonunion, refracture, and reoperation among a cohort of NFL players with operatively treated Jones fractures. Between 2004 and 2014, 25 consecutive NFL players who underwent acute Jones fracture fixation by a single surgeon were reviewed. Operative treatment for the majority of patients involved fixation with a Jones-specific intramedullary screw and iliac crest bone marrow aspirate with demineralized bone matrix injected at the fracture site. Additionally, our protocol involved the use of noninvasive bone stimulators, application of customized orthoses, and an aggressive patient-specific rehabilitation protocol. Patient demographics were recorded along with position played, seasons played after surgery, RTP, and complications. RTP was defined as the ability to play in a single regular-season NFL game after surgery. At the time of surgery, average age for all patients was 24.0 years and BMI 31.0. Player positions included 8 wide receivers, 4 linebackers, 4 tight ends, 2 defensive tackles, 2 cornerbacks, 1 offensive tackle, 1 center, 1 tackle, 1 defensive end, and 1 quarterback. Seventy-six percent of players underwent operative fixation during their first 3 seasons. Forty-eight percent were diagnosed before or during their rookie (first) season.RTP was 100% for all players and 80% were still playing at time of publication. Three patients (12.0%) refractured and required revision surgery. Time until RTP was influenced by other variables and difficult to measure because many surgeries were performed early in the

  19. Return to play after shoulder instability in National Football League athletes.

    Science.gov (United States)

    Okoroha, Kelechi R; Taylor, Kevin A; Marshall, Nathan E; Keller, Robert A; Fidai, Mohsin; Mahan, Michael C; Varma, Vishal; Moutzouros, Vasilios

    2017-09-20

    We hypothesized that National Football League (NFL) players sustaining a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type. We identified and evaluated 83 NFL players who sustained an in-season shoulder instability event while playing in the NFL. NFL RTP, incidence of surgery, time to RTP, recurrent instability events, seasons/games played after the injury, and demographic data were collected. Overall RTP was determined, and players who did and did not undergo operative repair were compared. Ninety-two percent of NFL players returned to NFL regular season play at a median of 0.0 weeks in those sustaining a shoulder subluxation and 3.0 weeks in those sustaining a dislocation who did not undergo surgical repair (P = .029). Players who underwent operative repair returned to play at a median of 39.3 weeks. Forty-seven percent of players had a recurrent instability event. For players who were able to RTP, those who underwent surgical repair (31%) had a lower recurrence rate (26% vs. 55%, P = .021) and longer interval between a recurrent instability event after RTP (14.7 vs. 2.5 weeks, P = .050). There is a high rate of RTP after shoulder instability events in NFL players. Players who sustain shoulder subluxations RTP faster but are more likely to experience recurrent instability than those with shoulder dislocations. Surgical stabilization of the shoulder after an instability event decreases the chances of a second instability event and affords a player a greater interval between the initial injury and a recurrent event. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Return to Play and Performance After Jones Fracture in National Basketball Association Athletes.

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    Begly, John P; Guss, Michael; Ramme, Austin J; Karia, Raj; Meislin, Robert J

    2016-07-01

    Basketball players are at risk for foot injuries, including Jones fractures. It is unknown how this injury affects the future play and performance of athletes. National Basketball Association (NBA) players who sustain Jones fractures of the base of the fifth metatarsal have high rates of return to play and do not experience a decrease in performance on return to competition when compared with preinjury and with control-matched peers. Retrospective cohort study. Level 5. Data on 26 elite basketball players with Jones fractures over 19 NBA seasons (1994-1995 to 2012-2013) were obtained from injury reports, press releases, player profiles, and online public databases. Variables included age, body mass index (BMI), player position, experience, and surgical treatment. Individual season statistics pre- and postinjury were collected. Twenty-six controls were identified by matched player position, age, and performance statistics. The mean age at the time of injury was 24.8 years, mean BMI was 24.7 kg/m(2), and the mean experience prior to injury was 4.1 NBA seasons. Return to previous level of competition was achieved by 85% of athletes. There was no change in player efficiency rating (PER) when pre- and postinjury performance was compared. When compared with controls, no decline in PER measured performance was identified. The majority of NBA players sustaining a Jones fracture return to their preinjury level of competition. These elite athletes demonstrate no decrease in performance on their return to play. Jones fractures are well-studied injuries in terms of etiology, diagnosis, and management. However, the effect of these injuries on future performance of athletes is unknown. Using the findings of our study, orthopaedic surgeons may be better prepared to counsel and educate elite athletes who sustain a Jones fracture. © 2015 The Author(s).

  1. Return to play after chondroplasty of the knee in National Football League athletes.

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    Scillia, Anthony J; Aune, Kyle T; Andrachuk, John S; Cain, E Lyle; Dugas, Jeffrey R; Fleisig, Glenn S; Andrews, James R

    2015-03-01

    Knee injuries, including articular cartilage damage, are common in football players and are potentially career threatening. The rate of return to play (RTP) as well as the factors affecting return after arthroscopic chondroplasty of the knee is performed in National Football League (NFL) athletes are not known. To determine the rate of return to regular season NFL competition after arthroscopic knee surgery including chondroplasty of articular cartilage lesions. In addition, identification of factors that influence successful return was investigated. Case series; Level of evidence, 4. Athletes in the NFL who underwent arthroscopic chondroplasty at a single institution were identified. Retrospective chart review and review of the NFL online database were utilized to determine the rate of RTP and factors affecting an athlete's ability to return. Chi-square and Student t tests were used to assess differences among players who were and were not able to RTP, and logistic regression was employed to determine a player's odds of return. There were 52 patients (54 procedures) identified from the surgical database who met the inclusion criteria for the study operated on between August 1, 2001, and March 31, 2011. Of these players, 36 (67%) were able to return to regular season NFL game play at an average of 8.2 months, including 13 (24%) who were still active in the NFL. The average time to follow-up was 5.9 years, and all players were allowed at least 2 years of follow-up. There was no significant correlation of RTP to athlete age, lesion size, lesion location, position played, or round selected in the NFL draft. Players who underwent concomitant microfracture were 4.4 times less likely to return to the NFL than were those who did not undergo this procedure (95% CI, 1.3-15.5). Athletes who played more than 11.6 games per season were 4.7 times more likely to RTP than were those who played fewer games per season (95% CI, 1.4-16.6). Athletes who returned to play competed in 56

  2. Return to Play After Multi-Ligament Knee Injuries in National Football League (NFL) Athletes

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    Bakshi, Neil K.; Khan, Moin; Finney, Fred Tolbert; Stotts, Jeffrey; Sikka, Robby Singh; Bedi, Asheesh

    2017-01-01

    Objectives: Return to play (RTP) of NFL athletes following isolated ACL tears has been reported in the literature. However, there have been no studies reporting on RTP of NFL athletes following multi-ligament knee injuries. The authors hypothesize that NFL athletes with multi-ligament knee injuries will have lower RTP rates and longer time to RTP compared to athletes with isolated ACL tears, as reported in the literature. We also hypothesize that athletes with ACL and MCL injuries will have higher RTP rates and shorter time to RTP compared to athletes with an ACL tear and a PCL and/or LCL tear(s). Methods: NFL injury surveillance data was reviewed for all multi-ligament knee injuries between 2000 and 2016 with RTP information. Athletes were excluded if RTP was limited due to reasons unrelated to the injury such as suspension, unrelated injury, or personal matters. Extracted data included injury, RTP, time to return to play (months), number of games played, percent of possible games played, and performance. Results: 51 NFL athletes were found to have multi-ligament knee injuries between 2000 and 2016 that met inclusion and exclusion criteria. 47.1% (24/51) of athletes had ACL and MCL tears. 52.9% (27/51) of athletes had ACL and PCL and/or LCL tears. Of the players with ACL and PCL/LCL tears, there were 8 frank knee dislocations. The overall return to play rate following multi-ligament knee injuries was 62.7%. Athletes with ACL/MCL tears had an RTP rate of 70.8%, while the athletes with ACL and PCL/LCL tears had an RTP rate of 55.6% (p=.26). Athletes with frank knee dislocations had a 50% RTP rate. Mean time to RTP for all 51 athletes was 11.9 ± 3.52 months. The mean time to RTP for athletes with ACL/MCL injuries was 10.4±1.6 months compared with 13.7±4.3 for those with combined ACL and PCL/LCL injuries, and for frank dislocations was 20 ±6.1 (p<.001). Athletes with ACL/MCL injuries were more likely to return to prior performance levels 46% vs 18% compared to

  3. MRI assessment of calf injuries in Australian Football League players: findings that influence return to play

    Energy Technology Data Exchange (ETDEWEB)

    Waterworth, George; Wein, Sara; Rotstein, Andrew H. [Victoria House Medical Imaging, Prahran, Victoria (Australia); Gorelik, Alexandra [Royal Melbourne Hospital, University of Melbourne, Melbourne Epicentre, Parkville (Australia)

    2017-03-15

    Calf muscle strains have become increasingly prevalent in recent seasons of the Australian Football League (AFL) and represent a significant cause of time lost from competition. The purpose of this study was to examine the association between MRI features of calf muscle strains and games missed and to thereby identify parameters that are of prognostic value. A retrospective analysis of MRI scans of AFL players with calf strains referred to a musculoskeletal radiology clinic over a 5-year period (2008-2012) was performed. The muscle(s) and muscle component affected, the site and size of strain, and the presence of an intramuscular tendon tear or intermuscular fluid were recorded. These data were cross-referenced with whether a player missed at least one game. Imaging features of prognostic value were thus identified. Sixty-three athletes had MRI scans for calf muscle strains. Soleus strains were more common than strains of other muscles. Players with soleus strains were more likely to miss at least one game if they had multiple muscle involvement (p = 0.017), musculotendinous junction strains (p = 0.046), and deep strains (p = 0.036). In a combined analysis of gastrocnemius and soleus strains, intramuscular tendon tears were observed in a significantly greater proportion of players who missed games (p = 0.010). Amongst AFL players with calf injuries, there is an association between missing at least one game and multiple muscle involvement, musculotendinous junction strains, deep strain location, and intramuscular tendon tears. In this setting, MRI may therefore provide prognostic information to help guide return-to-play decisions. (orig.)

  4. Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group.

    Science.gov (United States)

    Brophy, Robert H; Schmitz, Leah; Wright, Rick W; Dunn, Warren R; Parker, Richard D; Andrish, Jack T; McCarty, Eric C; Spindler, Kurt P

    2012-11-01

    There is limited information on outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACLR) in soccer athletes. The purpose of this study was to (1) test the hypotheses that player sex, side of injury, and graft choice do not influence RTP and (2) define the risk for future ACL injury in soccer players after ACLR. Cohort study; Level of evidence, 3. Soccer players in a prospective cohort were contacted to determine RTP after ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant), and incidence of subsequent ACL surgery was recorded. Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACLR returned to soccer. At average follow-up of 7.0 years, 36% were still playing, a significant decrease compared with initial RTP (P return to play. Twelve soccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% vs 5.5%, P = .03). Soccer athletes who underwent ACLR on their nondominant limb had a higher future rate of contralateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) (P = .03). Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer after ACLR declines over time. ACLR on the nondominant limb potentially places the dominant limb at risk for future ACL injury.

  5. Return to Play After Revision Anterior Cruciate Ligament Reconstruction in National Football League Players.

    Science.gov (United States)

    Okoroha, Kelechi R; Kadri, Omar; Keller, Robert A; Marshall, Nathan; Cizmic, Zlatan; Moutzouros, Vasilios

    2017-04-01

    National Football League (NFL) players who undergo anterior cruciate ligament (ACL) reconstruction have been shown to have a lower return to play (RTP) than previously expected. However, RTP in the NFL after revision ACL reconstruction (RACLR) is not well defined. The purpose of this study is to determine the RTP of NFL players after RACLR and evaluate factors that predict RTP. Our hypothesis was that more experienced and established players would be more likely to RTP after RACLR. Cohort study; Level of evidence, 3. A total of 24 NFL players who underwent RACLR between 2007 and 2014 were reviewed and evaluated. Return to NFL play, time to return, seasons and games played prior to and after revision surgery, draft status, and demographic data were collected. Overall RTP was determined, and players who did RTP were compared with those unable to RTP. Data were also compared with control players matched for age, position, size, and experience. After RACLR, 79% (19/24) of NFL players returned to NFL regular-season play at an average of 12.6 months. All players who were drafted in the first 4 rounds, played in at least 55 games, or played 4 seasons of NFL play prior to injury were able to RTP. Players drafted in the first 4 rounds of the NFL draft were more likely to RTP than those who were not (odds ratio, 0.1; 95% CI, 0.01-1.00; P = .05). Those who returned to NFL play played in significantly less games and seasons after their injury than before (P = .01 and P = .01, respectively). However, these values did not differ when compared with matched controls (P = .67 and P = .33). NFL players who RTP after RACLR do so at a similar rate but prolonged time period compared with after primary ACL reconstruction. Athletes who were drafted in earlier rounds were more likely to RTP than those who were not. Additionally, player experience prior to injury is an important factor when predicting RTP after RACLR.

  6. Variables Affecting Return to Play After Anterior Cruciate Ligament Injury in the National Football League.

    Science.gov (United States)

    Eisenstein, Emmanuel D; Rawicki, Nathaniel L; Rensing, Nicholas J; Kusnezov, Nicholas A; Lanzi, Joseph T

    2016-10-01

    Anterior cruciate ligament (ACL) injuries are common in the National Football League (NFL). Limited literature exists regarding return to play (RTP) and the factors affecting RTP after ACL reconstruction in NFL players. To determine RTP rates after ACL reconstruction in NFL players and to ascertain which variables affect RTP in these players. We hypothesized that RTP in this population will be less than in the general population and similar to the limited studies published previously. Case-control study; Level of evidence, 3. A total of 92 NFL athletes who sustained ACL injuries requiring ACL reconstruction from 2013 to 2015 were retrospectively studied to determine rate of RTP and the variables affecting RTP. Sixty-two percent (57/92) of NFL athletes returned to NFL game play prior to the end of the 2015-2016 postseason. ACL injuries were noted in 10 different player positions, with 81.5% of all injuries as isolated ACL injuries (75/92) and 18.5% with concomitant knee injuries. A significant difference in ability to RTP was found for players who sustained in-season injuries compared with those who sustained off-season/preseason injuries (P = .02). No significant differences in RTP were found for players who played less than 4 years in the NFL compared with those who played longer. The mean draft round of players who returned was 3.96, with the odds ratio favoring RTP at 4.44 (P = .003) for players drafted in the first 3 rounds of the NFL draft compared with those drafted in the fourth round or later. No significant differences were found with regard to playing surface, laterality, concomitant injury, previous ipsilateral or contralateral ACL reconstruction, final outcome of the game, or contact compared with noncontact injuries. The RTP rates we reported after ACL reconstruction in NFL players are similar to prior studies; however, running backs and wide receivers had lower rates of RTP than previously reported. As previously published, quarterbacks were found to

  7. A preliminary study of youth sport concussions: Parents' health literacy and knowledge of return-to-play protocol criteria.

    Science.gov (United States)

    Turner, Robert W; Lucas, Jeffery W; Margolis, Lewis H; Corwell, Brian N

    2017-01-01

    To preliminarily explore parents' health literacy and knowledge of youth sport league rules involving concussion education and training, and return-to-play protocols. This study was guided by the Knowledge, Attitude and Practice (KAP) model of health knowledge to examine parents' concussion literacy, and understanding of concussion education and training, and return-to-play protocols in youth sports. The mixed-method design involved 119 participants; that included in-person (n=8) and telephone (n=4) interviews, and web-based surveys administered through Mechanical Turk via Qualtrics (n=98). Most respondents were not familiar with concussion protocols, but trusted coaches' knowledge in return-to-play rules. More than half of the respondents report that the return-to-play concussion criteria have not been clearly explained to them. The majority of respondents were not familiar with the CDC's 'Heads Up' online concussion training programme, nor were they familiar with any other educational/training tool. About one-fifth of the parents had conversations with a coach or medical staff about youth sport concussions. Parents have a general understanding of how to identify concussion symptoms, but lack knowledge of immediate steps to take following an incident other than seeking medical help.

  8. Return to play after an initial or recurrent concussion in a prospective study of physician-observed junior ice hockey concussions: implications for return to play after a concussion.

    Science.gov (United States)

    Echlin, Paul Sean; Tator, Charles H; Cusimano, Michael D; Cantu, Robert C; Taunton, Jack E; Upshur, Ross E G; Czarnota, Michael; Hall, Craig R; Johnson, Andrew M; Forwell, Lorie A; Driediger, Molly; Skopelja, Elaine N

    2010-11-01

    The authors investigated return-to-play duration for initial and recurrent concussion in the same season in 2 teams of junior (16-21-year-old) ice hockey players during a regular season. The authors conducted a prospective cohort study during 1 junior regular season (2009-2010) of 67 male fourth-tier ice hockey players (mean age 18.2 ± 1.2 years [SD], range 16-21 years) from 2 teams. Prior to the start of the season, every player underwent baseline assessments that were determined using the Sideline Concussion Assessment Tool 2 (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). The study protocol also required players who entered the study during the season to complete a baseline SCAT2 and ImPACT. If the protocol was not followed, the postinjury test results of a player without true baseline test results were compared with previously established age- and sex-matched group normative levels. Each game was directly observed by a physician and at least 1 neutral nonphysician observer. Players suspected of suffering a concussion were evaluated by the physician during the game. If a concussion was diagnosed, the player underwent clinical evaluation at the physician's office within 24 hours. The return-to-play decision was based on clinical evaluation guided by the Zurich return-to-play protocol (contained in the consensus statement of international expert opinion at the 3rd International Conference on Concussion in Sport held in Zurich, November 2008). This clinical evaluation and return-to-play protocol was augmented by the 2 tests (SCAT2 and ImPACT) also recommended by the Zurich consensus statement, for which baseline values had been obtained. Seventeen players sustained a physician-observed or self-reported, physician-diagnosed concussion during a physician-observed ice hockey game. The mean clinical return-to-play duration (in 15 cases) was 12.8 ± 7.02 days (median 10 days, range 7-29 days); the mean number of physician office visits

  9. Concussion Incidence and Return-to-Play Time in National Basketball Association Players: Results From 2006 to 2014.

    Science.gov (United States)

    Padaki, Ajay S; Cole, Brian J; Ahmad, Christopher S

    2016-09-01

    Various research efforts have studied concussions in the National Football League, Major League Baseball, and the National Hockey League. However, no study has investigated the incidence and return-to-play trends in the National Basketball Association (NBA), which this study aims to do. Increased media scrutiny and public awareness, in addition to the institution of a league-wide concussion protocol, may have resulted in more conservative return-to-play practices. Descriptive epidemiology study. All concussions to NBA players that were publicly reported in the media from the beginning of the 2006 NBA season to the end of the 2014 season were included. The incidence and return-to-play statistics were generated by synthesizing information from publicly available records. There were 134 publicly reported concussions to NBA players from the beginning of the 2006 season to the conclusion of the 2014 season, resulting in an average of 14.9 concussions per season. The incidence has not changed significantly during this time span. The average games missed after a concussion from 2006 to 2010 was 1.6, significantly less than the 5.0 games missed from 2011 to 2014, following the institution of the NBA concussion protocol (P = .023). Although the incidence of publicly reported concussions in the NBA has not changed appreciably over the past 9 seasons, the time missed after a concussion has. While players often returned in the same game in the 2006 season, the combination of implemented policy, national coverage, medical staff awareness, and player education may have contributed to players now missing an average of 4 to 6 games after a concussion. A multitude of factors has resulted in more conservative return-to-play practices for NBA players after concussions. © 2016 The Author(s).

  10. Return to Play

    Science.gov (United States)

    Mangan, Marianne

    2013-01-01

    Call it physical activity, call it games, or call it play. Whatever its name, it's a place we all need to return to. In the physical education, recreation, and dance professions, we need to redesign programs to address the need for and want of play that is inherent in all of us.

  11. Return to play after thigh muscle injury in elite football players: implementation and validation of the Munich muscle injury classification

    Science.gov (United States)

    Ekstrand, Jan; Askling, Carl; Magnusson, Henrik; Mithoefer, Kai

    2013-01-01

    Background Owing to the complexity and heterogeneity of muscle injuries, a generally accepted classification system is still lacking. Aims To prospectively implement and validate a novel muscle injury classification and to evaluate its predictive value for return to professional football. Methods The recently described Munich muscle injury classification was prospectively evaluated in 31 European professional male football teams during the 2011/2012 season. Thigh muscle injury types were recorded by team medical staff and correlated to individual player exposure and resultant time-loss. Results In total, 393 thigh muscle injuries occurred. The muscle classification system was well received with a 100% response rate. Two-thirds of thigh muscle injuries were classified as structural and were associated with longer lay-off times compared to functional muscle disorders (pinjuries) with increasing lay-off time associated with more severe structural injury. Median lay-off time of functional disorders was 5–8 days without significant differences between subgroups. There was no significant difference in the absence time between anterior and posterior thigh injuries. Conclusions The Munich muscle classification demonstrates a positive prognostic validity for return to play after thigh muscle injury in professional male football players. Structural injuries are associated with longer average lay-off times than functional muscle disorders. Subclassification of structural injuries correlates with return to play, while subgrouping of functional disorders shows less prognostic relevance. Functional disorders are often underestimated clinically and require further systematic study. PMID:23645834

  12. Current Cervical Carcinoma Screening Guidelines

    Directory of Open Access Journals (Sweden)

    Megan J. Schlichte

    2015-05-01

    Full Text Available A formidable threat to the health of women, cervical carcinoma can be prevented in many cases with adequate screening. The current guidelines for cervical carcinoma screening were created as joint recommendations of the American Cancer Society (ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP and the American Society for Clinical Pathology (ASCP in 2012, and later accepted and promoted by the American Congress of Obstetricians and Gynecologists (ACOG. The 2012 recommendations underscore the utility of molecular testing as an adjunct to cytology screening for certain women and provide guidance to clinicians based on different risk-benefit considerations for different ages. This manuscript will review screening techniques and current recommendations for cervical cancer screening and human papilloma virus (HPV testing, as well as possible future screening strategies.

  13. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013.

    Science.gov (United States)

    De Souza, Mary Jane; Nattiv, Aurelia; Joy, Elizabeth; Misra, Madhusmita; Williams, Nancy I; Mallinson, Rebecca J; Gibbs, Jenna C; Olmsted, Marion; Goolsby, Marci; Matheson, Gordon

    2014-03-01

    The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves 3 components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with 1 or more of the 3 Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement represents a set of recommendations developed following the first (San Francisco, California) and second (Indianapolis, Indianna) International Symposia on the Female Athlete Triad. It is intended to provide clinical guidelines for physicians, athletic trainers, and other health care providers for the screening, diagnosis, and treatment of the Female Athlete Triad and to provide clear recommendations for return to play. The 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad Expert Panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision-making regarding sport participation, clearance, and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team, and implementation of treatment contracts. This consensus paper has been endorsed by The Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians, and other health care professionals, the American College of Sports Medicine, and the American Medical Society for Sports Medicine.

  14. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013.

    Science.gov (United States)

    De Souza, Mary Jane; Nattiv, Aurelia; Joy, Elizabeth; Misra, Madhusmita; Williams, Nancy I; Mallinson, Rebecca J; Gibbs, Jenna C; Olmsted, Marion; Goolsby, Marci; Matheson, Gordon

    2014-02-01

    The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves three components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction and (3) low bone mineral density. Female athletes often present with one or more of the three Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical eating disorders, amenorrhoea and osteoporosis. This consensus statement represents a set of recommendations developed following the 1st (San Francisco, California, USA) and 2nd (Indianapolis, Indiana, USA) International Symposia on the Female Athlete Triad. It is intended to provide clinical guidelines for physicians, athletic trainers and other healthcare providers for the screening, diagnosis and treatment of the Female Athlete Triad and to provide clear recommendations for return to play. The 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad expert panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision-making regarding sport participation, clearance and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team and implementation of treatment contracts. This consensus paper has been endorsed by the Female Athlete Triad Coalition, an International Consortium of leading Triad researchers, physicians and other healthcare professionals, the American College of Sports Medicine and the American Medical Society for Sports Medicine.

  15. Platelet-Rich Plasma in Addition to Rehabilitation for Acute Hamstring Injuries in NFL Players: Clinical Effects and Time to Return to Play.

    Science.gov (United States)

    Rettig, Arthur C; Meyer, Susan; Bhadra, Arup K

    2013-01-01

    Platelet-rich plasma (PRP) injections have been proposed to hasten soft tissue healing. There is a lack of evidence in the current literature to support their efficacy in elite athletes. To investigate the effects of the addition of PRP to rehabilitation in the treatment of acute hamstring injuries in professional National Football League (NFL) players and to report the time to return to play. Case control study. Ten NFL players with similar hamstring injury patterns were retrospectively divided into 2 groups. The treatment group (PRP; n = 5) was injected with PRP and the control group (non-PRP; n = 5) was not injected; both groups completed a rehabilitation program. The PRP injections were administered under ultrasound guidance with precise localization of the injury site, within 24 to 48 hours of injury. Age, muscle involved, extent of injury, grading, and time to return to play were noted. Descriptive statistics and the exact Wilcoxon rank-sum test were used for data analysis. The mean age was 23 years (range, 22-27 years) for the PRP group and 26 years (range, 22-28 years) for the non-PRP group (P = .42). The median longitudinal extent of the injury was 14 cm (range, 9-18 cm) in the PRP group and 15 cm (range, 9-16 cm) in the non-PRP group (P = .77). The average transverse extent of the injury in the PRP and non-PRP groups was 4 cm (range, 1.6-6 cm) and 3.5 cm (range, 2-5 cm), respectively, and the respective average anteroposterior extent was 4 cm (range, 1.9-5 cm) and 2.9 cm (range, 1.5-4 cm). The long head of biceps femoris was most commonly involved (4 in each group), with a single tear of the semimembranosus in each group. The median injury classification was grade 2 in both groups. The median time to return to play was 20 days (range,16-30 days) in the PRP group and 17 days (range, 8-81 days) in the non-PRP group (P = .73). There were no significant differences in recovery from hamstring injury between treatment with PRP and routine rehabilitation. A

  16. Assessing long-term return to play after hip arthroscopy in football players evaluating risk factors for good prognosis.

    Science.gov (United States)

    Barastegui, D; Seijas, R; Alvarez-Diaz, P; Rivera, E; Alentorn-Geli, E; Steinbacher, G; Cuscó, X; Cugat, R

    2017-05-17

    Groin pain is the third most common disease in football players and has often been associated with hip pathology such as femoroacetabular impingement and labral lesions. Hip arthroscopy offers possibilities of function restoration via minimally invasive procedures. The aim of this study is to evaluate professional football player's injuries and their return to play after hip arthroscopy for FAI and labral injuries. Patients that underwent hip arthroscopy between 2009 and 2014 were selected retrospectively. From this population, only professional soccer players competing at national level were included (Tegner 10). Arthroscopic surgery was proposed in patients with persistent pain. All patients were assessed for VAS score preoperatively and at 3, 6, 12 and 24 months post-op. HOS (sport and DLA) and mHHS tests were performed at the same time periods. All patients were men with a mean age of 26.5 ± 7.1 years old. Preoperative VAS (7.4 ± 1.3), HOS ADL (67.7 ± 5.5), HOS sport (37.6 ± 18.7) and mHHS (72.5 ± 8.8) showed improved scores during long-term follow-up. Time to return to play was 10.8 months (SD ± 4.3), with range between 4 and 20 months. Mean follow-up was 45.4 ± 15.6 months (range from 26 to 72 months). No differences were observed between non-active and active patients at final follow-up with respect to chondral lesions, but significant differences were observed with reference to management of the labrum (p = 0.031), where a higher rate of labrectomies existed among inactive patients and a higher rate of suture among active patients. Hip arthroscopy is a safe procedure with very good return to play results, but for optimized return to football one should consider patient age at the time of surgery, the condition of the labrum and low scores on the Harris Hip Score (mHHS) and HOS (sport version) as predictive factors for poor prognosis. Level of evidence IV.

  17. Strategic Assessment of Risk and Risk Tolerance (StARRT) framework for return-to-play decision-making.

    Science.gov (United States)

    Shrier, Ian

    2015-10-01

    The sport medicine clinician is faced with return-to-play (RTP) decisions for every patient who wants to return to activity. The complex interaction of factors related to history, physical examination, testing, activity and baseline characteristics can make RTP decision-making challenging. Further, when reasoning is not explicit, unnecessary conflict can arise among clinicians themselves, or among clinicians and patients. This conflict can have negative health consequences for the patient. In 2010, a transparent framework for RTP decisions was proposed. However, some have identified limitations to the framework and found difficulties in its implementation. This paper presents a revised framework that addresses the limitations, and provides concrete examples of how to apply it in simple and complex cases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. No Association Between Return to Play After Injury and Increased Rate of Anterior Cruciate Ligament Injury in Men’s Professional Soccer

    Science.gov (United States)

    Lundblad, Matilda; Waldén, Markus; Hägglund, Martin; Ekstrand, Jan; Thomeé, Christoffer; Karlsson, Jón

    2016-01-01

    Background: Studies have shown that previous injury, not necessarily anatomically related, is an important injury risk factor. However, it is not known whether a player runs an increased risk of anterior cruciate ligament (ACL) injury after returning to play from other injury types. Purpose: To analyze whether professional soccer players are more susceptible to ACL injury after returning to play from any previous injury. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 101 elite male soccer players suffering a first-time complete ACL injury between 2001 and 2014 were included and matched according to team, age, and playing position with control players who did not have a current injury (1:1 match). For each injured player, the 90-day period prior to the ACL injury was analyzed for injuries and compared with that of control players by using odds ratios (ORs) and 95% CIs. Results: The odds of a player with an ACL injury sustaining a previous injury in the 90-day period did not differ significantly from that of controls (OR, 1.20; 95% CI, 0.66-2.17; P = .65). Testing the frequency of absence periods due to injury between the groups revealed that the odds of a player with an ACL injury having a previous period of absence due to injury did not differ compared with controls (OR, 1.14; 95% CI, 0.64-2.01; P = .77). Conclusion: Players with ACL injury did not have a greater occurrence of absence due to injury in the 3 months preceding their ACL injury compared with matched controls. This indicates that previous injury of any type does not increase the risk of suffering an ACL injury. PMID:27830159

  19. Chronic Traumatic Encephalopathy: A Review of Clinical Diagnosis, Animal Models, Sex Differences, and A Revised Return-to-Play Protocol

    Directory of Open Access Journals (Sweden)

    Natalie D. Fitzgerald

    2017-10-01

    Full Text Available Chronic traumatic encephalopathy (CTE is a progressive neurodegenerative disease marked by debilitating cognitive and behavioral symptoms. CTE is thought to be caused by traumatic brain injuries (TBIs, though it remains unclear how the frequency, duration and intensity of TBIs contribute to CTE vulnerability. It is estimated that as many as 4M sports-related TBIs may occur annually in the US, though mild TBIs are often underreported and/or undiagnosed. As participation in athletics is arguably a voluntary and controllable risk factor for TBI, it is important to identify and understand factors that might affect an athlete’s’ likelihood of developing CTE. This review summarizes CTE symptomology and pathology, reviews relevant findings from animal models of TBI/CTE, discusses clinical criteria and emerging technologies used for diagnosis, reviews the extent to which sex differences may contribute to TBI severity and/or recovery and, finally, presents a data-driven protocol for return-to-play procedures for student athletes in contact sports.

  20. Measuring heterogeneity of reinjury risk assessments at the time of clearance to return to play: A feasibility study.

    Science.gov (United States)

    Shrier, Ian; Serner, Andreas; Wangensteen, Arnlaug; Steele, Russell J; Weir, Adam

    2017-03-01

    Different individuals may make different return to play (RTP) decisions due to different risk assessments or risk tolerances. Our objectives were to determine the feasibility of eliciting reinjury risk assessments with Bayesian methods, and risk tolerance with questionnaires, from clinicians and athletes in a real-world RTP setting. Feasibility study with a descriptive prospective case-series. We recruited the athlete, sport physician and physiotherapist caring for an athlete ("triplet") within on-going groin and hamstring injury studies. We applied Bayesian methods to elicit estimates for reinjury risk over the next 2 months, based on the available clinical knowledge, and projected activity level. We used a standardized questionnaire to elicit factors affecting risk tolerance. Although our methods appeared feasible in general, there were important challenges that included language, time availability of practicing clinicians, and general work-flow issues related to embedding our study within an on-going larger study. We did obtain valuable data from more than one person on 10 of the 15 eligible athletes recruited. Despite the limited number of cases, there were clinically meaningful differences in risk estimates in some cases. In one triplet, participants estimated the reinjury risk between 1-10%, 20-50% and 30-40% for the same athlete. The most common factors modifying risk tolerance were "timing and season", "pressure from athlete", and "external pressure". Bayesian methods for risk elicitation in clinical sport medicine are feasible, and large differences in both risk estimation and risk tolerance sometimes occur. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  1. Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury.

    Science.gov (United States)

    van der Made, Anne D; Almusa, Emad; Whiteley, Rod; Hamilton, Bruce; Eirale, Cristiano; van Hellemondt, Frank; Tol, Johannes L

    2017-09-13

    Hamstring injury with intramuscular tendon involvement is regarded as a serious injury with a delay in return to play (RTP) of more than 50 days and reinjury rates up to 63%. However, this reputation is based on retrospective case series with high risk of bias. Determine whether intramuscular tendon involvement is associated with delayed RTP and elevated rates of reinjury. MRI of male athletes with an acute hamstring injury was obtained within 5 days of injury. Evaluation included standardised MRI scoring and scoring of intramuscular tendon involvement. Time to RTP and reinjury rate were prospectively recorded. Out of 70 included participants, intramuscular tendon disruption was present in 29 (41.4%) injuries. Injuries without intramuscular tendon disruption had a mean time to RTP of 22.2±7.4 days. Injuries with <50%, 50%-99% and 100% disruption of tendon cross-sectional area had a mean time to RTP of 24.0±9.7, 25.3±8.6 and 31.6±10.9 days, respectively. Injuries with full-thickness disruption took longer to RTP compared with injuries without disruption (p=0.025). Longitudinal intramuscular tendon disruption was not significantly associated with time to RTP. Waviness was present in 17 (24.3%) injuries. Mean time to RTP for injuries without and with waviness was 22.6±7.5 and 30.2±10.8 days (p=0.014). There were 11 (15.7%) reinjuries within 12 months, five (17.2%) in the group with intramuscular tendon disruption and six (14.6%) in the group without intramuscular tendon disruption. Time to RTP for injuries with full-thickness disruption of the intramuscular tendon and waviness is significantly longer (by slightly more than 1 week) compared with injuries without intramuscular tendon involvement. However, due to the considerable overlap in time to RTP between groups with and without intramuscular tendon involvement, its clinical significance for the individual athlete is limited. © Article author(s) (or their employer(s) unless otherwise stated in the text

  2. Sports chiropractic management of concussions using the Sport Concussion Assessment Tool 2 symptom scoring, serial examinations, and graded return to play protocol: a retrospective case series.

    Science.gov (United States)

    Shane, Eric R; Pierce, Kevin M; Gonzalez, Jannet K; Campbell, Nathan J

    2013-12-01

    The purpose of this case series is to report how the symptom section of the Sport Concussion Assessment Tool 2 (SCAT2) was used to manage athletes with concussions in a high school training room setting and to address the need for SCAT2 baseline measurements. During a 4-month period, 3 doctors of chiropractic with certification from the American Chiropractic Board of Sports Physicians managed 15 high school athletes with concussions in a multidisciplinary setting. Fourteen athletes were male American football players, and one was a female volleyball player. Of the 15 athletes, 3 athletes had baseline SCAT2 documentation. Athletes were evaluated and returned to play with a graded return to play protocol using the SCAT2 symptoms and serial physical examinations. Once participants were asymptomatic, they began a graded return to play process. A total of 47 SCAT2 tests were performed on the 15 athletes, averaging 3.13 SCAT2 evaluations per patient. Of the 15 athletes evaluated, 6 were managed and cleared for return to play; 2 of the athletes sustained concussions in the last week of the season, thus ending their season; and 3 athletes were cleared by medical doctors. None of the athletes under care reported an adverse event. The utilization of the SCAT2 with serial physical examinations provided objective measures for athlete's injuries, allowing the practitioners to evaluate concussions. More efforts are needed to collect baseline SCAT2 to compare these scores with subsequent SCAT2 scores following athletic injuries.

  3. Fatty Infiltrate of the Lumbar Multifidus Muscles Predicts Return to Play in Young Athletes With Extension-Based Low Back Pain.

    Science.gov (United States)

    Winslow, John; Getzin, Andrew; Greenberger, Hilary; Silbert, Walter

    2017-08-16

    To evaluate the predictive value of fatty infiltrate of the lumbar multifidus muscles (LMM) for return to play in young athletes with extension-based low back pain (EB LBP). Retrospective cohort study. Hospital-based sports medicine practice. Sixty-two athletes, 61.3% female, and 38.7% male, mean age 14.8 years, with a primary complaint of EB LBP who underwent magnetic resonance imaging (MRI); 46.8% had a pars interarticularis stress reaction or fracture and 53.2% were MRI negative. A musculoskeletal fellowship-trained radiologist reviewed MRI for all subjects and graded the degree of fatty infiltrate of the LMM, using the Goutallier classification system (GCS), at the L4/L5 and L5/S1 levels. Days to return to play after first MD visit were correlated with the amount of fatty infiltrate in the LMM measured on MRI for each subject. When the level of fatty infiltrate increased to a 2 or 3 on the GCS (greater than fatty streaks in the muscle), the predicted probability of return to sport decreased significantly. Our study demonstrated that athletes with EB LBP and fatty infiltrate in the LMM had lower odds of return to sport compared with athletes with normal muscle. II B. This study provides sports medicine clinicians with a prognostic tool to help manage young athletes with EB LBP. Clinicians can make decisions regarding rehabilitation and return to play based on MRI findings.

  4. Diagnostic terminology, athlete status, and history of concussion affect return to play expectations and anticipated symptoms following mild traumatic brain injury.

    Science.gov (United States)

    Kelly, Kiersten; Erdal, Kristi

    2016-11-13

    "Mild traumatic brain injury" (mTBI) and "concussion" are terms often used interchangeably. However, "mTBI" is frequently seen as representing a broader injury that encompasses the construct of "concussion," which often conveys transience or decreased severity. The present study examined the influence of varying diagnostic terminology on acute injury expectations in an undergraduate population (N = 105). Participants were presented with an mTBI vignette and were randomly assigned to one of two conditions in which the term "mTBI" or "concussion" was used to describe the injury. There were no significant differences between the two conditions on anxiety, symptomatology, timeline, or consequence scales. However, participants in the "mTBI" group allocated more days to return to play than participants in the "concussion" group, suggesting that terminology has an effect on perceptions of the severity of the injury. Varsity athletes allocated fewer days to return to play than nonathletes. Individuals with a history of concussion, both athletes and nonathletes, indicated fewer days to return to play, but greater symptomatology than individuals with no history of concussion. Clinicians should consider the influence of diagnostic terminology, athletic background, and history of concussion on perceptions of the severity of an injury because expectations can influence injury outcomes and compliance in a recovery process.

  5. Invisalign: current guidelines for effective treatment.

    Science.gov (United States)

    Kuncio, Daniel A

    2014-03-01

    Invisalign is an increasingly popular technique for aligning teeth and correcting malocclusions orthodontically. This article analyzes the current professional literature published on Invisalign and the benefits and risks of using the technique for both patients and doctors. The steady increase in the number of cases treated with Invisalign and where the technique is going in the future is investigated. Ten guidelines for Invisalign treatment and patient selection are given, along with case examples.

  6. Non-operative management of a complete anterior cruciate ligament injury in an English Premier League football player with return to play in less than 8 weeks: applying common sense in the absence of evidence.

    Science.gov (United States)

    Weiler, Richard; Monte-Colombo, Mathew; Mitchell, Adam; Haddad, Fares

    2015-04-26

    This case report illustrates and discusses the non-operative management of a complete anterior cruciate ligament (ACL) injury in an English Premier League football player, his return to play within 8 weeks and problem-free follow-up at 18 months post injury. When non-operative verses surgical ACL reconstruction is considered there are many fundamental gaps in our knowledge and currently, at elite level, there are no cases in cutting sports within the literature to guide these decisions. When the norm is for all professional footballers to be recommended surgery, it will be very challenging when circumstances and patient autonomy dictate a conservative approach, where prognosis, end points and risk are unclear and assumed to be high. This case challenges current dogma and provides a starting point for much needed debate about best practice, treatment options, research direction and not just at the elite level of sport.

  7. Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player's risk of subsequent injury.

    Science.gov (United States)

    Blanch, Peter; Gabbett, Tim J

    2016-04-01

    The return to sport from injury is a difficult multifactorial decision, and risk of reinjury is an important component. Most protocols for ascertaining the return to play status involve assessment of the healing status of the original injury and functional tests which have little proven predictive ability. Little attention has been paid to ascertaining whether an athlete has completed sufficient training to be prepared for competition. Recently, we have completed a series of studies in cricket, rugby league and Australian rules football that have shown that when an athlete's training and playing load for a given week (acute load) spikes above what they have been doing on average over the past 4 weeks (chronic load), they are more likely to be injured. This spike in the acute:chronic workload ratio may be from an unusual week or an ebbing of the athlete's training load over a period of time as in recuperation from injury. Our findings demonstrate a strong predictive (R(2)=0.53) polynomial relationship between acute:chronic workload ratio and injury likelihood. In the elite team setting, it is possible to quantify the loads we are expecting athletes to endure when returning to sport, so assessment of the acute:chronic workload ratio should be included in the return to play decision-making process. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Ivarsson A

    2017-03-01

    Full Text Available Andreas Ivarsson,1 Ulrika Tranaeus,2,3 Urban Johnson,1 Andreas Stenling 4 1Center of Research on Welfare, Health and Sport, School of Health and Welfare, Halmstad University, Halmstad, 2Performance and Training Unit, The Swedish School of Sport and Health Sciences (GIH, 3Musculoskeletal & Sports Injury Epidemiology Center, IMM, Karolinska Institutet, Stockholm, 4Department of Psychology, Umeå University, Umeå, Sweden Abstract: Previous research offers evidence that psychological factors influence an injured athlete during the rehabilitation process. Our first objective was to conduct a systematic review and meta-analysis of the results from all published studies that examined the relationships among negative affective responses after sport injuries, rehabilitation adherence, and return to play (RTP. The second objective was to use a meta-analytic path analysis to investigate whether an indirect effect existed between negative affective responses and RTP through rehabilitation adherence. This literature review resulted in seven studies providing 14 effect sizes. The results from the meta-analysis showed that negative affective responses had a negative effect on successful RTP, whereas rehabilitation adherence had a positive effect on RTP. The results from the meta-analytic path analysis showed a weak and nonsignificant indirect effect of negative affective responses on RTP via rehabilitation adherence. These results underline the importance of providing supportive environments for injured athletes to increase the chances of successful RTP via a decrease in negative affective responses and increase in rehabilitation adherence. Keywords: affective responses, rehabilitation behaviors, return to play, sport injuries

  9. Return to play and performance after anterior cruciate ligament reconstruction in the National Basketball Association: surgeon case series and literature review.

    Science.gov (United States)

    Nwachukwu, Benedict U; Anthony, Shawn G; Lin, Kenneth M; Wang, Tim; Altchek, David W; Allen, Answorth A

    2017-09-01

    To investigate return to play (RTP) and functional performance after anterior cruciate ligament reconstruction (ACLR) in National Basketball Association (NBA) players and to perform a systematic review of the literature to understand RTP after ACLR in professional basketball. NBA players undergoing ACLR between 2008 and 2014 by two surgeons were identified. RTP and performance were assessed based on a review of publically available statistics. A systematic review of the literature was performed using the MEDLINE database. Inclusion criteria were: English language, ACL surgery outcome, professional basketball and RTP outcome. We reviewed studies for RTP rates and RTP performance. Our study included 12 professional basketball players with NBA level experience. Eleven of the 12 players returned to their prior level of play. Eight of the 9 (88.9%) players actively playing in the NBA returned to play in the NBA at a mean 9.8 months. Among players returning to NBA play, during RTP season 1, mean per game statistics decreased for the following: minutes, points, rebounds, assists, steals, blocks, turnovers and personal fouls - none of these changes reached statistical significance. Player efficiency ratings significantly declined from pre-injury (12.5) to the first RTP season (7.6) (p = 0.05). By RTP season 2, player performance metrics approximated pre-injury levels and were not significantly different. Six studies met inclusion criteria; reported RTP rates ranged from 78-86%. Identified studies similarly found a decline in functional performance after RTP. There is a high rate (89%) of return to NBA play for NBA players undergoing ACLR. After RTP, however, there is a quantitative decline in initial season 1 RTP statistics with a significant decrease in player efficiency rating. By RTP season 2, performance metrics demonstrated an improvement compared to RTP season 1 but did not reach pre-injury functional performance, though performance metrics are not significantly

  10. Orthopaedic thromboprophylaxis: limitations of current guidelines

    DEFF Research Database (Denmark)

    Warwick, D.; Dahl, O.E.; Fisher, W.D.

    2008-01-01

    research into 'evidence-based' advice. Guidelines should, in theory, benefit patient care by ensuring that every patient routinely receives the best prophylaxis; without guidelines, it is argued, patients may fail to receive treatment or be exposed to protocols which are ineffective, dangerous or expensive...

  11. Brain network activation as a novel biomarker for the return-to-play pathway following sport-related brain injury: A prospective case study

    Directory of Open Access Journals (Sweden)

    Adam W Kiefer

    2015-11-01

    Full Text Available Children and adolescent athletes are at a higher risk for concussion than adults, and also experience longer recovery times and increased associated symptoms. It has also recently been demonstrated that multiple, seemingly mild concussions may result in exacerbated and prolonged neurologic deficits. Objective assessments and return to play criteria are needed to reduce risk and morbidity associated with concussive events in these populations. Recent research has pushed to study the use of electroencephalography as an objective measure of brain injury. In the present case study, we present a novel approach that examines event related potentials via a brain network activation (BNA analysis as a biomarker of concussion and recovery. Specifically, changes in BNA scores as indexed through this approach, offer a potential indicator of neurological health as the BNA assessment qualitatively and quantitatively indexes the network dynamics associated with brain injury. Objective tools such as these support accurate and efficient assessment of brain injury and may offer a useful step in categorizing the temporal and spatial changes in brain activity following concussive blows, as well as the functional connectivity of brain networks, associated with concussion.

  12. Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-analysis

    Science.gov (United States)

    Ivarsson, Andreas; Tranaeus, Ulrika; Johnson, Urban; Stenling, Andreas

    2017-01-01

    Previous research offers evidence that psychological factors influence an injured athlete during the rehabilitation process. Our first objective was to conduct a systematic review and meta-analysis of the results from all published studies that examined the relationships among negative affective responses after sport injuries, rehabilitation adherence, and return to play (RTP). The second objective was to use a meta-analytic path analysis to investigate whether an indirect effect existed between negative affective responses and RTP through rehabilitation adherence. This literature review resulted in seven studies providing 14 effect sizes. The results from the meta-analysis showed that negative affective responses had a negative effect on successful RTP, whereas rehabilitation adherence had a positive effect on RTP. The results from the meta-analytic path analysis showed a weak and nonsignificant indirect effect of negative affective responses on RTP via rehabilitation adherence. These results underline the importance of providing supportive environments for injured athletes to increase the chances of successful RTP via a decrease in negative affective responses and increase in rehabilitation adherence. PMID:28331375

  13. Standard guidelines for electrosurgery with radiofrequency current

    Directory of Open Access Journals (Sweden)

    Mutalik Sharad

    2009-08-01

    Full Text Available Definition: Radiofrequency (RF induces thermal destruction of the targeted tissue by an electrical current at a frequency of 0.5 MHz (RF. As the electrode tip is not heated, there is minimal thermal damage to the surrounding tissues, producing good esthetic results. Therefore, RF ablation is also known as cold ablation or "coblation." Modality: It has three modes of operation: (a Cut, (b cut and coagulate and (c coagulate. Therefore, it can be used for various purposes like incision, ablation, fulguration, shave excision and coagulation. Because of the coagulation facility, hemostasis can be achieved and operation becomes easier and faster. Indications: It is effective in treating various skin conditions like dermatosis papulosa nigra, warts, molluscum contagiosum, colloid milia, acquired junctional, compound and dermal melanocytic nevi, seborrheic keratosis, skin tags, granuloma pyogenicum, verrucous epidermal nevi, xanthelesma, rhinophyma, superficial basal cell carcinoma and telangiectasia. It can also be used for cosmetic indications such as resurfacing, earlobe repair and blepharoplasty. Anesthesia: The procedure is accomplished either under topical anesthesia eutactic mixture of local anesthetics or local injectable anesthesia, under all aseptic precautions. Procedure: While operating, only the tip of the electrode should come in contact with the tissue. Actual contact of the electrode with the tissue should be very brief in order to prevent excessive damage to the deeper tissues. This can be accomplished by moving the electrode quickly. Complications: Complications are uncommon and mainly occur due to an improper technique. The treating physician should be aware of the contraindications of the procedure as listed in these guidelines. Physician qualification: RF surgery may be performed by a dermatologist who has acquired adequate training during post-graduation or through recognized fellowships and workshops dedicated to RF surgery. He

  14. Suppression of Serum Prolactin Levels after Sports Concussion with Prompt Resolution Upon Independent Clinical Assessment To Permit Return-to-Play.

    Science.gov (United States)

    La Fountaine, Michael F; Toda, Michita; Testa, Anthony; Bauman, William A

    2016-05-01

    A significant outflow of neurotransmitters and metabolites with associated enhanced cortical excitation occurs after concussive head trauma. Cellular changes in the acute post-injury period cannot be observed directly in humans, and as such, require indirect evidence from systems sufficiently sensitive to central neuronal cellular excitation. Dopamine is a neurotransmitter with numerous targets in the central and peripheral nervous system. Changes to central dopaminergic tone result in reciprocal responses to the level of serum prolactin (PRL). Thus, a concussion may lead to abnormal dopaminergic tone, resulting in dynamic perturbations in the serum PRL concentration. To determine the effect of concussion on serum PRL concentrations, venipuncture was performed in the morning in four male intercollegiate athletes (age, 20 ± 1 years; height, 71 ± 5 inches; weight, 174 ± 21 pounds) within 48 h of concussion and again at 7 and 14 days post-injury. Serum PRL concentrations for each visit were categorized by quartile within the normal range. In all athletes, serum PRL concentrations increased from the lower quartiles in samples obtained closer to the time of injury to the higher quartiles at 14 days post-injury. These serum PRL changes accompanied the resolution of symptoms and the clinical decision to permit return-to-play. It may be postulated that transient augmentation of central dopaminergic tone resulted in inhibition of PRL secretion early after concussion and that disinhibition of PRL release occurred when central dopaminergic tone subsequently returned to baseline levels. This novel observation provides evidence for dopaminergic dysfunction after concussion that may be tracked by determination of serum PRL levels.

  15. ACL Injury, Return To Play And Reinjury In The Elite, Collegiate Athlete: An Analysis Of A Single, Division I NCAA Cohort

    Science.gov (United States)

    Kamath, Ganesh V.; Murphy, Timothy; Creighton, Robert A.; Taft, Timothy N.; Spang, Jeffrey T.

    2014-01-01

    Objectives: Graft survivorship, reinjury rates, and career length are poorly understood after ACL reconstruction in the elite, NCAA Division-I athlete. The purpose of this study was to examine the outcomes of ACL reconstruction in a Division-I athlete cohort. Methods: Retrospective chart review was performed of all Division-I athletes at a single, public university from 2000 to 2009 until completion of eligibility. Athletes with a Pre-collegiate (PC) and Intra-collegiate (IC) ACL reconstruction were separated into two cohorts. Graft survivorship, reoperation rates, and career length information was collected. Results: 35 athletes were identified with a pre-collegiate (PC) ACL reconstruction; 60 with an intra-collegiate (IC) reconstruction. The PC group had a 17.1% injury rate to the original graft, with a 20.0% rate of contralateral ACL injury. For the IC group, the reinjury rates were 1.9% to the ACL graft, with a 9.2% rate of contralateral ACL injury after an IntraCollegiate ACL reconstruction. The PC group used 78% of their total eligibility (avg 3.11 yrs). Athletes in the IC group used an average of 77% of their remaining NCAA eligibility. 88.3% of the IC group played an additional non-redshirt year after their injury. Reoperation rate for the PC group was 51.4% and 20.3% for the IC group. Conclusion: Reoperation and reinjury rates are high after ACL reconstruction in the Division-I athlete. Pre-collegiate ACL reconstruction is associated with a very high rate of repeat ACL reinjury to the graft or opposite knee (37.1%). The majority of athletes are able to return to play after successful reconstruction.

  16. [Update on Current Care Guideline: Insomnia].

    Science.gov (United States)

    Partinen, Markku; Huutoniemi, Anne; Kajaste, Soili; Lagerstedt, Rea; Markkula, Juha; Mäkinen, Erkki; Paakkari, Ilari; Partonen, Timo; Polo, Päivi; Saarenpää-Heikkilä, Outi; Seppälä, Maaria; Kukkonen-Harjula, Katriina; Tuunainen, Arja

    2016-01-01

    Insomnia symptoms must be differentiated from insomnia disorder. The correct aiagnosis or insomnia aisoraer is important, as insomnia may also be a symptom of many other diseases. Cognitive behavioral methods are recommended as first-line treatment options. Treatment of acute insomnia with hypnotics should not exceed two weeks. In elderly persons adverse effects of hypnotics may exceed their beneficial effects in long-term use. Antidepressive medications acting on the histamine-1 system may be used in very small doses. The new guideline includes e.g. insomnia in pregnant and menopausal women and in cancer patients, and driving issues.

  17. Occlusion on oral implants: current clinical guidelines.

    Science.gov (United States)

    Koyano, K; Esaki, D

    2015-02-01

    Proper implant occlusion is essential for adequate oral function and the prevention of adverse consequences, such as implant overloading. Dental implants are thought to be more prone to occlusal overloading than natural teeth because of the loss of the periodontal ligament, which provides shock absorption and periodontal mechanoreceptors, which provide tactile sensitivity and proprioceptive motion feedback. Although many guidelines and theories on implant occlusion have been proposed, few have provided strong supportive evidence. Thus, we performed a narrative literature review to ascertain the influence of implant occlusion on the occurrence of complications of implant treatment and discuss the clinical considerations focused on the overloading factors at present. The search terms were 'dental implant', 'dental implantation', 'dental occlusion' and 'dental prosthesis'. The inclusion criteria were literature published in English up to September 2013. Randomised controlled trials (RCTs), prospective cohort studies and case-control studies with at least 20 cases and 12 months follow-up interval were included. Based on the selected literature, this review explores factors related to the implant prosthesis (cantilever, crown/implant ratio, premature contact, occlusal scheme, implant-abutment connection, splinting implants and tooth-implant connection) and other considerations, such as the number, diameter, length and angulation of implants. Over 700 abstracts were reviewed, from which more than 30 manuscripts were included. We found insufficient evidence to establish firm clinical guidelines for implant occlusion. To discuss the ideal occlusion for implants, further well-designed RCTs are required in the future.

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

    Science.gov (United States)

    Reddy, Ashwini P; Gupta, Meera R

    2014-01-01

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

  19. An Exposition of Current Mobile Learning Design Guidelines and Frameworks

    Science.gov (United States)

    Teall, Ed; Wang, Minjuan; Callaghan, Vic; Ng, Jason W. P.

    2014-01-01

    As mobile devices with wireless access become more readily available, learning delivered via mobile devices of all types must be designed to ensure successful learning. This paper first examines three questions related to the design of mobile learning: 1) what mobile learning (m-learning) guidelines can be identified in the current literature, 2)…

  20. An Exposition of Current Mobile Learning Design Guidelines and Frameworks

    Science.gov (United States)

    Teall, Ed; Wang, Minjuan; Callaghan, Vic; Ng, Jason W. P.

    2014-01-01

    As mobile devices with wireless access become more readily available, learning delivered via mobile devices of all types must be designed to ensure successful learning. This paper first examines three questions related to the design of mobile learning: 1) what mobile learning (m-learning) guidelines can be identified in the current literature, 2)…

  1. Epidemiology of Sports-Related Concussions in National Collegiate Athletic Association Athletes From 2009-2010 to 2013-2014: Symptom Prevalence, Symptom Resolution Time, and Return-to-Play Time.

    Science.gov (United States)

    Wasserman, Erin B; Kerr, Zachary Y; Zuckerman, Scott L; Covassin, Tracey

    2016-01-01

    Limited data exist among collegiate student-athletes on the epidemiology of sports-related concussion (SRC) outcomes, such as symptoms, symptom resolution time, and return-to-play time. This study used the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) to describe the epidemiology of SRC outcomes in 25 collegiate sports. Descriptive epidemiology study. SRC data from the NCAA ISP during the 2009-2010 to 2013-2014 academic years were analyzed regarding symptoms, time to resolution of symptoms, and time to return to play. Findings were also stratified by sex in sex-comparable sports (ie, ice hockey, soccer, basketball, lacrosse, baseball/softball) and whether SRCs were reported as recurrent. Of the 1670 concussions reported during the 2009-2010 to 2013-2014 academic years, an average (±SD) of 5.29 ± 2.94 concussion symptoms were reported, with the most common being headache (92.2%) and dizziness (68.9%). Most concussions had symptoms resolve within 1 week (60.1%); however, 6.2% had a symptom resolution time of over 4 weeks. Additionally, 8.9% of concussions required over 4 weeks before return to play. The proportion of SRCs that required at least 1 week before return to play increased from 42.7% in 2009-2010 to 70.2% in 2013-2014 (linear trend, P concussions in male athletes included amnesia and disorientation; a larger proportion of concussions in female athletes included headache, excess drowsiness, and nausea/vomiting. A total of 151 SRCs (9.0%) were reported as recurrent. The average number of symptoms reported with recurrent SRCs (5.99 ± 3.43) was greater than that of nonrecurrent SRCs (5.22 ± 2.88; P = .01). A greater proportion of recurrent SRCs also resulted in a long symptom resolution time (14.6% vs 5.4%, respectively; P concussion management practices in which team medical staff members withhold players from participation longer to ensure symptom resolution. Concussion symptoms may differ by sex and recurrence. Future

  2. Diabetes and Hypertension: A Comparative Review of Current Guidelines.

    Science.gov (United States)

    Cryer, Michael J; Horani, Tariq; DiPette, Donald J

    2016-02-01

    Cardiovascular disease plays a major role in the morbidity and mortality of patients with diabetes mellitus. In turn, hypertension is a major risk factor for cardiovascular disease, and its prevalence is increased in diabetes mellitus. Therefore, the detection and management of elevated blood pressure (BP) is a critical component of the comprehensive clinical management of diabetics. Despite significant advances in our understanding of the pathogenesis and treatment of hypertension, there continues to be debate regarding the pharmacologic treatment of hypertension, especially in high-risk groups such as in patients with diabetes mellitus with and without chronic kidney disease (CKD). This debate largely involves at what BP (ie, treatment threshold BP) to initiate pharmacologic antihypertensive therapy and subsequently what treatment target BP should be achieved (ie, goal BP). Presently, there are several guidelines that address hypertension in diabetes mellitus, including the recently released guideline from the Eighth Report of the Joint National Committee (JNC 8). Therefore, this review will compare and contrast these current guidelines, as they relate to the management and treatment of hypertension in diabetes mellitus. Since diabetes mellitus and CKD are significantly inter-related, the presence of CKD as it relates to patients with diabetes mellitus will also be addressed. ©2015 Wiley Periodicals, Inc.

  3. Management and prevention of neonatal anemia: current evidence and guidelines.

    Science.gov (United States)

    von Lindern, Jeannette S; Lopriore, Enrico

    2014-04-01

    Neonatal anemia is a common disorder, particularly in (very) preterm neonates. Management of neonatal anemia is based principally on red blood cell (RBC) transfusion. Although the use of blood products is nowadays widespread in neonatal medicine, evidence on the potential benefit is extremely limited. Recent studies suggest that RBC transfusions in newborns may be associated with an increased risk for necrotizing enterocolitis, transfer of infectious agents and negative effects on neurodevelopmental outcome. Whether the benefits of RBC transfusions outweigh the risks is controversial and requires further studies. In this review, we summarize the current evidence on the management of neonatal anemia and compare the various international guidelines. In addition, we discuss the various strategies to prevent neonatal anemia and reduce the need for RBC transfusions and discuss important trials currently enrolling patients to improve the management in neonatal anemia.

  4. Is current medical education adequately preparing future physicians to manage concussion: an initial evaluation.

    Science.gov (United States)

    Donaworth, Michael A; Grandhi, Ravi K; Logan, Kelsey; Gubanich, Paul J; Myer, Gregory D

    2016-01-01

    In 2010, there were 2.5 million hospitalizations, emergency room visits, or deaths associated with concussions in the United States.[1] Knowledge deficits exist among physicians regarding concussion management, which can lead to severe repercussions, including poor patient outcomes, poor patient satisfaction, and potential medical-legal issues. While concussion is a prevalent condition evaluated in the medical field, medical students continue to have a knowledge deficit regarding concussion diagnosis, prognosis, medical management, and return to play guidelines. Medical students from a mid-western medical school completed a survey on concussion diagnosis, prognosis, medical management, and return to play guidelines. The response rate was 40%. The data suggests that the vast majority of medical students are able to define concussion; however, most reported never having a lecture dedicated to concussion during medical school and also lacked clinical experience with acute concussion and post-concussive syndrome. There are clear areas of deficiency as noted by the inability of students to correctly identify symptoms and appropriate management of concussion. The current study indicates that at an individual, mid-western, top 50 medical school, current medical trainees may not be adequately educated to identify and manage concussion. Future research is warranted to determine the optimal guidelines to educate future physicians as it pertains to concussion diagnosis, management, prognosis, and return to play guidelines.

  5. In touch with psoriasis: topical treatments and current guidelines.

    LENUS (Irish Health Repository)

    Murphy, G

    2011-06-01

    This article describes topical therapies and treatment guidelines for psoriasis and is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. The highly variable nature of psoriasis and its individual presentation in patients can make it difficult to choose the most appropriate treatment. There are many treatment options, from topical treatment with emollients for very mild psoriasis, to systemic therapy with fumaric acid esters, methotrexate or biologics for severe disease. For the treatment of mild-to-moderate psoriasis, topical therapy is generally the most appropriate and a variety of options, both historical and recent, are available. Newer therapies offer greater convenience and fewer side-effects. Of the more recently available therapies, vitamin D analogues and topical corticosteroids are the two with the greatest proven efficacy in randomized clinical trials. A recent Cochrane review showed the highest efficacy overall with the fixed combination vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate). Indeed, clinical trials have shown that two-compound calcipotriol\\/betamethasone dipropionate ointment has higher efficacy than calcipotriol or betamethasone dipropionate alone. With regard to safety, two-compound calcipotriol\\/betamethasone dipropionate was shown to be suitable for intermittent long-term treatment of mild-to-moderate psoriasis. The findings of the Cochrane review are reflected in the current treatment guidelines from the USA and Germany regarding the treatment of mild-to-moderate psoriasis. In both these guidelines, which will be discussed in this article, the recommended treatments for this patient group are vitamin D analogues and corticosteroids, particularly when used in combination.

  6. In touch with psoriasis: topical treatments and current guidelines.

    LENUS (Irish Health Repository)

    Murphy, G

    2012-02-01

    This article describes topical therapies and treatment guidelines for psoriasis and is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. The highly variable nature of psoriasis and its individual presentation in patients can make it difficult to choose the most appropriate treatment. There are many treatment options, from topical treatment with emollients for very mild psoriasis, to systemic therapy with fumaric acid esters, methotrexate or biologics for severe disease. For the treatment of mild-to-moderate psoriasis, topical therapy is generally the most appropriate and a variety of options, both historical and recent, are available. Newer therapies offer greater convenience and fewer side-effects. Of the more recently available therapies, vitamin D analogues and topical corticosteroids are the two with the greatest proven efficacy in randomized clinical trials. A recent Cochrane review showed the highest efficacy overall with the fixed combination vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate). Indeed, clinical trials have shown that two-compound calcipotriol\\/betamethasone dipropionate ointment has higher efficacy than calcipotriol or betamethasone dipropionate alone. With regard to safety, two-compound calcipotriol\\/betamethasone dipropionate was shown to be suitable for intermittent long-term treatment of mild-to-moderate psoriasis. The findings of the Cochrane review are reflected in the current treatment guidelines from the USA and Germany regarding the treatment of mild-to-moderate psoriasis. In both these guidelines, which will be discussed in this article, the recommended treatments for this patient group are vitamin D analogues and corticosteroids, particularly when used in combination.

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

    Science.gov (United States)

    Myers, Timothy R

    2008-06-01

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

  8. Applicability of the current hypertension guidelines in Latin America.

    Science.gov (United States)

    Alcocer, Luis; Meaney, Eduardo; Hernandez-Hernandez, Hector

    2015-08-01

    Recent research has focused on the development of evidence-based guidelines that are intended to regulate the conduct of physicians in the diagnosis and control of hypertension, with the goal of achieving greater effectiveness and equity at the lowest possible cost. In Latin America, guidelines are available for the management of hypertension at three levels: national, regional and international. The national and regional Latin American and Caribbean (LAC) guidelines are in fact adaptations of the international guidelines. The potential benefit of applying guidelines developed in other regions to local healthcare decision making is that it will enable decision makers to take advantage of existing analyses and transfer or adapt them to their local contexts. However, this adaptation precludes the assessment of their generalizability and potential transferability. In addition, this region is characterized by wide socioeconomic differences between its inhabitants, both among and within nations. Therefore, new guidelines for the LAC region must include recommendations that are common to all hypertensive patients in the region. Moreover, we advocate the inclusion of a specific section that makes comprehensive recommendations and provides strategies for implementation according to the socioeconomic conditions of particular groups. In addition to developing guidelines that are truly applicable to the LAC region, it seems sensible to consider information that is specific to this region. Furthermore, developing evidence-based guidelines is not enough to affect positively the burden of disease caused by hypertension. Therefore, professional programs are required for the implementation of such guidelines as well as the auditing of their results. Achieving these ambitious goals will require collaborative efforts by many groups including policymakers, international organizations, healthcare providers, universities and society.

  9. The current state of epilepsy guidelines: A systematic review.

    Science.gov (United States)

    Sauro, Khara M; Wiebe, Samuel; Dunkley, Colin; Janszky, Jozsef; Kumlien, Eva; Moshé, Solomon; Nakasato, Nobukazu; Pedley, Timothy A; Perucca, Emilio; Senties, Horacio; Thomas, Sanjeev V; Wang, Yuping; Wilmshurst, Jo; Jetté, Nathalie

    2016-01-01

    The International League Against Epilepsy (ILAE) Epilepsy Guidelines Task Force, composed of 14 international members, was established in 2011 to identify, using systematic review methodology, international epilepsy clinical care guidelines, assess their quality, and determine gaps in areas of need of development. A systematic review of the literature (1985-2014) was performed in six electronic databases (e.g. Medline, Embase) using a broad search strategy without initial limits to language or study design. Six gray literature databases (e.g., American Academy of Neurology [AAN], ILAE) were also searched to minimize publication bias. Two independent reviewers screened abstracts, reviewed full text articles, and performed data abstraction. Descriptive statistics and a meta-analysis were generated. The search identified 10,926 abstracts. Of the 410 articles selected for full text review, 63 met our eligibility criteria for a guideline. Of those included, 54 were in English and 9 were in other languages (French, Spanish, and Italian). Of all guidelines, 29% did not specify the target age groups, 27% were focused on adults, 22% included only children, and 6% specifically addressed issues related to women with epilepsy. Guidelines included in the review were most often aimed at guiding clinical practice for status epilepticus (n = 7), first seizure (n = 6), drug-resistant epilepsy (n = 5), and febrile seizures (n = 4), among others. Most of the guidelines were therapeutic (n = 35) or diagnostic (n = 16) in nature. The quality of the guidelines using a 1-7 point scale (7 = highest) varied and was moderate overall (mean = 4.99 ± 1.05 [SD]). We identified substantial gaps in topics (e.g., epilepsy in the elderly) and there was considerable heterogeneity in methodologic quality. The findings should offer a valuable resource for health professionals caring for people with epilepsy, since they will help guide the prioritization, development, and dissemination of future

  10. Current codex guidelines for assessment of potential protein allergenicity.

    Science.gov (United States)

    Ladics, G S

    2008-10-01

    A rigorous safety assessment process exists for GM crops. It includes evaluation of the introduced protein as well as the crop containing such protein with the goal of demonstrating the GM crop is "as-safe-as" non-transgenic crops in the food supply. One of the major issues for GM crops is the assessment of the expressed protein for allergenic potential. Currently, no single factor is recognized as an identifier for protein allergenicity. Therefore, a weight-of-evidence approach, which takes into account a variety of factors and approaches for an overall assessment of allergenic potential, is conducted [Codex Alimentarious Commission, 2003. Alinorm 03/34: Joint FAO/WHO Food Standard Programme, Codex Alimentarious Commission, Twenty-Fifth Session, Rome, Italy, 30 June-5 July, 2003. Appendix III, Guideline for the conduct of food safety assessment of foods derived from recombinant-DNA plants, and Appendix IV, Annex on the assessment of possible allergenicity, pp. 47-60]. This assessment is based on what is known about allergens, including the history of exposure and safety of the gene(s) source; protein structure (e.g., amino acid sequence identity to human allergens); stability to pepsin digestion in vitro [Thomas, K. et al., 2004. A multi-laboratory evaluation of a common in vitro pepsin digestion assay protocol used in assessing the safety of novel proteins. Regul. Toxicol. Pharmacol. 39, 87-98]; an estimate of exposure of the novel protein(s) to the gastrointestinal tract where absorption occurs (e.g., protein abundance in the crop, processing effects); and when appropriate, specific IgE binding studies or skin prick testing. Additional approaches may be considered (e.g., animal models; targeted sera screening) as the science evolves; however, such approaches have not been thoroughly evaluated or validated for predicting protein allergenicity.

  11. [Update on current care guidelines: urinary tract infections].

    Science.gov (United States)

    Wuorela, Maarit; Kouri, Timo; Laato, Matti; Lipponen, Pertti; Sammalkorpi, Kari; Uhari, Matti; Uusitalo, Leena; Vuento, Risto

    2011-01-01

    This guideline is focused on the diagnostics and treatment of acute, recurrent and relapsing urinary tract infections in adults and children. Sexually transmitted diseases are not addressed, but must be considered in differential diagnostics. The resistance prevalence of the causative microbes and the ecological adverse effects of antimicrobial agents were considered important factors in selecting optimal therapeutic choices for the guideline. Diagnosis and management of cystitis in otherwise healthy women aged 18-65 years can be based on structured telephone interviews. Primary antimicrobiotic drugs are nitrofurantoin, pivmesillinam and trimetoprim for three days.

  12. Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Rim, Chai Hong; Seong, Jin Sil [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy.

  13. Economic evaluation guidelines in Latin America: a current snapshot.

    Science.gov (United States)

    Augustovski, Federico; Garay, Osvaldo Ulises; Pichon-Riviere, Andres; Rubinstein, Adolfo; Caporale, Joaquín E

    2010-10-01

    Economic evaluation guidelines are widespread in developed countries with fourth hurdle systems but as of yet not in Latin America. In the present article, a systematic search was conducted in order to retrieve regional guidelines in PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and the gray literature. Four national guidelines were found: Brazil, Colombia, Cuba and Mexico. We report a thorough review of these documents, as well as a comparison among them. We conclude that, despite some differences found, they are broadly similar, and are broadly in accordance with international documents. The existence of these documents, together with other experiences in the region that explicitly use economic evaluation information for health decision making clearly shows that this global tendency is gaining momentum in Latin America, although there is still a long way to go. In the near future we will be able to see if these documents were successfully used and applied for transparent and evidence-based decision making.

  14. Core Stability in Athletes: A Critical Analysis of Current Guidelines.

    Science.gov (United States)

    Wirth, Klaus; Hartmann, Hagen; Mickel, Christoph; Szilvas, Elena; Keiner, Michael; Sander, Andre

    2017-03-01

    Over the last two decades, exercise of the core muscles has gained major interest in professional sports. Research has focused on injury prevention and increasing athletic performance. We analyzed the guidelines for so-called functional strength training for back pain prevention and found that programs were similar to those for back pain rehabilitation; even the arguments were identical. Surprisingly, most exercise specifications have neither been tested for their effectiveness nor compared with the load specifications normally used for strength training. Analysis of the scientific literature on core stability exercises shows that adaptations in the central nervous system (voluntary activation of trunk muscles) have been used to justify exercise guidelines. Adaptations of morphological structures, important for the stability of the trunk and therefore the athlete's health, have not been adequately addressed in experimental studies or in reviews. In this article, we explain why the guidelines created for back pain rehabilitation are insufficient for strength training in professional athletes. We critically analyze common concepts such as 'selective activation' and training on unstable surfaces.

  15. Screening for prostate cancer: the current evidence and guidelines controversy.

    Science.gov (United States)

    Gomella, Leonard G; Liu, Xiaolong S; Trabulsi, Edouard J; Kelly, Wm Kevin; Myers, Ronald; Showalter, Timothy; Dicker, Adam; Wender, Richard

    2011-10-01

    Prostate cancer presents a global public health dilemma. While screening with prostate specific antigen (PSA) has led to more men diagnosed with prostate cancer than in previous years, the potential for negative effects from over-diagnosis and treatment cannot be ignored. We reviewed Medline for recent articles that discuss clinical trials, evidence based recommendations and guidelines from major medical organizations in the United States and worldwide concerning prostate cancer screening. Results from the European Randomized Screening for Prostate Cancer (ERSPC), the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, and Göteborg Swedish trials regarding prostate screening are controversial with the ERSPC and Göteborg showing a reduction in prostate cancer mortality and the PLCO trial showing no benefit. Recommendations from the American Urological Association (AUA), Japanese Urological Association (JUA), and National Comprehensive Cancer Network (NCCN) have recommended that all men obtain a baseline PSA beginning at age 40. The American Cancer Society (ACS) stratifies screening recommendations based on age and risk, but states that screening should take place only after an informed discussion between provider and patient. The United States Preventative Health Service Task Force (USPSTF) states that evidence is insufficient to assess the risks and benefits of prostate cancer screening in men younger than 75 years. Other major international health organizations offer a similar reserved approach or recommend against screening for prostate cancer. Most groups indicate that screening to determine who should undergo prostate biopsy typically includes both a serum PSA and digital rectal examination, with the latest ACS publications noting that the rectal exam is optional. A common theme from all groups is that an informed discussion with the patients is strongly recommended and that screening does increase the number of men diagnosed with non

  16. Current clinical practice guidelines in atrial fibrillation: a review

    Directory of Open Access Journals (Sweden)

    osé Kelvin Galvez-Olortegui

    2016-03-01

    Full Text Available El objetivo del presente estudio es la evaluación metodológica de las guías de práctica clínica en fibrilación auricular. Este es el segundo de una serie de artículos de revisión, análisis, valoración metodológica y contenido de las guías de práctica clínica en cardiología. De todas las guías de práctica clínica se seleccionaron la Guía Americana, Canadiense y la del National Institute for Health and Care Excellence, (NICE, por su sigla en inglés, y se utilizó el instrumento Appraisal of Guidelines for Research and Evaluation (AGREE II para evaluar cada una de ellas En general, las guías obtuvieron el menor puntaje en el dominio de aplicabilidad (media 36,1%; mientras que el mayor puntaje fue para el dominio de claridad en la presentación (media 93,5%. El menor puntaje hallado fue en el dominio de independencia editorial (Guía Canadiense y el mayor de todos los puntajes fue en el dominio “Claridad de la presentación” (guía The National Institute for Health and Care Excellence, NICE. Al evaluar la calidad global de las guías de práctica clínica analizadas, NICE es la que mejor puntuaciones obtiene al aplicar el instrumento Appraisal of Guidelines for Research and Evaluation II (AGREE, seguido de la americana, siendo ambas recomendadas sin modificaciones.

  17. Galeazzi fractures: Is DRUJ instability predicted by current guidelines?

    Science.gov (United States)

    Tsismenakis, Tony; Tornetta, Paul

    2016-07-01

    Clinically significant distal radioulnar joint (DRUJ) injuries can occur with radial shaft fractures. Several radiographic methods of diagnosis, such as radial shortening of >5mm or fracture line within 7.5cm from the lunate facet, have been proposed but not clinically validated. The purpose of this study was to compare radiographic measurements of radial shaft fractures associated with and without clinically significant DRUJ injury (i.e., true Galeazzi fracture-dislocation) in order to evaluate the predictive value of reported parameters of DRUJ injury. A retrospective record and radiographic review was performed of 66 consecutive skeletally mature patients with isolated radial shaft fractures from 2004 to 2014 treated at one level 1 academic trauma center. Intraoperatively determined DRUJ instability after radial shaft fixation was used as the gold standard for diagnosis of a Galeazzi fracture-dislocation. Average age was 34 years old (range: 18-90). By thirds, there were 10 proximal (15%), 27 middle (41%), and 29 distal (44%) fractures. 13 (20%) had an associated ulnar styloid fracture. 7 (11%) patients had DRUJ instability after radial fixation. Radial shortening averaged 4.4±5.2mm (-2.6-22), and 21 had shortening of >5mm. Twenty-six (39%) fractures were within 7.5cm of the wrist joint. Previous guidelines were only moderately accurate. Even greater shortening did not predict instability (3/7 patients with >10mm shortening had a true injury). Four out of 7 cases with instability had ulnar styloid fractures (p=0.02). Using a larger data set than has historically been evaluated, previously reported radiographic guidelines are only moderately accurate. The presence of an ulnar styloid fracture can be helpful. Surgeons should be aware of these associations but rely primarily on intraoperative assessment of the DRUJ after radial fixation to determine treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Perioperative anesthetic documentation: Adherence to current Australian guidelines

    Directory of Open Access Journals (Sweden)

    Islam Elhalawani

    2013-01-01

    Full Text Available Purpose: The lack of adequate perioperative documentation has legal implications and can potentially affect the quality and safety of patient care. Despite the presence of guidelines, the adequacy of perioperative documentation in Australasia has not been adequately assessed. The aim of this study is to assess the adequacy of anesthetic documentation on the pre and intraoperative encounters and to test the hypotheses that documentation is incomplete in the settings of emergency vs. elective procedures, regional vs. general anesthesia, and manual vs. electronic documentation. Materials and Methods: The study was an observational retrospective study in the setting of a 250-bed teaching hospital in metropolitan Adelaide, Australia. The perioperative records of 850 patients were analyzed. A scoring system was designed, based on a policy statement from the Australian and New Zealand College of Anesthetists and a survey of the hospital anesthetists. Scored and categorical data was analyzed using Chi-square test. Numerical data was analyzed using student t-test. The null hypothesis was accepted or rejected at 0.05 significance. Results: There were significant deficiencies in the adequacy of preanesthetic and intraoperative records. This has been shown to be true in all cases. Documentation was found to be poorer in the emergency setting when compared to elective cases (median scores 15 vs. 21 P = 0.03 as well as documentation of airway assessment for cases done solely under regional anesthesia (42 vs. 85%, P = 0.05. There were no significant differences in the adequacy of electronic vs. manual records ( P = 0.92. Conclusion: There are significant deficiencies in the adequacy of perioperative records. This has been shown to be true in all cases, but is especially so in emergency cases and for patients having only regional anesthesia.

  19. Do current national and international guidelines have specific recommendations for older adults with bipolar disorder?

    DEFF Research Database (Denmark)

    Dols, Annemiek; Kessing, Lars Vedel; Strejilevich, Sergio A

    2016-01-01

    and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). RESULTS: There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD...... a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. METHODS: The International Society of Bipolar Disorders OABD task force compiled...... and mostly not informed by specific research evidence. CONCLUSIONS: There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited...

  20. Informed consent in human subject research: a comparison of current international and Nigerian guidelines.

    Science.gov (United States)

    Fadare, Joseph O; Porteri, Corinna

    2010-03-01

    Informed consent is a basic requirement for the conduct of ethical research involving human subjects. Currently, the Helsinki Declaration of the World Medical Association and the International Ethical Guidelines for Biomedical Research of the Council for International Organizations of Medical Sciences (CIOMS) are widely accepted as international codes regulating human subject research and the informed consent sections of these documents are quite important. Debates on the applicability of these guidelines in different socio-cultural settings are ongoing and many workers have advocated the need for national or regional guidelines. Nigeria, a developing country, has recently adopted its national guideline regulating human subject research: the National Health Research Ethics Committee (NHREC) code. A content analysis of the three guidelines was done to see if the Nigerian guidelines confer any additional protection for research subjects. The concept of a Community Advisory Committee in the Nigerian guideline is a novel one that emphasizes research as a community burden and should promote a form of "research friendship" to foster the welfare of research participants. There is also the need for a regular update of the NHREC code so as to address some issues that were not considered in its current version.

  1. [Comments on current guidelines of type 2 diabetes mellitus treatment].

    Science.gov (United States)

    Martinka, Emil

    In an effort to facilitate the widest possible application of recent findings in diabetology and the related medical fields, with regard to characteristics of medicines and current possibilities of using modern procedures, but also to their limitations due to the financial capacities of health insurance companies, SDS innovates its therapeutic recommendations for the treatment of diabetes mellitus on a regular basis. The most recent recommendations were issued by SDS in August 2016. The review discusses and describes several factors which the authors considered during their preparation: (1) Compliance with the findings of evidence-based medicine, compliance with reference recommendations (therapeutic recommendations ADA/EASD), compliance with summary characteristics of active substances in the treatment of diabetes mellitus and approved possibilities of their use, and compliance with indica-tive restrictions (IO) which define medical and economic conditions for health insurance covered treatment. (2) Certain departure from the "glucocentric" approach to therapy, in favour of the approach preferring the selection of drugs based on clinical characteristics of the patient and proven benefits/risks of individual drugs (3) Preference of groups as well as individual active substances within groups based on evidence medicine regarding the individual active substances for specific patient groups. (4) Emphasis on individualization of goals for glycemic control (5) Emphasis on the right classification of diabetes mellitus as the basic condition for the selection of an optimum thera-peutic procedure, and (6) Emphasis on education and overcoming of clinical inertia, and patient medication adherence and medication "literacy" as the basic condition for successful therapy. The discussion also considers the outcomes of the most recent studies including of the studies focusing on empagliflozin and liraglutide, as well as recent modifications of the therapeutic recommendations of

  2. Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines?

    Science.gov (United States)

    Naik, Ronak J; Patel, Neil R; Wang, Ming; Shah, Nishant C

    2016-08-01

    In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists. A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice. Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis. Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.

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

    OpenAIRE

    Jones, Nicola L.

    2004-01-01

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

  4. Critical analysis of the current treatment guidelines for complex ptsd in adults

    NARCIS (Netherlands)

    de Jongh, A.; Resick, P.A.; Zoelner, L.A.; van Minnen, A.; Lee, C.W.; Monson, C.M.; Foa, E.B.; Wheeler, K.; ten Broeke, E.; Feeny, N.; Rauch, S.A.M.; Chard, K.M.; Mueser, K.T.; Sloan, D.M.; van der Gaag, M.; Rothbaum, B.O.; Neuner, F.; de Roos, C.; Hehenkamp, L.M.J.; Rosner, R.; Bicanic, I.A.E.

    2016-01-01

    According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a “stabilization phase.” This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused

  5. CRITICAL ANALYSIS of the CURRENT TREATMENT GUIDELINES for COMPLEX PTSD in ADULTS

    NARCIS (Netherlands)

    De Jongh, Ad; Resick, Patricia A.; Zoellner, Lori A.; Van Minnen, Agnes; Lee, Christopher W.; Monson, Candice M.; Foa, Edna B.; Wheeler, Kathleen; Broeke, Erik Ten; Feeny, Norah; Rauch, Sheila A M; Chard, Kathleen M.; Mueser, Kim T.; Sloan, Denise M.; Van Der Gaag, Mark; Rothbaum, Barbara Olasov; Neuner, Frank; De Roos, Carlijn; Hehenkamp, Lieve M J; Rosner, Rita; Bicanic, Iva A E

    2016-01-01

    According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused

  6. The evaluation of uveitis in juvenile idiopathic arthritis (JIA) patients : are current ophthalmologic screening guidelines adequate?

    NARCIS (Netherlands)

    Reininga, J K; Los, L I; Wulffraat, N M; Armbrust, W

    2008-01-01

    OBJECTIVE: The aims of this study are to examine in our juvenile idiopathic arthritis (JIA) population: 1) the prevalence and characteristics of uveitis, 2) the complications and outcome of uveitis, 3) prognostic factors, and 4) the adequacy of the current ophthalmologic screening guidelines. METHOD

  7. The evaluation of uveitis in juvenile idiopathic arthritis (JIA) patients : are current ophthalmologic screening guidelines adequate?

    NARCIS (Netherlands)

    Reininga, J K; Los, L I; Wulffraat, N M; Armbrust, W

    2008-01-01

    OBJECTIVE: The aims of this study are to examine in our juvenile idiopathic arthritis (JIA) population: 1) the prevalence and characteristics of uveitis, 2) the complications and outcome of uveitis, 3) prognostic factors, and 4) the adequacy of the current ophthalmologic screening guidelines. METHOD

  8. Building an information security strategy for EHR: guidelines for assessing the current situation.

    Science.gov (United States)

    Mohammad, Yara; Stergioulas, Lampros

    2010-01-01

    This paper is looking at electronic health record (EHR) systems and their information security strategy. It focuses on the first step of building an information security strategy which is analysing the current situation of an EHR system. This research is based on different research methods applied to different EHR systems. In this paper we define eight elements that can be used as guidelines for how best to assess the current situation of any EHR system.

  9. [Methodology for the development and update of practice guidelines: current state].

    Science.gov (United States)

    Barrera-Cruz, Antonio; Viniegra-Osorio, Arturo; Valenzuela-Flores, Adriana Abigail; Torres-Arreola, Laura Pilar; Dávila-Torres, Javier

    2016-01-01

    The current scenario of health services in Mexico reveals as a priority the implementation of strategies that allow us to better respond to the needs and expectations of individuals and society as a whole, through the provision of efficient and effective alternatives for the prevention, diagnosis and treatment of diseases. In this context, clinical practice guidelines constitute an element of management in the health care system, whose objective is to establish a national bechmark for encouraging clinical and management decision making, based on recommendations from the best available evidence, in order to contribute to the quality and effectiveness of health care. The purpose of this document is to show the methodology used for the development and updating of clinical practice guidelines that the Instituto Mexicano del Seguro Social has developed in line with the sectorial model in order to serve the user of these guidelines.

  10. Are the current Australian sun exposure guidelines effective in maintaining adequate levels of 25-hydroxyvitamin D?

    Science.gov (United States)

    Kimlin, Michael; Sun, Jiandong; Sinclair, Craig; Heward, Sue; Hill, Jane; Dunstone, Kimberley; Brodie, Alison

    2016-01-01

    An adequate vitamin D status, as measured by serum 25-hydroxyvitamin D (25(OH)D) concentration, is important in humans for maintenance of healthy bones and muscle function. Serum 25(OH)D concentration was assessed in participants from Melbourne, Australia (37.81S, 144.96E), who were provided with the current Australian guidelines on sun exposure for 25(OH)D adequacy (25(OH)D ≥50 nmol/L). Participants were interviewed in February (summer, n=104) and August (winter, n=99) of 2013. Serum 25(OH)D concentration was examined as a function of measures of sun exposure and sun protection habits with control of key characteristics such as dietary intake of vitamin D, body mass index (BMI) and skin colour, that may modify this relationship. The mean 25(OH)D concentration in participants who complied with the current sun exposure guidelines was 67.3 nmol/L in summer and 41.9 nmol/L in winter. At the end of the study, 69.3% of participants who complied with the summer sun exposure guidelines were 25(OH)D adequate, while only 27.6% of participants who complied with the winter sun exposure guidelines were 25(OH)D adequate at the end of the study. The results suggest that the current Australian guidelines for sun exposure for 25(OH)D adequacy are effective for most in summer and ineffective for most in winter. This article is part of a Special Issue entitled '17th Vitamin D Workshop'.

  11. Current practices and guidelines for clinical next-generation sequencing oncology testing

    Institute of Scientific and Technical Information of China (English)

    Samuel P. Strom

    2016-01-01

    Next-generation sequencing (NGS) has been rapidly integrated into molecular pathology, dramatically increasing the breadth genomic of information available to oncologists and their patients. This review will explore the ways in which this new technology is currently applied to bolster care for patients with solid tumors and hematological malignancies, focusing on practices and guidelines for assessing the technical validity and clinical utility of DNA variants identified during clinical NGS oncology testing.

  12. Perspective: Improving nutritional guidelines for sustainable health policies: Current status and perspectives

    DEFF Research Database (Denmark)

    Magni, Paolo; Bier, Dennis M; Pecorelli, Sergio

    2017-01-01

    application of these concepts requires the translation of scientific information into practical approaches that have a tangible and measurable impact at both individual and population levels. The agenda for the future is expected to support available methodology in nutrition research to personalize guideline...... a constructive coalition among scientists, policy makers, and communication professionals for sustainable health and nutritional policies. Currently, a strong rationale and available data support a personalized dietary approach according to personal variables, including sex and age, circulating metabolic...

  13. Decreased suicide rate after induced abortion, after the Current Care Guidelines in Finland 1987-2012.

    Science.gov (United States)

    Gissler, Mika; Karalis, Elina; Ulander, Veli-Matti

    2015-02-01

    Women with a recent induced abortion have a 3-fold risk for suicide, compared to non-pregnant women. The increased risk was recognised in unofficial guidelines (1996) and Current Care Guidelines (2001) on abortion treatment, highlighting the importance of a check-up 2 - 3 weeks after the termination, to monitor for mental health disorders. We studied the suicide trends after induced abortion in 1987 - 2012 in Finland. We linked the Register on Induced Abortions (N = 284,751) and Cause-of-Death Register (N = 3798 suicides) to identify women who had committed suicide within 1 year after an induced abortion (N = 79). The abortion rates per 100,000 person-years were calculated for 1987 - 1996 (period with no guidelines), 1997 - 2001 (with unofficial guidelines) and 2002 - 2012 (with Current Care Guidelines). The suicide rate after induced abortion declined by 24%, from 32.4/100,000 in 1987 - 1996 to 24.3/100,000 in 1997 - 2001 and then 24.8/100,000 in 2002 - 2012. The age-adjusted suicide rate among women aged 15 - 49 decreased by 13%; from 11.4/100,000 to 10.4/100,000 and 9.9/100,000, respectively. After induced abortions, the suicide rate increased by 30% among teenagers (to 25/100,000), stagnated for women aged 20 - 24 (at 32/100,000), but decreased by 43% (to 21/100,000) for women aged 25 - 49. The excess risk for suicide after induced abortion decreased, but the change was not statistically significant. Women with a recent induced abortion still have a 2-fold suicide risk. A mandatory check-up may decrease this risk. The causes for the increased suicide risk, including mental health prior to pregnancy and the social circumstances, should be investigated further. © 2014 the Nordic Societies of Public Health.

  14. Refractory Immune Thrombocytopenic Purpura and Cytomegalovirus Infection: A Call for a Change in the Current Guidelines

    Directory of Open Access Journals (Sweden)

    Alex Shimanovsky

    2016-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP is characterized by a decreased platelet count caused by excess destruction of platelets and inadequate platelet production. In many cases the etiology is not known, but viral illness is thought to play a role in the development of some cases of ITP. The current (2011 American Society of Hematology ITP guidelines recommend initial diagnostic studies to include testing for HIV and Hepatitis C. The guidelines suggest that initial treatment consist of observation, therapy with corticosteroids, IVIG or anti D. While most cases respond to the standard therapy such that the steroids may be tapered and the platelet counts remain at a hemostatically safe level. Some patients with ITP are dependent on long term steroid maintenance and the thrombocytopenia persists with the tapering of the steroids. Recent case reports demonstrate that ITP related to cytomegalovirus (CMV can persist in spite of standard therapy and that antiviral therapy maybe indicated. Herein we report a case of a 26-year-old female with persistent ITP that resolved after the delivery of a CMV infected infant and placenta. Furthermore we review the current literature on CMV-associated ITP and propose that the current ITP guidelines be amended to include assessment for CMV as part of the work-up for severe and refractory ITP prior to splenectomy.

  15. Concussion knowledge and return-to-play attitudes among subelite ...

    African Journals Online (AJOL)

    constituting 4.8% of injuries reported across the same season of. English Premiership Rugby. ... Effective concussion prevention and management has been highlighted as a priority in contact sports in general, and particularly in rugby union.

  16. Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel.

    Science.gov (United States)

    Serafetinides, Efraim; Kitrey, Noam D; Djakovic, Nenad; Kuehhas, Franklin E; Lumen, Nicolaas; Sharma, Davendra M; Summerton, Duncan J

    2015-05-01

    The most recent European Association of Urology (EAU) guidelines on urological trauma were published in 2014. To present a summary of the 2014 version of the EAU guidelines on upper urinary tract injuries with the emphasis upon diagnosis and treatment. The EAU trauma guidelines panel reviewed literature by a Medline search on upper urinary tract injuries; publication dates up to December 2013 were accepted. The focus was on newer publications and reviews, although older key references could be included. A full version of the guidelines is available in print and online. Blunt trauma is the main cause of renal injuries. The preferred diagnostic modality of renal trauma is computed tomography (CT) scan. Conservative management is the best approach in stable patients. Angiography and selective embolisation are the first-line treatments. Surgical exploration is primarily for the control of haemorrhage (which may necessitate nephrectomy) and renal salvage. Urinary extravasation is managed with endourologic or percutaneous techniques. Complications may require additional imaging or interventions. Follow-up is focused on renal function and blood pressure. Penetrating trauma is the main cause of noniatrogenic ureteral injuries. The diagnosis is often made by CT scanning or at laparotomy, and the mainstay of treatment is open repair. The type of repair depends upon the severity and location of the injury. Renal injuries are best managed conservatively or with minimally invasive techniques. Preservation of renal units is feasible in most cases. This review, performed by the EAU trauma guidelines panel, summarises the current management of upper urinary tract injuries. Patients with trauma benefit from being accurately diagnosed and treated appropriately, according to the nature and severity of their injury. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  17. Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening.

    Science.gov (United States)

    Smith, Robert A; Andrews, Kimberly; Brooks, Durado; DeSantis, Carol E; Fedewa, Stacey A; Lortet-Tieulent, Joannie; Manassaram-Baptiste, Deana; Brawley, Otis W; Wender, Richard C

    2016-01-01

    Each year the American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, we summarize current ACS cancer screening guidelines, including the update of the breast cancer screening guideline, discuss quality issues in colorectal cancer screening and new developments in lung cancer screening, and provide the latest data on utilization of cancer screening from the National Health Interview Survey.

  18. Clinical compliance of viewing conditions in radiology reporting environments against current guidelines and standards

    Science.gov (United States)

    Daly, S.; Rainford, L.; Butler, M. L.

    2014-03-01

    Several studies have demonstrated the importance of environmental conditions in the radiology reporting environment, with many indicating that incorrect parameters could lead to error and misinterpretation. Literature is available with recommendations as to the levels that should be achieved in clinical practice, but evidence of adherence to these guidelines in radiology reporting environments is absent. This study audited the reporting environments of four teleradiologist and eight hospital based radiology reporting areas. This audit aimed to quantify adherence to guidelines and identify differences in the locations with respect to layout and design, monitor distance and angle as well as the ambient factors of the reporting environments. In line with international recommendations, an audit tool was designed to enquire in relation to the layout and design of reporting environments, monitor angle and distances used by radiologists when reporting, as well as the ambient factors such as noise, light and temperature. The review of conditions were carried out by the same independent auditor for consistency. The results obtained were compared against international standards and current research. Each radiology environment was given an overall compliance score to establish whether or not their environments were in line with recommended guidelines. Poor compliance to international recommendations and standards among radiology reporting environments was identified. Teleradiology reporting environments demonstrated greater compliance than hospital environments. The findings of this study identified a need for greater awareness of environmental and perceptual issues in the clinical setting. Further work involving a larger number of clinical centres is recommended.

  19. Health Risk Assessment of Dietary Cadmium Intake: Do Current Guidelines Indicate How Much is Safe?

    Science.gov (United States)

    Satarug, Soisungwan; Vesey, David A.; Gobe, Glenda C.

    2017-01-01

    Background: Cadmium (Cd), a food-chain contaminant, is a significant health hazard. The kidney is one of the primary sites of injury after chronic Cd exposure. Kidney-based risk assessment establishes the urinary Cd threshold at 5.24 μg/g creatinine, and tolerable dietary intake of Cd at 62 μg/day per 70-kg person. However, cohort studies show that dietary Cd intake below a threshold limit and that tolerable levels may increase the risk of death from cancer, cardiovascular disease, and Alzheimer’s disease. Objective: We evaluated if the current tolerable dietary Cd intake guideline and urinary Cd threshold limit provide sufficient health protection. Discussion: Staple foods constitute 40–60% of total dietary Cd intake by average consumers. Diets high in shellfish, crustaceans, mollusks, spinach, and offal add to dietary Cd sources. Modeling studies predict the current tolerable dietary intake corresponding to urinary Cd of 0.70–1.85 μg/g creatinine in men and 0.95–3.07 μg/g creatinine in women. Urinary Cd levels of protection from this pervasive toxic metal. Citation: Satarug S, Vesey DA, Gobe GC. 2017. Health risk assessment of dietary cadmium intake: do current guidelines indicate how much is safe? Environ Health Perspect 125:284–288; http://dx.doi.org/10.1289/EHP108 PMID:28248635

  20. Screening for Maternal Thyroid Dysfunction in Pregnancy: A Review of the Clinical Evidence and Current Guidelines

    Directory of Open Access Journals (Sweden)

    Donny L. F. Chang

    2013-01-01

    Full Text Available Observational studies have demonstrated that maternal thyroid dysfunction and thyroid autoimmunity in pregnancy may be associated with adverse obstetric and fetal outcomes. Treatment of overt maternal hyperthyroidism and overt hypothyroidism clearly improves outcomes. To date there is limited evidence that levothyroxine treatment of pregnant women with subclinical hypothyroidism, isolated hypothyroxinemia, or thyroid autoimmunity is beneficial. Therefore, there is ongoing debate regarding the need for universal screening for thyroid dysfunction during pregnancy. Current guidelines differ; some recommend an aggressive case-finding approach, whereas others advocate testing only symptomatic women or those with a personal history of thyroid disease or other associated medical conditions.

  1. Review of the current management of lower urinary tract injuries by the EAU Trauma Guidelines Panel.

    Science.gov (United States)

    Lumen, Nicolaas; Kuehhas, Franklin E; Djakovic, Nenad; Kitrey, Noam D; Serafetinidis, Efraim; Sharma, Davendra M; Summerton, Duncan J

    2015-05-01

    The most recent European Association of Urology (EAU) guidelines on urologic trauma were published in 2014. To present a summary of the 2014 version of the EAU guidelines on urologic trauma of the lower urinary tract with an emphasis on diagnosis and treatment. The EAU Trauma Panel reviewed the English-language literature via a Medline search for lower urinary tract injury (LUTI) up to November 2013. The focus was on newer publications and reviews, although older key references could be included. A full version of the guidelines is available in print (EAU Guidelines 2014 edition, ISBN/EAN 978-90-79754-65-6) and online (www.uroweb.org). Blunt trauma is the main cause of LUTI. The preferred diagnostic modality for bladder and urethral injury is cystography and urethrography, respectively. In the treatment of bladder injuries, it is important to distinguish between extra- and intraperitoneal ruptures. Treatment of male anterior urethral injuries depends on the cause (blunt vs penetrating vs penile-fracture-related injury). Blunt posterior urethral injuries can be corrected by immediate/early endoscopic realignment. If this is not possible, such injuries are managed by suprapubic urinary diversion and deferred (>3 mo) urethroplasty. Treatment of female urethral injuries depends on the location of the injury and is usually surgical. Correct treatment of LUTIs is important to minimise long-term urinary symptoms and sexual dysfunction. This review performed by the EAU trauma panel summarises the current management of LUTIs. Patients with trauma to the lower urinary tract benefit from accurate diagnosis and appropriate treatment according to the nature and severity of their injury. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  2. Combining estimates of interest in prognostic modelling studies after multiple imputation: current practice and guidelines

    Directory of Open Access Journals (Sweden)

    Holder Roger L

    2009-07-01

    Full Text Available Abstract Background Multiple imputation (MI provides an effective approach to handle missing covariate data within prognostic modelling studies, as it can properly account for the missing data uncertainty. The multiply imputed datasets are each analysed using standard prognostic modelling techniques to obtain the estimates of interest. The estimates from each imputed dataset are then combined into one overall estimate and variance, incorporating both the within and between imputation variability. Rubin's rules for combining these multiply imputed estimates are based on asymptotic theory. The resulting combined estimates may be more accurate if the posterior distribution of the population parameter of interest is better approximated by the normal distribution. However, the normality assumption may not be appropriate for all the parameters of interest when analysing prognostic modelling studies, such as predicted survival probabilities and model performance measures. Methods Guidelines for combining the estimates of interest when analysing prognostic modelling studies are provided. A literature review is performed to identify current practice for combining such estimates in prognostic modelling studies. Results Methods for combining all reported estimates after MI were not well reported in the current literature. Rubin's rules without applying any transformations were the standard approach used, when any method was stated. Conclusion The proposed simple guidelines for combining estimates after MI may lead to a wider and more appropriate use of MI in future prognostic modelling studies.

  3. CT pulmonary angiography utilization in the emergency department: diagnostic yield and adherence to current guidelines.

    Science.gov (United States)

    Perelas, Apostolos; Dimou, Anastasios; Saenz, Augustina; Rhee, Ji Hyun; Teerapuncharoen, Krittika; Rowden, Adam; Eiger, Glenn

    2015-01-01

    The aim is to investigate the patterns of computed tomography pulmonary angiography (CTPA) use and adherence to current guidelines. Medical records of patients investigated with CTPA for pulmonary embolism (PE) in a single academic hospital from January 2011 until December 2012 were reviewed. Wells scores were calculated retrospectively by researchers blinded to the results of the CTPA. "Avoidable imaging" was defined as imaging performed against current recommendations of the European Society of Cardiology or the PIOPED investigation group. A total of 646 patients underwent testing; 61 cases of PE were diagnosed (9.4%). Potentially avoidable imaging was performed in 49.5% and 71.5% of patients, depending on the criteria used; 11.5% of imaging studies were performed in low-risk patients with negative D-dimer assays. There is evidence of CTPA overuse and D-dimer underuse. Adherence to guidelines and appropriate use of D-dimer assay might reduce avoidable imaging and ionizing radiation exposure. © The Author(s) 2014.

  4. Cost of treating chronic hepatitis B: Comparison of current treatment guidelines

    Institute of Scientific and Technical Information of China (English)

    Monica Robotin; Yumi Patton; Melanie Kansil; Andrew Penman; Jacob George

    2012-01-01

    AIM:To compare program costs of chronic hepatitis B (CHB) screening and treatment using Australian and other published CHB treatment guidelines.METHODS:Economic modeling demonstrated that in Australia a strategy of hepatocellular cancer (HCC)prevention in patients with CHB is more cost-effective than current standard care,or HCC screening.Based upon this model,we developed the B positive program to optimize CHB management of Australians born in countries of high CHB prevalence.We estimated CHB program costs using the B positive program algorithm and compared them to estimated costs of using the CHB treatment guidelines published by the AsianPacific,American and European Associations for the Study of Liver Disease (APASL,AASLD,EASL) and those suggested by an independent United States hepatology panel.We used a Markov model that factored in the costs of CHB screening and treatment,individualized by viral load and alanine aminotransferase levels,and calculated the relative costs of program components.Costs were discounted by 5% and calculated in Australian dollars (AUD).RESULTS:Using the B positive algorithm,total program costs amount to 13 979 224 AUD,or 9634 AUD per patient.The least costly strategy is based upon using the AASLD guidelines,which would cost 34% less than our B positive algorithm.Using the EASL and the United States Expert Group guidelines would increase program costs by 46%.The largest expenditure relates to the cost of drug treatment (66.9% of total program costs).The contribution of CHB surveillance (20.2%)and HCC screening and surveillance (6.6%) is small -and together they represent only approximately a quarter of the total program costs.CONCLUSION:The significant cost variations in CHB screening and treatment using different guidelines are relevant for clinicians and policy makers involved in designing population-based disease control programs.(C) 2012 Baishideng.All rights reserved.

  5. Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States

    Science.gov (United States)

    Moore, Andrew; Nelson, Christina; Molins, Claudia; Mead, Paul

    2016-01-01

    In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%–40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%–100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics. PMID:27314832

  6. Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines

    Science.gov (United States)

    Dhayat, Sameer A.; Mirgorod, Philip; Lenschow, Christina; Senninger, Norbert

    2017-01-01

    Background Pancreatic ductal adenocarcinoma (PDAC) remains one of the most deadly cancers in Europe and the USA. There is consensus that radical tumor surgery is the only viable option for any long-term survival in patients with PDAC. So far, limited data are available regarding the routine surgical management of patients with advanced PDAC in the light of surgical guidelines. Methods A national survey on perioperative management of patients with PDAC and currently applied criteria on their tumor resectability in German university and community hospitals was carried out. Results With a response rate of 81.6% (231/283) a total of 95 (41.1%) participating departments practicing pancreatic surgery in Germany are certified as competence and reference centers for surgical diseases of the pancreas in 2016. More than 95% of them indicate to carry out structured and interdisciplinary therapies along with an interdisciplinary pre- and postoperative tumor board. The majority of survey respondents prefer the pylorus-preserving partial pancreatoduodenectomy (93.1%) with standard lymphadenectomy for cancer of the pancreatic head. Intraoperative histological evaluation of the resection margins is used regularly by 99% of the survey respondents. 98.7% of survey respondents carry out partial or complete vein resection, 126 respondents (54.5%) would resect tumor adjacent arteries, and 102 respondents (44.2%) would perform metastasectomy if complete PDAC resection (R0) is possible. Conclusion Evidence-based and standardized pancreatic surgery is practiced by a large number of hospitals in Germany. However, a significant number of survey respondents support an extended radical tumor resection in patients with advanced PDAC even when not indicated by current clinical guidelines. PMID:28267771

  7. [Update on current care guidelines: physical activity and exercise training for adults in sickness and in health].

    Science.gov (United States)

    2011-01-01

    The purpose of the aforementioned guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity, either alone or combined with other lifestyle modifications, plays a key role in the management of several chronic diseases. In this guideline, the following diseases will be discussed: musculoskeletal, endocrinological, cardiovascular and respiratory diseases, as well as cancer, depression and urinary incontinence. In addition, physical activity during pregnancy and in senior citizens is discussed. Physical activity and exercise training have also been mentioned in 27 other Current Care clinical guidelines.

  8. Current status of preventive cardiology training among United States cardiology fellowships and comparison to training guidelines.

    Science.gov (United States)

    Pack, Quinn R; Keteyian, Steven J; McBride, Patrick E; Weaver, W Douglas; Kim, Henry E

    2012-07-01

    We evaluated preventive cardiology education in United States cardiology fellowship programs and their adherence to Core Cardiovascular Training Symposium training guidelines, which recommend 1 month of training, faculty with expertise, and clinical experience in cardiac rehabilitation, lipid disorder management, and diabetes management as a part of the prevention curricula. We sent an anonymous survey to United States cardiology program directors and their chief fellow. The survey assessed the program curricula, rotation structure, faculty expertise, obstacles, and recommended improvements. The results revealed that 24% of surveyed programs met the Core Cardiovascular Training Symposium guidelines with a dedicated 1-month rotation in preventive cardiology, 24% had no formalized training in preventive cardiology, and 30% had no faculty with expertise in preventive cardiology, which correlated with fewer rotations in prevention than those with specialized faculty (p = 0.009). Fellows rotated though the following experiences (% of programs): cardiac rehabilitation, 71%; lipid management, 37%; hypertension, 15%; diabetes, 7%; weight management/obesity, 6%; cardiac nutrition, 6%; and smoking cessation, 5%. The program directors cited "lack of time" as the greatest obstacle to providing preventive cardiology training and the chief fellows reported "lack of a developed curriculum" (p = 0.01). The most recommended improvement was for the American College of Cardiology to develop a web-based curriculum/module. In conclusion, most surveyed United States cardiology training programs currently do not adhere to basic preventive cardiovascular medicine Core Cardiovascular Training Symposium recommendations. Additional attention to developing curricular content and structure, including the creation of an American College of Cardiology on-line knowledge module might improve fellowship training in preventive cardiology.

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

    Science.gov (United States)

    Farrelly, N; Dibben, C; Hunt, N

    2006-01-01

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

  10. Low Body Mass Index Can Identify Majority of Osteoporotic Inflammatory Bowel Disease Patients Missed by Current Guidelines

    Directory of Open Access Journals (Sweden)

    Ashish Atreja

    2012-01-01

    Full Text Available Background. Patients with inflammatory bowel disease (IBD are at high risk of developing osteoporosis. Our objective was to determine the usefulness of IBD guidelines in identifying patients at risk for developing osteoporosis. Methods. We utilized institutional repository to identify patients seen in IBD center and extracted data on demographics, disease history, conventional, and nonconventional risk factors for osteoporosis and Dual Energy X-ray Absorptiometry (DXA findings. Results. 59% of patients (1004/1703 in our IBD cohort had at least one risk factor for osteoporosis screening. DXA was documented in 263 patients with indication of screening (provider adherence, 26.2%, and of these, 196 patients had DXA completed (“at-risk” group. Ninety-five patients not meeting guidelines-based risk factors also had DXA completed (“not at-risk” group. 139 (70.9% patients in “at-risk” group had low BMD, while 51 (53.7% of “not-at-risk” patients had low BMD. Majority of the patients with osteoporosis (83.3% missed by the current guidelines had low BMI. Multivariate logistic regression analysis showed that low BMI was the strongest risk factor for osteoporosis (OR 3.07; 95% CI, 1.47–6.42; P=0.003. Conclusions. Provider adherence to current guidelines is suboptimal. Low BMI can identify majority of the patients with osteoporosis that are missed by current guidelines.

  11. Retinal damage by optical radiation. An alternative approach to current, ACGIH-inspired guidelines

    NARCIS (Netherlands)

    Vos, J.J.; Norren, D. van

    2005-01-01

    Background: The ACGIH guidelines for protection against retinal damage by optical radiation are often difficult to apply due to their lack of transparency. The less known guidelines by the Netherlands Health Council (HCN), dating from 1978 and updated in 1993, might offer a way out in many cases. Me

  12. Adequacy of Physicians Knowledge Level of Cardiopulmonary Resuscitation to Current Guidelines

    Directory of Open Access Journals (Sweden)

    Ümmu Kocalar

    2016-01-01

    Full Text Available Aim: The purpose of this study is to test the level of information on CPR and suitability to current application of the phsicians practicing in hospital ANEAH. Material and Method: The form of a test of 20 questions fort his purpose has been prepared in accordance with the 2010 AHA-ERC CPR guidelines. This form distributed to volunteer physicians to fill in. A total of 173 physicians agreed to participate in he study. The results were analyzed statistically and tried to determine the factors affecting the level of information. Results:According to the results of the study physicians gender, age and the total duration of physicians and medical asistance doesn%u2019t affect the level of information. The number of CPR within 1 month positively affect the level of knowledge. The number of theoretical and practical training in medical school, have taken the positive impact the level of knowledge of physicians. The training period after graduation, significantly increased the level of physicians information. The order of these training sessions with the asistant courses, congress, seminars and lessions on the sempozims are effective. Discussion: CPR trainig programs for physicians should be standardized, updated and expanded. Recurent in-service trainig should be provided to increase phsicians knowledge on skills.

  13. The Investigators' Brochure: a comparison of the draft international conference on harmonisation guideline with current Food and Drug Administration requirements.

    Science.gov (United States)

    Cocchetto, D M

    1995-12-01

    For several years, the United States Food and Drug Administration (FDA) has participated in a collaborative effort to harmonize the technical procedures for development and regulatory approval of human pharmaceuticals in multiple countries. This harmonization effort is the work of the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). At this point, ICH focuses on achieving harmonization of technical requirements in three major regions of the world, i.e., the United States, European Union, and Japan. One area for which harmonization is being sought is the format and content of the Investigators' Brochure. On October 27, 1993, the ICH Steering Committee agreed that the ICH draft guideline on the Investigators' Brochure should be made available for public comment. On August 9, 1994, the FDA published the draft guideline for the format and content of the Investigators' Brochure. This draft guideline was prepared by the Efficacy Expert Working Group of the ICH. FDA solicited written comments on this draft guideline until October 11, 1994. Ultimately, FDA intends to adopt the ICH Steering Committee's final guidelines on Investigators' Brochures as part of a larger document on good clinical practices. Therefore, the content of this draft guideline warrants careful attention. In this paper, ICH's proposed information for inclusion in the Investigators' Brochure is reviewed and compared with current regulatory requirements of FDA. The expanded contents of the Investigators' Brochure proposed by ICH, which represent potential new requirements beyond current FDA regulations, are highlighted. The major controversial elements of this draft guideline are summarized.

  14. Could a revision of the current guidelines for cancer drug use improve the quality of cancer treatment?

    Directory of Open Access Journals (Sweden)

    Lippert TH

    2014-01-01

    Full Text Available Theodor H Lippert,1 Hans-Jörg Ruoff,1 Manfred Volm2 1Medical Faculty, University of Tübingen, Tübingen, Germany; 2Medical Faculty, University of Heidelberg, Heidelberg, Germany Abstract: Clinical practice guidelines are indispensable for such a variable disease as malignant solid tumors, with the complex possibilities of drug treatment. The current guidelines may be criticized on several points, however. First, there is a lack of information on the outcome of treatment, such as the expected success and failure rates. Treating not only drug responders but also nonresponders, that is, patients with drug resistance, must result in failures. There is no mention of the possibility of excluding the drug nonresponders, identifiable by special laboratory tests and no consideration is given to the different side effects of the recommended drug regimens. Nor are there any instructions concerning tumor cases for which anticancer drug treatment is futile. In such cases, early palliative care may lead to significant improvements in both life quality and life expectancy. Not least, there is no transparency concerning the preparation of the guidelines: persons cannot be identified who could give a statement of conflicts of interest, and responsibility is assumed only by anonymous medical associations. A revision of the current guidelines could considerably improve cancer treatment. Keywords: anticancer drugs, quality of guidelines, critical remarks

  15. Cancer screening in the United States, 2015: a review of current American cancer society guidelines and current issues in cancer screening.

    Science.gov (United States)

    Smith, Robert A; Manassaram-Baptiste, Deana; Brooks, Durado; Doroshenk, Mary; Fedewa, Stacey; Saslow, Debbie; Brawley, Otis W; Wender, Richard

    2015-01-01

    Each year, the American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection along with a report on data and trends in cancer screening rates and select issues related to cancer screening. In this issue of the journal, we summarize current ACS cancer screening guidelines. The latest data on utilization of cancer screening from the National Health Interview Survey (NHIS) also is described, as are several issues related to screening coverage under the Affordable Care Act, including the expansion of the Medicaid program.

  16. Revision of OECD Guidelines for Genotoxicity Testing: Current Status and Next Steps

    Science.gov (United States)

    Over the past 30 years, assays have been developed to evaluate chemical genotoxicity. OECD Genotoxicity Test Guidelines (TG) describe assay procedures for regulatory safety testing. Since the last OECD TG revision (1997), there has been tremendous scientific and technological pro...

  17. Are the current IHS guidelines for migraine drug trials being followed?

    DEFF Research Database (Denmark)

    Hougaard, Anders; Tfelt-Hansen, Peer

    2010-01-01

    In 2000, the Clinical Trials Subcommittee of the International Headache Society (IHS) published the second edition of its guidelines for controlled trials of drugs in migraine. The purpose of this publication was to improve the quality of such trials by increasing the awareness amongst...... or not double-blinded. Adherence to international guidelines like these of IHS is important to ensure that only high-quality trials are performed, and to provide the consensus that is required for meta analyses. The primary efficacy measure for trials of acute treatment should be "pain free" and not "headache...... investigators of the methodological issues specific to this particular illness. Until now the adherence to these guidelines has not been systematically assessed. We reviewed all published controlled trials of drugs in migraine from 2002 to 2008. Eligible trials were scored for compliance with the IHS guidelines...

  18. Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening.

    Science.gov (United States)

    Smith, Robert A; Andrews, Kimberly S; Brooks, Durado; Fedewa, Stacey A; Manassaram-Baptiste, Deana; Saslow, Debbie; Brawley, Otis W; Wender, Richard C

    2017-03-01

    Answer questions and earn CME/CNE Each year, the American Cancer Society publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, the authors summarize current American Cancer Society cancer screening guidelines, describe an update of their guideline for using human papillomavirus vaccination for cancer prevention, describe updates in US Preventive Services Task Force recommendations for breast and colorectal cancer screening, discuss interim findings from the UK Collaborative Trial on Ovarian Cancer Screening, and provide the latest data on utilization of cancer screening from the National Health Interview Survey. CA Cancer J Clin 2017;67:100-121. © 2017 American Cancer Society. © 2017 American Cancer Society.

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

    OpenAIRE

    2010-01-01

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

  20. Current guidelines for high-density lipoprotein cholesterol in therapy and future directions

    Directory of Open Access Journals (Sweden)

    Subedi BH

    2014-04-01

    Full Text Available Bishnu H Subedi,1,2 Parag H Joshi,1 Steven R Jones,1 Seth S Martin,1 Michael J Blaha,1 Erin D Michos1 1Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 2Greater Baltimore Medical Center, Baltimore, MD, USA Abstract: Many studies have suggested that a significant risk factor for atherosclerotic cardiovascular disease (ASCVD is low high-density lipoprotein cholesterol (HDL-C. Therefore, increasing HDL-C with therapeutic agents has been considered an attractive strategy. In the prestatin era, fibrates and niacin monotherapy, which cause modest increases in HDL-C, reduced ASCVD events. Since their introduction, statins have become the cornerstone of lipoprotein therapy, the benefits of which are primarily attributed to decrease in low-density lipoprotein cholesterol. Findings from several randomized trials involving niacin or cholesteryl ester transfer protein inhibitors have challenged the concept that a quantitative elevation of plasma HDL-C will uniformly translate into ASCVD benefits. Consequently, the HDL, or more correctly, HDL-C hypothesis has become more controversial. There are no clear guidelines thus far for targeting HDL-C or HDL due to lack of solid outcomes data for HDL specific therapies. HDL-C levels are only one marker of HDL out of its several structural or functional properties. Novel approaches are ongoing in developing and assessing agents that closely mimic the structure of natural HDL or replicate its various functions, for example, reverse cholesterol transport, vasodilation, anti-inflammation, or inhibition of platelet aggregation. Potential new approaches like HDL infusions, delipidated HDL, liver X receptor agonists, Apo A-I upregulators, Apo A mimetics, and gene therapy are in early phase trials. This review will outline current therapies and describe future directions for HDL therapeutics. Keywords: high-density lipoprotein, lipids, cholesterol, atherosclerosis, cardiovascular disease, therapy

  1. Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres

    DEFF Research Database (Denmark)

    Alanen, Seija I; Johannala-Kemppainen, Riitta; Ijäs, Jarja J;

    2007-01-01

    OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information implement......OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information...... implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n...... =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264...

  2. Do current national and international guidelines have specific recommendations for older adults with bipolar disorder? A brief report.

    Science.gov (United States)

    Dols, Annemiek; Kessing, Lars Vedel; Strejilevich, Sergio A; Rej, Soham; Tsai, Shang-Ying; Gildengers, Ariel G; Almeida, Osvaldo P; Shulman, Kenneth I; Sajatovic, Martha

    2016-12-01

    Older adults with bipolar disorder (OABD) are a growing segment of patients with bipolar disorder (BD) for which specific guidelines are warranted. Although, OABD are frequently excluded from randomized controlled trials due to their age or somatic comorbidity, more treatment data from a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. The International Society of Bipolar Disorders OABD task force compiled and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD. General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general and mostly not informed by specific research evidence. There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited mental health workforce with geriatric expertise, it is critical that additional effort and resources be devoted to studying treatment interventions specific to OABD and that treatment guidelines reflect research findings. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  3. Toward best practice in Human Machine Interface design for older drivers: A review of current design guidelines.

    Science.gov (United States)

    Young, K L; Koppel, S; Charlton, J L

    2017-09-01

    Older adults are the fastest growing segment of the driving population. While there is a strong emphasis for older people to maintain their mobility, the safety of older drivers is a serious community concern. Frailty and declines in a range of age-related sensory, cognitive, and physical impairments can place older drivers at an increased risk of crash-related injuries and death. A number of studies have indicated that in-vehicle technologies such as Advanced Driver Assistance Systems (ADAS) and In-Vehicle Information Systems (IVIS) may provide assistance to older drivers. However, these technologies will only benefit older drivers if their design is congruent with the complex needs and diverse abilities of this driving cohort. The design of ADAS and IVIS is largely informed by automotive Human Machine Interface (HMI) guidelines. However, it is unclear to what extent the declining sensory, cognitive and physical capabilities of older drivers are addressed in the current guidelines. This paper provides a review of key current design guidelines for IVIS and ADAS with respect to the extent they address age-related changes in functional capacities. The review revealed that most of the HMI guidelines do not address design issues related to older driver impairments. In fact, in many guidelines driver age and sensory cognitive and physical impairments are not mentioned at all and where reference is made, it is typically very broad. Prescriptive advice on how to actually design a system so that it addresses the needs and limitations of older drivers is not provided. In order for older drivers to reap the full benefits that in-vehicle technology can afford, it is critical that further work establish how older driver limitations and capabilities can be supported by the system design process, including their inclusion into HMI design guidelines. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Practice Patterns and Opinions on Current Clinical Practice Guidelines Regarding the Management of Delirium in the Intensive Care Unit.

    Science.gov (United States)

    Mo, Yoonsun; Zimmermann, Anthony E; Thomas, Michael C

    2017-04-01

    The aim of this study was to determine current delirium practices in the intensive care unit (ICU) setting and evaluate awareness and adoption of the 2013 Pain, Agitation, and Delirium (PAD) guidelines with emphasis on delirium management. A large-scale, multidisciplinary, online survey was administered to physician, pharmacist, nurse, and mid-level practitioner members of the Society of Critical Care Medicine (SCCM) between September 2014 and October 2014. A total of 635 respondents completed the survey. Nonpharmacologic interventions such as early mobilization were used in most ICUs (83%) for prevention of delirium. A majority of respondents (97%) reported using pharmacologic agents to treat hyperactive delirium. Ninety percent of the respondents answered that they were aware of the 2013 PAD guidelines, and 75% of respondents felt that their delirium practices have been changed as a result of the new guidelines. In addition, logistic regression analysis of this study showed that respondents who use delirium screening tools were twice more likely to be fully aware of key components of the updated guidelines (odds ratio [OR] = 2.07, 95% confidence interval [CI] = 1.20-3.60). Most critical care practitioners are fully aware and knowledgeable of key recommendations in the new guidelines and have changed their delirium practices accordingly.

  5. Are the current IHS guidelines for migraine drug trials being followed?

    DEFF Research Database (Denmark)

    Hougaard, Anders; Tfelt-Hansen, Peer

    2010-01-01

    In 2000, the Clinical Trials Subcommittee of the International Headache Society (IHS) published the second edition of its guidelines for controlled trials of drugs in migraine. The purpose of this publication was to improve the quality of such trials by increasing the awareness amongst investigat......In 2000, the Clinical Trials Subcommittee of the International Headache Society (IHS) published the second edition of its guidelines for controlled trials of drugs in migraine. The purpose of this publication was to improve the quality of such trials by increasing the awareness amongst...... investigators of the methodological issues specific to this particular illness. Until now the adherence to these guidelines has not been systematically assessed. We reviewed all published controlled trials of drugs in migraine from 2002 to 2008. Eligible trials were scored for compliance with the IHS guidelines...... by using grading scales based on the most essential recommendations of the guidelines. The primary efficacy measure of each trial was also recorded. A total of 145 trials of acute treatment and 52 trials of prophylactic treatment were eligible for review. Of the randomized, double-blind trials, acute...

  6. Current Practice vs. Guideline Based Imaging in Abdominal Radiology in the German Speaking Area: Results of an Online Survey.

    Science.gov (United States)

    Schreyer, A G; Wessling, J; Grenacher, L

    2016-03-01

    The working group for abdominal imaging within the German Roentgen Society (DRG) performed an online survey amongst radiologist concerning the current status of techniques for abdominal imaging. The results of this survey were compared with the most recent guidelines. We performed an online survey open for all members of the DRG during a 76-day period with 65 questions and an overall estimated time for finishing the questionnaire of 15 minutes concerning technical specifications for abdominal radiological imaging. The results were evaluated using descriptive statistics. 90 of all participants, who filled out the survey covering more than 80% of the questions, were included in the statistical evaluation. 27% of all participants were registered radiologists while 73% represented radiologists working in a hospital. Most participants worked in a managerial position. The participants gave detailed information regarding the radiological techniques used in dedicated organ systems (esophagus, stomach, pancreas, liver, small intestines, colon) regarding acquired contrast phases and oral and intravenous administration of contrast medium. The results confirm that most radiologists participating in this survey perform their examinations and choose their modalities in conformity with the current existing clinical guidelines. Because most clinical guidelines do not specify radiological examinations in detail, there is a noteworthy heterogeneity of the acquired contrast phases and major divergence in terms of technical parameters. Therefore a joint radiological effort should be initiated for developing and publishing updated radiological parameters for abdominal imaging. • In German speaking countries indications for abdominal radiological examinations are performed with a high compliance to published guidelines. • There is a significant heterogeneity regarding the acquisition of different contrast phases for parenchymal abdominal organs. • There is an urgent need to

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

    Science.gov (United States)

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

    2016-02-26

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  9. Diabetic Dyslipidemia Review: An Update on Current Concepts and Management Guidelines of Diabetic Dyslipidemia.

    Science.gov (United States)

    Dake, Andrew W; Sora, Nicoleta D

    2016-04-01

    Cardiovascular disease is the most common cause of morbidity and mortality in patients with diabetes and the major source of cost in the care of diabetes. Treatment of dyslipidemia with cholesterol-lowering medications has been shown to decrease cardiovascular events. However, available guidelines for the treatment of dyslipidemia often contain significant differences in their recommendations. Lipid guidelines from National Cholesterol Education Program Adult Treatment Panel III, American Association of Clinical Endocrinologists, American Diabetes Association and American Heart Association/American College of Cardiology were reviewed. In addition a literature review was performed using PubMed to research diabetic peculiarities to the topic of lipids. Summarized within this article are the aforementioned, commonly-used guidelines as they relate to diabetes, as well as information regarding the diabetic phenotype of dislipidemia and the association between statins and new-onset diabetes. While the multitude of guidelines and the differences between them may contribute to confusion for practitioners, they are best viewed as tools to help tailor appropriate treatment plans for individual patients. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  10. Current guidelines and recommendations for the management of skin and soft tissue infections.

    Science.gov (United States)

    Montravers, Philippe; Snauwaert, Aurelie; Welsch, Camille

    2016-04-01

    The incidence of severe skin and soft tissue infections (SSTIs) has significantly increased over the last years. In addition, major ecological changes have been reported with the emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA), involved in a large proportion of these cases. A large number of expert opinions, guidelines, and recommendations for the management of SSTIs have been published over the last decade. The purpose of this review is to compare these guidelines. A total of six official publications have presented recommendations for the management of SSTIs. During the same period, other guidelines for the management of MRSA infections have also been published, including some recommendations for SSTIs. The applicability of the guidelines is questionable in many ways. The distinction between necrotizing/nonnecrotizing infections is valuable but difficult to apply prior to surgical management. The prescribers should choose a pragmatic approach to empirical antibiotic therapy, taking into account the patient's initial severity, the extent of infection and risk factors for resistant microorganisms essentially related to healthcare-associated circumstances.

  11. Elderly patients with community-acquired pneumonia are not treated according to current guidelines

    DEFF Research Database (Denmark)

    Lindhardt Damsgaard, Tove; Klausen, Henrik Hedegaard; Christiansen, Christina

    2013-01-01

    Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in elderly patients, and the most important cause of death in the developed world. Optimised treatment and care will benefit patients as well as the health economy. This study investigated in-hospital compliance...... with guidelines for treatment and care of patients with CAP....

  12. How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews.

    Directory of Open Access Journals (Sweden)

    Hyun-Woo Cho

    Full Text Available OBJECTIVES: The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs and evidence from current systematic reviews and meta-analyses (SR-MAs and to analyze the impact of this gap on present CPGs. METHODS: We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. RESULTS: Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54% mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure. However, the CPGs did not recommend acupuncture (or acupressure. Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (subacute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (subacute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. CONCLUSIONS: The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.

  13. A Prospective Real World Experience of Moxonidine Use in Indian Hypertensive Patients–Prescription beyond Current Guidelines

    Science.gov (United States)

    Sagarad, Suresh V; Biradar-Kerure, Sudha; MR, Ramakrishna; Kumar S, Chaitanya; Reddy, S S

    2013-01-01

    Objective: The primary objective of this study was to assess the use of moxonidine, a centrally acting anti–hypertensive agent in real world practice. Material and Methods: Patients who attended out-patients clinic with diagnosis of hypertension were enrolled in the study. Demographics with co-morbid illnesses of all patients were recorded. Patient’s prescriptions were recorded and anti-hypertensive medications were also analysed. Results: A total of 990 patients were eligible during the study period. Moxonidine was used in 4.54% of patients. Two groups could be identified in moxonidine users – one Group with resistant hypertension (30 patients, 3.03% of total, 66.66% of moxonidine users) on multiple drugs to control BP and another Group with intolerance to conventional, first line drugs (15 patients 1.51% of total, 33.33% of moxonidine users). Moxonidine was not used in newly diagnosed hypertension cases. Resistant hypertension and renal failure predicted the use of moxonidine. Majority of drug used was as per current guidelines. Conclusions: Our study results reflected real world practice of current anti-hypertensive therapy. Patients generally receive medications in accordance with current recommendations and guidelines. Small but significant proportion of patients may require use of drugs like moxonidine to control high BP. Guidelines need to incorporate these real world practices. PMID:24298479

  14. Current and potential cyber attacks on medical journals; guidelines for improving security.

    Science.gov (United States)

    Dadkhah, Mehdi; Seno, Seyed Amin Hosseini; Borchardt, Glenn

    2017-03-01

    At the moment, scholarly publishing is faced with much academic misconduct and threats such as predatory journals, hijacked journals, phishing, and other scams. In response, we have been discussing this misconduct and trying to increase the awareness of researchers, but it seems that there is a lack of research that presents guidelines for editors to help them protect themselves against these threats. It seems that information security is missing in some parts of scholarly publishing that particularly involves medical journals. In this paper, we explain different types of cyber-attacks that especially threaten editors and academic journals. We then explain the details involved in each type of attack. Finally, we present general guidelines for detection and prevention of the attacks. In some cases, we use small experiments to show that our claim is true. Finally, we conclude the paper with a prioritization of these attacks.

  15. Speaker-Oriented Classroom Acoustics Design Guidelines in the Context of Current Regulations in European Countries

    DEFF Research Database (Denmark)

    Pelegrin Garcia, David; Brunskog, Jonas; Rasmussen, Birgit

    2014-01-01

    experienced at work. With the aim of improving working conditions for teachers, this article presents guidelines for classroom acoustics design that meet simultaneously criteria of vocal comfort and speech intelligibility, which may be of use in future discussions for updating regulatory requirements...... in classroom acoustics. Two room acoustic parameters are shown relevant for a speaker: the voice support, linked to vocal effort, and the decay time derived from an oral-binaural impulse response, linked to vocal comfort. Theoretical prediction models for room-averaged values of these parameters are combined...... with a model of speech intelligibility based on the useful-to-detrimental ratio and empirical models of signal-to-noise ratio in classrooms in order to derive classroom acoustic guidelines, taking into account physical volume restrictions linked to the number of students present in a classroom. The recommended...

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

    Directory of Open Access Journals (Sweden)

    Bruno ePacciardi

    2013-05-01

    Full Text Available Agitated behavior constitutes up to 10% of emergency psychiatric interventions. Pharmacological tranquilization is often used as a valid treatment for agitation but a strong evidence base does not underpin it. Available literature shows different recommendations, supported by research data, theoretical considerations or clinical experience. Rapid tranquilization is mainly based on parenteral drug treatment and the few existing guidelines on this topic, when suggesting the use of first generation antipsychotics and benzodiazepines, include drugs with questionable tolerability profile such as chlorpromazine, haloperidol, midazolam and lorazepam. In order to systematically evaluate safety concerns related to the adoption of such guidelines, we reviewed them independently from principal diagnosis while examining tolerability data for suggested treatments. There is a growing evidence about safety profile of second generation antipsychotics for rapid tranquilization but further controlled studies providing definitive data in this area are urgently needed.

  17. [Update on current care guidelines: diagnosis and treatment of sexually transmitted infections].

    Science.gov (United States)

    Hiltunen-Back, Eija; Alanen, Anna; Heikkilä, Elina; Puolakkainen, Mirja; Reunala, Timo; Suni, Jukka; Suomalainen, Pekka; Valtonen, Kirsi; Varis, Tiina; Vuento, Risto

    2010-01-01

    Recognition of common sexually transmitted infection (STI) syndromes allows more efficient diagnosis and treatment. These evidence-based guidelines provide advice on the management of STIs, including the use of the appropriate diagnostic methods and therapeutic regimens. Early and appropriate therapy has the potential to significantly reduce the long-term complications of STIs. The prevention of further infection through the counselling and treatment of partners contributes to the sexual health of patients.

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

    Science.gov (United States)

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

    2017-01-01

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

  19. Current indicators of nutritional care in children with type 1 diabetes in India: Do we need a national nutritional guideline?

    Directory of Open Access Journals (Sweden)

    Sanjay Kalra

    2017-01-01

    Full Text Available Background: Nutrition is an important pillar of management in children with type 1 diabetes. Indian food is heavily influenced by region, religion, traditions, seasons, and cultural choices. This survey was done to assess current practices and the need for India specific nutritional guidelines for children with type 1 diabetes. Materials and Methods: Two 12-item questionnaires were administered to forty health-care professionals across India. The first questionnaire evaluated current clinical practice indicators for nutrition in these children and second assessed practices for counseling a child on dietary habits. Results: There is great heterogeneity across the country with regard to dietary advice offered to children with type 1 diabetes. 97.5% of the respondents feel there is a need for an Indian dietary guideline for children with type 1 diabetes. Conclusion: There is need of India specific nutritional guidelines that should be made considering key variants such as age, region, cultural preference, economic burden and psychosocial beliefs, to offer guidance to diabetes care professionals.

  20. Return to play after health complications associated with infectious mononucleosis guided on autonomic nervous system activity in elite athlete: A case study [Rekonvalescence po infekční mononukleóze řízená na základě aktivity autonomního nervového systému u vrcholového sportovce: Kazuistika

    Directory of Open Access Journals (Sweden)

    Jaroslav Větvička

    2012-06-01

    Full Text Available BACKGROUND: Infectious mononucleosis (IM is an acute serious illness which requires among other things an interruption of training. The return to play for athletes after IM is complicated and a long-term process which could result in the relapse of health complications linked fundamentally with the illness. OBJECTIVE: The aim of this study was to design a convalescence program which leads to an improvement in physical fitness and provides a safe return to play without relapse of health complications for an elite athlete who suffered from IM. METHODS: The convalescence program lasted almost 3 months. Training load was optimized based on autonomic nervous system (ANS activity which was assessed by spectral analysis (SA of heart rate variability (HRV. There were evaluated an individual spectral variables: very low frequency power (PVLF (0.02-0.05 Hz; low frequency power (PLF (0.05-0.15 Hz, high frequency power (PHF (0.15-0.50 Hz, total power (PT (0.02-0.50 Hz, ratio PVLF/PHF and PLF/PHF; heart rate (HR, and age-dependent complex index of SA HRV: index of vagal activity, sympathovagal balance, and total score. Further, perceived exertion during exercise and morning fatigue was assessed. Repeated biochemical analysis was focused on the selected transaminase level. RESULTS: Among recovery periods, an increase in mean of PT was accompanied by elevation of PVLF/PHF and PLF/PHF. No significant differences in mean values of any complex index of SA HRV among periods were found. A decline in HR was identified during measurements in lying, but mostly in supine. A significant elevation of perceived exertion during exercise occurred between periods. The morning fatigue culminated during the last period. No relationship between subjective feeling of fatigue and complex index of SA HRV was found. CONCLUSIONS: A convalescence strategy based on assessment of ANS activity brought an improvement in physical fitness, in spite of borderline or mild elevated

  1. The management of compound leg injuries in the West Midlands (UK): are we meeting current guidelines?

    Science.gov (United States)

    Allison, K; Wong, M; Bolland, B; Peart, F; Porter, K

    2005-07-01

    The joint British Association of Plastic Surgeons and British Orthopaedic Association (BAPS/BOA) guidelines for the management of patients with open tibia fractures were published in 1991 and 1997 and provided a synopsis of injury epidemiology and best care. We present a retrospective review of 66 patients treated over a 2-year period (January 2001-February 2003) at a regional plastic surgery unit. There were 33 direct admissions and 33 transfers from other hospitals in which the average delay in transfer was 7.8 days (1-28) and in whom 26 (79%) patients had already undergone surgery. Plastic surgeons were involved in 46 (62%) of the 66 patient cohort and 27 (82%) transferred patients. The delay after admission until soft tissue cover was 3.8 days (0-15). Twenty-nine (44%) complications were recorded, 20 (69%) of these were in the transferred group and additional orthopaedic intervention was needed in 11 (42%) of patients who had been operated on in other hospitals. Despite widespread dissemination and teaching of the BAPS/BOA guidelines, complex extremity trauma is often not managed well in our region. There are unacceptable delays in admission, late communication, poor note keeping and follow up. The initial surgery/fixation is often sub-optimal and soft tissue reconstruction has to be considered at the least advantageous time period for the patient, leading to an increased hospital stay and complications.

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

    OpenAIRE

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

    2001-01-01

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

  3. APA guidelines: their importance and a plan to keep them current: 2013 annual report of the Policy and Planning Board.

    Science.gov (United States)

    2014-01-01

    When guidelines are approved by APA, they become association policy, and it is imperative that they remain current. The revision of guidelines poses several challenges to the association. These challenges range from the availability and allocation of resources to support the complicated processes involved in developing and updating these policies to the lack of a clearly defined process that includes identification of tasks, assignments of responsibilities, and so forth. For this reason, the APA Board of Directors asked the Policy and Planning Board (P&P) to work with the boards of the four directorates (i.e., the Education Directorate, the Practice Directorate, the Public Interest Directorate, and the Science Directorate) to create a proposal that would (a) make recommendations with regard to how the review and revision of guidelines documents might best be accomplished in accordance with the APA Strategic Plan and existing policies and procedures and (b) make suggestions regarding the association resources that might be required. The Board of Directors approved the proposed review process in December 2013. 2014 APA, all rights reserved

  4. Upper extremity sarcoma: impact of current practice guidelines and controversies on reconstructive approaches

    Directory of Open Access Journals (Sweden)

    Dobke Marek

    2017-01-01

    Full Text Available The goals of sarcoma management include both a cure and the functional preservation of involved tissues and adjacent critical structures with common opinions favoring immediate reconstruction. The question arises whether these goals are contradictory. This paper discusses the question based on the experience of 28 patients with different types of extremity sarcoma, with 24 surgically treated by the University of California San Diego (UCSD orthopedic and plastic surgery team (2011–2016 and the collection of evidence from published practice guidelines, reviews, case studies, and clinical trials. Included are the impact of limb-sparing and functional reconstructive concepts, efforts regarding the adequacy of surgical margins, and the rationale of immediate versus delayed reconstructive approaches, and the disease-free status of sarcoma management.

  5. Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups

    DEFF Research Database (Denmark)

    Laillou, Arnaud; Prak, Sophonneary; de Groot, Richard;

    2014-01-01

    BACKGROUND: Timely treatment of acute malnutrition in children 500,000 deaths annually. Screening at community level is essential to identify children with malnutrition. Current WHO guidelines for community screening for malnutrition recommend a Mid Upper Arm...

  6. [Therapeutic strategies. Evolution and current status of the European Guidelines on Cardiovascular disease prevention].

    Science.gov (United States)

    Guijarro, Carlos; García-Díaz, Juan de Dios

    2013-01-01

    The European Guidelines on Dyslipidaemias (2011) and Cardiovascular Prevention (2012) have incorporated important changes. Firstly, it highlights the identification of a group of "very high risk" patients: patients with atherosclerotic disease in any vascular area, diabetes with associated risk factors, advanced chronic renal failure, or a SCORE estimate >10%. Patients with diabetes and no other risk factors, moderate renal failure, severe hypertension, genetic dyslipidaemias, or a SCORE estimate 5-10%, are considered as "high risk". The HDL cholesterol and triglycerides levels are considered as modulators of risks, but not therapeutic objectives per se. The therapeutic objectives are set at LDL cholesterol levels < 70 mg/dl (or at least a reduction of at least 50%) for patients at very high risk, and an LDL < 100 mg/dl for high risk patients. As well as the changes in lifestyle, pharmacological treatment with statins is the focal point of lipid lowering treatments. Other pharmacological options may be considered if the treatment with the maximum tolerable doses of statins do not achieve the therapeutic objectives. Copyright © 2013 Elsevier España, S.L. y SEA. All rights reserved.

  7. Current Practice of Heart Donor Evaluation in Germany: Multivariable Risk Factor Analysis Confirms Practicability of Guidelines

    Directory of Open Access Journals (Sweden)

    Sylke Ruth Zeissig

    2013-01-01

    Full Text Available Background. Organ shortage has liberalised the acceptance criteria of grafts for heart transplantation, but which donor characteristics ultimately influence the decision to perform transplantation? For the first time this was evaluated using real-time donor data from the German organ procurement organization (DSO. Observed associations are discussed with regard to international recommendations and guidelines. Methods. 5291 German donors (2006–2010 were formally eligible for heart donation. In logistic regression models 160 donor parameters were evaluated to assess their influence on using grafts for transplantation (random split of cases: 2/3 study sample, 1/3 validation sample. Results. Successful procurement was determined by low donor age (OR 0.87 per year; 95% CI [0.85–0.89], P<0.0001, large donor height (OR 1.04 per cm; 95% CI [1.02–1.06], P<0.0001, exclusion of impaired left ventricular function or wall motion (OR 0.01; 95% CI [0.002–0.036], P<0.0001, arrhythmia (OR 0.05; 95% CI [0.009–0.260], P=0.0004, and of severe coronary artery disease (OR 0.003; 95% CI [<0.001–0.01], P<0.0001. Donor characteristics differed between cases where the procedure was aborted without and with allocation initiated via Eurotransplant.

  8. Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

    Institute of Scientific and Technical Information of China (English)

    Stefania Angeloni; Cinzia Leboffe; Antonella Parente; Mario Venditti; Alessandra Giordano; Manuela Merli; Oliviero Riggio

    2008-01-01

    AIM:To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice.METHODS:All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study.SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was>250 cells/mm3,and empirically treated with cefotaxime.RESULTS:Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women;mean age:58.6±11.2 years).Prevalence of SBP,in our population,was 17%.Ascitic fluid culture was positive in nine (24%)cases only.Eleven episodes were nosocomial and 71%community-acquired.Treatment with cefotaxime was successful in 59% of cases,while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h.Change of antibiotic therapy led to the resolution of infection in 87% of episodes.Among the cases with positive culture,the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series.In these cases,the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime.CONCLUSIOM:In clinical practice,ascitic PMN count is a valid tool for starting a prompt antibiotic treatment and evaluating its efficacy.The initial treatment with cefotaxime failed more frequently than expected.An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding.A different first-line antibiotic treatment should be investigated.

  9. Atopic Dermatitis in Children: Current Clinical Guidelines for Diagnosis and Therapy

    Directory of Open Access Journals (Sweden)

    L. S. Namazova-Baranova

    2016-01-01

    Full Text Available Atopic dermatitis is a chronic multifactorial skin disease that is common enough in childhood. The article presents the current data on epidemiology and dynamics of incidence of pathological symptoms, pathogenesis basics, and key factors of the disease development, shows the current classification of the disease. The authors consider in detail the key principles of the diagnosis and peculiarities of a clinical aspect depending on age. Algorithms of a therapeutic approach, as well as basics of an individual hypoallergenic diet are proposed. General recommendations and possible prognosis for pediatric patients with atopic dermatitis are given.

  10. Current guidelines in melanoma treatment. Melanoma Working Group of Gent and Bordet.

    Science.gov (United States)

    Brochez, L; Verhaeghe, E; Sales, F; Del Marmol, V; Deraemaecker, R; Vossaert, K; Naeyaert, J M

    2000-01-01

    This article focuses on the actual management of cutaneous melanoma, dealing both with established, internationally well-accepted standard procedures and interventions which are still being investigated. It wants to offer a global picture to the dermatologist of what is currently available in the therapeutic arsenal against melanoma.

  11. Investigation of assumptions underlying current safety guidelines on EM-induced nerve stimulation

    Science.gov (United States)

    Neufeld, Esra; Vogiatzis Oikonomidis, Ioannis; Iacono, Maria Ida; Angelone, Leonardo M.; Kainz, Wolfgang; Kuster, Niels

    2016-06-01

    An intricate network of a variety of nerves is embedded within the complex anatomy of the human body. Although nerves are shielded from unwanted excitation, they can still be stimulated by external electromagnetic sources that induce strongly non-uniform field distributions. Current exposure safety standards designed to limit unwanted nerve stimulation are based on a series of explicit and implicit assumptions and simplifications. This paper demonstrates the applicability of functionalized anatomical phantoms with integrated coupled electromagnetic and neuronal dynamics solvers for investigating the impact of magnetic resonance exposure on nerve excitation within the full complexity of the human anatomy. The impact of neuronal dynamics models, temperature and local hot-spots, nerve trajectory and potential smoothing, anatomical inhomogeneity, and pulse duration on nerve stimulation was evaluated. As a result, multiple assumptions underlying current safety standards are questioned. It is demonstrated that coupled EM-neuronal dynamics modeling involving realistic anatomies is valuable to establish conservative safety criteria.

  12. Review of current typhoid fever vaccines, cross-protection against paratyphoid fever, and the European guidelines.

    Science.gov (United States)

    Zuckerman, Jane N; Hatz, Christoph; Kantele, Anu

    2017-10-01

    Typhoid and paratyphoid fever remain a global health problem, which - in non-endemic countries - are mainly seen in travelers, particularly in VFRs (visiting friends and relatives), with occasional local outbreaks occurring. A rise in anti-microbial resistance emphasizes the role of preventive measures, especially vaccinations against typhoid and paratyphoid fever for travelers visiting endemic countries. Areas covered: This state-of-the-art review recapitulates the epidemiology and mechanisms of disease of typhoid and paratyphoid fever, depicts the perspective of non-endemic countries and travelers (VFRs), and collectively presents current European recommendations for typhoid fever vaccination. We provide a brief overview of available (and developmental) vaccines in Europe, present current data on cross-protection to S. Paratyphi, and aim to provide a background for typhoid vaccine decision-making in travelers. Expert commentary: European recommendations are not harmonized. Experts must assess vaccination of travelers based on current country-specific recommendations. Travel health practitioners should be aware of the issues surrounding vaccination of travelers and be motivated to increase awareness of typhoid and paratyphoid fever risks.

  13. Current status and guidelines for the assessment of tumour vascular support with dynamic contrast-enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Miles, K.A. [University of Sussex, Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer (United Kingdom); Lee, T.Y. [Robarts Research Institute, Imaging Research Laboratories, London, Ontario (Canada); Goh, V. [St Thomas' Hospital, Division of Imaging Sciences and Biomedical Engineering, King' s College London, London (United Kingdom); Klotz, E. [Computed Tomography H IM CT PLM-E PA, Siemens Healthcare Sector, Forchheim (Germany); Cuenod, C. [INSERM U970 PARCC, Hopital Europeen Georges Pompidou (HEGP), Paris (France); Bisdas, S. [Eberhard Karls University, Department of Neuroradiology, Tuebingen (Germany); Groves, A.M. [University College London, University College Hospital, Institute of Nuclear Medicine, London (United Kingdom); Hayball, M.P. [Cambridge Computed Imaging Ltd, Cambridge (United Kingdom); Alonzi, R. [Mount Vernon Cancer Centre, Northwood (United Kingdom); Brunner, T. [Gray Institute for Radiation, Oncology and Biology, Oxford (United Kingdom)

    2012-07-15

    Dynamic contrast-enhanced computed tomography (DCE-CT) assesses the vascular support of tumours through analysis of temporal changes in attenuation in blood vessels and tissues during a rapid series of images acquired with intravenous administration of iodinated contrast material. Commercial software for DCE-CT analysis allows pixel-by-pixel calculation of a range of validated physiological parameters and depiction as parametric maps. Clinical studies support the use of DCE-CT parameters as surrogates for physiological and molecular processes underlying tumour angiogenesis. DCE-CT has been used to provide biomarkers of drug action in early phase trials for the treatment of a range of cancers. DCE-CT can be appended to current imaging assessments of tumour response with the benefits of wide availability and low cost. This paper sets out guidelines for the use of DCE-CT in assessing tumour vascular support that were developed using a Delphi process. Recommendations encompass CT system requirements and quality assurance, radiation dosimetry, patient preparation, administration of contrast material, CT acquisition parameters, terminology and units, data processing and reporting. DCE-CT has reached technical maturity for use in therapeutic trials in oncology. The development of these consensus guidelines may promote broader application of DCE-CT for the evaluation of tumour vascularity. (orig.)

  14. The mean dietary protein intake at different stages of chronic kidney disease is higher than current guidelines.

    Science.gov (United States)

    Moore, Linda W; Byham-Gray, Laura D; Scott Parrott, J; Rigassio-Radler, Diane; Mandayam, Sreedhar; Jones, Stephen L; Mitch, William E; Osama Gaber, A

    2013-04-01

    The actual dietary protein intake of adults without and with different stages of chronic kidney disease is not known. To evaluate this we performed cross-sectional analyses of 16,872 adults (20 years of age and older) participating in the National Health and Nutrition Examination Survey 2001-2008 who completed a dietary interview by stage of kidney disease. Dietary protein intake was assessed from 24-h recall systematically collected using the Automated Multiple Pass Method. Complex survey analyses were used to derive population estimates of dietary protein intake at each stage of chronic kidney disease. Using dietary protein intake of adults without chronic kidney disease as the comparator, and after adjusting for age, the mean dietary protein intake was 1.30 g/kg ideal body weight/day (g/kgIBW/d) and was not different from stage 1 or stage 2 (1.28 and 1.25 g/kgIBW/d, respectively), but was significantly different in stage 3 and stage 4 (1.22 and 1.13 g/kgIBW/d, respectively). These mean values appear to be above the Institute of Medicine requirements for healthy adults and the NKF-KDOQI guidelines for stages 3 and 4 chronic kidney disease. Thus, the mean dietary protein intake is higher than current guidelines, even after adjusting for age.

  15. Australian survey of current practice and guideline use in adult cancer pain assessment and management: The community nurse perspective.

    Science.gov (United States)

    Phillips, Jane L; Lovell, Melanie; Luckett, Tim; Agar, Meera; Green, Anna; Davidson, Patricia

    2015-01-01

    Cancer pain remains a major public health concern. Despite effective treatments being available to manage the majority of cancer pain, this debilitating symptom is frequently under treated. As cancer has becomes a chronic disease a range of health professionals, including community nurses in Australia are increasingly caring for people living with cancer related pain. Yet, little is known about community nurses capacity to assess and manage cancer pain in accordance with best available evidence. This study aimed to: identify the barriers and facilitators to adult cancer pain assessment and management as perceived by Australian health professionals; identify if cancer pain guidelines are currently used; identify barriers and facilitators to guideline use; and establish the need for Australian cancer pain guidelines. This article reports on community nurses' perceptions of managing cancer pain in the community setting. A cross-sectional survey was administered online. Invitations were circulated via peak bodies and clinical leaders seeking the views and experiences of health professionals involved in caring for people living with cancer pain. Descriptive statistics were used to summarise the quantitative data, and thematic content analysis were used to describe the qualitative data. Sixty-two community nurses responded to the survey, representing 29% of the total sample. These participants reported high levels of adherence to accepted cancer pain management practices in their workplace, with 71% nominating the Palliative Care Therapeutic Guideline V.3 as being most frequently used to manage community patients' cancer related pain. Key barriers to effective cancer pain management in the community were: difficulties accessing non-pharmacological interventions (89%), lack of coordination by multiple providers (89%), and impact of distance on ability to access pain-related services for patients (86%). A range of system, health professional and consumer barriers limit

  16. Evaluation of Functional Lower Urinary Tract Dysfunction in Children: Are the Physicians Complying with the Current Guidelines?

    Directory of Open Access Journals (Sweden)

    Mesrur Selcuk Silay

    2013-01-01

    were used for statistical analyses. Results. Of the 117 departments a total of 93 have completed the survey (n: 58 urology; n: 35 paediatric nephrology. Routine use of a questionnaire with validated symptom scoring system was found to be 13.9%. Of the participants, only 38.7% were asking all of the patients to fill the bladder diary. During treatment, only 24.7% were applying standard urotherapy for every patient. Almost half of the clinicians (45.1% believed that they were personally insufficient during the evaluation of those children. Finally, 86% reported that children with LUTD were not adequately approached. Conclusions. Evaluation of LUTD in children is not complying with the current guidelines. General approach for those children needs to be revisited by the clinicians.

  17. Utilization study of antidiabetic agents in a teaching hospital of Sikkim and adherence to current standard treatment guidelines

    Directory of Open Access Journals (Sweden)

    Sushrut Varun Satpathy

    2016-01-01

    Full Text Available Objective: Diabetes has gradually emerged as one of the most serious public health problems in our country. This underlines the need for timely disease detection and decisive therapeutic intervention. This prospective cross-sectional observational study aims at analyzing the utilization pattern of antidiabetic agents in a remote North-East Indian tertiary care teaching hospital in the perspective of current standard treatment guidelines. Materials and Methods: Diabetic patients receiving antidiabetic medication, both as outpatients and inpatients in our hospital over a period of 12 months (May 2013–May 2014, were included in this study. The data obtained were sorted and analyzed on the basis of gender, type of therapy, and hospital setting. Results: A total of 310 patients were included in the study. Metformin was the single most frequently prescribed antidiabetic agent (66.8% followed by the sulfonylureas group (37.4%. Insulin was prescribed in 23.2% of the patients. Combination antidiabetic drug therapy (65.1% was used more frequently than monotherapy (34.8%. The use of biguanides (P < 0.0001 and sulfonylureas (P = 0.02 in combination was significant as compared to their use as monotherapy. A total of 48% of all antidiabetic combinations used, comprised metformin and sulfonylureas (n = 96. Insulin use was significantly higher as monotherapy and in inpatients (P< 0.0001. The utilization of drugs from the National List of Essential Medicines was 51.2%, while 11% of antidiabetics were prescribed by generic name. Conclusion: The pattern of utilization largely conforms to the current standard treatment guidelines. Increased use of generic drugs is an area with scope for improvement.

  18. Current role of rufinamide in the treatment of childhood epilepsy: literature review and treatment guidelines.

    Science.gov (United States)

    Coppola, Giangennaro; Besag, Frank; Cusmai, Raffaella; Dulac, Olivier; Kluger, Gerhard; Moavero, Romina; Nabbout, Rima; Nikanorova, Marina; Pisani, Francesco; Verrotti, Alberto; von Stülpnagel, Celina; Curatolo, Paolo

    2014-11-01

    The literature on the efficacy and safety of rufinamide in childhood-onset epilepsy syndromes currently includes approximately 600 paediatric patients. This paper summarizes the views of a panel of experienced European epileptologists with regard to the current role of rufinamide in the treatment of childhood epilepsies. Rufinamide is effective in decreasing the seizure frequency in the Lennox-Gastaut syndrome (LGS), especially tonic and atonic seizures. It might consequently be preferred to other drugs as a second-line treatment for LGS when drop-attacks are frequent. The mean responder rate in the published studies is 38% with seizure freedom achieved in 2.4% of patients. Rufinamide has shown some efficacy in epileptic encephalopathies other than LGS. It can be also effective as adjunctive therapy in children and adolescents with drug-resistant partial seizures. The available data suggest that rufinamide has an acceptable risk/benefit ratio with quite a low risk of aggravating seizures. Common adverse effects (somnolence, nausea and vomiting) are usually mild and self-limiting; they are more frequently observed during titration than in the maintenance phase, suggesting that low escalation rates might be associated with fewer adverse effects. Rufinamide appears to have a favourable cognitive profile compared with other antiepileptic drugs. Rufinamide is only approved for adjunctive treatment of seizures associated with LGS in children 4 years of age and older. There are very few data on rufinamide treatment at the onset of LGS or early in the course of the disorder; whether early treatment will improve outcome has yet to be determined. Copyright © 2014 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  19. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS).

    Science.gov (United States)

    Lefaucheur, Jean-Pascal; Antal, Andrea; Ayache, Samar S; Benninger, David H; Brunelin, Jérôme; Cogiamanian, Filippo; Cotelli, Maria; De Ridder, Dirk; Ferrucci, Roberta; Langguth, Berthold; Marangolo, Paola; Mylius, Veit; Nitsche, Michael A; Padberg, Frank; Palm, Ulrich; Poulet, Emmanuel; Priori, Alberto; Rossi, Simone; Schecklmann, Martin; Vanneste, Sven; Ziemann, Ulf; Garcia-Larrea, Luis; Paulus, Walter

    2017-01-01

    A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform t

  20. [Current recommendations about the diagnosis and treatment of testosterone deficit syndrome: Clinical guidelines].

    Science.gov (United States)

    Valero Rosa, José; Márquez López, Javier; Campos Hernández, Pablo; Puigvert Martínez, Ana; Prieto Castro, Rafael

    2013-09-01

    Testosterone deficit syndrome (TDS) is a clinical and biochemical syndrome associated with advanced age and characterized by some typical symptoms and decrease in serum testosterone levels, which can affect multiple organs and systems, deteriorating the quality of life of the males who suffer it. Due to the low specificity of the clinical picture, as well as that of the commonly used questionnaires, when there is a diagnostic suspicion, serum testosterone determination is necessary, without a current universally accepted determination method. The increased survival of males in the western world and their demand of a better quality of life,including the preservation of sexual activity, up to increasingly more advanced ages: together with the appearance of new ways of testosterone delivery, make this entity, clinical-biochemical, acquirean increasingly greater importance. From a therapeutic point of view, testosterone replacement therapy has precise indications, with individualized evaluation in each patient on the basis of risk/benefit, and with an adequate, well defined follow up, that will allow the control of possible adverse events. TRT is recommended in patients with diminished testosterone associated with muscle mass and strength loss, decrease of bone density of the lumbar spine or diminished libido and quality of erection. Contraindications for therapy would include active or non treated prostate cancer, PSA >4 ng/ml before evaluation, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe LUTS due to BPH.

  1. [Treatment of arterial hypertension in pregnancy in relation to current guidelines of the Polish Society of Arterial Hypertension from 2011].

    Science.gov (United States)

    Szczepaniak-Chicheł, Ludwina; Tykarski, Andrzej

    2012-10-01

    Arterial hypertension concerns 7-10% of pregnancies and leads to an increased risk of complications for both, the mother and the child. This rate will probably rise in the years to come due to the notable tendency among women to delay the decision to become pregnant - values of blood pressure and occurrence of arterial hypertension increase with age, as well as due to the growing problem of obesity resulting from inappropriate dietary habits and lack of regular everyday physical activity. Difficulties with management of that clinical condition are partly related with lack of unified and widely accepted guidelines. Different opinions in the subject of terminology and classification of pregnancy hypertension or indications for pharmacotherapy as well as choice of the optimal antihypertensive drug, emerge from objective causes such as combination of various pathogenetic factors typical for arterial hypertension itself and those connected with pregnancy elsewhere stressed priorities of therapy from the point of view of the health of the mother and of the fetus, as well as lack of randomized clinical trials due to obvious ethical purposes, but also from the fact that pregnancy hypertension is a focus of attention for different specialists - obstetricians, hypertensiologists and perinatologists. A good cooperation regarding experience and information among all of these specializations would be the most beneficial for pregnant women and their children. Lack of new modern antihypertensive agents, safe and effective in pregnancy while the older ones are being withdrawn from the market as their production is no longer cost-effective for pharmacological companies, has become an increasing problem in many countries, and Poland among them. The aim of the following publication was to present the statement on management of pregnancy hypertension from the current guidelines of the Polish Society of Arterial Hypertension 2011 to gynecologists and obstetricians, with a commentary

  2. Remotely-Supervised Transcranial Direct Current Stimulation (tDCS for Clinical Trials: Guidelines for Technology and Protocols

    Directory of Open Access Journals (Sweden)

    Leigh E Charvet

    2015-03-01

    Full Text Available The effect of transcranial direct current stimulation (tDCS is cumulative. Treatment protocols typically require multiple consecutive sessions spanning weeks or months. However, traveling to clinic for a tDCS session can present an obstacle to subjects and their caregivers. With modified devices and headgear, tDCS treatment can be administered remotely under clinical supervision, potentially enhancing recruitment, throughput, and convenience. Here we propose standards and protocols for clinical trials utilizing remotely-supervised tDCS with the goal of providing safe, reproducible and well-tolerated stimulation therapy outside of the clinic. The recommendations include: 1 training of staff in tDCS treatment and supervision, 2 assessment of the user’s capability to participate in tDCS remotely, 3 ongoing training procedures and materials including assessments of the user and/or caregiver, 4 simple and fail-safe electrode preparation techniques and tDCS headgear, 5 strict dose control for each session, 6 ongoing monitoring to quantify compliance (device preparation, electrode saturation/placement, stimulation protocol, with corresponding corrective steps as required, 7 monitoring for treatment-emergent adverse effects, 8 guidelines for discontinuation of a session and/or study participation including emergency failsafe procedures tailored to the treatment population’s level of need. These guidelines are intended to provide a minimal level of methodological rigor for clinical trials seeking to apply tDCS outside a specialized treatment center. We outline indication-specific applications (Attention Deficit Hyperactivity Disorder, Depression, Multiple Sclerosis, Palliative Care following these recommendations that support a standardized framework for evaluating the tolerability and reproducibility of remote-supervised tDCS that, once established, will allow for translation of tDCS clinical trials to a greater size and range of patient populations.

  3. Allermatch™, a webtool for the prediction of potential allergenicity according to current FAO/WHO Codex alimentarius guidelines

    Directory of Open Access Journals (Sweden)

    Nap Jan

    2004-09-01

    Full Text Available Abstract Background Novel proteins entering the food chain, for example by genetic modification of plants, have to be tested for allergenicity. Allermatch™ http://allermatch.org is a webtool for the efficient and standardized prediction of potential allergenicity of proteins and peptides according to the current recommendations of the FAO/WHO Expert Consultation, as outlined in the Codex alimentarius. Description A query amino acid sequence is compared with all known allergenic proteins retrieved from the protein databases using a sliding window approach. This identifies stretches of 80 amino acids with more than 35% similarity or small identical stretches of at least six amino acids. The outcome of the analysis is presented in a concise format. The predictive performance of the FAO/WHO criteria is evaluated by screening sets of allergens and non-allergens against the Allermatch databases. Besides correct predictions, both methods are shown to generate false positive and false negative hits and the outcomes should therefore be combined with other methods of allergenicity assessment, as advised by the FAO/WHO. Conclusions Allermatch™ provides an accessible, efficient, and useful webtool for analysis of potential allergenicity of proteins introduced in genetically modified food prior to market release that complies with current FAO/WHO guidelines.

  4. Allermatch, a webtool for the prediction of potential allergenicity according to current FAO/WHO Codex alimentarius guidelines.

    Science.gov (United States)

    Fiers, Mark W E J; Kleter, Gijs A; Nijland, Herman; Peijnenburg, Ad A C M; Nap, Jan Peter; van Ham, Roeland C H J

    2004-09-16

    Novel proteins entering the food chain, for example by genetic modification of plants, have to be tested for allergenicity. Allermatch http://allermatch.org is a webtool for the efficient and standardized prediction of potential allergenicity of proteins and peptides according to the current recommendations of the FAO/WHO Expert Consultation, as outlined in the Codex alimentarius. A query amino acid sequence is compared with all known allergenic proteins retrieved from the protein databases using a sliding window approach. This identifies stretches of 80 amino acids with more than 35% similarity or small identical stretches of at least six amino acids. The outcome of the analysis is presented in a concise format. The predictive performance of the FAO/WHO criteria is evaluated by screening sets of allergens and non-allergens against the Allermatch databases. Besides correct predictions, both methods are shown to generate false positive and false negative hits and the outcomes should therefore be combined with other methods of allergenicity assessment, as advised by the FAO/WHO. Allermatch provides an accessible, efficient, and useful webtool for analysis of potential allergenicity of proteins introduced in genetically modified food prior to market release that complies with current FAO/WHO guidelines.

  5. Australian survey of current practice and guideline use in adult cancer pain assessment and management: perspectives of oncologists.

    Science.gov (United States)

    Luckett, Tim; Davidson, Patricia Mary; Boyle, Frances; Liauw, Winston; Agar, Meera; Green, Anna; Lovell, Melanie

    2014-06-01

    Cancer pain continues to be undertreated in up to half of cases, despite the availability of evidence-based guidelines. This study aimed to: (i) identify barriers and facilitators to adult cancer pain assessment and management, as perceived by Australian health professionals; (ii) establish the perceived need for new Australian guidelines and implementation strategy; (iii) identify which guidelines are used; (iv) identify barriers and facilitators to guideline use. This article focuses on the perceptions of responding oncologists. A cross-sectional survey was administered online. Invitations were circulated via peak bodies and clinical leaders. Comments were coded independently by two researchers. In all 76 oncologists self-reported high concordance with evidence-based recommendations, except validated pain scales. Perceived barriers to pain management included insufficient non-pharmacological interventions, access to /coordination between services, and time. Only 22 percent of respondents reported using pain guidelines. Perceived barriers to guideline use included lack of access, awareness and any single standard. Respondents were generally supportive of new Australian guidelines and especially an implementation strategy. Barriers to evidence-based practice and guideline use identified by our survey might be addressed via a clinical pathway that gives step-by-step guidance on evidence-based practice along with a framework for evaluation. Particular attention should be paid to promoting use of validated scales, patient education and non-pharmacological interventions, training of an appropriately skilled workforce and improving care coordination. Challenges are discussed. © 2012 Wiley Publishing Asia Pty Ltd.

  6. Contemporary Atrial Fibrillation Management: A Comparison of the Current AHA/ACC/HRS, CCS, and ESC Guidelines.

    Science.gov (United States)

    Andrade, Jason G; Macle, Laurent; Nattel, Stanley; Verma, Atul; Cairns, John

    2017-08-01

    In this article we compare and contrast the current recommendations, and highlight the important differences, in the American College of Cardiology/American Heart Association/Heart Rhythm Society, European Society of Cardiology, and Canadian Cardiovascular Society atrial fibrillation (AF) guidelines. Although many of the recommendations of the various societies are similar, there are important differences in the methodologies underlying their development and the specific content. Specifically, key differences can be observed in: (1) the definition of nonvalvular AF, which subsequently affects anticoagulation choices and candidacy for non-vitamin K antagonist oral anticoagulants; (2) the symptom score used to guide management decisions and longitudinal patient profiling; (3) the stroke risk stratification algorithm used to determine indications for oral anticoagulant therapy; (4) the role of acetylsalicylic acid in stroke prevention in AF; (5) the antithrombotic regimens used in the context of coronary artery disease, acute coronary syndromes, and percutaneous coronary intervention; (6) the rate control target and medications recommended to achieve the target; and (7) the role of "first-line" catheter ablation, open surgical ablation, and left atrial appendage exclusion. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  7. Current guidelines for the evaluation and management of atopic dermatitis: A comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines.

    Science.gov (United States)

    Eichenfield, Lawrence F; Ahluwalia, Jusleen; Waldman, Andrea; Borok, Jenna; Udkoff, Jeremy; Boguniewicz, Mark

    2017-04-01

    Atopic dermatitis (AD) is a chronic pruritic inflammatory disease that commonly presents in the pediatric population. Although definitions and diagnosis of AD have largely been agreed upon, allergists and dermatologists have similar and divergent approaches to the management of AD. This review facilitated integration of the American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma & Immunology Joint Task Force 2012 AD Practice Parameter and the 2014 American Academy of Dermatology guidelines to highlight the basic principles of AD management and discuss therapies and management of AD from the distinct perspectives of the allergist and dermatologist. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  8. [Update on Current Care Guideline: Physical activity and exercise training for adults in sickness and in health].

    Science.gov (United States)

    Rauramaa, Rainer; Kukkonen-Harjula, Katriina; Arokoski, Jari; Hohtari, Hannele; Ketola, Eeva; Kettunen, Jyrki; Komulainen, Pirjo; Kujala, Urho; Laukkanen, Jari; Pylkkänen, Liisa; Savela, Salla; Savonen, Kai; Tikkanen, Heikki

    2016-01-01

    The purpose of the guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity plays a key role in the management of several chronic noncommunicable diseases. In this guideline, the following diseases are discussed: endocrinological, cardiovascular, musculoskeletal and respiratory diseases, as well as depression and cancer. In addition, physical activity during pregnancy and in senior citizens is reviewed. Exercise counseling should be included as part of disease management and lifestyle guidance.

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

    Directory of Open Access Journals (Sweden)

    Hetlevik Irene

    2009-10-01

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

  10. EVALUATION OF THE CONFORMITY OF CARDIOVASCULAR THERAPY TO CURRENT CLINICAL GUIDELINES IN THE IMPROVEMENT OF OUTCOMES IN PATIENTS AFTER STROKE (ACCORDING TO THE LIS-2 REGISTER

    Directory of Open Access Journals (Sweden)

    A. Yu. Suvorov

    2015-01-01

    Full Text Available Aim. To study the conformity of preventative therapy prescribed to patients during a hospital stay and at a discharge to clinical guidelines using a special algorithm, and to assess the impact of the results on a long-term mortality based on the LIS-2 register (Lyubertsy study of mortality in patients after cerebral stroke.Material and methods. The scales to assess the quality of cardiovascular care for the prevention of recurrent stroke along with the prevention of recurrent ischemic attacks index (PRIA index for this assessment were developed according to current clinical guidelines. Analysis of the therapy was performed using PRIA index on survived hospital patients from LIS-2 register (N=753. The impact of PRIA index results on a long-term mortality (Me=2.3 years was studied.Results. Based upon the results of the assessment obtained with PRIA index, higher treatment conformity to clinical guidelines resulted in a significantly better long-term survival. Non-conformity to clinical guidelines was due to the lack of prescription of drugs with proven efficacy and irrational choice of preventive therapy. Median of treatment quality assessment was 44.4% (22.2; 44.4.Conclusion. Low conformity of preventive therapy to clinical guidelines is found in the LIS-2 register. The algorithm for the assessment of preventive cardiovascular therapy quality allows identifying limitations in the prevention of recurrent stroke, and can serve as an example of implementation of evidence-based medicine in clinical practice.

  11. 脑出血相关治疗指南与临床现状%Guideline and current status on prevention and treatment of intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    宋水江; 戴加勇; 汤永国

    2013-01-01

    The AHA/ASA guideline for intracerebral hemorrhage has been published nearly 2 years,however,the clinicians pay much less attention to it than the guideline of cerebral ischemia.At present there's big gaps between the status of control for intracerebral hemorrhage and guideline.Based on the analysis of current situation,comparing with the requirements of guideline,we hope to make the treatment of intracerebral hemorrhage in our country accord with the principle of guideline,making more patients benefit from the treatment.%美国心脏协会(AHA)和美国卒中学会(ASA)制定的《自发性脑出血诊疗指南》发表已逾3年,但临床医生对于脑出血指南的重视程度远不如缺血性脑血管病指南.目前有关脑出血的防治现状与指南存在较大差距.文章通过对现状的分析,对照指南的要求,希望能使中国脑出血的治疗更符合指南的精神,使更多脑出血患者从治疗中获益.

  12. Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments

    Science.gov (United States)

    Siering, Ulrich; Neugebauer, Edmund A. M.; Brockhaus, Anne Catharina; Lampert, Ulrike; Eikermann, Michaela

    2017-01-01

    Introduction The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within 6 domains and 2 overall assessments (1. overall guideline quality; 2. recommendation for use). The aim of this systematic review was twofold. Firstly, to investigate how often AGREE II users conduct the 2 overall assessments. Secondly, to investigate the influence of the 6 domain scores on each of the 2 overall assessments. Materials and methods A systematic bibliographic search was conducted for publications reporting guideline appraisals with AGREE II. The impact of the 6 domain scores on the overall assessment of guideline quality was examined using a multiple linear regression model. Their impact on the recommendation for use (possible answers: “yes”, “yes, with modifications”, “no”) was examined using a multinomial regression model. Results 118 relevant publications including 1453 guidelines were identified. 77.1% of the publications reported results for at least one overall assessment, but only 32.2% reported results for both overall assessments. The results of the regression analyses showed a statistically significant influence of all domains on overall guideline quality, with Domain 3 (rigour of development) having the strongest influence. For the recommendation for use, the results showed a significant influence of Domains 3 to 5 (“yes” vs. “no”) and Domains 3 and 5 (“yes, with modifications” vs. “no”). Conclusions The 2 overall assessments of AGREE II are underreported by guideline assessors. Domains 3 and 5 have the strongest influence on the results of the 2 overall assessments, while the other domains have a varying influence. Within a normative approach, our findings could be used as guidance for weighting individual domains in AGREE II to make the overall assessments more objective. Alternatively, a stronger content analysis

  13. Recreational drugs and HIV in Europe: current use of recreational drugs and principal HIV guidelines related recommendations

    Directory of Open Access Journals (Sweden)

    Noe Garin Escriva

    2014-11-01

    Full Text Available Introduction: Recreational drug consumption has been associated with both higher rates of risk activities related to HIV transmission and also worse adherence and management of HIV patients under HAART treatment. Moreover, relevant interactions may be present in patients under HAART treatment. Our aim is to present the European trends of drug consumption per country and age groups and assess the way drug consumption is addressed in general HIV guidelines. Materials and Methods: Last 12-month prevalence drug use was obtained from the European Monitoring Centre for Drugs and Drug Addiction for the four most consumed drugs (cannabis, cocaine, amphetamines, ecstasys. Consumption rates were collected and analyzed by country and age. Principal HIV guidelines were assessed to identify the degree of incorporation of drug use issues at three levels: transmission risk, adherence to the HAART and management of interactions. Guidelines: (a WHO; (b EACS; (c BHIVA; (d US DHHS; (e IAS-USA; (f GESIDA; (g French CPG; (h Italian CPG. Results: Data on drugs of abuse consumption was obtained from 29 European countries, with results showing relevant drug utilization in Europe. Cannabis was the most frequent drug across all countries, with 10 countries over 5% of prevalence over the last year. Other drugs prevalence accounted for about 0.5–1%, reaching up to: 2.1% for cocaine in Spain, 1.4% for ecstasy in the Netherlands and 1.1% for amphetamines in Estonia. 15–24 and 25–34 years old subgroups had the highest prevalence, although notable use of cannabis and cocaine was also found in the 35–44 and 45–54 subgroups. From the eight guidelines assessed, six considered recreational drugs at any point. Recommendations for specific drugs were given in 50% of the guidelines. From those guidelines addressing drug consumption: three assessed risk habits which related to transmission risk, six appraised issues on adherence to HAART and five comprised data on

  14. Ethical issues in the translation of social neuroscience: a policy analysis of current guidelines for public dialogue in human research.

    Science.gov (United States)

    Zimmerman, Emma; Racine, Eric

    2012-01-01

    Social neuroscience and its potential implications create an interesting case study for examining human research ethics policies on the topic of public communication of research. We reviewed mainstream national and international human research ethics guidelines and policies on issues of public communication of research. Our analysis relied on five thematic nets to capture the interactions between research and the public: public understanding, knowledge translation, public participation, social outcomes, and dual use. Coverage of these topics is sparse and inconsistent in mainstream policies and guidelines. We identify three options to address these gaps and analyze their strengths and weaknesses.

  15. Adherence to current guidelines for chronic obstructive pulmonary disease (COPD among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids

    Directory of Open Access Journals (Sweden)

    Asche CV

    2012-03-01

    Full Text Available Carl Victor Asche1,2, Shelah Leader3, Craig Plauschinat4, Swetha Raparla1, Ming Yan1, Xiangyang Ye1, Dave Young11Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, 2Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, Illinois, 3Formerly of Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, 4Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USABackground: To estimate the potential cost savings by following the current Global Initiative for Chronic Obstructive Lung Disease (GOLD guideline recommendations in patients being treated for chronic obstructive pulmonary disease (COPD with the combination of long-acting β2-agonist (LABA, long-acting muscarinic antagonist (LAMA or inhaled corticosteroids (ICS.Methods: The Geisinger Health System (GHS database was utilized to identify subjects between January 1, 2004 to March 12, 2007. The index date was based on the first prescription of a LAMA plus LABA, LAMA plus LABA/ICS, or LABA plus ICS. Patients were included in the study if they: had a COPD diagnosis; had data representative of treatment 12 months prior to and 12 months post index date; were 40 years of age or over; had no prior diagnosis for asthma; and had pulmonary function test (PFT data. We examined the baseline characteristics of these patients along with their healthcare resource utilization. Based on PFT data within 30 days of the index date, a subgroup was classified as adhering or non-adhering to GOLD guidelines.Results: A total of 364 subjects could be classified as adhering or non-adherent to current GOLD guidelines based on their PFT results. The adherent subgroup received COPD medications consistent with current GOLD guidelines. Of the LAMA plus LABA cohort, 25 patients adhered and 39 patients were non-adherent to current GOLD guidelines. In the

  16. Cancer screening in the United States, 2013: a review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening.

    Science.gov (United States)

    Smith, Robert A; Brooks, Durado; Cokkinides, Vilma; Saslow, Debbie; Brawley, Otis W

    2013-01-01

    Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, a report on data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, current ACS cancer screening guidelines are summarized, as are updated guidelines on cervical cancer screening and lung cancer screening with low-dose helical computed tomography. The latest data on the use of cancer screening from the National Health Interview Survey also are described, as are several issues related to screening coverage under the Patient Protection and Affordable Care Act of 2010.

  17. Prevention of hamstring injuries in male soccer : Exercise programs and return to play

    OpenAIRE

    van der Horst, N

    2017-01-01

    The aim of the studies reported in this thesis was to investigate strategies for the prevention of hamstring injuries. Hamstring injuries are the most prevalent muscle injury in soccer. In spite of efforts to reduce the occurrence of hamstring injuries in soccer, injury rates have not decreased over the last three decades. Therefore, research on hamstring injury prevention is necessary to reduce hamstring injury rates. Exercise programs to reduce soccer injuries are easy to implement during r...

  18. Prevention of hamstring injuries in male soccer : Exercise programs and return to play

    NARCIS (Netherlands)

    van der Horst, N

    2017-01-01

    The aim of the studies reported in this thesis was to investigate strategies for the prevention of hamstring injuries. Hamstring injuries are the most prevalent muscle injury in soccer. In spite of efforts to reduce the occurrence of hamstring injuries in soccer, injury rates have not decreased over

  19. Prevention of hamstring injuries in male soccer : Exercise programs and return to play

    NARCIS (Netherlands)

    Horst, Nick van der

    2017-01-01

    The aim of the studies reported in this thesis was to investigate strategies for the prevention of hamstring injuries. Hamstring injuries are the most prevalent muscle injury in soccer. In spite of efforts to reduce the occurrence of hamstring injuries in soccer, injury rates have not decreased over

  20. Incidence of late vitamin K deficiency bleeding in newborns in the Netherlands in 2005 : Evaluation of the current guideline

    NARCIS (Netherlands)

    IJland, M.M.; Pereira, R.R.; Cornelissen, E.A.M.

    2008-01-01

    Vitamin K prophylaxis is recommended to prevent the hazard of haemorrhage caused by vitamin K deficiency in newborns. The present Dutch guideline recommends 1 mg of vitamin K1 orally at birth, followed by a daily dose of 25 μg of vitamin K1 from 1 to 13 weeks of age for breastfed infants. Since the

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  3. Identification of NSAID users at risk for gastrointestinal complications: a systematic review of current guidelines and consensus agreements.

    NARCIS (Netherlands)

    Tielemans, M.M.; Eikendal, T.; Jansen, J.B.M.J.; Oijen, M.G.H. van

    2010-01-01

    NSAIDs are among the most often used drugs worldwide. Numerous NSAID users are at risk for developing gastrointestinal complications. The purpose of this review was to identify and stratify risk factors for gastrointestinal complications in NSAID users documented in guidelines and consensus agreemen

  4. Recreational drugs and HIV in Europe: current use of recreational drugs and principal HIV guidelines related recommendations

    OpenAIRE

    Noe Garin Escriva; Cesar Velasco Muñoz; Jan Thomas De Pourcq; Belen Lopez Garcia; Josep Maria Haro Abad; Maria Antonia Mangues Bafalluy; Antoni Trilla Garcia

    2014-01-01

    Introduction: Recreational drug consumption has been associated with both higher rates of risk activities related to HIV transmission and also worse adherence and management of HIV patients under HAART treatment. Moreover, relevant interactions may be present in patients under HAART treatment. Our aim is to present the European trends of drug consumption per country and age groups and assess the way drug consumption is addressed in general HIV guidelines. Materials and Methods: Last 12-month ...

  5. The prevalence and correlates of meeting the current physical activity for health guidelines in older people: a cross-sectional study in Brazilian women.

    Science.gov (United States)

    Vagetti, Gislaine Cristina; Barbosa Filho, Valter Cordeiro; Moreira, Natália Boneti; de Oliveira, Valdomiro; Mazzardo, Oldemar; de Campos, Wagner

    2013-01-01

    This study aimed to identify the prevalence and correlates of meeting the current physical activity for health (PAfH) guidelines, proposed by the World Health Organization in 2010, in community-dwelling older women from Brazil. A cross-sectional study was performed with 1806 women (aged 60.0-92.7 years) who were randomly selected from eighteen care centers. The short version of the International Physical Activity Questionnaire was used to determine the weekly time spent in physical activities, and this variable was categorized into three categories (0high blood pressure (OR=1.33, 95% CI: 1.09-1.62) were more likely to meet the current PAfH guidelines than their peers with primary incomplete education, negative self-rated health, and normal blood pressure. Increasing age was inversely associated with meeting the PAfH guidelines (odds ranging: 0.77-0.48). These results highlighted the elderly population subgroups, in a developing country, that needspecific guidelinesfor inclusion inhealth programs andmotivation toparticipate in physical activities. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. What's a Pregnant Woman to Eat? A Review of Current USDA Dietary Guidelines and MyPyramid

    OpenAIRE

    2006-01-01

    The purpose of this article is to clarify the nutritional recommendations for pregnant women in light of the new Food Guide Pyramid, known as “MyPyramid,” along with the Dietary Guidelines for Americans 2005 and recommendations by the Institute of Medicine. The differences between the Food Guide Pyramid (introduced in 1992) and the more recent, color-coded MyPyramid (introduced in 2005) are discussed. A list of nutritional recommendations for pregnant women is presented, which may serve as a ...

  7. Variability in delivered dose and respirable delivered dose from nebulizers: are current regulatory testing guidelines sufficient to produce meaningful information?

    Science.gov (United States)

    Hatley, Ross HM; Byrne, Sarah M

    2017-01-01

    Background To improve convenience to patients, there have been advances in the operation of nebulizers, resulting in fast treatment times and less drug lost to the environment. However, limited attention has been paid to the effects of these developments on the delivered dose (DD) and respirable delivered dose (RDD). Published pharmacopoeia and ISO testing guidelines for adult-use testing utilize a single breathing pattern, which may not be sufficient to enable effective comparisons between the devices. Materials and methods The DD of 5 mg of salbutamol sulfate into adult breathing patterns with inhalation:exhalation (I:E) ratios between 1:1 and 1:4 was determined. Droplet size was determined by laser diffraction and RDD calculated. Nine different nebulizer brands with different modes of operation (conventional, venturi, breath-enhanced, mesh, and breath-activated) were tested. Results Between the non-breath-activated nebulizers, a 2.5-fold difference in DD (~750–1,900 µg salbutamol) was found; with RDD, there was a more than fourfold difference (~210–980 µg). With increasing time spent on exhalation, there were progressive reductions in DD and RDD, with the RDD at an I:E ratio of 1:4 being as little as 40% of the dose with the 1:1 I:E ratio. The DD and RDD from the breath-activated mesh nebulizer were independent of the I:E ratio, and for the breath-activated jet nebulizer, there was less than 20% change in RDD between the I:E ratios of 1:1 and 1:4. Conclusion Comparing nebulizers using the I:E ratio recommended in the guidelines does not predict relative performance between the devices at other ratios. There was significant variance in DD or RDD between different brands of non-breath-activated nebulizer. In future, consideration should be given to revision of the test protocols included in the guidelines, to reflect more accurately the potential therapeutic dose that is delivered to a realistic spectrum of breathing patterns. PMID:28203110

  8. Optimal screening of children with acute malnutrition requires a change in current WHO guidelines as MUAC and WHZ identify different patient groups

    DEFF Research Database (Denmark)

    Laillou, Arnaud; Prak, Sophonneary; de Groot, Richard

    2014-01-01

    BACKGROUND: Timely treatment of acute malnutrition in children 500,000 deaths annually. Screening at community level is essential to identify children with malnutrition. Current WHO guidelines for community screening for malnutrition recommend a Mid Upper Arm...... Circumference (MUAC) of malnutrition (SAM). However, it is currently unclear how MUAC relates to the other indicator used to define acute malnutrition: weight-for-height Z-score (WHZ). METHODS: Secondary data from >11,000 Cambodian children, obtained by different surveys between...... 2010 and 2012, was used to calculate sensitivity and ROC curves for MUAC and WHZ. FINDINGS: The secondary analysis showed that using the current WHO cut-off of 115 mm for screening for severe acute malnutrition over 90% of children with a weight-for-height z-score (WHZ)

  9. A Mismatch Between Athlete Practice and Current Sports Nutrition Guidelines Among Elite Female and Male Middle- and Long-Distance Athletes.

    Science.gov (United States)

    Heikura, Ida A; Stellingwerff, Trent; Mero, Antti A; Uusitalo, Arja Leena Tuulia; Burke, Louise M

    2017-08-01

    Contemporary nutrition guidelines promote a variety of periodized and time-sensitive recommendations, but current information regarding the knowledge and practice of these strategies among world-class athletes is limited. The aim of this study was to investigate this theme by implementing a questionnaire on dietary periodization practices in national/international level female (n = 27) and male (n = 21) middle- and long-distance runners/race-walkers. The questionnaire aimed to gain information on between and within-day dietary choices, as well as timing of pre- and posttraining meals and practices of training with low or high carbohydrate (CHO) availability. Data are shown as percentage (%) of all athletes, with differences in responses between subgroups (sex or event) shown as Chi-square x(2) when p key sessions. Twenty-six percent of athletes (11% of middle vs 42% of long-distance athletes [x(2) (1, n = 46) = 4.308, p = .038, phi = 0.3])) reported to undertake training in the fasted state, while 11% said they periodically restrict CHO intake, with 30% ingesting CHO during training sessions. Our findings show that elite endurance athletes appear to execute pre- and post-key session nutrition recovery recommendations. However, very few athletes deliberately undertake some contemporary dietary periodization approaches, such as training in the fasted state or periodically restricting CHO intake. This study suggests mismatches between athlete practice and current and developing sports nutrition guidelines.

  10. Study of quality assurance regulations for linear accelerators in Korea: A comparison study between the current status in Korea and the international guidelines

    CERN Document Server

    Lee, Hyunho; Jo, Yunhui; Yoon, Myonggeun

    2015-01-01

    Quality assurance (QA) for medical linear accelerators is indispensable for appropriate cancer treatment. Some international organizations and western advanced countries provide QA guidelines for linear accelerators. Currently, QA regulations for linear accelerators in Korean hospitals specify a system in which each hospital stipulates its independent hospital-based protocols for QA procedures (HP_QAPs) and conducts QA based on these HP_QAPs while regulatory authorities verify whether items under these HP_QAPs have been performed. However, because this regulatory method cannot guarantee the quality of universal treatment, and QA items with tolerance criteria are different in many hospitals, the presentation of standardized QA items and tolerance criteria is essential. In this study, QA items in HP_QAPs from various hospitals and those presented by international organizations. Concordance rates between QA items for linear accelerators that were presented by the aforementioned organizations and those currently ...

  11. Beyond current guidelines: reduction in minimum administered radiopharmaceutical activity with preserved diagnostic image quality in pediatric hepatobiliary scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Fahey, Frederic; Markelewicz, Robert; Grant, Frederick; Drubach, Laura; Treves, S. Ted [Harvard Medical School, Division of Nuclear Medicine and Molecular Imaging, Boston Children' s Hospital, Boston, MA (United States); Harvard Medical School, Joint Program in Nuclear Medicine, Boston (United States); Zukotynski, Katherine [University of Toronto, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto (Canada); Harvard Medical School, Joint Program in Nuclear Medicine, Boston (United States); Zurakowski, David [Boston Children' s Hospital, Departments of Anesthesia and Surgery, Boston (United States); Falone, Anthony; Vitello, Marie; Cao, Xinhua [Harvard Medical School, Division of Nuclear Medicine and Molecular Imaging, Boston Children' s Hospital, Boston, MA (United States); Vija, A.H.; Bhattacharya, Manojeet; Ding, Xinhong [Siemens Medical Solutions USA, Inc., Molecular Imaging, Malvern, PA (United States); Bar-Sever, Zvi [Schneider Children' s Medical Center, Petach Tikvah (Israel); Tel-Aviv University, Tel-Aviv (Israel); Gelfand, Michael [Cincinnati Children' s Hospital, Cincinnati, OH (United States)

    2014-12-15

    To determine if the minimum administered radiopharmaceutical activity for hepatobiliary scintigraphy can be reduced while preserving diagnostic image quality using enhanced planar processing (EPP). A total of 40 infants between 10 and 270 days old (body mass 2.2 - 6.5 kg) had hepatobiliary scintigraphy during the period 2004 - 2010 following the intravenous administration of either {sup 99m}Tc-mebrofenin (18 patients) or {sup 99m}Tc-disofenin (22 patients). Due to the small size of these patients, they all received the minimum administered activity of 18.5 MBq consistent with the North American Consensus Guidelines. Six nuclear medicine physicians subjectively graded the acceptability of the image quality for clinical interpretation using a four-point scale (not acceptable, fair, good, excellent). Each physician independently graded seven image sets including the original study (full activity) and simulated reduced activity studies using binomial subsampling (50 % of full activity, 25 % of full activity and activity reduced by weight), with and without EPP. For full-activity studies, 98 % were deemed acceptable by the six physicians for clinical interpretation. The percentages of acceptable 50 % reduced activity studies with and without EPP were not significantly different from the percentage of acceptable full-activity studies (P = 0.193 and P = 0.998, respectively). The percentage of acceptable 25 % reduced activity studies without EPP was significantly different from the percentage of acceptable full-activity studies (P < 0.001); however, this difference vanished when EPP was applied (P = 0.482). The activity reduced by weight ranged from 1.85 to 4.81 MBq (10 % to 26 % of full dose) and the percentages of acceptable studies with and without EPP were significantly different from the percentage of acceptable full-activity studies (P < 0.001 and P = 0.02, respectively). Clinically interpretable hepatobiliary scintigraphy images can be obtained in infants when the

  12. Author Guidelines

    OpenAIRE

    Istadi Istadi

    2011-01-01

    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 ...

  13. Implementation workshop of WHO guidelines on evaluation of malaria vaccines: Current regulatory concepts and issues related to vaccine quality, Pretoria, South Africa 07 Nov 2014.

    Science.gov (United States)

    Ho, Mei Mei; Baca-Estrada, Maria; Conrad, Christoph; Karikari-Boateng, Eric; Kang, Hye-Na

    2015-08-26

    The current World Health Organization (WHO) guidelines on the quality, safety and efficacy of recombinant malaria vaccines targeting the pre-erythrocytic and blood stages of Plasmodium falciparum were adopted by the WHO Expert Committee on Biological Standardization in 2012 to provide guidance on the quality, nonclinical and clinical aspects of recombinant malaria vaccines. A WHO workshop was organised to facilitate implementation into African (national/regional) regulatory practices, of the regulatory evaluation principles outlined in the guidelines regarding quality aspects. The workshop was used also to share knowledge and experience on regulatory topics of chemistry, manufacturing and control with a focus on vaccines through presentations and an interactive discussion using a case study approach. The basic principles and concepts of vaccine quality including consistency of production, quality control and manufacturing process were presented and discussed in the meeting. By reviewing and practicing a case study, better understanding on the relationship between consistency of production and batch release tests of an adjuvanted pre-erythrocytic recombinant malaria vaccine was reached. The case study exercise was considered very useful to understand regulatory evaluation principles of vaccines and a suggestion was made to WHO to provide such practices also through its Global Learning Opportunities for Vaccine Quality programme.

  14. Implementation of concussion guidelines in community Australian Football and Rugby League-The experiences and challenges faced by coaches and sports trainers.

    Science.gov (United States)

    Kemp, Joanne L; Newton, Joshua D; White, Peta E; Finch, Caroline F

    2016-04-01

    While guidelines outlining the appropriate management of sport-related concussion have been developed and adapted for use within community sport, it remains unknown how they are experienced by those responsible for implementing them. Longitudinal study. 111 coaches and sports trainers from community-level Australian Football and Rugby League teams completed pre- and post-season surveys assessing their attitudes towards using concussion guidelines. Participants also provided post-season feedback regarding their experiences in using the guidelines. 71% of participants reported using the guidelines in the preceding season. Post-season attitude was related to pre-season attitude (p=0.002), football code (p=0.015), and team role (p=0.045). An interaction between team role and guideline use (p=0.012) was also found, with coaches who had used the guidelines, and sports trainers who had not, reporting more positive post-season attitudes towards using the concussion guidelines. Implementation challenges included disputing of decisions about return-to-play by players, parents, and coaches, and a perceived lack of time. Recommendations for improved guideline materials included using larger fonts and providing for witnessing of advice given to players. This is the first study to examine the implementation of concussion guidelines in community sport. Training of coaches/sports trainers needs enhancement. In addition, new education should be developed for parents/players about the importance of the return-to-play advice given to them by those who follow these guidelines. Information provided by those who attempted to use the guidelines will assist the refinement of implementation and dissemination processes around concussion guidelines across sports. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  15. The emergence of international food safety standards and guidelines: understanding the current landscape through a historical approach.

    Science.gov (United States)

    Ramsingh, Brigit

    2014-07-01

    Following the Second World War, the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) teamed up to construct an International Codex Alimentarius (or 'food code') which emerged in 1963. The Codex Committee on Food Hygiene (CCFH) was charged with the task of developing microbial hygiene standards, although it found itself embroiled in debate with the WHO over the nature these standards should take. The WHO was increasingly relying upon the input of biometricians and especially the International Commission on Microbial Specifications for Foods (ICMSF) which had developed statistical sampling plans for determining the microbial counts in the final end products. The CCFH, however, was initially more focused on a qualitative approach which looked at the entire food production system and developed codes of practice as well as more descriptive end-product specifications which the WHO argued were 'not scientifically correct'. Drawing upon historical archival material (correspondence and reports) from the WHO and FAO, this article examines this debate over microbial hygiene standards and suggests that there are many lessons from history which could shed light upon current debates and efforts in international food safety management systems and approaches.

  16. Guidelines for Better Heart Health

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues Guidelines for Better Heart Health Past Issues / Winter 2007 ... women either had or did not have CVD. Guidelines at a Glance: Prevention should be tailored to ...

  17. [Requirements for the prevention of nosocomial infections. German Guideline 2009 and reality. Current data from hospitals in Frankfurt am Main, Germany].

    Science.gov (United States)

    Heudorf, U; Exner, M

    2011-03-01

    In 2009, the new directive of the German Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) entitled Human and Organizational Requirements for the Prevention of Nosocomial Infections was published, including detailed information on the needs of hygiene professionals in hospital settings. Compared to the needs calculated according to the above policy, the current staff hygiene health professionals (HHPs) in the hospitals of Frankfurt am Main (Frankfurt/M), Germany, was on average 27.6%: 36% in the large hospitals (>600 beds), 21.6% in medium hospitals (300-600 beds), and 19.8% in small hospitals (hospitals had a full-time hygienist. The demands of the KRINKO policy have not been met by any of the hospitals. Hospitals with lower percentages of hospital hygiene staff not only had a lower rating of hygienic quality, they also showed a lower usage of hand disinfection per patient-day. In Germany, there is currently a lack of trained HHPs and hygienists to meet the needs of the KRINKO policy. Therefore, the reactions of the hospitals in Frankfurt/M ranged from the establishment of additional jobs for HHPs to changes in structures and organization of hospital hygiene. Thus, the new KRINKO guideline in Frankfurt/M did not result in a wave of recruitment of health professionals, but at least resulted in organizational and structural improvements in hygiene.

  18. 世界各国高血压临床指南的现状分析和循证评价%Analysis on current status of clinical guidelines for hypertension in the world and evaluation on evidence-based clinical guidelines with Appraisal of Guidelines for Research and Evaluation instrument

    Institute of Scientific and Technical Information of China (English)

    唐海沁; 符赵鑫; 张勇; 丁琳; 李瑾

    2014-01-01

    Objective To assess and analyze the current status of clinical guidelines for hypertension in the world by using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.Methods The clinical guidelines for hypertension were identified and approved by searching China hownet,WANFANG database,PUBMED database,MEDLINE,Embase and related institutions and authorization web site from 1995 to January 2012,and relevant Web sites of agencies and organizations that produce and/or endorse guidelines.Names of the guidelines,published years and organizations,methodology of development and reference number were descriptively analyzed.AGREE instrument was used to evaluate the qualities of latest edited clinical guidelines for hypertension in countries all over the world.Results Nine guidelines were enrolled.The results showed that the hypertension guidelines scored the highest average of 88.4% for clarity of presentation and reliability field; for applicability fields,scored an average of 86.1%; the scope and goal field scored an average of 83.8%; participants field scored an average of 71.7%; editorial independence field scored an average of 64.1% ; rigor of development field scored the lowest average of 62.9%.The overall assessment showed that NICE 2011,Canada 2012,ESC 2009,Australia 2010 editions were the positively recommended guidelines,JNC7,Japan 2009,China Taiwan 2010,China 2010,South Africa 2011 editions were the recommended guidelines (still need to supplement and improve).No recommend or uncertain guide was found.Conclusions The quality of the hypertension guidelines is higher in general,but some common deficiency in the rigor of development and editorial independence in Asian and African guidelines formulated by the states still exists.There still exist certain gaps in evidence-based medical requirement.And the contents and quality are needed for further regulating and enhancing.A set of scientific systemic hypertension clinical guidelines

  19. Transparent Guideline Methodology Needed

    DEFF Research Database (Denmark)

    Lidal, Ingeborg; Norén, Camilla; Mäkelä, Marjukka

    2013-01-01

    Group.2 Similar criteria for guideline quality have been suggested elsewhere.3 Our conclusion was that this much needed guideline is currently unclear about several aspects of the methodology used in developing the recommendations. This means potential users cannot be certain that the recommendations...... are based on best currently available evidence. Our concerns are in two main categories: the rigor of development, including methodology of searching, evaluating, and combining the evidence; and editorial independence, including funding and possible conflicts of interest....

  20. Guideline.gov: A Database of Clinical Specialty Guidelines.

    Science.gov (United States)

    El-Khayat, Yamila M; Forbes, Carrie S; Coghill, Jeffrey G

    2017-01-01

    The National Guidelines Clearinghouse (NGC), also known as Guideline.gov, is a database of resources to assist health care providers with a central depository of guidelines for clinical specialty areas in medicine. The database is provided free of charge and is sponsored by the U.S. Department of Health and Human Services and the Agency for Healthcare Research and Quality. The guidelines for treatment are updated regularly, with new guidelines replacing older guidelines every five years. There are hundreds of current guidelines with more added each week. The purpose and goal of NGC is to provide physicians, nurses, and other health care providers, insurance companies, and others in the field of health care with a unified database of the most current, detailed, relevant, and objective clinical practice guidelines.

  1. Are recommendations for psychological treatment of borderline personality disorder in current U.K. guidelines justified? Systematic review and subgroup analysis.

    Science.gov (United States)

    Omar, Hussein; Tejerina-Arreal, Maria; Crawford, Mike J

    2014-08-01

    Current U.K. guidelines on the management of borderline personality disorder include specific recommendations about the duration of therapy and number of sessions per week that patients should be offered. However, very little research has been conducted to examine the impact of these aspects of treatment process on patient outcomes. We therefore undertook a systematic review to examine the impact of treatment duration, number of sessions per week and access group-based therapy on general mental health, depression, social functioning and deliberate self-harm. We identified 25 randomized trials for possible inclusion in the review. However, differences in outcome measures used meant that only 12 studies could be included in the analysis. Statistically significant reductions in self-harm and depression and improvement in social functioning were found for treatments that include more than one session per week and those that included group-based sessions but were not found for those that deliver in individual sessions or one or fewer sessions per week. Longer term outcomes of short-term interventions have not been examined. Further research is needed to examine the impact of shorter term interventions and to compare the effects of group-based versus individual therapies for people with borderline personality disorder.

  2. Care of critically ill surgical patients using the 80-hour Accreditation Council of Graduate Medical Education work-week guidelines: a survey of current strategies.

    Science.gov (United States)

    Gordon, Chad R; Axelrad, Alex; Alexander, James B; Dellinger, R Phillip; Ross, Steven E

    2006-06-01

    As a result of the recently mandated work-hour restrictions, it has become more difficult to provide 24-hour intensive care unit (ICU) in-house coverage by the general surgical residents. To assess the current state of providing appropriate continuous care to surgical critical care patients during the era of resident work-hour constraints, a national survey was conducted by the Association of Program Directors of Surgery. The results revealed that 37 per cent of programs surveyed have residents other than general surgery housestaff providing cross-coverage and writing orders for surgical ICU patients. Residents in emergency medicine, anesthesia, family medicine, otorhinolaryngology, obstetrics/gynecology, internal medicine, urology, and orthopedic surgery have provided this cross-coverage. Some found it necessary to use physician extenders (i.e., nurse practitioners or physician assistants), thereby decreasing the burden of surgical housestaff coverage. The results indicated that 30 per cent use physician extenders to help cover the ICU during daytime hours and 11 per cent used them during nighttime hours. In addition, 24 per cent used a "night-float" system in an attempt to maintain continuous care, yet still adhere to the mandated guidelines. In conclusion, our survey found multiple strategies, including the use of physician extenders, a "night-float" system, and the use of nongeneral surgical residents in an attempt to provide continuous coverage for surgical ICU patients. The overall outcome of these new strategies still needs to be assessed before any beneficial results can be demonstrated.

  3. Current activity guidelines for CABG patients are too restrictive: comparison of the forces exerted on the median sternotomy during a cough vs. lifting activities combined with valsalva maneuver.

    Science.gov (United States)

    Parker, R; Adams, J L; Ogola, G; McBrayer, D; Hubbard, J M; McCullough, T L; Hartman, J M; Cleveland, T

    2008-06-01

    The current activity guidelines for coronary artery bypass graft surgery (CABG) patients are overly restrictive, hindering recovery. As the sternotomy repair must withstand repeated coughs during convalescence, this provides a benchmark for the force tending to separate the incision that can be tolerated. Nine volunteers performed 5 weightlifting activities (lifting 5 lbs [2.3 kg], lifting a 25-lb simulated grandchild [11.4 kg], lifting a 30-lb suitcase [13.6 kg], lifting two 20-lb weights [18.2 kg], and lifting a gallon of milk to a counter [3.7 kg]), plus coughing. Valsalva forces were detected using a mouthpiece configured with an Ashcroft Inc. expiratory pressure gauge (model N10-120CMW). Three measurements were taken for each activity to calculate the mean internal forces while external forces on the sternotomy were calculated using vector algebra. Total force exerted on the sternotomy by the cough was compared to the total force exerted by each of the 5 activities using paired T-tests. The cough exerted a significantly greater force across the median sternotomy (mean 27.5 kg-mass) than any of the five weightlifting activities ( P force on the median sternotomy incision than a cough. The strength of the repair is significantly greater than is implied by the recommendation to "not lift more than 5 lbs".

  4. Development and Preliminary Validation of a Comprehensive Questionnaire to Assess Women’s Knowledge and Perception of the Current Weight Gain Guidelines during Pregnancy

    Directory of Open Access Journals (Sweden)

    Holly Ockenden

    2016-11-01

    Full Text Available The aim of this study was to develop and validate an electronic questionnaire, the Electronic Maternal Health Survey (EMat Health Survey, related to women’s knowledge and perceptions of the current gestational weight gain guidelines (GWG, as well as pregnancy-related health behaviours. Constructs addressed within the questionnaire include self-efficacy, locus of control, perceived barriers, and facilitators of physical activity and diet, outcome expectations, social environment and health practices. Content validity was examined using an expert panel (n = 7 and pilot testing items in a small sample (n = 5 of pregnant women and recent mothers (target population. Test re-test reliability was assessed among a sample (n = 71 of the target population. Reliability scores were calculated for all constructs (r and intra-class correlation coefficients (ICC, those with a score of >0.5 were considered acceptable. The content validity of the questionnaire reflects the degree to which all relevant components of excessive GWG risk in women are included. Strong test-retest reliability was found in the current study, indicating that responses to the questionnaire were reliable in this population. The EMat Health Survey adds to the growing body of literature on maternal health and gestational weight gain by providing the first comprehensive questionnaire that can be self-administered and remotely accessed. The questionnaire can be completed in 15–25 min and collects useful data on various social determinants of health and GWG as well as associated health behaviours. This online tool may assist researchers by providing them with a platform to collect useful information in developing and tailoring interventions to better support women in achieving recommended weight gain targets in pregnancy.

  5. Exercise in patients with hypertrophic cardiomyopathy: A review of current evidence, national guideline recommendations and a proposal for a new direction to fitness.

    Science.gov (United States)

    Hindieh, Waseem; Adler, Arnon; Weissler-Snir, Adaya; Fourey, Dana; Harris, Sarah; Rakowski, Harry

    2017-04-01

    Hypertrophic cardiomyopathy is a common genetic disorder with a prevalence of 1:500 in the general population. Amongst a varied spectrum of clinical presentations, the most feared complication of this cardiac disorder is sudden cardiac death. Although only a minority of patients with hypertrophic cardiomyopathy who suffer sudden cardiac death or resuscitated cardiac arrest do so during exercise, strenuous physical activity is regarded as an important trigger for these tragic outcomes. Furthermore, during exercise, patients with hypertrophic cardiomyopathy may develop augmentation of left ventricular outflow tract obstruction, myocardial ischemia, diastolic dysfunction and/or inappropriate vasodilation in non-exercising vascular beds. This in turn may lead to exertional dyspnea, chest pain or syncope. Accordingly, patients with hypertrophic cardiomyopathy are disqualified from competitive sports and in many cases are recommended to avoid strenuous physical activity of any kind. Nevertheless, avoidance of physical activity comes with a price. The positive effects of regular exercise have been extensively reported to convey a wide range of benefits including reduced cardiovascular events, weight reduction and improved wellbeing. Therefore, finding the right exercise level that will offer some of the benefits of physical activity without increasing the risk of sudden cardiac death is of utmost importance. In this review, we discuss the current evidence for and against exercise in this patient population and review national guideline recommendations. We also propose alternative fitness strategies including a novel fitness program implemented by our hypertrophic cardiomyopathy center which may be of particular usefulness for hypertrophic cardiomyopathy patients. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  6. Transparent Guideline Methodology Needed

    DEFF Research Database (Denmark)

    Lidal, Ingeborg; Norén, Camilla; Mäkelä, Marjukka

    2013-01-01

    As part of learning at the Nordic Workshop of Evidence-based Medicine, we have read with interest the practice guidelines for central venous access, published in your Journal in 2012.1 We appraised the quality of this guideline using the checklist developed by The Evidence-Based Medicine Working ...... are based on best currently available evidence. Our concerns are in two main categories: the rigor of development, including methodology of searching, evaluating, and combining the evidence; and editorial independence, including funding and possible conflicts of interest....... Group.2 Similar criteria for guideline quality have been suggested elsewhere.3 Our conclusion was that this much needed guideline is currently unclear about several aspects of the methodology used in developing the recommendations. This means potential users cannot be certain that the recommendations...

  7. 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.

  8. Low Quality of Free Coaching Apps With Respect to the American College of Sports Medicine Guidelines: A Review of Current Mobile Apps.

    Science.gov (United States)

    Modave, François; Bian, Jiang; Leavitt, Trevor; Bromwell, Jennifer; Harris Iii, Charles; Vincent, Heather

    2015-07-24

    Low physical activity level is a significant contributor to chronic disease, weight dysregulation, and mortality. Nearly 70% of the American population is overweight, and 35% is obese. Obesity costs an estimated US$ 147 billion annually in health care, and as many as 95 million years of life. Although poor nutritional habits remain the major culprit, lack of physical activity significantly contributes to the obesity epidemic and related lifestyle diseases. Over the past 10 years, mobile devices have become ubiquitous, and there is an ever-increasing number of mobile apps that are being developed to facilitate physical activity, particularly for active people. However, no systematic assessment has been performed about their quality with respect to following the parameters of sound fitness principles and scientific evidence, or suitability for a variety of fitness levels. The aim of this paper is to fill this gap and assess the quality of mobile coaching apps on iOS mobile devices. A set of 30 popular mobile apps pertaining to physical activity programming was identified and reviewed on an iPhone device. These apps met the inclusion criteria and provided specific prescriptive fitness and exercise programming content. The content of these apps was compared against the current guidelines and fitness principles established by the American College of Sports Medicine (ACSM). A weighted scoring method based on the recommendations of the ACSM was developed to generate subscores for quality of programming content for aerobic (0-6 scale), resistance (0-6 scale), and flexibility (0-2 scale) components using the frequency, intensity, time, and type (FITT) principle. An overall score (0-14 scale) was generated from the subscores to represent the overall quality of a fitness coaching app. Only 3 apps scored above 50% on the aerobic component (mean 0.7514, SD 1.2150, maximum 4.1636), 4 scored above 50% on the resistance/strength component (mean 1.4525, SD 1.2101, maximum 4

  9. American College of Sports Medicine Roundtable on Exertional Heat Stroke - Return to Duty/Return to Play: Conference Proceedings

    Science.gov (United States)

    2010-01-01

    stroke: a clinico -pathologic study of 125 fatal cases . Mil. Surg. 1946; 99:397Y449. 35. McDermott BP, Casa DJ, Yeargin SW, et al. Recovery and return...sub- sequent military retention and hospitalization (44). Although a recent epidemiological study of military cases suggested EHI may increase long...ulations (11,62), but approximately 50% of military EHS cases in basic training do not share these demo- graphics and should, therefore, be considered

  10. Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not

    NARCIS (Netherlands)

    R.J. de Vos (Robert-Jan); G. Reurink (Gustaaf); G.J. Goudswaard (Gert Jan); M.H. Moen (Maaike); A. Weir (Adam); J.L. Tol (Johannes)

    2014-01-01

    markdownabstract__Abstract__ Background Acute hamstring re-injuries are common and hard to predict. The aim of this study was to investigate the association between clinical and imaging findings and the occurrence of hamstring re-injuries. Methods We obtained baseline data (clinical and MRI finding

  11. POST OPERATIVE REHABILITATION OF GRADE III MEDIAL COLLATERAL LIGAMENT INJURIES: EVIDENCE BASED REHABILITATION AND RETURN TO PLAY.

    Science.gov (United States)

    Logan, Catherine A; O'Brien, Luke T; LaPrade, Robert F

    2016-12-01

    The medial collateral ligament is the most commonly injured ligament of the knee, with injury generally sustained in the athletic population as a result of valgus contact with or without tibial external rotation. The capacity of the medial collateral ligament to heal has been demonstrated in both laboratory and clinical studies; however, complete ruptures heal less consistently and may result in persistent instability. When operative intervention is deemed necessary, anatomical medial knee reconstruction is recommended. Post-operative rehabilitation focuses on early motion and the return of normal neuromuscular firing patterns with progression based on attainment of specific phase criteria and goals. The purpose of this clinical commentary is to discuss the determinants of phase progression and the importance of objectively assessing readiness for advancement that is consistent with post-operative healing. Additional tests and validated measures to assess readiness for sport are also presented.

  12. German Guidelines.

    Science.gov (United States)

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

    2016-10-01

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

  13. 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.

  14. Web Accessibility and Guidelines

    Science.gov (United States)

    Harper, Simon; Yesilada, Yeliz

    Access to, and movement around, complex online environments, of which the World Wide Web (Web) is the most popular example, has long been considered an important and major issue in the Web design and usability field. The commonly used slang phrase ‘surfing the Web’ implies rapid and free access, pointing to its importance among designers and users alike. It has also been long established that this potentially complex and difficult access is further complicated, and becomes neither rapid nor free, if the user is disabled. There are millions of people who have disabilities that affect their use of the Web. Web accessibility aims to help these people to perceive, understand, navigate, and interact with, as well as contribute to, the Web, and thereby the society in general. This accessibility is, in part, facilitated by the Web Content Accessibility Guidelines (WCAG) currently moving from version one to two. These guidelines are intended to encourage designers to make sure their sites conform to specifications, and in that conformance enable the assistive technologies of disabled users to better interact with the page content. In this way, it was hoped that accessibility could be supported. While this is in part true, guidelines do not solve all problems and the new WCAG version two guidelines are surrounded by controversy and intrigue. This chapter aims to establish the published literature related to Web accessibility and Web accessibility guidelines, and discuss limitations of the current guidelines and future directions.

  15. Epetra developers coding guidelines.

    Energy Technology Data Exchange (ETDEWEB)

    Heroux, Michael Allen; Sexton, Paul Michael

    2003-12-01

    Epetra is a package of classes for the construction and use of serial and distributed parallel linear algebra objects. It is one of the base packages in Trilinos. This document describes guidelines for Epetra coding style. The issues discussed here go beyond correct C++ syntax to address issues that make code more readable and self-consistent. The guidelines presented here are intended to aid current and future development of Epetra specifically. They reflect design decisions that were made in the early development stages of Epetra. Some of the guidelines are contrary to more commonly used conventions, but we choose to continue these practices for the purposes of self-consistency. These guidelines are intended to be complimentary to policies established in the Trilinos Developers Guide.

  16. Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

    NARCIS (Netherlands)

    M.A.E. Nobbenhuis (Marielle); C.J.L.M. Meijer (Chris); A.J.C. van den Brule; L. Rozendaal (Lawrence); F. Voorhorst (Feja); E.K.J. Risse (Elle); R.H.M. Verheijen (René); T.J.M. Helmerhorst (Theo)

    2001-01-01

    textabstractWe assessed a possible role for high-risk human papillomavirus (HPV) testing in the policy after treatment for cervical intraepithelial neoplasia (CIN) 2 or 3 (moderate to severe dysplasia). According to the Dutch guidelines follow-up after treatment consists of cervical cytology at 6, 1

  17. Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia

    NARCIS (Netherlands)

    M.A.E. Nobbenhuis (Marielle); C.J.L.M. Meijer (Chris); A.J.C. van den Brule; L. Rozendaal (Lawrence); F. Voorhorst (Feja); E.K.J. Risse (Elle); R.H.M. Verheijen (René); T.J.M. Helmerhorst (Theo)

    2001-01-01

    textabstractWe assessed a possible role for high-risk human papillomavirus (HPV) testing in the policy after treatment for cervical intraepithelial neoplasia (CIN) 2 or 3 (moderate to severe dysplasia). According to the Dutch guidelines follow-up after treatment consists of cervical cytology at 6, 1

  18. 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...

  19. [Reflections on residency training under the current recommendations of the European Union of Medical specialists and the European Board of Anaesthesia (UEMS/EBA guidelines)].

    Science.gov (United States)

    Sáez Fernández, A; Sistac Ballarín, J M; Martínez Torrente, F; Calvo Vecino, J M; Olmos Rodríguez, M

    2011-01-01

    The recent publication of guidelines for postgraduate training in anesthesiology, pain, and intensive care issued by the European Board of Anaesthesia (EBA) and the European Union of Medical Specialists (UEMS) (http://www.sedar.es/revistasedar/uems.pdf) specifies directions we must take with our residents. The training section of the Sociedad Española de Anestesiología y Reanimación (SEDAR) has decided to make the guidelines available on the association's website so that the UEMS/EBA proposals can be compared to the training program drafted by the Spanish national board for our specialty. Our aim is to identify points of convergence between the two proposals and to target gaps where improvements can be made so that Spanish residency training in this specialty is in harmony with the European framework.

  20. Is point of care testing in Irish hospitals ready for the laboratory modernisation process? An audit against the current national Irish guidelines.

    LENUS (Irish Health Repository)

    O'Kelly, R A

    2013-04-11

    BACKGROUND: The Laboratory modernisation process in Ireland will include point of care testing (POCT) as one of its central tenets. However, a previous baseline survey showed that POCT was under-resourced particularly with respect to information technology (IT) and staffing. AIMS: An audit was undertaken to see if POCT services had improved since the publication of National Guidelines and if such services were ready for the major changes in laboratory medicine as envisaged by the Health Service Executive. METHODS: The 15 recommendations of the 2007 Guidelines were used as a template for a questionnaire, which was distributed by the Irish External Quality Assessment Scheme. RESULTS: Thirty-nine of a possible 45 acute hospitals replied. Only a quarter of respondent hospitals had POCT committees, however, allocation of staff to POCT had doubled since the first baseline survey. Poor IT infrastructure, the use of unapproved devices, and low levels of adverse incident reporting were still major issues. CONCLUSIONS: Point of care testing remains under-resourced, despite the roll out of such devices throughout the health service including primary care. The present high standards of laboratory medicine may not be maintained if the quality and cost-effectiveness of POCT is not controlled. Adherence to national Guidelines and adequate resourcing is essential to ensure patient safety.

  1. Uniform guidelines improve client care.

    Science.gov (United States)

    Barnett, B

    1994-12-01

    Uniform national guidelines on the delivery of family planning methods and services improve client care, assuming these guidelines are based on current scientific information. Compliance with these guidelines yields safe and efficient delivery of family planning services. Service providers need information, training, supplies, and guidelines to deliver quality services. Guidelines contribute to consistency among family planning programs in different settings. Even though clinics may not provide the same services, the guidelines allow them to provide the same standards of care. Specifically, eligibility criteria, contraindications, and follow-up schedules are the same regardless of the service delivery point. Various international health organizations (such as World Health Organization, USAID, Program for International Training in Health, International Planned Parenthood Federation, and Association for Voluntary Surgical Contraception) have developed guidelines for family planning service delivery. Governments can use these documents to develop national family planning guidelines and policies. They should adapt the guidelines to local needs and consider program resources. After development of the national guidelines, training, workshops, and dissemination of written materials should be provided for policymakers, physicians, nurses, and other health providers. Countries that have either developed or are working to draft their own national guidelines are Cameroon, Ghana, Mexico, and Nepal.

  2. Dietary guidelines

    DEFF Research Database (Denmark)

    Jelsøe, Erling

    2015-01-01

    Dietary guidelines are issued regularly in most developed countries. In almost all cases they are concerned solely with the nutritional aspects of food and eating and are based on an understanding of food exclusively as a source of nutrients. In recent years, however, a growing number of proposals...... 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...... and the role of expert cultures for the elaboration and communication of messages about health and sustainability. Finally, the article briefly points to some answers to the complexity of issues surrounding the creation of dietary guidelines...

  3. New Asthma Guidelines: What You Should Know

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Special Section New Asthma Guidelines: What You Should Know Past Issues / ... and chairs the Expert Panel that established the new guidelines. The report gives health care professionals new ...

  4. Current practice vs. guideline based imaging in abdominal radiology in the German speaking area. Results of an online survey; Versorgungsrealitaet vs. leitliniengerechte Bildgebung in der Abdominalradiologie im deutschsprachigen Raum. Ergebnisse einer Online-Umfrage

    Energy Technology Data Exchange (ETDEWEB)

    Schreyer, A.G. [University Hospital Regenburg (Germany). Dept. of Radiology; Wessling, J. [Clemens Hospital Muenchen (Germany). Dept. of Radiology; Grenacher, L. [Diagnostic Muenchen (Germany). Diagnostic Imaging Center

    2016-03-15

    The working group for abdominal imaging within the German Roentgen Society (DRG) performed an online survey amongst radiologist concerning the current status of techniques for abdominal imaging. The results of this survey were compared with the most recent guidelines. We performed an online survey open for all members of the DRG during a 76-day period with 65 questions and an overall estimated time for finishing the questionnaire of 15 minutes concerning technical specifications for abdominal radiological imaging. The results were evaluated using descriptive statistics. 90 of all participants, who filled out the survey covering more than 80 % of the questions, were included in the statistical evaluation. 27 % of all participants were registered radiologists while 73 % represented radiologists working in a hospital. Most participants worked in a managerial position. The participants gave detailed information regarding the radiological techniques used in dedicated organ systems (esophagus, stomach, pancreas, liver, small intestines, colon) regarding acquired contrast phases and oral and intravenous administration of contrast medium. The results confirm that most radiologists participating in this survey perform their examinations and choose their modalities in conformity with the current existing clinical guidelines. Because most clinical guidelines do not specify radiological examinations in detail, there is a noteworthy heterogeneity of the acquired contrast phases and major divergence in terms of technical parameters. Therefore a joint radiological effort should be initiated for developing and publishing updated radiological parameters for abdominal imaging.

  5. Instructional Guidelines. Welding.

    Science.gov (United States)

    Fordyce, H. L.; Doshier, Dale

    Using the standards of the American Welding Society and the American Society of Mechanical Engineers, this welding instructional guidelines manual presents a course of study in accordance with the current practices in industry. Intended for use in welding programs now practiced within the Federal Prison System, the phases of the program are…

  6. AUTHOR GUIDELINES

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2014-12-01

    Full Text Available 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 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 needAbout 1000 – 1200 wordsReferences: 5 – 10 (PubMed - Citation preferredInvited Commentary:Brief, provocative, opinionated communicationsOn issues of current public health needMain Text: 750-1000 words excluding referencesReferences: 5 – 10 (PubMed - Citation preferredOriginal Article:Articles from Original ResearchStructured abstract: 250 wordsMain Text: 2500 - 3000 words, IMRD formatKey Words: 5 - 8References: 20 – 25 (PubMed - Citation preferredTables / Figures: 3 – 4*Certificate of clearance from respective Institutional Ethical Committee (IECReview Article:On subject of public health relevanceAbstract: 250 wordsMain Text: 2500 - 3000 wordsKey Words: 3 - 4References: 20 – 25 (PubMed - Citation preferredTables / Figures: 3 – 4Short Communication / Article:Short report of a research project / outbreakMain Text : 1000 – 1200 wordsReferences: 10 – 15 (PubMed - Citation preferredTable / Figure: 01*Certificate of clearance from respective Institutional Ethical Committee (IECReport from the field

  7. [Obligation of guideline recommendations: Perception survey among guideline developers].

    Science.gov (United States)

    Weberschock, Tobias; Dreher, Andreas; Follmann, Markus; Nothacker, Monika; Kopp, Ina; Rosumek, Stefanie; Nast, Alexander

    2016-01-01

    Specific recommendations form the centerpiece of medical guidelines. The intended strength of a recommendation is usually expressed by the use of different wordings. Recent investigations showed that guideline users (recipients) interpret the binding character of wordings in different ways. The perception of different wording and their binding character of the strength of guideline recommendations among guideline developers (sender) have so far not been investigated in the German-speaking area. German-speaking guideline developers were invited online and at specialist meetings to participate in a survey investigating 13 different terms used in guideline recommendations. The aim was to measure their perceived binding character on a visual analog scale (VAS: 0-100). Additional demographic and occupational data were collected. The results were compared with data from a previous survey among guideline users. Overall, 136 guideline developers with an average of 4.2 (median 3) guideline (co-) authorships participated in the survey. While guideline developers interpreted the two imperative recommendations "must" and "must not" with a similarly high level of obligation, the level of obligation was not rated homogenously for strong and weak recommendations like "shall" or "should". Two out of five negative formulations were perceived as more binding than their corresponding positive formulations. In comparisons with the ratings of the guideline users the terms "darf nicht" (must not), (-5.8 VAS, p≤0.0001) and "muss" (must), (-2.9 VAS, p≤0.0006) were perceived as less binding by the guideline developers, as was "sollte nicht"(should not) (-6.6 VAS, p≤0.0001) and "kann nicht empfohlen werden" (cannot be recommended) (-9.4 VAS, p≤0.0001). Only "soll" (shall) was perceived as more binding (+8.7 VAS, p≤0.0001). The current survey demonstrates that guideline developers perceive the binding character of terms used in guideline recommendations in a similar way as it was

  8. Clinical guidelines: their implementation in general practice.

    OpenAIRE

    M Conroy; Shannon, W

    1995-01-01

    In recent years the development of clinical guidelines has received increasing attention from medical educators and those involved in standard setting, and has been initiated at both central and local levels. This review article outlines the current state of knowledge with regard to clinical guideline implementation in medical practice. It deals with the main aspects of the current guideline debate, such as, clinical freedom and doctor autonomy, the importance of ownership in guideline implem...

  9. Challenges in the implementation of the EAACI AIT guidelines: A situational analysis of current provision of allergen immunotherapy.

    Science.gov (United States)

    Ryan, D; Gerth van Wijk, R; Angier, E; Kristiansen, M; Zaman, H; Sheikh, A; Cardona, V; Vidal, C; Warner, A; Agache, I; Arasi, S; Fernandez-Rivas, M; Halken, S; Jutel, M; Lau, S; Pajno, G; Pfaar, O; Roberts, G; Sturm, G; Varga, E M; Van Ree, R; Muraro, A

    2017-08-29

    The European Academy of Allergy and Clinical Immunology (EAACI) has produced Guidelines on Allergen Immunotherapy (AIT). We sought to gauge the preparedness of primary care to participate in the delivery of AIT in Europe. We undertook a mixed-methods, situational analysis. This involved a purposeful literature search, and two surveys: one to primary care clinicians and the other to a wider group of stakeholders across Europe. The 10 papers identified all pointed out gaps or deficiencies in allergy care provision in primary care. The surveys also highlighted similar concerns, particularly in relation to concerns about lack of knowledge, skills, infrastructural weaknesses, reimbursement policies and communication with specialists as barriers to evidence-based care. Almost all countries (92%) reported the availability of AIT. In spite of that, only 28% and 44% of the countries reported the availability of guidelines for primary care physicians and specialists, respectively. Agreed pathways between specialists and primary care physicians were reported as existing in 32-48% of countries. Reimbursement appeared to be an important barrier as AIT was only fully reimbursed in 32% of countries. Additionally, 44% of respondents considered accessibility to AIT and 36% stating patient costs were barriers. Successful working with primary care providers is essential to scaling-up AIT provision in Europe, but to achieve this the identified barriers must be overcome. Development of primary care interpretation of guidelines to aid patient selection, establishment of disease management pathways and collaboration with specialist groups are required as a matter of urgency. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  10. GRADE guidelines

    DEFF Research Database (Denmark)

    Guyatt, Gordon H; Thorlund, Kristian; Oxman, Andrew D

    2013-01-01

    and absolute effects, presenting the ratio of the means of intervention and control groups, and presenting the results in minimally important difference units. We outline the merits and limitations of each alternative and provide guidance for meta-analysts and guideline developers....

  11. Lack of current implantable cardioverter defibrillator guidelines application for primary prevention of sudden cardiac death in Latin American patients with heart failure: a cross-sectional study.

    Science.gov (United States)

    Gonzalez-Zuelgaray, Jorge; Pellizon, Oscar; Muratore, Claudio A; Oropeza, Elsa Silva; Rabinovich, Rafael; Ramos, José Luis; Tentori, Maria Cristina; Reyes, Nicolás; Aguayo, Rubén; Marin, Jorge; Peterson, Brett J

    2013-02-01

    This cross-sectional study evaluated the application of accepted international implantable cardioverter defibrillator (ICD) guidelines for primary prevention of sudden cardiac death in patients with heart failure. The PLASMA (Probabilidad de Sufrir Muerte Arritmica) study was designed to characterize management of cardiac patients in Latin America. Twelve centres included 1958 consecutively admitted patients in cardiology units in 2008 and 2009. Discharged patients were evaluated for primary prevention, ICD indication and prescription by general cardiologists. Of 1711 discharged patients, 1525 (89%) had data available for evaluating indication status. Class I indications for ICD therapy were met for 153 (10%) patients based on collected data. Only 20 (13%, 95% confidence interval: 7.7-18.4%) patients with indication were prescribed an ICD. Patients prescribed an ICD were younger than patients who were not prescribed an ICD (62 vs. 68 years, P < 0.01). The reasons given by cardiologists for not prescribing an ICD for 133 patients with an indication were: indication criteria not met (75%), life expectancy <1 year (9.7%), rejection by the patient (5.2%), no medical coverage paying for the device (3.7%), psychiatric patient (2.2%), and other reasons (4.2%). In Latin America, international guidelines for primary prevention ICD implantation are not well followed. The main reason is that cardiologists believe that patients do not meet indication criteria, even though study data confirm that criteria are met. This poses a significant challenge and underlines the importance of continuous and improved medical education.

  12. 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

  13. 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

  14. 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.

  15. Jogging Guidelines.

    Science.gov (United States)

    President's Council on Physical Fitness and Sports, Washington, DC.

    Jogging guidelines are set forth under the following headings: a) What Is Jogging; c) Why One Should Jog; c) How To Begin; d) What To Wear (with the emphasis on proper shoes); e) When and Where To Jog; and f) How To Jog. A 16-week basic program, outlined for inactive adults, recommends for each week the number of days to exercise, the distance,…

  16. Current status of grassroots clinical guidelines of chronic diseases at home and abroad%国内外慢性病基层临床指南现状分析

    Institute of Scientific and Technical Information of China (English)

    蒋品; 唐海沁; 何伟; 张勇

    2015-01-01

    Objective To review the current status of grassroots clinical guidelines of chronic diseases at home and abroad by applying AGREE Ⅱ instrument, and provide reference for developing and formulating grassroots clinical guidelines of chronic diseases in China. Methods The databases of CBM, CNKI, VIP Database, WanFang Database and PubMed, and related websits to issuing and data of guidelines were retrieved from 2008 to 2014. The publushed grassroots clinical guidelines of chronic diseases were included and language was limited in Chinese and English. The names, publishing years and organizations, development methods and quantity of references of included guidelines were descriptively analyzed. Results ①There were totally 11 guidelines included from USA, Australia, Europe and China, and publish years were from 2008 to 2014. ②These guidelines covered hypertension, cardiovascular diseases, diabetes, chronic obstructive pulmonary disease (COPD) and bronchia asthma. ③The quantity of reference was from 0 to 146. ④The average score was, respectively, 88.1%, 50.2%, 31.4%, 90.1%, 49.7%and 38.3%in 6 domains of included guidelines including range and purpose, participants, preciseness, pellucidity, applicability and editor’s independence, and among them, there were 3 domains lower than 50%. All 11 included guidelines did not describe methods and evidence of retrieving and update program. Conclusion ①At present, the grassroots clinical guidelines of chronic diseases are less with slow development and lower quality in the world. ②The grassroots clinical guidelines of chronic diseases and the guidelines for grassroots common diseases including coronary heart disease and COPD are relatively few. It is suggested to develop simple and practical grassroots clinical guidelines of chronic diseases based on learning from foreign experience, aiming at Chinese situations and characteristics of grassroots general clinicians, and regarding prevention and treatment of chronic

  17. Assessment of possible allergenicity of hypothetical ORFs in common food crops using current bioinformatic guidelines and its implications for the safety assessment of GM crops.

    Science.gov (United States)

    Young, Gregory J; Zhang, Shiping; Mirsky, Henry P; Cressman, Robert F; Cong, Bin; Ladics, Gregory S; Zhong, Cathy X

    2012-10-01

    Before a genetically modified (GM) crop can be commercialized it must pass through a rigorous regulatory process to verify that it is safe for human and animal consumption, and to the environment. One particular area of focus is the potential introduction of a known or cross-reactive allergen not previously present within the crop. The assessment of possible allergenicity uses the guidelines outlined by the Food and Agriculture Organization (FAO) and World Health Organization's (WHO) Codex Alimentarius Commission (Codex) to evaluate all newly expressed proteins. Some regulatory authorities have broadened the scope of the assessment to include all DNA reading frames between stop codons across the insert and spanning the insert/genomic DNA junctions. To investigate the utility of this bioinformatic assessment, all naturally occurring stop-to-stop frames in the non-transgenic genomes of maize, rice, and soybean, as well as the human genome, were compared against the AllergenOnline (www.allergenonline.org) database using the Codex criteria. We discovered thousands of frames that exceeded the Codex defined threshold for potential cross-reactivity suggesting that evaluating hypothetical ORFs (stop-to-stop frames) has questionable value for making decisions on the safety of GM crops.

  18. Diagnosing attention-deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations?

    Science.gov (United States)

    Klein, B; Damiani-Taraba, G; Koster, A; Campbell, J; Scholz, C

    2015-03-01

    Children involved with child protection services (CPS) are diagnosed and treated for attention-deficit hyperactivity disorder (ADHD) at higher rates than the general population. Children with maltreatment histories are much more likely to have other factors contributing to behavioural and attentional regulation difficulties that may overlap with or mimic ADHD-like symptoms, including language and learning problems, post-traumatic stress disorder, attachment difficulties, mood disorders and anxiety disorders. A higher number of children in the child welfare system are diagnosed with ADHD and provided with psychotropic medications under a group care setting compared with family-based, foster care and kinship care settings. However, children's behavioural trajectories change over time while in care. A reassessment in the approach to ADHD-like symptoms in children exposed to confirmed (or suspected) maltreatment (e.g. neglect, abuse) is required. Diagnosis should be conducted within a multidisciplinary team and practice guidelines regarding ADHD diagnostic and management practices for children in CPS care are warranted both in the USA and in Canada. Increased education for caregivers, teachers and child welfare staff on the effects of maltreatment and often perplexing relationship with ADHD-like symptoms and co-morbid disorders is also necessary. Increased partnerships are needed to ensure the mental well-being of children with child protection involvement.

  19. International CPR guidelines - perspectives in CPR.

    Science.gov (United States)

    Nolan, Jerry P

    2013-09-01

    The International Liaison Committee on Resuscitation (ILCOR) co-ordinates regular reviews of cardiopulmonary resuscitation (CPR) science and publishes consensus on science statements and treatment recommendations. These outputs are used by international resuscitation organisations to generate clinical guidelines. This review will outline the history behind the development of international CPR guidelines and will provide a detailed description of the current guideline generating process. A perspective is provided on the future of this process and the prospects for completely unified international CPR guidelines.

  20. ADHD Rehabilitation through Video Gaming: A Systematic Review Using PRISMA Guidelines of the Current Findings and the Associated Risk of Bias

    Science.gov (United States)

    Strahler Rivero, Thiago; Herrera Nuñez, Lina Maria; Uehara Pires, Emmy; Amodeo Bueno, Orlando Francisco

    2015-01-01

    Empirical research studies have highlighted the need to investigate whether video game can be useful as a tool within a neuropsychological rehabilitation program for attention deficit hyperactivity disorder (ADHD) patients. However, little is known about the possible gains that this kind of video game-based interventions can produce and even if these gains can be transferred to real life abilities. The present paper aims to uncover key information related to the use of video game in ADHD neuropsychological rehabilitation/intervention by focusing on its gains and its capability to transfer/generalize these gains to real life situation via a systematic review of the empirical literature. The PRISMA guidelines were adopted. Internet-based bibliographic searches were conducted via seven major electronic databases (i.e., PsycARTICLES, PsycINFO, Web of Science, Core Collection BIOSIS Citation Index, MEDLINE, SciELO Citation Index, and PubMed) to access studies examining the association between video game interventions in ADHD patients and behavioral and cognitive outcomes. A total of 14 empirical studies meeting the inclusion criteria were identified. The studies reported the attention, working memory, and the behavioral aspects as the main target of the intervention. Cognitive and behavioral gains were reported after the video game training (VGT). However, many bias related to the choice of outcome instruments, sampling and blindness of assessors, weaken the results power. Additional researches are important to clarify the effects and stability of the VGT programs, and an important effort should be made to construct better methods to assess improvements on everyday cognitive abilities and real world functioning. PMID:26557098

  1. ADHD rehabilitation through video gaming: A systematic review using PRISMA guidelines of the current findings and the associated risk of bias.

    Directory of Open Access Journals (Sweden)

    Thiago eStrahler Rivero

    2015-10-01

    Full Text Available Empirical research studies have highlighted the need to investigate whether video game can be useful as a tool within a neuropsychological rehabilitation program for Attention Deficit Hyperactivity Disorder patients. However, little is known about the possible gains that this kind of video game based interventions can produce and even if these gains can be transferred to real life abilities. The present paper aims to uncover key information related to the use of video game in ADHD neuropsychological rehabilitation/intervention by focusing on its gains and its capability to transfer/generalize these gains to real life situation via a systematic review of the empirical literature. The PRISMA guidelines were adopted. Internet-based bibliographic searches were conducted via seven major electronic databases (i.e., PsycARTICLES, PsycINFO, Web of Science, Core Collection BIOSIS Citation Index, MEDLINE, SciELO Citation Index, and PubMed to access studies examining the association between video game interventions in ADHD patients and behavioral and cognitive outcomes. A total of 14 empirical studies meeting the inclusion criteria were identified. The studies reported the attention, working memory and the behavioral aspects as the main target of the intervention. Cognitive and behavioral gains were reported after the video game training. However, many bias related to the choice of outcome instruments, sampling and blindness of assessors, weaken the results power. Additional researches are important to clarify the effects and stability of the video games training programs, and an important effort should be made to construct better methods to assess improvements on everyday cognitive abilities and real world functioning.

  2. ADHD Rehabilitation through Video Gaming: A Systematic Review Using PRISMA Guidelines of the Current Findings and the Associated Risk of Bias.

    Science.gov (United States)

    Strahler Rivero, Thiago; Herrera Nuñez, Lina Maria; Uehara Pires, Emmy; Amodeo Bueno, Orlando Francisco

    2015-01-01

    Empirical research studies have highlighted the need to investigate whether video game can be useful as a tool within a neuropsychological rehabilitation program for attention deficit hyperactivity disorder (ADHD) patients. However, little is known about the possible gains that this kind of video game-based interventions can produce and even if these gains can be transferred to real life abilities. The present paper aims to uncover key information related to the use of video game in ADHD neuropsychological rehabilitation/intervention by focusing on its gains and its capability to transfer/generalize these gains to real life situation via a systematic review of the empirical literature. The PRISMA guidelines were adopted. Internet-based bibliographic searches were conducted via seven major electronic databases (i.e., PsycARTICLES, PsycINFO, Web of Science, Core Collection BIOSIS Citation Index, MEDLINE, SciELO Citation Index, and PubMed) to access studies examining the association between video game interventions in ADHD patients and behavioral and cognitive outcomes. A total of 14 empirical studies meeting the inclusion criteria were identified. The studies reported the attention, working memory, and the behavioral aspects as the main target of the intervention. Cognitive and behavioral gains were reported after the video game training (VGT). However, many bias related to the choice of outcome instruments, sampling and blindness of assessors, weaken the results power. Additional researches are important to clarify the effects and stability of the VGT programs, and an important effort should be made to construct better methods to assess improvements on everyday cognitive abilities and real world functioning.

  3. Japanese Guideline for Allergic Rhinitis

    OpenAIRE

    Kimihiro Okubo; Yuichi Kurono; Shigeharu Fujieda; Satoshi Ogino; Eiichi Uchio; Hiroshi Odajima; Hiroshi Takenaka; Kohtaro Baba

    2011-01-01

    Like asthma and atopic dermatitis, allergic rhinitis is an allergic disease, but of the three, it is the only type I allergic disease. Allergic rhinitis includes pollinosis, which is intractable and reduces quality of life (QOL) when it becomes severe. A guideline is needed to understand allergic rhinitis and to use this knowledge to develop a treatment plan. In Japan, the first guideline was prepared after a symposium held by the Japanese Society of Allergology in 1993. The current 6th editi...

  4. The Current Recommended Vitamin D Intake Guideline for Diet and Supplements During Pregnancy Is Not Adequate to Achieve Vitamin D Sufficiency for Most Pregnant Women.

    Directory of Open Access Journals (Sweden)

    Fariba Aghajafari

    Full Text Available The aims of this study were to determine if pregnant women consumed the recommended vitamin D through diet alone or through diet and supplements, and if they achieved the current reference range vitamin D status when their reported dietary intake met the current recommendations.Data and banked blood samples collected in second trimester from a subset of 537 women in the APrON (Alberta Pregnant Outcomes and Nutrition study cohort were examined. Frozen collected plasma were assayed using LC-MS/MS (liquid chromatography-tandem mass spectrometry to determine 25(OHD2, 25(OHD3, 3-epi-25(OHD3 concentrations. Dietary data were obtained from questionnaires including a Supplement Intake Questionnaire and a 24-hour recall of the previous day's diet.Participants were 87% Caucasian; mean (SD age of 31.3 (4.3; BMI 25.8 (4.7; 58% were primiparous; 90% had education beyond high school; 80% had a family income higher than CAN $70,000/year. 25(OHD2, 25(OHD3, and 3-epi-25(OHD3 were identified in all of the 537 plasma samples;3-epi-25(OHD3 contributed 5% of the total vitamin D. The median (IQR total 25(OHD (D2+D3 was 92.7 (30.4 nmol/L and 20% of women had 25(OHD concentration 75 nmol/L in some pregnant women who are residing in higher latitudes (Calgary, 51°N in Alberta, Canada and the current vitamin D recommendations for Canadian pregnant women need to be re-evaluated.

  5. Sports-related concussions: diagnosis, complications, and current management strategies.

    Science.gov (United States)

    Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E

    2016-04-01

    Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

  6. EAU guidelines on iatrogenic trauma.

    Science.gov (United States)

    Summerton, Duncan J; Kitrey, Noam D; Lumen, Nicolaas; Serafetinidis, Efraim; Djakovic, Nenad

    2012-10-01

    The European Association of Urology (EAU) Trauma Guidelines Panel presents an updated iatrogenic trauma section of their guidelines. Iatrogenic injuries are known complications of surgery to the urinary tract. Timely and adequate intervention is key to their management. To assess the optimal evaluation and management of iatrogenic injuries and present an update of the iatrogenic section of the EAU Trauma Guidelines. A systematic search of the literature was conducted, consulting Medline and the Cochrane Register of Systematic reviews. No time limitations were applied, although the focus was on more recent publications. The expert panel developed statements and recommendations. Statements were rated according to their level of evidence, and recommendations received a grade following a rating system modified from the Oxford Centre for Evidence-based Medicine. Currently, only limited high-powered studies are available addressing iatrogenic injuries. Because the reporting of complications or sequelae of interventions is now increasingly becoming a standard requirement, this situation will likely change in the future. This section of the trauma guidelines presents an updated overview of the treatment of iatrogenic trauma that will be incorporated in the trauma guidelines available at the EAU Web site (http://www. uroweb.org/guidelines/online-guidelines/). Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  7. Guidelines for Description

    NARCIS (Netherlands)

    Links, P.; Horsman, Peter; Kühnel, Karsten; Priddy, M.; Reijnhoudt, Linda; Merenmies, Mark

    2013-01-01

    The Guidelines follow the conceptual metadata model (deliverable 17.2). They include guidelines for description of collection-holding institutions, document collections, organisations, personalities, events, camps and ghettos. As much as possible the guidelines comply with the descriptive standards

  8. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2015-10-01

    Full Text Available Guidelines for Article Submission SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education.To be considered for publication, the article should be presented in the following system:First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page.Second page and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion.Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1         INTRODUCTION1.1      Subheading of the Content 1.1.1   Subheading of the Content  For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table.For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure.The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples: Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press.Internet source: Andrewes, S. (2003. Group work v. whole-class activities. Retrieved October 1, 2012 from http://www

  9. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2014-03-01

    Full Text Available Guidelines for Article Submission SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education.To be considered for publication, the article should be presented in the following system:First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page.Second page and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion.Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1         INTRODUCTION1.1      Subheading of the content 1.1.1   Subheading of the content  For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table.For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure.The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples: Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press.Internet source: Andrewes, S. (2003. Group work v. whole-class activities. Retrieved October 1, 2012 from http://www

  10. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2014-09-01

    Full Text Available Guidelines for Article Submission SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education.To be considered for publication, the article should be presented in the following system:First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page.Second page and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion.Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1         INTRODUCTION1.1      Subheading of the content 1.1.1   Subheading of the content  For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table.For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure.The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples: Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press.Internet source: Andrewes, S. (2003. Group work v. whole-class activities. Retrieved October 1, 2012 from http://www

  11. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2016-03-01

    Full Text Available Guidelines for Article Submission SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education. To be considered for publication, the article should be presented in the following system: First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page. Second p age and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion. Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1 INTRODUCTION 1.1 Subheading of the Content 1.1.1 Subheading of the Content For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table. For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure. The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples:   Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press. Internet source: Andrewes, S. (2003. Group work v. whole-class activities. Retrieved October 1, 2012 from http://www.teachingenglish.org

  12. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Yunisrina Qismullah Yusuf

    2015-03-01

    Full Text Available Guidelines for Article Submission SiELE journal accepts articles on research and development in the field of teaching and learning of English, linguistics, educational development, policy and cultural studies in education. To be considered for publication, the article should be presented in the following system: First page: include a title page with the full title of the paper (must not exceed 16 words, the author(s’ name(s, affiliation(s, phone number(s and e-mail address of the corresponding author. A brief bio-data of the author(s (maximum of 100 words is provided in this page. Second page and subsequent page: Submissions should be between 4000-6000 (including abstract, table(s, figure(s and references in A4 size paper with margins as the following: top 3 cm, bottom 3 cm, right 2.5 cm and left 4 cm. The font is Times New Roman, size 12 and single spaced. The article should generally consist of the following sections: introduction, review of literature, method, findings, discussion and conclusion. Headings and subheadings should be presented as follows (provide a space between the headings and sub-headings. 1 INTRODUCTION 1.1 Subheading of the content 1.1.1 Subheading of the content For Tables, the title size is 12 and the content size is 10. Please number the tables subsequently throughout your article and the title is written above the table. For Figures, the title size is 12 and the content size (if any is 10. Please number the figures subsequently throughout your article and the title is written below the figure. The reference list should be arranged alphabetically following the guidelines of the Publication Manual of the American Psychological Association (5th ed.. See the following examples: Back Matter| 79 80 | STUDIES IN ENGLISH LANGUAGE AND EDUCATION, Volume 1, Number 1, March 2014 Book: Ellis, R. (2003. Task-based language learning and teaching. Oxford: Oxford University Press. Internet source: Andrewes, S. (2003. Group work v

  13. Editorial: can China master the guideline challenge?

    Directory of Open Access Journals (Sweden)

    Yang Kehu

    2013-01-01

    Full Text Available Abstract China is experiencing increased health care use and expenditures, without sufficient controls to ensure quality and value. Transparent, cost-conscious and patient-centered guidelines based on the best available evidence could help establishing these quality and practice measures. We examined how guidelines could support the Chinese health reform. Specifically, we summarized the current state of the art and related challenges in guideline development and explored possible solutions in the context of the Chinese health reform. China currently lacks capacity for evidence-based guideline development and coordination by a central agency. Most Chinese guideline users rely on recommendations developed by professional groups that lack demonstration of transparency (including conflict of interest management and evidence synthesis and quality. These deficiencies appear larger than in other regions of the world. In addition, misperceptions about the role of guidelines in assisting practitioners as opposed to providing rules requiring adherence, and a perception that traditional Chinese medicine (TCM cannot be appropriately incorporated in guidelines are present. China’s capacity could be strengthened by a central guideline agency to provide or coordinate evidence synthesis for guideline development and to oversee the work of guideline developers. China can build on what is known and work with the international community to develop methods to meet the challenges of evidence-based guideline development.

  14. [Preoperative fasting guidelines: an update].

    Science.gov (United States)

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

    2015-03-01

    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Are current UK National Institute for Health and Clinical Excellence (NICE) obesity risk guidelines useful? Cross-sectional associations with cardiovascular disease risk factors in a large, representative English population.

    Science.gov (United States)

    Tabassum, Faiza; Batty, G David

    2013-01-01

    The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35-97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women.

  16. [AWMF-guideline: disorders related to cannabis].

    Science.gov (United States)

    Bonnet, U; Harries-Hedder, K; Leweke, F M; Schneider, U; Tossmann, P

    2004-06-01

    Actually, guidelines for treatment of substance-related disorders were written under the overall control of the DG-Sucht e. V. and the DGPPN e. V. This appears within the framework of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaft (AWMF). The leading objective of these guidelines is the description of the current scientifically proven and evidence-based medicine in addiction to derive recommendations to therapy. In this context, the guideline for treatment of cannabis-related disorders is introduced.

  17. [Update on current care guidelines: ovarian cancer].

    Science.gov (United States)

    Leminen, Arto; Auranen, Annika; Bützow, Ralf; Hietanen, Sakari; Komulainen, Marja; Kuoppala, Tapio; Mäenpää, Johanna; Puistola, Ulla; Vuento, Maarit; Vuorela, Piia; Yliskoski, Merja

    2012-01-01

    Ovarian cancer is the most lethal gynaecological cancer. It appears that seemingly ovarian or primary peritoneal carcinomas, in fact, originate from fimbriae. BRCA1/2 mutation carriers are recommended for the removal of ovaries and fimbriae, to reduce the risk of cancer. Treatment of epithelial ovarian cancer is based on the combination of surgery and chemotherapy. The residual tumour volume at the primary operation is the most important predictive factor of survival. The best response at the primary treatment is observed with combination chemotherapy with taxane and platinum. Adding bevacitzumab to first line chemotherapy may improve survival.

  18. Current guidelines in defining therapeutic strategies.

    Science.gov (United States)

    Ferrajoli, Alessandra; Keating, Michael J

    2004-08-01

    The past three decades have brought major changes in the approach toward chronic lymphocytic leukemia (CLL). This disease was considered a simple form of leukemia for which the only goal of treatment was control of the leukocytosis and of the symptoms related to disease expansion. Many biologic discoveries have increased our understanding of the disease process. New prognostic markers have been identified and are being incorporated into clinical practice. Now, CLL is considered a complex and challenging leukemia for which multiple treatment options are emerging, from chemotherapy to monoclonal antibodies, from vaccines to immunomodulatory strategies. The evaluation of treatment results also has been revolutionized: clones carrying genetic aberrations are monitored, and patients who have had a response are assessed for the presence of minimal residual disease.

  19. [Update on current care guidelines. Neck pain].

    Science.gov (United States)

    2009-01-01

    Neck pain is very common. Age, female gender, obesity, and several physical and psychological work related factors increase the risk while physical activity appears to decrease it. Non-specific neck pain is most common but serious or specific illness must be ruled out and neural compression identified. Patients are encouraged to remain active and improve their ergonomics. Acute neck pain often disappears without any special treatment. Paracetamol is the primary pain medication. Multidisciplinary treatment is recommended if disabling pain has lasted for two months, and intensive muscle exercises in chronic neck pain. Progressive muscle weakness and myelopathy indicate a surgical assessment.

  20. [Update on Current Care Guideline: Headache (children)].

    Science.gov (United States)

    HämäläInen, Mirja; Katri, Laimi; Laukkala, Tanja; Nokelainen, Pekka; Raisio, Mikael; Rantala, Heikki; Aanttila, Pirjo; Sätilä, Heli

    2016-01-01

    The majority of children with recurrent headaches can be effectively treated in the primary health care. Paracetamol and ibuprofen are the recommended first-line pain medications. Limited evidence is available on the effectiveness of triptans in children and adolescents. However, nasal sumatriptan and possibly oral rizatriptan and nasal zolmitriptan can be considered for children and adolescents, as well as oral almotriptan for adolescents. Propranolol is the first-line prophylactic medication for migraine.

  1. Current Consensus Guidelines for Treatment of Neurocysticercosis

    Science.gov (United States)

    García, Hector H.; Evans, Carlton A. W.; Nash, Theodore E.; Takayanagui, Osvaldo M.; White, A. Clinton; Botero, David; Rajshekhar, Vedantam; Tsang, Victor C. W.; Schantz, Peter M.; Allan, James C.; Flisser, Ana; Correa, Dolores; Sarti, Elsa; Friedland, Jon S.; Martinez, S. Manuel; Gonzalez, Armando E.; Gilman, Robert H.; Del Brutto, Oscar H.

    2002-01-01

    Taenia solium neurocysticercosis is a common cause of epileptic seizures and other neurological morbidity in most developing countries. It is also an increasingly common diagnosis in industrialized countries because of immigration from areas where it is endemic. Its clinical manifestations are highly variable and depend on the number, stage, and size of the lesions and the host's immune response. In part due to this variability, major discrepancies exist in the treatment of neurocysticercosis. A panel of experts in taeniasis/cysticercosis discussed the evidence on treatment of neurocysticercosis for each clinical presentation, and we present the panel's consensus and areas of disagreement. Overall, four general recommendations were made: (i) individualize therapeutic decisions, including whether to use antiparasitic drugs, based on the number, location, and viability of the parasites within the nervous system; (ii) actively manage growing cysticerci either with antiparasitic drugs or surgical excision; (iii) prioritize the management of intracranial hypertension secondary to neurocysticercosis before considering any other form of therapy; and (iv) manage seizures as done for seizures due to other causes of secondary seizures (remote symptomatic seizures) because they are due to an organic focus that has been present for a long time. PMID:12364377

  2. [Update on Current Care Guideline: Sinusitis].

    Science.gov (United States)

    Hytönen, Maija; Nokso-Koivisto, Johanna; Huovinen, Pentti; Ilkko, Eero; Jousimaa, Jukkapekka; Kivistö, Juho; Korppi, Matti; Liira, Helena; Malmivaara, Antti; Numminen, Jura; Pirilä, Tapio

    2013-01-01

    Patients with common cold have often symptoms similar to sinusitis. These symptoms often resolve in time, but symptomatic treatment (e.g. analgesics, decongestants) may be used. If symptoms continue for over 10 days, or severe symptoms continue for over 3 days, or symptoms turn worse in the course of the disease, bacterial sinusitis should be suspected. Diagnosis is based on clinical findings, and can be confirmed with ultrasound examination. Amoxicillin, penicillin or doxicyclin are recommended for bacterial sinusitis. Patients with chronic or recurrent sinusitis should be referred to specialist care.

  3. EAU guidelines on primary urethral carcinoma

    NARCIS (Netherlands)

    Gakis, G.; Witjes, J.A.; Comperat, E.; Cowan, N.C.; Santis, M. de; Lebret, T.; Ribal, M.J.; Sherif, A.M.

    2013-01-01

    CONTEXT: The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). OBJECTIVE: To review the curre

  4. EAU guidelines on primary urethral carcinoma

    NARCIS (Netherlands)

    Gakis, G.; Witjes, J.A.; Comperat, E.; Cowan, N.C.; Santis, M. de; Lebret, T.; Ribal, M.J.; Sherif, A.M.

    2013-01-01

    CONTEXT: The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). OBJECTIVE: To review the curre

  5. [Elaboration and critical evaluation of clinical guidelines].

    Science.gov (United States)

    García Villar, C

    2015-11-01

    Clinical guidelines are documents to help professionals and patients select the best diagnostic or therapeutic option. Elaborating guidelines requires an efficient literature search and a critical evaluation of the articles found to select the most appropriate ones. After that, the recommendations are formulated and then must be externally evaluated before they can be disseminated. Even when the guidelines are very thorough and rigorous, it is important to know whether they fulfill all the methodological requisites before applying them. With this aim, various scales have been developed to critically appraise guidelines. Of these, the AGREE II instrument is currently the most widely used. This article explains the main steps in elaborating clinical guidelines and the main aspects that should be analyzed to know whether the guidelines are well written.

  6. Development of clinical practice guidelines.

    Science.gov (United States)

    Hollon, Steven D; Areán, Patricia A; Craske, Michelle G; Crawford, Kermit A; Kivlahan, Daniel R; Magnavita, Jeffrey J; Ollendick, Thomas H; Sexton, Thomas L; Spring, Bonnie; Bufka, Lynn F; Galper, Daniel I; Kurtzman, Howard

    2014-01-01

    Clinical practice guidelines (CPGs) are intended to improve mental, behavioral, and physical health by promoting clinical practices that are based on the best available evidence. The American Psychological Association (APA) is committed to generating patient-focused CPGs that are scientifically sound, clinically useful, and informative for psychologists, other health professionals, training programs, policy makers, and the public. The Institute of Medicine (IOM) 2011 standards for generating CPGs represent current best practices in the field. These standards involve multidisciplinary guideline development panels charged with generating recommendations based on comprehensive systematic reviews of the evidence. The IOM standards will guide the APA as it generates CPGs that can be used to inform the general public and the practice community regarding the benefits and harms of various treatment options. CPG recommendations are advisory rather than compulsory. When used appropriately, high-quality guidelines can facilitate shared decision making and identify gaps in knowledge.

  7. Inventory of Cancer Guidelines: a tool to advance the guideline enterprise and improve the uptake of evidence.

    Science.gov (United States)

    Brouwers, Melissa C; Rawski, Ellen; Spithoff, Karen; Oliver, Thomas K

    2011-04-01

    The Inventory of Cancer Guidelines (ICG) was designed to mitigate challenges associated with inconsistencies in the quality of cancer guidelines, keeping guidelines current and the duplication of effort in guideline development. The ICG is a searchable database of quality-appraised guidelines in cancer control that also includes designations of guidelines in progress, those in need of an update and those currently being updated. From a clinical perspective, the majority of the completed guidelines target breast, lung, colorectal and prostate cancers, and focus on the treatment stage of the cancer continuum. There is considerable variability in guideline quality both within and across guideline developers, as measured by the Appraisal of Guidelines for Research and Evaluation II. Quality domains of applicability and editorial independence are the guideline quality domains that score the poorest. While the ability to inform on the status of cancer control guidelines is important, the real potential of the ICG is in its ability to leverage positive change in the guideline enterprise. Pilot projects are underway to use data from the ICG to tailor audit and feedback interventions for guideline developers and to pursue collaborative updating and guideline adaptation initiatives, using the ICG as the platform from which these partnerships can evolve.

  8. Current assessment of the effects of environmental chemicals on the mammary gland in guideline rodent studies by the U.S. Environmental Protection Agency (U.S. EPA), Organisation for Economic Co-operation and Development (OECD), and National Toxicology Program (NTP).

    Science.gov (United States)

    Makris, Susan L

    2011-08-01

    Evaluation of the structural and/or functional integrity of the mammary gland (MG) across life stages is integral to the assessment of developmental, reproductive, and carcinogenic risk for environmental chemicals. In this commentary I characterize MG assessment recommended in U.S. Environmental Protection Agency, Organisation for Economic Co-operation and Development, and National Toxicology Program guideline toxicology study protocols and identify any information gaps for the evaluation of MG development, structure, and function. Several data gaps, issues, and challenges were identified. Current guidelines that include a lactation phase do not provide specific recommendations to record observations on maternal or offspring lactation or nursing behavior. In guideline studies, the assessment of MG toxicity often relies upon indirect, nonspecific, or surrogate end points, and information that could be useful in the interpretation of these data (e.g., mode of action or toxicokinetics) is often unavailable. Most guideline studies designed to assess general organ toxicity do not expose test animals during sensitive stages of MG development; histopathological evaluation of the developing MG is not routinely conducted; and evaluation of MG tissue for both sexes is inconsistently recommended. I propose the following general recommendations to enhance MG assessment in guideline toxicology studies: a) inclusion of more specific criteria for the evaluation of MG end points in guideline language, b) inclusion of histopathological evaluation of MG development (using whole-mount techniques) in existing or new guideline protocols that include offspring with perinatal and/or pubertal treatment, c) incorporation of perinatal exposures into rodent subchronic and carcinogenicity assays, and d) expansion of the histopathological evaluation of male MG tissue.

  9. 5 CFR 1312.10 - Systematic review guidelines.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Systematic review guidelines. 1312.10... Declassification of National Security Information § 1312.10 Systematic review guidelines. The EOP Security Officer will prepare and keep current such guidelines as are required by Executive Order 12958 for...

  10. Treatment Guidelines for Children and Adolescents with Bipolar Disorder

    Science.gov (United States)

    Kowatch, Robert A.; Fristad, Mary; Birmaher, Boris; Wagner, Karen Dineen; Findling, Robert L.; Hellander, Martha

    2005-01-01

    Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute…

  11. Updated guidelines on digital media use by children.

    Science.gov (United States)

    Licata, Joseph Isaac; Baker, Amy Elizabeth

    2017-04-01

    Given the speed at which mobile media has grown recently, the updated American Academy of Pediatrics guidelines for digital technology use by children are a welcome addition to the toolbox of pediatric healthcare providers. This article discusses the changes to the guidelines as well as other useful current research not specifically included in those guidelines.

  12. EAU guidelines on chronic pelvic pain.

    Science.gov (United States)

    Fall, Magnus; Baranowski, Andrew P; Elneil, Sohier; Engeler, Daniel; Hughes, John; Messelink, Embert J; Oberpenning, Frank; de C Williams, Amanda C

    2010-01-01

    These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice. To revise guidelines for the diagnosis, therapy, and follow-up of CPP patients. Guidelines were compiled by a working group and based on a systematic review of current literature using the PubMed database, with important papers reviewed for the 2003 EAU guidelines as a background. A panel of experts weighted the references. The full text of the guidelines is available through the EAU Central Office and the EAU Web site (www.uroweb.org). This article is a short version of the full guidelines text and summarises the main conclusions from the guidelines on the management of CPP. A guidelines text is presented including chapters on chronic prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecologic practice, neurogenic dysfunctions, the role of the pelvic floor and pudendal nerve, psychological factors, general treatment of CPP, nerve blocks, and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from CPP.

  13. The comparison of current and previous (2002) editions of American clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome%美国新版《儿童睡眠呼吸暂停综合征诊治指南》与2002版指南的比较

    Institute of Scientific and Technical Information of China (English)

    邓力; 印根权

    2013-01-01

    2012年8月27日,美国儿科学会杂志在线发布了新版,意在指导初级保健医师对儿童青少年OSAS的诊断与治疗.自从前一版 (2002版) 指南发表后,有关OSAS研究的文献质量有明显提高.新版指南是在参考1999至2010年间发表的3 166篇文献中的350篇文献相关数据基础上所制定的.本文主要比较新版指南与2002版的不同,以及十年间对儿童OSAS认识的变化.%The current clinical practice guideline, diagnosis and management of childhood obstructive sleep apnea syndrome (OSAS), was issued in Pediatrics on line by American academy of pediatrics on August 27th, 2012. This revised guideline, intended for use by primary earc clinicians, provides recommesdations for the diagnosis and management of OSAS in children and adolescents. Since the previous guideline (version 2002) was published, studies of OSAS have bees improved significantly. The current guideline was formulated according to the relevant data from 350 of 3166 articles published from 1999 to 2010. What are the differences between the two guidelines? What are the greatest changes in cbildhood OSAS in the past 10 years? This article will focus on the comparison between these two guidelines.

  14. CORRELATION OF MRI GRADING OF BONE STRESS INJURIES WITH CLINICAL RISK FACTORS AND RETURN TO PLAY: A 5-YEAR PROSPECTIVE STUDY IN COLLEGIATE TRACK AND FIELD ATHLETES

    Science.gov (United States)

    Nattiv, Aurelia; Kennedy, Gannon; Barrack, Michelle T.; Abdelkerim, Ashraf; Goolsby, Marci A.; Arends, Julie C.; Seeger, Leanne L.

    2015-01-01

    Background Bone stress injuries are common in track and field athletes. Knowledge of risk factors and correlation of these to magnetic resonance imaging (MRI) grading could be helpful in determining recovery time. Purpose To examine the relationships between MRI grading of bone stress injury with clinical risk factors and time to return to sport in collegiate track and field athletes. Study Design Prospective cohort over 5 years. Methods Two hundred and eleven male and female collegiate track and field and cross-country athletes were followed prospectively through their competitive seasons. All athletes had a pre-participation history, physical exam, and anthropometric measurements obtained annually. An additional questionnaire was completed regarding nutritional behaviors, menstrual patterns and prior injuries, as well as a 3-day diet record. Dual energy X-ray absorptiometry was obtained at baseline and each year of participation in the study. Athletes with clinical evidence of bone stress injuries had plain radiographs. If radiographs were negative, MRI was obtained. Bone stress injuries were evaluated by two independent radiologists utilizing an MRI grading system. MRI grading and risk factors were evaluated to identify predictors of time to return to sport. Results Thirty-four (12 males, 22 females) of the 211 collegiate athletes sustained 61 bone stress injuries during the 5-year study period. The average prospective assessment for participants was 2.1 years. MRI grade and total body bone mineral density (BMD) emerged as significant and independent predictors of time to return to sport in the multiple regression model. Specifically, the higher the MRI grade, the longer the recovery time (psport. Conclusions Higher MRI grade, lower BMD, and skeletal sites of predominant trabecular bone structure were independently associated with delayed recovery of bone stress injuries in track and field athletes. Knowledge of these risk factors, as well as nutritional and menstrual factors, can be clinically useful in determining time to return to sport. PMID:23825184

  15. Conservative management of posterior interosseous neuropathy in an elite baseball pitcher's return to play: a case report and review of the literature.

    Science.gov (United States)

    Robb, Andrew; Sajko, Sandy

    2009-12-01

    This report documents retrospectively a case of Posterior Interosseous Neuropathy (PIN) occurring in an elite baseball pitcher experiencing a deep ache in the radial aspect of the forearm and altered sensation in the dorsum of the hand on the throwing arm during his pitching motion. The initial clinical goal was to control for inflammation to the nerve and muscle with active rest, microcurrent therapy, low-level laser therapy, and cessation of throwing. Minimizing mechanosensitivity at the common extensor region of the right elbow and PIN, was achieved by employing the use of myofascial release and augmented soft tissue mobilization techniques. Neurodynamic mobilization technique was also administered to improve neural function. Implementation of a sport specific protocol for the purposes of maintaining throwing mechanics and overall conditioning was utilized. Successful resolution of symptomatology and return to pre-injury status was achieved in 5 weeks. A review of literature and an evidence-based discussion for the differential diagnoses, clinical examination, diagnosis, management and rehabilitation of PIN is presented.

  16. FROM ACUTE ACHILLES TENDON RUPTURE TO RETURN TO PLAY – A CASE REPORT EVALUATING RECOVERY OF TENDON STRUCTURE, MECHANICAL PROPERTIES, CLINICAL AND FUNCTIONAL OUTCOMES

    Science.gov (United States)

    Zellers, Jennifer A.; Cortes, Daniel H.

    2016-01-01

    Introduction Achilles tendon rupture results in significant functional deficits regardless of treatment strategy (surgical versus non-surgical intervention). Recovery post-rupture is highly variable, making comprehensive patient assessment critical. Assessment tools may change along the course of recovery as the patient progresses – for instance, moving from a seated heel-rise to standing heel-rise to jump testing. However, tools that serve as biomarkers for early recovery may be particularly useful in informing clinical decision-making. The purpose of this case report was to describe the progress of a young, athletic individual following Achilles tendon rupture managed non-surgically, using patient reported and functional performance outcome measures and comprehensively evaluating Achilles tendon structure and function incorporating a novel imaging technique (cSWE). Subject Description The subject is a 26 year-old, female basketball coach who sustained an Achilles tendon rupture and was managed non-surgically. Outcome The subject was able to steadily progress using a gradual tendon loading treatment approach well-supported by the literature. Multiple evaluative techniques including the addition of diagnostic ultrasound imaging and continuous shear wave elastography (cSWE) to standard clinical tests and measures were used to assess patient-reported symptoms, tendon structure, and tendon functional performance. Five assessments were performed over the course of 2-14 months post-rupture. By the 14-month follow-up, the subject had achieved full self-reported function. Tendon structural and mechanical properties showed similar shear modulus by 14 months, however, viscosity continued to be lower and tendon length longer on the ruptured side. Functional performance, evidenced by the heel-rise test and jump tests, also showed a positive trajectory, however, deficits of 12-28% remained between ruptured and non-ruptured sides at 14 months. Discussion This case report outlines comprehensive outcomes assessment in an athletic individual following non-surgically managed Achilles tendon rupture using a wide variety of tools that capture different aspects of tendon health. Interestingly, the course of recovery of patient symptoms, functional performance, and tendon structure do not occur in the same time frame. Therefore, it is important to assess patient outcomes using multiple outcome measures encompassing different aspects of patient performance to ensure the patient is progressing steadily with rehabilitation. Level of Evidence Level 4. PMID:27999728

  17. Correlation of MRI grading of bone stress injuries with clinical risk factors and return to play: a 5-year prospective study in collegiate track and field athletes.

    Science.gov (United States)

    Nattiv, Aurelia; Kennedy, Gannon; Barrack, Michelle T; Abdelkerim, Ashraf; Goolsby, Marci A; Arends, Julie C; Seeger, Leanne L

    2013-08-01

    Bone stress injuries are common in track and field athletes. Knowledge of risk factors and correlation of these to magnetic resonance imaging (MRI) grading could be helpful in determining recovery time. To examine the relationships between MRI grading of bone stress injuries with clinical risk factors and time to return to sport in collegiate track and field athletes. Cohort study (prognosis); Level of evidence, 2. A total of 211 male and female collegiate track and field and cross-country athletes were followed prospectively through their competitive seasons. All athletes had preparticipation history, physical examination, and anthropometric measurements obtained annually. An additional questionnaire was completed regarding nutritional behaviors, menstrual patterns, and prior injuries, as well as a 3-day diet record. Dual-energy X-ray absorptiometry was performed at baseline and each year of participation in the study. Athletes with clinical evidence of bone stress injuries had plain radiographs. If radiograph findings were negative, MRI was performed. Bone stress injuries were evaluated by 2 independent radiologists utilizing an MRI grading system. The MRI grading and risk factors were evaluated to identify predictors of time to return to sport. Thirty-four of the athletes (12 men, 22 women) sustained 61 bone stress injuries during the 5-year study period. The mean prospective assessment for participants was 2.7 years. In the multiple regression model, MRI grade and total-body bone mineral density (BMD) emerged as significant and independent predictors of time to return to sport. Specifically, the higher the MRI grade (P = .004) and lower the BMD (P = .030), the longer the recovery time. Location of the bone injury at predominantly trabecular sites of the femoral neck, pubic bone, and sacrum was also associated with a prolonged time to return to sport. Female athletes with oligomenorrhea and amenorrhea had bone stress injuries of higher MRI grades compared with eumenorrheic athletes (P = .009). Higher MRI grade, lower BMD, and skeletal sites of predominant trabecular bone structures were associated with a delayed recovery of bone stress injuries in track and field athletes. Knowledge of these risk factors, as well as nutritional and menstrual factors, can be clinically useful in determining injury severity and time to return to sport.

  18. Multiple muscle tear after fall on buttock-role of conservative management and exercise for early recovery and return to play.

    Science.gov (United States)

    Adhau, Rajesh; Angrish, Piyush; Ahuja, Ashok; Sandhu, Avtar Singh

    2014-04-01

    to describe role of alternative management as an approach to management and rehabilitation of multiple hip muscles tears by the use of 1 RM (Repetition Maximum) testing and hip muscle strengthening program along with the use of sports specific drills for rehabilitation and recovery. There is very limited literature describing multiple hip muscle tears and the conservative management of the same. 1RM testing and strengthening of hip muscles is an approach that is able to help in the return to sports of an athlete without surgical intervention. the patient, is a 21-year-old male hockey player who presented with pain right buttock, right lower leg and a limp on the right side while walking. Physical examination revealed a positive Trendelenburg sign both in stance and gait phase. Hip rotational movements showed a normal range of motion, there was a severe pain in the right buttock on movements which he described at 8/10 on VAS (Visual Analogue Scale). Strength assessment revealed weakness of the right hip flexors and extensors and also of the abductor and external hip rotator muscles. Treatment protocol followed was based on 1 RM testing of muscles and hip strengthening exercises and sports specific drills. following the intervention, the patient reported pain at 0/10 VAS while doing all activities and also showed good muscle control with no limp. this highlights an alternative protocol for treating multiple hip muscle tears and illustrates the importance of 1 RM testing as a part of examination and sports medicine intervention.

  19. Managing Ulcerative Colitis – The Guidelines and Beyond

    Directory of Open Access Journals (Sweden)

    Mitchell RKL Lie

    2013-11-01

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

  20. Assessing the perceived quality of brachial artery Flow Mediated Dilation studies for inclusion in meta-analyses and systematic reviews: Description of data employed in the development of a scoring ;tool based on currently accepted guidelines

    Directory of Open Access Journals (Sweden)

    Arno Greyling

    2016-09-01

    Full Text Available Brachial artery Flow Mediated Dilation (FMD is widely used as a non-invasive measure of endothelial function. Adherence to expert consensus guidelines on FMD measurement has been found to be of vital importance to obtain reproducible data. This article lists the literature data which was considered in the development of a tool to aid in the objective judgement of the extent to which published studies adhered to expert guidelines for FMD measurement. Application of this tool in a systematic review of FMD studies (http://dx.doi.org/10.1016/j.atherosclerosis.2016.03.011 (Greyling et al., 2016 [1] indicated that adherence to expert consensus guidelines is strongly correlated to the reproducibility of FMD data.

  1. Public informations guidelines

    Energy Technology Data Exchange (ETDEWEB)

    None

    1986-06-01

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

  2. Current role of MDCT in the diagnosis of coronary artery disease (2011). A clinical guideline of the Austrian Societies of Cardiology and Radiology; Aktueller Stellenwert der MSCTA in der Koronargefaessdiagnostik (2011). Klinischer Leitfaden der Oesterreichischen Gesellschaften fuer Kardiologie und Radiologie

    Energy Technology Data Exchange (ETDEWEB)

    Hergan, K. [Salzburger Landeskliniken, Paracelsus Medizinische Privatuniv. (Austria). Universitaetsinst. fuer Radiologie; Globits, S. [Landesklinikum St. Poelten (Austria). 3. Medizinische Abt./Kardiologie; Loewe, C. [Medizinische Univ. Wien (AT). Universitaetsklinik fuer Radiodiagnostik] (and others)

    2011-10-15

    The clinical guideline of the Austrian Societies for Cardiology and Radiology on the actual role of MDCT in the diagnosis of coronary artery diseases includes the following issues: CT calcium scoring; CT angiography (CTA) of the coronaries; actually recommended application of MDCR; generally inappropriate use of the technique for specific patients; radiation exposure; structural and organizational framework.

  3. After Guidelines, What?

    Directory of Open Access Journals (Sweden)

    Dennis M Bowie

    2004-01-01

    Full Text Available In a recent survey, Canadian Thoracic Society (CTS members indicated that they feel our association should be involved in the production of guidelines (1. There is evidence in the literature that suggests guidelines can have some effect in changing behaviour, although this is variable and modest at best. Certainly, the production of guidelines is not without costs, particularly in time spent by experts in reviewing the literature and producing them. For good reasons, delays frequently occur in their production, often leading to recommendations that may be outdated. People sometimes forget that one of the most important reasons for producing guidelines is to identify questions that require future research.

  4. American Clinical Neurophysiology Society Guideline 7: Guidelines for EEG Reporting.

    Science.gov (United States)

    Tatum, William O; Olga, Selioutski; Ochoa, Juan G; Munger Clary, Heidi; Cheek, Janna; Drislane, Frank; Tsuchida, Tammy N

    2016-08-01

    This EEG Guideline incorporates the practice of structuring a report of results obtained during routine adult electroencephalography. It is intended to reflect one of the current practices in reporting an EEG and serves as a revision of the previous guideline entitled "Writing an EEG Report." The goal of this guideline is not only to convey clinically relevant information, but also to improve interrater reliability for clinical and research use by standardizing the format of EEG reports. With this in mind, there is expanded documentation of the patient history to include more relevant clinical information that can affect the EEG recording and interpretation. Recommendations for the technical conditions of the recording are also enhanced to include post hoc review parameters and type of EEG recording. Sleep feature documentation is also expanded upon. More descriptive terms are included for background features and interictal discharges that are concordant with efforts to standardize terminology. In the clinical correlation section, examples of common clinical scenarios are now provided that encourages uniformity in reporting. Including digital samples of abnormal waveforms is now readily available with current EEG recording systems and may be beneficial in augmenting reports when controversial waveforms or important features are encountered.

  5. [Management of hypertension (ESC Guideline 2007/DHL Guideline 2008)].

    Science.gov (United States)

    Krauss, Timothy; Schunkert, Heribert

    2009-02-01

    The 2007 ESH/ESC (European Society of Hypertension/European Society of Cardiology) guidelines for the management of arterial hypertension focus on the individual patient with his specific cardiovascular risk profile. The existing hypertension classification remains the same as in previous editions. However, specific patient characteristics and risk profiles require a more individualized approach. Recommended diagnostic procedures have been extended in order to detect existing subclinical organ damage and/or established cardiovascular or renal diseases at an early stage. Urgency and mode of therapeutic approach can directly be derived from the relevant risk stratification matrix which continues to be an integral component of the current guidelines. The primary goal of treatment of the hypertensive patient is to achieve a maximum reduction in the long-term total risk of cardiovascular morbidity and mortality. Since blood pressure lowering per se is thought to be of major importance to achieve these goals, a number of well-established pharmaceutical substances remain at hand of the practitioner. In addition, lifestyle changes are increasingly regarded to be of high importance. In patients with established comorbidities and in young subjects the choice of a specific pharmaceutical substance class is fundamental. The gap between guideline recommendations and poor blood pressure control in medical practice remains and needs to be closed. Therefore, a collective striving of all parties involved for early detection and effective treatment is needed to overcome the current and future burden of arterial hypertension.

  6. DIMA – Annotation guidelines for German intonation

    DEFF Research Database (Denmark)

    Kügler, Frank; Smolibocki, Bernadett; Arnold, Denis

    2015-01-01

    easier since German intonation is currently annotated according to different models. To this end, we aim to provide guidelines that are easy to learn. The guidelines were evaluated running an inter-annotator reliability study on three different speech styles (read speech, monologue and dialogue......This paper presents newly developed guidelines for prosodic annotation of German as a consensus system agreed upon by German intonologists. The DIMA system is rooted in the framework of autosegmental-metrical phonology. One important goal of the consensus is to make exchanging data between groups...

  7. Japanese Guideline for Allergic Rhinitis 2014

    OpenAIRE

    Kimihiro Okubo; Yuichi Kurono; Shigeharu Fujieda; Satoshi Ogino; Eiichi Uchio; Hiroshi Odajima; Hiroshi Takenaka

    2014-01-01

    Like asthma and atopic dermatitis, allergic rhinitis is an allergic disease, but of the three, it is the only type I allergic disease. Allergic rhinitis includes pollinosis, which is intractable and reduces quality of life (QOL) when it becomes severe. A guideline is needed to understand allergic rhinitis and to use this knowledge to develop a treatment plan. In Japan, the first guideline was prepared after a symposium held by the Japanese Society of Allergology in 1993. The current 7th editi...

  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

  9. Engineering Technology Curriculum Guidelines

    Science.gov (United States)

    Gershon, J. J.

    1977-01-01

    Summarizes curriculum guidelines for the following engineering technologies: chemical, industrial, mining, petroleum, nuclear, civil, mechanical, electrical, automotive, and manufacturing. In a few years, these Engineering Council for Professional Development committee guidelines are intended to become the criteria by which programs will be judged…

  10. Measure Guideline: Ventilation Cooling

    Energy Technology Data Exchange (ETDEWEB)

    Springer, D.; Dakin, B.; German, A.

    2012-04-01

    The purpose of this measure guideline on ventilation cooling is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  11. Measure Guideline: Ventilation Cooling

    Energy Technology Data Exchange (ETDEWEB)

    Springer, D. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); Dakin, B. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); German, A. [Alliance for Residential Building Innovation (ARBI), David, CA (United States)

    2012-04-01

    The purpose of this measure guideline is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.

  12. D 59 Design Guidelines

    DEFF Research Database (Denmark)

    Burcharth, Hans F.; Lamberti, Alberto

    The present guidelines are specifically dedicated to Low Crested Structures on attempt to provide methodological tools both for the engineering design of structures and for prediction of performance and environmental impacts. It is anticipated that the guidelines will provide valuable inputs to c...

  13. Nonstructural seismic restraint guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Butler, D.M.; Czapinski, R.H.; Firneno, M.J.; Feemster, H.C.; Fornaciari, N.R.; Hillaire, R.G.; Kinzel, R.L.; Kirk, D.; McMahon, T.T.

    1993-08-01

    The Nonstructural Seismic Restraint Guidelines provide general information about how to secure or restrain items (such as material, equipment, furniture, and tools) in order to prevent injury and property, environmental, or programmatic damage during or following an earthquake. All SNL sites may experience earthquakes of magnitude 6.0 or higher on the Richter scale. Therefore, these guidelines are written for all SNL sites.

  14. Maintenance Trades Guidelines

    Science.gov (United States)

    Weidner, Theodore J.

    2008-01-01

    In 2002, APPA published "Maintenance Staffing Guidelines for Educational Facilities," the first building maintenance trades staffing guideline designed to assist educational facilities professionals with their staffing needs. addresses how facilities professionals can determine the appropriate size and mix of their organization. Contents…

  15. Evidence-based guidelines

    DEFF Research Database (Denmark)

    Rovira, Àlex; Wattjes, Mike P; Tintoré, Mar

    2015-01-01

    diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal...

  16. D 59 Design Guidelines

    DEFF Research Database (Denmark)

    Burcharth, Hans F.; Lamberti, Alberto

    The present guidelines are specifically dedicated to Low Crested Structures on attempt to provide methodological tools both for the engineering design of structures and for prediction of performance and environmental impacts. It is anticipated that the guidelines will provide valuable inputs to c...

  17. Proposed Radiation Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Davey, C. S.

    2004-07-01

    Current scientific evidence is that radiation at low levels is not harmful, but beneficial. This is borne out by both radiobiology and epidemiology. The ICRP 26 recommended limits of 50 mSv and 5 mSv per annum are comparable with the average natural background levels in Iran and Norway, respectively, and levels five times higher than that quoted for Iran are to be found in some populated parts of this world. The new limits proposed for ionising radiation are generated by comparison to existing recommended limits for essential minerals. There is a range of acceptable exposures to radiation, just as there is for minerals. The replacement for the ICRP 60 recommendations (20 mSv and 1 mSv for radiation workers and public respectively) should be higher limits of 200 mSv and 50 mSv. There should also be minimum recommended annual levels of 10 mSv, for both radiation workers and the public. The consequences of not proposing this change are continuing huge negative impacts to society. In cancer therapy, even the older guidelines caused unnecessary expense and delays. The cost to Canada is astronomical, when one considers the effect of the existing limits on the use of nuclear power, and the resulting use of hydrocarbons and the consequent increase in acid rain, etc. Of course, the same thing can be said of the entire world limited funds are diverted from areas where they would be better applied, and alternative solutions to societal needs are implemented, solutions which increase pollution and cause injury and death. It is time to reverse the current, expensive trend into misapplied ALARA, based on the paranoia about all things nuclear, which has developed since the linear no-threshold hypothesis was first proposed.propose the transition to a realistic and balanced approach to ionising radiation. (Author)

  18. European Guidelines for Workplace Drug Testing in Oral Fluid.

    Science.gov (United States)

    Brcak, Michaela; Beck, Olof; Bosch, Tessa; Carmichael, Duncan; Fucci, Nadia; George, Claire; Piper, Mark; Salomone, Alberto; Schielen, Wim; Steinmeyer, Stefan; Taskinen, Sanna; Weinmann, Wolfgang

    2017-06-28

    These guidelines for Legally Defensible Workplace Drug Testing have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. These guidelines are relevant to laboratory-based testing only. These guidelines follow current best practices and are constantly under review. This article is protected by copyright. All rights reserved.

  19. Colorectal Cancer Screening: A Guide to the Guidelines

    Directory of Open Access Journals (Sweden)

    Douglas K Rex

    1999-01-01

    Full Text Available The two most recent guidelines for colorectal cancer screening are those of the Agency for Healthcare Policy and Research, and the American Cancer Society. The guidelines are similar in many regards and reflect current literature, consensus opinion and compromise between members of multidisciplinary panels. The emphasis of both guidelines is to increase the options available for colorectal cancer screening. Increasing choice should expand the attractiveness of colorectal cancer screening to more patients and physicians, and the development of guidelines should help compel payers to provide reimbursement for colorectal cancer screening. These guidelines are summarized and evaluated as they pertain to colorectal cancer screening.

  20. [Guidelines for clinical practice].

    Science.gov (United States)

    Vleugels, A M

    1997-01-01

    Clinical practice guidelines are systematically developed statements that are intended to support medical decision making in well-defined clinical situations. Essentially, their object is to reduce the variability in medical practice, to improve quality, and to make appropriated control of the financial resources possible. Internationally, ever more organisations, associations, and institutions are concerned with the development of guidelines in many different areas of care. Making implicit knowledge explicit is one of the associated advantages of guidelines: they have a potential utility in training, in process evaluation, and in the reevaluation of outcome studies. In liability issues, their existence has a double effect: they can be used to justify medical behaviour, and they constitute a generally accepted reference point. A derivative problem is the legal liability of the compilers of the guidelines. The principle of the guideline approach can be challenged academically: science cannot give a definition of optimal care with absolute certainty. What is called objectivity often rests on methodologically disputable analyses; also the opinion of opinion leaders is not always a guarantee for scientific soundness. Moreover, patients are not all identical: biological variability, situational factors, patient expectations, and other elements play a role in this differentiation. Clinicians are often hesitant with respect to clinical guidelines: they are afraid of cookbook medicine and curtailment of their professional autonomy. Patients fear reduction of individualization of care and the use of guidelines as a rationing instrument. The effects of the introduction of clinical practice guidelines on medical practice, on the results and on the cost of care vary but are generally considered to be favourable. The choice of appropriate strategies in development, dissemination, and implementation turns out to be of critical importance. The article ends with concrete

  1. Primary care guidelines

    DEFF Research Database (Denmark)

    Ijäs, Jarja; Alanen, Seija; Kaila, Minna

    2009-01-01

    -sectional telephone survey. SETTING: All municipal health centres in Finland. SUBJECTS: Health centres where both the head physician and the senior nursing officer responded. MAIN OUTCOME MEASURES: Agreement in views of the senior executives on the adoption of clinical practices as recommended in the Hypertension......OBJECTIVE: To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. DESIGN: A cross...... Guideline. RESULTS: Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p

  2. EMI Messaging Guidelines

    CERN Document Server

    Cons, L.

    2011-01-01

    Guidelines for potential users of messaging within EMI. The goal is to provide enough practical information so that EMI product teams can start investigating whether using messaging in their products can be beneficial or not.

  3. Guidelines for Crisis Management.

    Science.gov (United States)

    Wimberley, Lloyd

    1985-01-01

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

  4. London 2012 packaging guidelines

    OpenAIRE

    2013-01-01

    These guidelines are intended to provide supplemental advice to suppliers and licensees regarding the provisions of the LOCOG Sustainable Sourcing Code that relate to packaging design and materials selection.

  5. Curriculum Guidelines for Periodontics.

    Science.gov (United States)

    Journal of Dental Education, 1985

    1985-01-01

    Guidelines describe the interrelationships of this and other dental fields, give an overview of the curriculum and its primary educational objectives, and outline the suggested prerequisites, core content, specific behavioral objectives, sequencing, and faculty requirements. (MSE)

  6. Electrical safety guidelines

    Energy Technology Data Exchange (ETDEWEB)

    1993-09-01

    The Electrical Safety Guidelines prescribes the DOE safety standards for DOE field offices or facilities involved in the use of electrical energy. It has been prepared to provide a uniform set of electrical safety standards and guidance for DOE installations in order to affect a reduction or elimination of risks associated with the use of electrical energy. The objectives of these guidelines are to enhance electrical safety awareness and mitigate electrical hazards to employees, the public, and the environment.

  7. Algorithms for builder guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Balcomb, J D; Lekov, A B

    1989-06-01

    The Builder Guidelines are designed to make simple, appropriate guidelines available to builders for their specific localities. Builders may select from passive solar and conservation strategies with different performance potentials. They can then compare the calculated results for their particular house design with a typical house in the same location. Algorithms used to develop the Builder Guidelines are described. The main algorithms used are the monthly solar ratio (SLR) method for winter heating, the diurnal heat capacity (DHC) method for temperature swing, and a new simplified calculation method (McCool) for summer cooling. This paper applies the algorithms to estimate the performance potential of passive solar strategies, and the annual heating and cooling loads of various combinations of conservation and passive solar strategies. The basis of the McCool method is described. All three methods are implemented in a microcomputer program used to generate the guideline numbers. Guidelines for Denver, Colorado, are used to illustrate the results. The structure of the guidelines and worksheet booklets are also presented. 5 refs., 3 tabs.

  8. Guidelines International Network: toward international standards for clinical practice guidelines.

    NARCIS (Netherlands)

    Qaseem, A.; Forland, F.; Macbeth, F.; Ollenschlager, G.; Phillips, S.; Wees, P.J. van der

    2012-01-01

    Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. In

  9. 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

  10. Society of Hair Testing guidelines for drug testing in hair.

    Science.gov (United States)

    Cooper, Gail A A; Kronstrand, Robert; Kintz, Pascal

    2012-05-10

    The Society of Hair Testing (SoHT) Guidelines for Drug Testing in Hair provide laboratories with recommended best practice guidelines whether they are currently offering drug testing in hair, or plan to offer a hair testing service in the future. The guidelines include reference to recommended sample collection and storage procedures, through sample preparation, pre-treatment and analysis and the use of cut-offs.

  11. Innovations in American Society of Clinical Oncology Practice Guideline Development.

    Science.gov (United States)

    Somerfield, Mark R; Bohlke, Kari; Browman, George P; Denduluri, Neelima; Einhaus, Kaitlin; Hayes, Daniel F; Khorana, Alok A; Miller, Robert S; Mohile, Supriya G; Oliver, Thomas K; Ortiz, Eduardo; Lyman, Gary H

    2016-09-10

    Since the beginning of its guidelines program in 1993, ASCO has continually sought ways to produce a greater number of guidelines while maintaining its commitment to using the rigorous development methods that minimize the biases that threaten the validity of practice recommendations. ASCO is implementing a range of guideline development and implementation innovations. In this article, we describe innovations that are designed to (1) integrate consideration of multiple chronic conditions into practice guidelines; (2) keep more of its guidelines current by applying evolving signals or (more) rapid, for-cause updating approaches; (3) increase the number of high-quality guidelines available to its membership through endorsement and adaptation of other groups' products; (4) improve coverage of its members' guideline needs through a new topic nomination process; and (5) enhance dissemination and promote implementation of ASCO guidelines in the oncology practice community through a network of volunteer ambassadors. We close with a summary of ASCO's plans to facilitate the integration of data from its rapid learning system, CancerLinQ, into ASCO guidelines and to develop tactics through which guideline recommendations can be embedded in clinicians' workflow in digital form. We highlight the challenges inherent in reconciling the need to provide clinicians with more interactive, point-of-care guidance with ASCO's abiding commitment to methodologic rigor in guideline development.

  12. [Guideline "Cancer rehabilitation"].

    Science.gov (United States)

    van den Berg, Jan-Paul; Velthuis, Miranda J; Gijsen, Brigitte C M; Lindeman, Eline; van der Pol, Marjolein A; Hillen, Harry F P

    2011-01-01

    Initiated by IKNL (Integraal Kankercentrum Nederland), a multidisciplinary guideline for cancer rehabilitation for adult oncology patients has been developed. The guideline describes the rehabilitation care of adult patients with cancer, during and after treatment. The guideline focuses on (a) prevalence of complaints either resulting from cancer or the treatment, (b) detection of these complaints and indicated referral, (c) the intake procedure before cancer rehabilitation, (d) intervention and evaluation within cancer rehabilitation and (e) the importance of patient empowerment. The guideline is directed at all professionals giving care to patients with cancer. It concerns those (such as medical specialists, general practitioners and nurses) who are responsible for detecting cancer-related complaints and for referral to cancer rehabilitation, as well as health care professionals involved in cancer rehabilitation care (such as consultants in rehabilitation medicine, physiotherapists and psychologists). The main goal of the guideline is that every cancer patient or ex-cancer patient with (residual) complaints resulting from cancer or its treatment receives timely and appropriate cancer rehabilitation.

  13. The quality of European dermatological guidelines: critical appraisal of the quality of EDF guidelines using the AGREE II instrument.

    Science.gov (United States)

    Werner, R N; Marinović, B; Rosumeck, S; Strohal, R; Haering, N S; Weberschock, T; Dreher, A C; Nast, A

    2016-03-01

    Clinical practice guidelines are systematically developed tools to assist clinicians and health policy makers in decision making for clearly defined clinical situations. In the light of the demand for evidence-based medicine and quality in health care and the increasing methodological requirements concerning guidelines development, it is important to evaluate existing practice guidelines to systematically identify strengths and weaknesses. Currently, the most accepted tool for the methodological evaluation of guidelines is the Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument. Intention of this assessment is to identify and critically appraise clinical practice guidelines commissioned by the European Dermatology Forum (EDF). A quality assessment of a predefined set of guidelines, including all available clinical practice guidelines published on the EDF guidelines internet site, was performed using the AGREE II instrument. To assure an objective assessment, four independent assessments were performed by evaluators situated in different European countries. Twenty-five EDF guidelines covering different dermatological topics were identified and evaluated. The assessment included seven guidelines developed on the highest methodological standard (systematic literature search and structured consensus conference, S3). Eighteen guidelines were identified that were based on either a structured consensus process (S2k), a systematic literature assessment (S2e) or on informal consensus only (S1). The methodological and reporting quality among the evaluated guidelines was heterogeneous. S3 guidelines generally received the highest scores. The domains 'clarity of presentation' and 'scope and purpose' achieved the highest mean ratings within the different domains of assessment, whereas the domains of 'applicability', 'stakeholder involvement' and 'editorial independence' scored poorly. Considering the large variations in the achieved scores, there is need for

  14. Guideline Implementation: Hand Hygiene.

    Science.gov (United States)

    Goldberg, Judith L

    2017-02-01

    Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  15. [The Dutch guideline 'Renal cell carcinoma'].

    NARCIS (Netherlands)

    Osanto, S.; Bex, A.; Hulsbergen- van de Kaa, C.A.; Soetekouw, P.M.M.B.; Stemkens, D.

    2012-01-01

    The Dutch guideline 'Renal Cell Carcinoma' has been revised on the basis of new literature. With the assistance of the Netherlands Cancer Registry an assessment was made of the current care for patients with renal cell carcinoma. Renal cell carcinoma is a type of cancer for which knowledge of the ge

  16. Guidelines for Planning in Higher Education.

    Science.gov (United States)

    Anderson, Kenneth E.; Acero, Herman D.

    Guidelines for planning in higher education (which might have an application in Colombia) are described. Chapter 1 provides an expanded definition of higher education that includes noncollege channels to lifelong education and embraces all viable postsecondary education. Chapter 2 addresses current problems facing higher education, such as lack of…

  17. Statins: Cholesterol guidelines and Indian perspective

    Directory of Open Access Journals (Sweden)

    Anil S Menon

    2015-01-01

    Full Text Available Statins have become an important drug in preventing the occurrence of atherosclerotic cardiovascular disease (ASCVD. The effectiveness of statins in reducing ASCVD has been established in large-scale clinical trials. The lipid management guidelines have been periodically modified due to accumulating evidence about the proportionate benefit achieved with a progressive reduction in cholesterol levels with higher doses of statins and even in those at low risk of development of ASCVD. The current American College of Cardiology/American Heart Association guidelines have based its recommendations from data gathered exclusively from randomized controlled trials. It has simplified the use of statins, but also raised questions regarding the validity of its cardiovascular event risk prediction tool. Epidemiology of cardiovascular disease in India differs from the western population; there is an increased the prevalence of metabolic syndrome and atherogenic dyslipidemia phenotype a group not addressed in the current guidelines. The guidelines are based on trials, which do not have a representative South Asian population. This article reviews the relevant literature, and examines the issues involved in adopting the guidelines to the Indian population.

  18. Strategy Guideline: Demonstration Home

    Energy Technology Data Exchange (ETDEWEB)

    Savage, C.; Hunt, A.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  19. Strategy Guideline. Demonstration Home

    Energy Technology Data Exchange (ETDEWEB)

    Hunt, A.; Savage, C.

    2012-12-01

    This guideline will provide a general overview of the different kinds of demonstration home projects, a basic understanding of the different roles and responsibilities involved in the successful completion of a demonstration home, and an introduction into some of the lessons learned from actual demonstration home projects. Also, this guideline will specifically look at the communication methods employed during demonstration home projects. And lastly, we will focus on how to best create a communication plan for including an energy efficient message in a demonstration home project and carry that message to successful completion.

  20. Advanced control room design review guidelines: Integration of the NUREG-0700 guidelines and development of new human-system interface guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Carter, R.J.

    1997-07-01

    This report documents the work conducted in four tasks of the Nuclear Regulatory Commission (NRC) project entitled Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation. The purpose of the first task was to integrate the applicable sections of NUREG-0700 into the advanced control room design review (ACRDR) guidelines to ensure that all applicable guidelines are together in one document and conveniently accessible to users. The primary objective of the second task was to formulate a strategy for the development of new ACRDR guidelines that have not otherwise been identified. The main focus of the third task was to modify the individual ACRDR guidelines generated to date to ensure that they are suitable for the intended nuclear power plant (NPP) control station system application. The goal of the fourth task was to develop human factors guidelines for two human-system interface categories that are missing from the current ACRDR guidelines document. During the first task those areas in NUREG-0700 that are not addressed by the ACRDR guidelines document were identified, the areas were subsequently reviewed against six recent industry human factors engineering review guidelines, and the NUREG-0700 guidelines were updated as necessary. In the second task 13 general categories of human-system interface guidelines that are either missing from or not adequately addressed by the ACRDR document were discovered. An approach was derived for the development of new ACRDR guidelines, a preliminary assessment of the available sources that may be useful in the creation of new guidelines and their applicability to the identified human-system interface categories was performed, and an estimate was made of the amount of time and level of effort required to complete the development of needed new ACRDR guidelines. During the third task those NPP control station systems to which the NUREG-0700 and ACRDR guidelines apply were identified, matrices of such

  1. Dietary Guidelines should reflect new understandings about adult protein needs

    Directory of Open Access Journals (Sweden)

    Layman Donald K

    2009-03-01

    Full Text Available Abstract Dietary Guidelines for Americans provide nutrition advice aimed at promoting healthy dietary choices for life-long health and reducing risk of chronic diseases. With the advancing age of the population, the 2010 Dietary Guidelines confront increasing risks for age-related problems of obesity, osteoporosis, type 2 diabetes, Metabolic Syndrome, heart disease, and sarcopenia. New research demonstrates that the meal distribution and amount of protein are important in maintaining body composition, bone health and glucose homeostasis. This editorial reviews the benefits of dietary protein for adult health, addresses omissions in current nutrition guidelines, and offers concepts for improving the Dietary Guidelines.

  2. Field Campaign Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Voyles, J. W. [DOE ARM Climate Research Facility, Washington, DC (United States); Chapman, L. A. [DOE ARM Climate Research Facility, Washington, DC (United States)

    2015-12-01

    This document establishes a common set of guidelines for the Atmospheric Radiation Measurement (ARM) Climate Research Facility for planning, executing, and closing out field campaigns. The steps that guide individual field campaigns are described in the Field Campaign Tracking System and are specifically tailored to meet the scope of each field campaign.

  3. Record Keeping Guidelines

    Science.gov (United States)

    American Psychologist, 2007

    2007-01-01

    These guidelines are designed to educate psychologists and provide a framework for making decisions regarding professional record keeping. State and federal laws, as well as the American Psychological Association's "Ethical Principles of Psychologists and Code of Conduct," generally require maintenance of appropriate records of psychological…

  4. GRADE Equity Guidelines 3

    DEFF Research Database (Denmark)

    Welch, Vivian A; Akl, Elie A; Pottie, Kevin

    2017-01-01

    OBJECTIVE: The aim of this paper is to describe a conceptual framework for how to consider health equity in the GRADE (Grading Recommendations Assessment and Development Evidence) guideline development process. STUDY DESIGN AND SETTING: Consensus-based guidance developed by the GRADE working grou...

  5. Children's Advertising Guidelines.

    Science.gov (United States)

    Council of Better Business Bureaus, Inc., New York, NY.

    These guidelines have been developed for the use of advertisers and advertising agencies and for the self-regulatory mechanism which these groups have established, the National Advertising Division, to help ensure that advertising directed to children is truthful, accurate, and fair to children's perceptions. Preliminary sections set forth basic…

  6. Curricular Guidelines for Endodontics.

    Science.gov (United States)

    Journal of Dental Education, 1981

    1981-01-01

    Guidelines developed by the Section on Endodontics of the American Association of Dental Schools for use by educational institutions as curriculum development aids are provided. Endodontics is that branch of dentistry dealing with diagnosis and treatment of oral conditions that arise as a result of pathoses of dental pulp. (MLW)

  7. Tinnitus guidelines and treatment

    DEFF Research Database (Denmark)

    Larsen, Dalia Gustaityté; Ovesen, Therese

    2014-01-01

    In this study literature search was performed on tinnitus guidelines and treatment. Tinnitus can be described as the perception of sound in the absence of external acoustic stimulation, and validated questionnaires, oto-neurological examination, audiometry tests, MRI and angiography are necessary...

  8. Guidelines for heart transplantation

    OpenAIRE

    de Jonge, N; Kirkels, J.H.; Klöpping, C.; Lahpor, J.R.; Caliskan, K.; Maat, A.P.W.M.; Brügemann, J; Erasmus, M.E.; Klautz, R. J. M.; Verwey, H.F; Oomen, A.; Peels, C.H.; Golüke, A.E.J.; Nicastia, D.; Koole, M.A.C.

    2008-01-01

    Based on the changes in the field of heart transplantation and the treatment and prognosis of patients with heart failure, these updated guidelines were composed by a committee under the supervision of both the Netherlands Society of Cardiology and the Netherlands Association for Cardiothoracic surgery (NVVC and NVT).

  9. Guidelines for heart transplantation

    NARCIS (Netherlands)

    Kirkels, J. H.; Klopping, C.; Lahpor, J. R.; Caliskan, K.; Maat, A. P. W. M.; Brugemann, J.; Erasmus, M. E.; Klautz, R. J. M.; Verwey, H. F.; Oomen, A.; Peels, C. H.; Goluke, A. E. J.; Nicastia, D. M.; Koole, M. A. C.; Balk, A. H. M. M.; de Jonge, N.

    Based on the changes in the field of heart transplantation and the treatment and prognosis of patients with heart failure, these updated guidelines were composed by a committee under the supervision of both the Netherlands Society of Cardiology and the Netherlands Association for Cardiothoracic

  10. ADULT INFLUENZA VACCINATION GUIDELINE

    African Journals Online (AJOL)

    immune system status, and degree of similarity of the virus strains contained .... unethically influence the content of the guideline. All funds ... more severe response to such infections. .... 2 - gcC in cold chain, and stored in the fridge and not the.

  11. Measure Guideline: Evaporative Condensers

    Energy Technology Data Exchange (ETDEWEB)

    German, A [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States); Dakin, B. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States); Hoeschele, M. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States)

    2012-03-01

    This measure guideline on evaporative condensers provides information on properly designing, installing, and maintaining evaporative condenser systems as well as understanding the benefits, costs, and tradeoffs. This is a prescriptive approach that outlines selection criteria, design and installation procedures, and operation and maintenance best practices.

  12. Curricular Guidelines for Endodontics.

    Science.gov (United States)

    Journal of Dental Education, 1981

    1981-01-01

    Guidelines developed by the Section on Endodontics of the American Association of Dental Schools for use by educational institutions as curriculum development aids are provided. Endodontics is that branch of dentistry dealing with diagnosis and treatment of oral conditions that arise as a result of pathoses of dental pulp. (MLW)

  13. Curricular Guidelines for Neuroanatomy.

    Science.gov (United States)

    Journal of Dental Education, 1981

    1981-01-01

    Presented are the curricular guidelines for Neuroanatomy developed by the Section on Anatomical Sciences of the American Association of Dental Schools for use by individual educational institutions as curriculum development aids. Included are recommendations for primary educational goals, prerequisites, scope, content, behavioral objectives,…

  14. [Evidence-based clinical practice guidelines in oral care 2: process and content of evidence-based guideline development

    NARCIS (Netherlands)

    Mettes, T.G.P.H.; Loveren, C. van; Oirschot, B.A.J.A. van; Maanen-Schakel, N.W. van; Weijden, F.G. van der; Bruers, J.J.

    2015-01-01

    In 2014, an advisory report was published by a national working committee concerning how the current, applied method of evidence-based guideline development in healthcare can be used in oral care in a national guideline programme. In an independent Institute of Knowledge Translation in Oral Care, as

  15. Medicare depreciation; useful life guidelines--HCFA. Proposed rule.

    Science.gov (United States)

    1982-09-30

    We are proposing to amend Medicare regulations to clarify which useful life guidelines providers of health care services may use to determine the useful life of a depreciable asset for Medicare reimbursement purposes. Current regulations state that providers must utilize HHS useful life guidelines or, if none have been published by HHS, the American Hospital Association (AHA) useful life guidelines of 1973 or IRS guidelines. We are proposing to eliminate the reference to IRS guidelines because those previously acceptable for Medicare purposes are outdated and have been made obsolete by the IRS or by statutory change. We would also delete the specific reference to the 1973 AHA guidelines. In addition, we intend this amendment to clarify that certain tax legislation on accelerated depreciation, recently passed by Congress, does not apply to the Medicare program.

  16. Osteoporosis: therapeutic guidelines. Guidelines for practice management of osteoporosis.

    Science.gov (United States)

    Khan, Sana N; Craig, Latasha; Wild, Robert

    2013-12-01

    Therapeutic guidelines of osteoporosis are reviewed from North American Menopause Society, American Association of Clinical Endocrinologists, American College of Obstetrics and Gynecology, and the National Osteoporosis Foundation. The various guidelines are compared and discussed.

  17. Guidelines International Network: toward international standards for clinical practice guidelines.

    Science.gov (United States)

    Qaseem, Amir; Forland, Frode; Macbeth, Fergus; Ollenschläger, Günter; Phillips, Sue; van der Wees, Philip

    2012-04-03

    Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. Institute of Medicine and the United Kingdom's National Institute for Health and Clinical Excellence have developed recommendations to define trustworthy guidelines within their locales. Many groups charged with guideline development find the lengthy list of standards developed by such organizations to be aspirational but infeasible to follow in entirety. Founded in 2002, the Guidelines International Network (G-I-N) is a network of guideline developers that includes 93 organizations and 89 individual members representing 46 countries. The G-I-N board of trustees recognized the importance of guideline development processes that are both rigorous and feasible even for modestly funded groups to implement and initiated an effort toward consensus about minimum standards for high-quality guidelines. In contrast to other existing standards for guideline development at national or local levels, the key components proposed by G-I-N will represent the consensus of an international, multidisciplinary group of active guideline developers. This article presents G-I-N's proposed set of key components for guideline development. These key components address panel composition, decision-making process, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding. It is hoped that this article promotes discussion and eventual agreement on a set of international standards for guideline development.

  18. Guidelines for antiretroviral therapy in adults

    Directory of Open Access Journals (Sweden)

    G Meintjes

    2012-09-01

    Full Text Available These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in January 2008. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART in Southern Africa has continued to grow. Cohort studies from the region show excellent clinical outcomes; however, ART is still being started late (in advanced disease, resulting in relatively high early mortality rates. New data on antiretroviral (ARV tolerability in the region and several new ARV drugs have become available. Although currently few in number, some patients in the region are failing protease inhibitor (PI-based second-line regimens. To address this, guidelines on third-line (or ‘salvage’ therapy have been expanded.

  19. Guidelines for Building Science Education

    Energy Technology Data Exchange (ETDEWEB)

    Metzger, Cheryn E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rashkin, Samuel [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Huelman, Pat [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-11-01

    The U.S. Department of Energy’s (DOE) residential research and demonstration program, Building America, has triumphed through 20 years of innovation. Partnering with researchers, builders, remodelers, and manufacturers to develop innovative processes like advanced framing and ventilation standards, Building America has proven an energy efficient design can be more cost effective, healthy, and durable than a standard house. As Building America partners continue to achieve their stretch goals, they have found that the barrier to true market transformation for high performance homes is the limited knowledge-base of the professionals working in the building industry. With dozens of professionals taking part in the design and execution of building and selling homes, each person should have basic building science knowledge relevant to their role, and an understanding of how various home components interface with each other. Instead, our industry typically experiences a fragmented approach to home building and design. After obtaining important input from stakeholders at the Building Science Education Kick-Off Meeting, DOE created a building science education strategy addressing education issues preventing the widespread adoption of high performance homes. This strategy targets the next generation and provides valuable guidance for the current workforce. The initiative includes: • Race to Zero Student Design Competition: Engages universities and provides students who will be the next generation of architects, engineers, construction managers and entrepreneurs with the necessary skills and experience they need to begin careers in clean energy and generate creative solutions to real world problems. • Building Science to Sales Translator: Simplifies building science into compelling sales language and tools to sell high performance homes to their customers. • Building Science Education Guidance: Brings together industry and academia to solve problems related to

  20. Guidelines for Building Science Education

    Energy Technology Data Exchange (ETDEWEB)

    Metzger, Cheryn E.; Rashkin, Samuel; Huelman, Pat

    2015-03-11

    The U.S. Department of Energy’s (DOE) residential research and demonstration program, Building America, has triumphed through 20 years of innovation. Partnering with researchers, builders, remodelers, and manufacturers to develop innovative processes like advanced framing and ventilation standards, Building America has proven an energy efficient design can be more cost effective, healthy, and durable than a standard house. As Building America partners continue to achieve their stretch goals, they have found that the barrier to true market transformation for high performance homes is the limited knowledge-base of the professionals working in the building industry. With dozens of professionals taking part in the design and execution of building and selling homes, each person should have basic building science knowledge relevant to their role, and an understanding of how various home components interface with each other. Instead, our industry typically experiences a fragmented approach to home building and design. After obtaining important input from stakeholders at the Building Science Education Kick-Off Meeting, DOE created a building science education strategy addressing education issues preventing the widespread adoption of high performance homes. This strategy targets the next generation and provides valuable guidance for the current workforce. The initiative includes: • Race to Zero Student Design Competition: Engages universities and provides students who will be the next generation of architects, engineers, construction managers and entrepreneurs with the necessary skills and experience they need to begin careers in clean energy and generate creative solutions to real world problems. • Building Science to Sales Translator: Simplifies building science into compelling sales language and tools to sell high performance homes to their customers. • Building Science Education Guidance: Brings together industry and academia to solve problems related to

  1. Pharmacogenetics: from bench to byte--an update of guidelines

    NARCIS (Netherlands)

    Swen, J.J.; Nijenhuis, M.; Boer, A. de; Grandia, L.; Maitland-van der Zee, A.H.; Mulder, H.; Rongen, G.A.P.J.M.; Schaik, R.H. van; Schalekamp, T.; Touw, D.J.; Weide, J. van der; Wilffert, B.; Deneer, V.H.; Guchelaar, H.J.

    2011-01-01

    Currently, there are very few guidelines linking the results of pharmacogenetic tests to specific therapeutic recommendations. Therefore, the Royal Dutch Association for the Advancement of Pharmacy established the Pharmacogenetics Working Group with the objective of developing pharmacogenetics-based

  2. Pharmacogenetics : From Bench to Byte-An Update of Guidelines

    NARCIS (Netherlands)

    Swen, J.J.; Nijenhuis, M.; De Boer, A.; Grandia, L.; Maitland-Van Der Zee, A.H.; Mulder, H.; Rongen, G.A.P.J.M.; Van Schaik, R.H.N.; Schalekamp, T.; Touw, D.J.; Van Der Weide, J.; Wilffert, B.; Deneer, V.H.M.; Guchelaar, H.-J.

    2011-01-01

    Currently, there are very few guidelines linking the results of pharmacogenetic tests to specific therapeutic recommendations. Therefore, the Royal Dutch Association for the Advancement of Pharmacy established the Pharmacogenetics Working Group with the objective of developing pharmacogenetics-based

  3. Clinical practice guideline for the management of intracranial aneurysms.

    Science.gov (United States)

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

    2014-09-01

    An intracranial aneurysm, with or without subarachnoid hemorrhage (SAH), is a relevant health problem. The rupture of an intracranial aneurysm is a critical concern for individual health; even an unruptured intracranial aneurysm is an anxious condition for the individual. The aim of this guideline is to present current and comprehensive recommendations for the management of intracranial aneurysms, with or without rupture. We performed an extensive literature search, using Medline. We met in person to discuss recommendations. This document is reviewed by the Task Force Team of the Korean Society of Interventional Neuroradiology (KSIN). We divided the current guideline for ruptured intracranial aneurysms (RIAs) and unruptured intracranial aneurysms (UIAs). The guideline for RIAs focuses on diagnosis and treatment. And the guideline for UIAs focuses on the definition of a high-risk patient, screening, principle for treatment and selection of treatment method. This guideline provides practical, evidence-based advice for the management of patients with an intracranial aneurysm, with or without rupture.

  4. Perils of the new labor management guidelines.

    Science.gov (United States)

    Cohen, Wayne R; Friedman, Emanuel A

    2015-04-01

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

  5. Guidelines, evidence, and cultural factors.

    NARCIS (Netherlands)

    Christiaens, T.; Backer, D. de; Burgers, J.S.; Baerheim, A.

    2004-01-01

    OBJECTIVE: To compare four recent guidelines on uncomplicated cystitis and to examine how cultural factors may have affected recommendations. DESIGN: Descriptive study with a qualitative analysis of authors' reasons for recommendations. MATERIAL: Guidelines for general practitioners published

  6. Chondral Rib Fractures in Professional American Football: Two Cases and Current Practice Patterns Among NFL Team Physicians.

    Science.gov (United States)

    McAdams, Timothy R; Deimel, Jay F; Ferguson, Jeff; Beamer, Brandon S; Beaulieu, Christopher F

    2016-02-01

    Although a recognized and discussed injury, chondral rib fractures in professional American football have not been previously reported in the literature. There currently exists no consensus on how to identify and treat these injuries or the expected return to play for the athlete. To present 2 cases of chondral rib injuries in the National Football League (NFL) and discuss the current practice patterns for management of these injuries among the NFL team physicians. Case series; Level of evidence, 4. Two cases of NFL players with chondral rib injuries are presented. A survey regarding work-up and treatment of these injuries was completed by team physicians at the 2014 NFL Combine. Our experience in identifying and treating these injuries is presented in conjunction with a survey of NFL team physicians' experiences. Two cases of rib chondral injuries were diagnosed by computed tomography (CT) and treated with rest and protective splinting. Return to play was 2 to 4 weeks. NFL Combine survey results show that NFL team physicians see a mean of 4 costal cartilage injuries per 5-year period, or approximately 1 case per year per team. Seventy percent of team physicians use CT scanning and 43% use magnetic resonance imaging for diagnosis of these injuries. An anesthetic block is used acutely in 57% and only electively in subsequent games by 39%. A high index of suspicion is necessary to diagnose chondral rib injuries in American football. CT scan is most commonly used to confirm diagnosis. Return to play can take up to 2 to 4 weeks with a protective device, although anesthetic blocks can be used to potentially expedite return. Chondral rib injuries are common among NFL football players, while there is no literature to support proper diagnosis and treatment of these injuries or expected duration of recovery. These injuries are likely common in other contact sports and levels of competition as well. Our series combined with NFL team physician survey results can aid team

  7. Internet experiments: methods, guidelines, metadata

    Science.gov (United States)

    Reips, Ulf-Dietrich

    2009-02-01

    The Internet experiment is now a well-established and widely used method. The present paper describes guidelines for the proper conduct of Internet experiments, e.g. handling of dropout, unobtrusive naming of materials, and pre-testing. Several methods are presented that further increase the quality of Internet experiments and help to avoid frequent errors. These methods include the "seriousness check", "warm-up," "high hurdle," and "multiple site entry" techniques, control of multiple submissions, and control of motivational confounding. Finally, metadata from sites like WEXTOR (http://wextor.org) and the web experiment list (http://genpsylab-wexlist.uzh.ch/) are reported that show the current state of Internet-based research in terms of the distribution of fields, topics, and research designs used.

  8. Offshore waste treatment guidelines

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2010-12-15

    These guidelines were prepared to aid offshore oil and gas operators in the management of waste materials related to petroleum drilling and production operations in offshore areas regulated by the Canada-Newfoundland and Labrador Offshore Petroleum Board (CNLOPB) and the Canada-Nova Scotia Offshore Petroleum Board (CNSOPB). A description of the relevant sections of the regulatory regime applicable to Canada's offshore oil and gas operations was included. Offshore operators are expected to take all reasonable measures to minimize the volumes of waste materials generated by their operations. The guidelines included recommendations for identifying, monitoring, and reporting discharges; performance expectations for specific discharges; requirements for greenhouse gas (GHG) and other air emissions; methods of characterizing and monitoring produced water, drilling muds, and desalination brine. Operational discharges associated with the installation and maintenance of subsea systems were also reviewed, and qualifications of analytical laboratories were presented. 24 refs., 2 appendices.

  9. Guidelines or gospels?

    Science.gov (United States)

    Sundt, Thoralf M

    2016-06-01

    In the interest of advancing evidenced-based medicine, enthusiasm for clinical practice guidelines has skyrocketed. They have a genuine impact on clinical practice and are frequently referenced in the literature. Their construction is complex and labor intensive, and has significant limitations given the necessary process as well as the data available. There has been less focus on their appropriate clinical application as dictated by these inherent limitations. It is worthwhile taking a step back and considering how we know what we think we know based on statistical analysis of biomedical data sets and the real implications of those population data for making predictions about the individual patient we encounter in the clinic. These data as used to establish guidelines for care should be the foundation and starting point for our thoughtful recommendations and decision making, not the final word. The importance of nuance in clinical judgment remains even in this "evidence-based" world.

  10. Measure Guideline: Evaporative Condensers

    Energy Technology Data Exchange (ETDEWEB)

    German, A.; Dakin, B.; Hoeschele, M.

    2012-03-01

    The purpose of this measure guideline on evaporative condensers is to provide information on a cost-effective solution for energy and demand savings in homes with cooling loads. This is a prescriptive approach that outlines selection criteria, design and installation procedures, and operation and maintenance best practices. This document has been prepared to provide a process for properly designing, installing, and maintaining evaporative condenser systems as well as understanding the benefits, costs, and tradeoffs.

  11. Guideline implementation: Surgical attire.

    Science.gov (United States)

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-02-01

    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  12. Guidelines for the Design and Conduct of Clinical Studies in Knee Articular Cartilage Repair: International Cartilage Repair Society Recommendations Based on Current Scientific Evidence and Standards of Clinical Care.

    Science.gov (United States)

    Mithoefer, Kai; Saris, Daniel B F; Farr, Jack; Kon, Elizaveta; Zaslav, Kenneth; Cole, Brian J; Ranstam, Jonas; Yao, Jian; Shive, Matthew; Levine, David; Dalemans, Wilfried; Brittberg, Mats

    2011-04-01

    To summarize current clinical research practice and develop methodological standards for objective scientific evaluation of knee cartilage repair procedures and products. A comprehensive literature review was performed of high-level original studies providing information relevant for the design of clinical studies on articular cartilage repair in the knee. Analysis of cartilage repair publications and synopses of ongoing trials were used to identify important criteria for the design, reporting, and interpretation of studies in this field. Current literature reflects the methodological limitations of the scientific evidence available for articular cartilage repair. However, clinical trial databases of ongoing trials document a trend suggesting improved study designs and clinical evaluation methodology. Based on the current scientific information and standards of clinical care, detailed methodological recommendations were developed for the statistical study design, patient recruitment, control group considerations, study endpoint definition, documentation of results, use of validated patient-reported outcome instruments, and inclusion and exclusion criteria for the design and conduct of scientifically sound cartilage repair study protocols. A consensus statement among the International Cartilage Repair Society (ICRS) and contributing authors experienced in clinical trial design and implementation was achieved. High-quality clinical research methodology is critical for the optimal evaluation of current and new cartilage repair technologies. In addition to generally applicable principles for orthopedic study design, specific criteria and considerations apply to cartilage repair studies. Systematic application of these criteria and considerations can facilitate study designs that are scientifically rigorous, ethical, practical, and appropriate for the question(s) being addressed in any given cartilage repair research project.

  13. Improving the use of research evidence in guideline development: 1. Guidelines for guidelines

    Directory of Open Access Journals (Sweden)

    Oxman Andrew D

    2006-11-01

    Full Text Available Abstract Background The World Health Organization (WHO, like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the first of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. Objectives We reviewed the literature on guidelines for the development of guidelines. Methods We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. Key questions and answers We found no experimental research that compared different formats of guidelines for guidelines or studies that compared different components of guidelines for guidelines. However, there are many examples, surveys and other observational studies that compared the impact of different guideline development documents on guideline quality. What have other organizations done to develop guidelines for guidelines from which WHO can learn? • Establish a credible, independent committee that evaluates existing methods for developing guidelines or that updates existing ones. • Obtain feedback and approval from various stakeholders during the development process of guidelines for guidelines. • Develop a detailed source document (manual that guideline developers can use as reference material. What should be the key components of WHO guidelines for guidelines? • Guidelines for guidelines should include information and instructions about the following components: 1 Priority setting; 2 Group composition and consultations; 3 Declaration and avoidance of conflicts of interest; 4 Group processes; 5

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

    Science.gov (United States)

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

    2015-10-06

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

  15. Rigour of development of clinical practice guidelines for the pharmacological treatment of bipolar disorder: systematic review.

    Science.gov (United States)

    Castellani, Arianna; Girlanda, Francesca; Barbui, Corrado

    2015-03-15

    There is an increasing concern about the quality of clinical practice guidelines. Because no information is available on the rigour of development of clinical practice guidelines for bipolar disorder, we carried out a systematic review of those focusing on its pharmacological treatment. We searched the National Guideline Clearinghouse, MEDLINE, EMBASE, PsychINFO and CINHAL for guidelines published from 2003 to 2014. The quality of each guideline was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Fourteen guidelines were appraised. The overall quality of included guidelines varied considerably, both within and across AGREE II domains. Overall, six guidelines were rated as "recommended", two "recommended with modifications", and six were not recommended according to AGREE II ratings. The mean score for rigour of development was 46.8% of the maximum possible score, with no guidelines scoring the maximum score in this domain. Guidelines with lower editorial independence scores also had lower rigour of development scores, whereas those with higher-quality domain scores scored high in both domains. As current appraisal focused on guidelines for the pharmacological treatment of bipolar disorder, it will be important to critically assess the rigour of development of other guidelines for bipolar and other psychiatric disorders. Health care providers, policy makers, physicians and patients alike need to be aware of the variability in guideline quality and identify the high-quality guidelines that meet their needs. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. From expert-driven to user-oriented communication of infection control guidelines

    NARCIS (Netherlands)

    Verhoeven, Fenne; Steehouder, Michael F.; Hendrix, Ron M.G.; Gemert-Pijnen, van Julia E.W.C.

    2009-01-01

    Currently, infection control guidelines in hospitals and other health care institutions are more expert-driven than user-oriented. In order to enhance the usability of the expert-driven guideline format, we developed a website for the communication of existing guidelines that better fit the practica

  17. Improving fertility care. The role of guidelines, quality indicators and patients.

    NARCIS (Netherlands)

    Mourad, S.M.

    2010-01-01

    Clinical practice guidelines can help improve the quality of care, and decrease variation in delivered care between settings. However, as guidelines do not implement themselves, efforts should be made to improve current guideline implementation. For clinical fertility care, we performed a large mult

  18. Time to detoxify medical literature from guideline overdose

    Institute of Scientific and Technical Information of China (English)

    Dinesh Vyas; Arpita K Vyas

    2012-01-01

    The current financial turmoil in the United States has been attributed to multiple reasons including healthcare expenditure.Health care spending has increased from 5.7 percent of the gross domestic product (GDP)in 1965 to 16 percent of the GDP in 2004.Healthcare is driven with a goal to provide best possible care available at that period of time.Guidelines are generally assumed to have the high level of certainty and security as conclusions generated by the conventional scientific method leading many clinicians to use guidelines as the final arbiters of care.To provide the standard of care,physicians follow guidelines,proposed by either groups of physicians or various medical societies or government organizations like National Comprehensive Cancer Network.This has lead to multiple tests for the patient and has not survived the test of time.This independence leads to lacunae in the standardization of guidelines,hence flooding of literature with multiple guidelines and confusion to patients and physicians and eventually overtreatment,inefficiency,and patient inconvenience.There is an urgent need to restrict articles with Guidelines and develop some strategy like have an intermediate stage of pre-guidelines and after 5-10 years of trials,a systematic launch of the Guidelines.There can be better ways than this for putting together guidelines as has been suggested by multiple authors and researchers.

  19. A review of clinical guidelines.

    LENUS (Irish Health Repository)

    Andrews, E J

    2012-02-03

    BACKGROUND: Clinical guidelines are increasingly used in patient management but few clinicians are familiar with their origin or appropriate application. METHODS: A Medline search using the terms \\'clinical guidelines\\' and \\'practice guidelines\\' was conducted. Additional references were sourced by manual searching from the bibliographies of articles located. RESULTS AND CONCLUSION: Clinical guidelines originated in the USA in the early 1980s, initially as a cost containment exercise. Significant improvements in the process and outcomes of care have been demonstrated following their introduction, although the extent of improvement varies considerably. The principles for the development of guidelines are well established but many published guidelines fall short of these basic quality criteria. Guidelines are only one aspect of improving quality and should be used within a wider framework of promoting clinical effectiveness. Understanding their limitations as well as their potential benefits should enable clinicians to have a clearer view of their place in everyday practice.

  20. Nurses' experiences of guideline implementation

    DEFF Research Database (Denmark)

    Alanen, Seija; Välimäki, Marita; Kaila, Minna

    2009-01-01

    AIMS: The aim of the study was to address the following questions: What kind of experiences do primary care nurses have of guideline implementation? What do nurses think are the most important factors affecting the adoption of guidelines? BACKGROUND: The implementation of clinical guidelines seems...... to local circumstances, seems to be crucial for successful implementation. CONCLUSIONS: Clinical guidelines can be promising tools in enhancing evidence-based nursing practice, as nurses see them as practical work tools in patient care and so are willing to adopt them. However, support from management...... and physicians is needed to ensure the successful implementation of guidelines into nursing practices. RELEVANCE TO CLINICAL PRACTICE: Based on the findings of this study and previous knowledge of guideline implementation some practical recommendations are suggested. Select the most relevant guidelines...

  1. Perceived barriers to guideline adherence: A survey among general practitioners

    Directory of Open Access Journals (Sweden)

    Besters Casper F

    2011-09-01

    Full Text Available Abstract Background Despite considerable efforts to promote and support guideline use, adherence is often suboptimal. Barriers to adherence vary not only across guidelines but also across recommendations within guidelines. The aim of this study was to assess the perceived barriers to guideline adherence among GPs by focusing on key recommendations within guidelines. Methods We conducted a cross-sectional electronic survey among 703 GPs in the Netherlands. Sixteen key recommendations were derived from four national guidelines. Six statements were included to address the attitudes towards guidelines in general. In addition, GPs were asked to rate their perceived adherence (one statement and the perceived barriers (fourteen statements for each of the key recommendations, based on an existing framework. Results 264 GPs (38% completed the questionnaire. Although 35% of the GPs reported difficulties in changing routines and habits to follow guidelines, 89% believed that following guidelines leads to improved patient care. Perceived adherence varied between 52 and 95% across recommendations (mean: 77%. The most perceived barriers were related to external factors, in particular patient ability and behaviour (mean: 30% and patient preferences (mean: 23%. Lack of applicability of recommendations in general (mean: 22% and more specifically to individual patients (mean: 25% were also frequently perceived as barriers. The scores on perceived barriers differed largely between recommendations [minimum range 14%; maximum range 67%]. Conclusions Dutch GPs have a positive attitude towards the NHG guidelines, report high adherence rates and low levels of perceived barriers. However, the perceived adherence and perceived barriers varied largely across recommendations. The most perceived barriers across recommendations are patient related, suggesting that current guidelines do not always adequately incorporate patient preferences, needs and abilities. It may be

  2. Appraisal tools for clinical practice guidelines: a systematic review.

    Directory of Open Access Journals (Sweden)

    Ulrich Siering

    Full Text Available INTRODUCTION: Clinical practice guidelines can improve healthcare processes and patient outcomes, but are often of low quality. Guideline appraisal tools aim to help potential guideline users in assessing guideline quality. We conducted a systematic review of publications describing guideline appraisal tools in order to identify and compare existing tools. METHODS: Among others we searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from 1995 to May 2011 for relevant primary and secondary publications. We also handsearched the reference lists of relevant publications. On the basis of the available literature we firstly generated 34 items to be used in the comparison of appraisal tools and grouped them into thirteen quality dimensions. We then extracted formal characteristics as well as questions and statements of the appraisal tools and assigned them to the items. RESULTS: We identified 40 different appraisal tools. They covered between three and thirteen of the thirteen possible quality dimensions and between three and 29 of the possible 34 items. The main focus of the appraisal tools were the quality dimensions "evaluation of evidence" (mentioned in 35 tools; 88%, "presentation of guideline content" (34 tools; 85%, "transferability" (33 tools; 83%, "independence" (32 tools; 80%, "scope" (30 tools; 75%, and "information retrieval" (29 tools; 73%. The quality dimensions "consideration of different perspectives" and "dissemination, implementation and evaluation of the guideline" were covered by only twenty (50% and eighteen tools (45% respectively. CONCLUSIONS: Most guideline appraisal tools assess whether the literature search and the evaluation, synthesis and presentation of the evidence in guidelines follow the principles of evidence-based medicine. Although conflicts of interest and norms and values of guideline developers, as well as patient involvement, affect the trustworthiness of guidelines, they are currently

  3. Vitamin D supplementation guidelines.

    Science.gov (United States)

    Pludowski, Pawel; Holick, Michael F; Grant, William B; Konstantynowicz, Jerzy; Mascarenhas, Mario R; Haq, Afrozul; Povoroznyuk, Vladyslav; Balatska, Nataliya; Barbosa, Ana Paula; Karonova, Tatiana; Rudenka, Ema; Misiorowski, Waldemar; Zakharova, Irina; Rudenka, Alena; Łukaszkiewicz, Jacek; Marcinowska-Suchowierska, Ewa; Łaszcz, Natalia; Abramowicz, Pawel; Bhattoa, Harjit P; Wimalawansa, Sunil J

    2017-02-12

    Research carried out during the past two-decades extended the understanding of actions of vitamin D, from regulating calcium and phosphate absorption and bone metabolism to many pleiotropic actions in organs and tissues in the body. Most observational and ecological studies report association of higher serum 25-hydroxyvitamin D [25(OH)D] concentrations with improved outcomes for several chronic, communicable and non-communicable diseases. Consequently, numerous agencies and scientific organizations have developed recommendations for vitamin D supplementation and guidance on optimal serum 25(OH)D concentrations. The bone-centric guidelines recommend a target 25(OH)D concentration of 20ng/mL (50nmol/L), and age-dependent daily vitamin D doses of 400-800IU. The guidelines focused on pleiotropic effects of vitamin D recommend a target 25(OH)D concentration of 30ng/mL (75nmol/L), and age-, body weight-, disease-status, and ethnicity dependent vitamin D doses ranging between 400 and 2000IU/day. The wise and balanced choice of the recommendations to follow depends on one's individual health outcome concerns, age, body weight, latitude of residence, dietary and cultural habits, making the regional or nationwide guidelines more applicable in clinical practice. While natural sources of vitamin D can raise 25(OH)D concentrations, relative to dietary preferences and latitude of residence, in the context of general population, these sources are regarded ineffective to maintain the year-round 25(OH)D concentrations in the range of 30-50ng/mL (75-125nmol/L). Vitamin D self-administration related adverse effects, such as hypercalcemia and hypercalciuria are rare, and usually result from taking extremely high doses of vitamin D for a prolonged time. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. [Infective endocarditis : New ESC guidelines 2015].

    Science.gov (United States)

    Plicht, B; Lind, A; Erbel, R

    2016-07-01

    Infective endocarditis is an endovascular infection usually caused by bacteria. Mortality rate is still approximately 20 %. To improve patients' prognosis by implementation of current diagnostic and therapeutic evidence, the European Society of Cardiology published an updated version of the guidelines for management of infective endocarditis in 2015. It strengthens the role of imaging modalities like PET/CT for detection of infectious foci when echocardiography remains negative and highlights the use of modern tests for identification of possible pathogens. New diagnostic criteria were introduced to integrate these methods for improved diagnostic sensitivity. Complicated cases should be treated in reference centers with on-site cardiac surgery. The antibiotic and early surgical management should be discussed in a multidisciplinary endocarditis team. A few years ago, the indication for endocarditis prophylaxis was limited to high-risk patients. These recommendations were confirmed in current guidelines.

  5. EAU guidelines on primary urethral carcinoma.

    Science.gov (United States)

    Gakis, Georgios; Witjes, J Alfred; Compérat, Eva; Cowan, Nigel C; De Santis, Maria; Lebret, Thierry; Ribal, Maria J; Sherif, Amir M

    2013-11-01

    The European Association of Urology (EAU) Guidelines Group on Muscle-Invasive and Metastatic Bladder Cancer prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). To review the current literature on the diagnosis and treatment of patients with primary UC and assess its level of scientific evidence. A systematic literature search was performed to identify studies reporting urethral malignancies. Medline was searched using the controlled vocabulary of the Medical Subject Headings database, along with a free-text protocol. Primary UC is considered a rare cancer, accounting for EAU. It aims to increase awareness in the urologic community and provide scientific transparency to improve outcomes of this rare urogenital malignancy. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  6. [Anemia: guidelines comparison].

    Science.gov (United States)

    Del Vecchio, Lucia

    2009-01-01

    The development of recombinant human erythropoietin and its introduction into the market in the late 1980s has significantly improved the quality of life of patients with chronic kidney disease (CKD) and reduced the need for blood transfusions. Starting from a cautious target, a progressive increase in the recommended hemoglobin levels has been observed over the years, in parallel with an increase in the obtained levels. This trend has gone together with the publication of findings of observational studies showing a relationship between the increase in hemoglobin levels and a reduction in the mortality risk, with the conduction of clinical trials testing the effects of complete anemia correction, and with the compilation of guidelines on anemia control in CKD patients by scientific societies and organizations. In the last two years, evidence of a possible increase in the mortality risk in those patients who were randomized to high hemoglobin levels has resulted in a decrease in the upper limit of the recommended Hb target to be obtained with erythropoietin stimulating agents (ESA), and consequently in a narrowing of the target range. Comparison of guidelines on anemia control in CKD patients is an interesting starting point to discuss single recommendations, strengthen their importance, or suggest new topics of research to fill up important gaps in knowledge.

  7. Postdoctoral program guidelines.

    Energy Technology Data Exchange (ETDEWEB)

    Teich-McGoldrick, Stephanie; Miller, Andrew W.; Sava, Dorina Florentina; Liu, Yanli; Ferreira, Summer Rhodes; Biedermann, Laura Butler; Cruz-Campa, Jose Luis; Hall, Lisa Michelle; Liu, Xiaohua H.; Ekoto, Isaac

    2012-04-01

    We, the Postdoc Professional Development Program (PD2P) leadership team, wrote these postdoc guidelines to be a starting point for communication between new postdocs, their staff mentors, and their managers. These guidelines detail expectations and responsibilities of the three parties, as well as list relevant contacts. The purpose of the Postdoc Program is to bring in talented, creative people who enrich Sandia's environment by performing innovative R&D, as well as by stimulating intellectual curiosity and learning. Postdocs are temporary employees who come to Sandia for career development and advancement reasons. In general, the postdoc term is 1 year, renewable up to five times for a total of six years. However, center practices may vary; check with your manager. At term, a postdoc may apply for a staff position at Sandia or choose to move to university, industry or another lab. It is our vision that those who leave become long-term collaborators and advocates whose relationships with Sandia have a positive effect upon our national constituency.

  8. Computerizing clinical practice guidelines

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application and comp......It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application...... and compliance with CPGs in most areas of clinical practice are deficient. Computerization of CPGs has been brought forward as a method to disseminate and to support application of CPGs. Until now, CPG-computerization has focused on development of formal expressions of CPGs. The developed systems have, however......, not gained any extensive application in clinical practice. The basic assumption in this thesis is that the scanty penetration is due to an inappropriate design process when designing computerized CPGs for clinical work practice. This thesis examines the application of guidance within areas where CPG...

  9. [CPR--guidelines 2000. New international guidelines for cardiopulmonary resuscitation].

    Science.gov (United States)

    Gervais, H W

    2001-03-01

    The "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus an Science" are the first true international CPR guidelines in the history of resuscitation medicine. Experts from major international resuscitation organizations (International Liaison Committee on Resuscitation, ILCOR) achieved a consensus of recommendations which had to pass a rigorous review procedure applying the tools of evidence-based medicine: all proposed guidelines or guideline changes had to be based on critically appraised pieces of evidence which had to be integrated into a final class of recommendations. The most important changes compared to previous recommendations from either the European Resuscitation Council or the American Heart Association are presented and commented upon.

  10. Canadian Schizophrenia Guidelines: Introduction and Guideline Development Process.

    Science.gov (United States)

    Pringsheim, Tamara; Addington, Donald

    2017-09-01

    The aim of the Canadian Schizophrenia Guidelines is to provide evidence-based recommendations for the treatment of schizophrenia and schizophrenia spectrum disorders. The target users are health care professionals. Recommendations are provided as guidance to physicians and patients, with the goal of improving the overall standard of care of individuals with schizophrenia. The guidelines were developed using the ADAPTE process, a systematic approach and alternative to de novo guideline development, in which an existing guideline is customised to suit the local context. We assembled a multidisciplinary team of experts, patients, and family carers from across Canada with the goal of involving individuals with diverse areas of expertise and offering different perspectives. We identified 6 guidelines that were suitable for adaptation. Recommendations from each guideline were extracted and, based on content, were reviewed by the relevant working group. Each working group examined the evidence from which the recommendation was derived and the acceptability and applicability of the recommendation to the Canadian context. Working groups also made decisions on modifications to recommendations when language or terms differed between the source guideline and the Canadian context. Each working group presented selected recommendations to the guideline panel at an in-person consensus meeting. Once the consensus process was completed, each working group created a manuscript with the recommendations adapted from the included guidelines, with the rationale for each recommendation. The process yielded an up-to-date list of evidence-based recommendations that are relevant and applicable in Canada.

  11. Physical Activity Design Guidelines for School Architecture.

    Directory of Open Access Journals (Sweden)

    Jeri Brittin

    Full Text Available Increasing children's physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students' physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment's impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards.

  12. Physical Activity Design Guidelines for School Architecture

    Science.gov (United States)

    Brittin, Jeri; Sorensen, Dina; Trowbridge, Matthew; Lee, Karen K.; Breithecker, Dieter; Frerichs, Leah; Huang, Terry

    2015-01-01

    Increasing children’s physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students’ physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment’s impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards. PMID:26230850

  13. Physical Activity Design Guidelines for School Architecture.

    Science.gov (United States)

    Brittin, Jeri; Sorensen, Dina; Trowbridge, Matthew; Lee, Karen K; Breithecker, Dieter; Frerichs, Leah; Huang, Terry

    2015-01-01

    Increasing children's physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students' physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment's impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards.

  14. Quality assessment of clinical guidelines in China: 1993-2010

    Institute of Scientific and Technical Information of China (English)

    CHEN Yao-long; XIE Chang-chun; YANG Ke-hu; YAO Liang; XIAO Xiao-juan; WANG Qi; WANG Ze-hao; LIANG Fu-xiang; LIANG Hui; WANG Xin; SHEN Xi-ping

    2012-01-01

    Background Clinical practice guidelines (CPGs) play an important role in healthcare in China as well as in the world.However,the current status and trends of Chinese CPGs are unknown.The aim of this study was to systematically review the present situation and the quality of Chinese CPGs published in the peer-reviewed medical literature.Methods To identify Chinese CPGs,a systematic search of relevant literature databases (CBM,WANFANG,VIP,and CNKI) was performed for the period January 1978 to December 2010.We used the AGREE Ⅱ instrument to assess the quality of the included guidelines.Results We evaluated 269 guidelines published in 115 medical journals from 1993 to 2010 and produced by 256different developers.Only four guidelines (1%) described the systematic methods for searching and selecting the evidence,14 (5%) guidelines indicated an explicit link between the supporting evidence and the recommendations,only one guideline used the Grading of Recommendations Assessment,Development and Evaluation (GRADE) system.Thirty-one guidelines (12%) mentioned updates and the average frequency of update was 5.5 years; none described a procedure for updating the guideline.From the assessment with the Appraisal of Guidelines for Research and Ecaluation Ⅱ (AGREE Ⅱ),the mean scores were low for the domains "scope and purpose" (19%) and "clarity of presentation" (26%)and very low for the other domains ("rigour of development" 7%,"stakeholder involvement" 8%,"applicability" 6% and "editorial independence" 2%).Conclusions Compared with other studies on the quality of guidelines assessed with the AGREE instrument in other countries,Chinese CPGs received lower scores,which indicates a relatively poor quality of the guidelines.However,there was some increase over time.

  15. [Cancer pain management: Systematic review and critical appraisal of clinical practice guidelines].

    Science.gov (United States)

    Martínez-Nicolás, I; Ángel-García, D; Saturno, P J; López-Soriano, F

    2016-01-01

    Although several clinical practice guidelines have been developed in the last decades, cancer pain management is still deficient. The purpose of this work was to carry out a comprehensive and systematic literature review of current clinical practice guidelines on cancer pain management, and critically appraise their methodology and content in order to evaluate their quality and validity to cope with this public health issue. A systematic review was performed in the main databases, using English, French and Spanish as languages, from 2008 to 2013. Reporting and methodological quality was rated with the Appraisal of Guidelines, Research and Evaluation II (AGREE-II) tool, including an inter-rater reliability analysis. Guideline recommendations were extracted and classified into several categories and levels of evidence, aiming to analyse guidelines variability and evidence-based content comprehensiveness. Six guidelines were included. A wide variability was found in both reporting and methodological quality of guidelines, as well as in the content and the level of evidence of their recommendations. The Scottish Intercollegiate Guidelines Network guideline was the best rated using AGREE-II, while the Sociedad Española de Oncología Médica guideline was the worst rated. The Ministry of Health Malaysia guideline was the most comprehensive, and the Scottish Intercollegiate Guidelines Network guideline was the second one. The current guidelines on cancer pain management have limited quality and content. We recommend Ministry of Health Malaysia and Scottish Intercollegiate Guidelines Network guidelines, whilst Sociedad Española de Oncología Médica guideline still needs to improve. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  16. Practice guidelines for tumor marker use in the clinic.

    Science.gov (United States)

    Sturgeon, Catharine

    2002-08-01

    Increasing interest in implementing the practice of evidence-based medicine in oncology has encouraged the development of clinical guidelines, many of which include recommendations about the appropriate use of serum tumor markers. Recent national and international guidelines relating to the use of tumor markers in germ cell, colorectal, breast, ovarian, prostate, lung, neuroendocrine, and thyroid cancers were identified from the scientific literature and other sources and tabulated. Guideline recommendations developed by national and international groups and relating to the use of tumor markers for specific cancers are reviewed and compared, considering the recommendations made for their use in screening, diagnosis, prognosis, and monitoring of therapy. Potential advantages and disadvantages of clinical guidelines, how best to implement them, and means of auditing their effectiveness are also considered. Excellent clinical guidelines, including recommendations for the most appropriate use of tumor markers, are already available for many cancers. Many questions relating to optimal use of these important tests remain to be answered, but current guidelines already contain much valuable information and advice. Further dissemination and implementation of the guidelines should encourage better use of tumor markers in clinical practice. Careful audit studies are also required to establish the impact of these guidelines on the practice of evidence-based medicine.

  17. Guidelines for hazard evaluation procedures

    National Research Council Canada - National Science Library

    2008-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi 1 . Hazard Evaluation Procedures ... Management Overview ... ... Part I Preface 11 Introduction to the Guidelines 1.1 Background ... 1.2 Relationship...

  18. [Clinical guideline 'Turner syndrome'].

    Science.gov (United States)

    van den Akker, Erica L T; van Alfen, A A E M Janiëlle; Sas, Theo C J; Kerstens, Michiel N; Cools, Martine; Lambalk, Cornelis B

    2014-01-01

    Turner syndrome occurs in women who are missing one X chromosome. The most obvious symptoms are small stature and ovarian failure. Turner patients have an increased risk of a large number of disorders, and should therefore have lifelong medical supervision. Recent insights into patient management have been incorporated into the guidelines. Patients are increasingly involved in their own treatment. In patients with 45,X karyotype, Y-chromosomal material is actively sought in a larger number of cells and/or other tissues, using FISH. Pubertal induction therapy, if required, is initiated at an appropriate age. Egg donation or vitrification are new therapeutic options for fertility treatment. Monitoring for cardiac and vascular disease using cardiac ultrasound and MRI is performed more often, partly in connection with the risk of aortal dissection. The coordination of care of patients with Turner syndrome is concentrated in specialized centres in the Netherlands and Belgium.

  19. Guidelines for publication

    Science.gov (United States)

    Rapp, Richard H.

    The AGU Publications Committee and the Board of Journal Editors recently adopted standards for the conduct of the publications process of AGU. These standards articulate the way in which we believe most geophysicists behave when acting as author, editor, or reviewer. We do not perceive a problem with the ethical conduct in any phase of the AGU publications activity. Rather we are presenting what is common practice as a reminder to us all and as help to those who may be just embarking on their scientific careers.We wish to thank in particular our colleagues in the American Chemical Society. With their permission we borrowed heavily from “Ethical Guidelines to Publication of Chemical Research” in the document presented below.

  20. Evidence-based guidelines

    DEFF Research Database (Denmark)

    Wattjes, Mike P; Rovira, Àlex; Miller, David

    2015-01-01

    for the prediction of long-term disability. With the introduction of a new generation of immunomodulatory and/or immunosuppressive drugs for the treatment of MS, MRI also makes an important contribution to the monitoring of treatment, and can be used to determine baseline tissue damage and detect subsequent repair....... This use of MRI can help predict treatment response and assess the efficacy and safety of new therapies. In the second part of the MAGNIMS (Magnetic Resonance Imaging in MS) network's guidelines on the use of MRI in MS, we focus on the implementation of this technique in prognostic and monitoring tasks. We...... present recommendations on how and when to use MRI for disease monitoring, and discuss some promising MRI approaches that may be introduced into clinical practice in the near future....

  1. [Guideline-based diagnosis of dementia etiology].

    Science.gov (United States)

    Hofmann, W

    2012-12-01

    Dementia encompasses a variety of underlying conditions among which Alzheimer's disease represents the most common cause and in addition, vascular and Parkinson's disease dementia, dementia with Lewy bodies and frontotemporal lobar degeneration. All the current guidelines specify a two-step procedure for the diagnostics of dementia. The first step entails performing a comprehensive description, diagnosis and confirmation of the syndrome. The presented article focuses on the second step: diagnosis of the etiology. This review gives an overview of the current diagnostic approaches including the new proposals of the biomarker in cerebrospinal fluid.

  2. EAU guidelines on laser technologies.

    Science.gov (United States)

    Herrmann, Thomas R W; Liatsikos, Evangelos N; Nagele, Udo; Traxer, Olivier; Merseburger, Axel S

    2012-04-01

    The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for

  3. Unifying acute stroke treatment guidelines for a Bayesian belief network.

    Science.gov (United States)

    Love, Alexa; Arnold, Corey W; El-Saden, Suzie; Liebeskind, David S; Andrada, Lewellyn; Saver, Jeffrey; Bui, Alex A T

    2013-01-01

    With the large number of clinical practice guidelines available, there is an increasing need for a comprehensive unified model for acute ischemic stroke treatment to assist in clinical decision making. We present a unified treatment model derived through review of existing clinical practice guidelines, meta-analyses, and clinical trials. Using logic from the treatment model, a Bayesian belief network was defined and fitted to data from our institution's observational quality improvement database for acute stroke patients. The resulting network validates known relationships between variables, treatment decisions and outcomes, and enables the exploration of new correlative relationships not defined in current guidelines.

  4. Changes in Descriptions on Prevention of Lifestyle-related Diseases in New Curriculum Guidelines for Elementary and Junior High Schools

    OpenAIRE

    本田, 藍; 中村, 修; 片渕, 結子

    2010-01-01

    We did this research to verify descriptions of lifestyle-related diseases by comparing the new curriculum guidelines with the current curriculum guidelines. We compared the contents of descriptions between the current curriculum guidelines and the new curriculum guidelines for elementary and junior high schools by extracting passages related to “lifestyle-related diseases” in “2. Goals and contents for respective grades” and “3. Preparation of an instruction plan and handling of content” from...

  5. The Digital electronic Guideline Library (DeGeL): a hybrid framework for representation and use of clinical guidelines.

    Science.gov (United States)

    Shahar, Yuval; Young, Ohad; Shalom, Erez; Mayaffit, Alon; Moskovitch, Robert; Hessing, Alon; Galperin, Maya

    2004-01-01

    We propose to present a poster (and potentially also a demonstration of the implemented system) summarizing the current state of our work on a hybrid, multiple-format representation of clinical guidelines that facilitates conversion of guidelines from free text to a formal representation. We describe a distributed Web-based architecture (DeGeL) and a set of tools using the hybrid representation. The tools enable performing tasks such as guideline specification, semantic markup, search, retrieval, visualization, eligibility determination, runtime application and retrospective quality assessment. The representation includes four parallel formats: Free text (one or more original sources); semistructured text (labeled by the target guideline-ontology semantic labels); semiformal text (which includes some control specification); and a formal, machine-executable representation. The specification, indexing, search, retrieval, and browsing tools are essentially independent of the ontology chosen for guideline representation, but editing the semi-formal and formal formats requires ontology-specific tools, which we have developed in the case of the Asbru guideline-specification language. The four formats support increasingly sophisticated computational tasks. The hybrid guidelines are stored in a Web-based library. All tools, such as for runtime guideline application or retrospective quality assessment, are designed to operate on all representations. We demonstrate the hybrid framework by providing examples from the semantic markup and search tools.

  6. Radon legislation and national guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Aakerblom, G

    1999-07-01

    The International Commission on Radiological Protection (ICRP) and The Council of the European Union have recommended the Member States to take action against radon in homes and at workplaces. Within the EU project European Research into Radon in Construction Concerted Action, ERRICCA, the Topic Group on Legal and Building Code Impact was designated to study the current radon legislation and give advice regarding future enactment of laws and recommendations. On behalf of the Group, a questionnaire on radon legislation was sent out to nearly all European states and a selection of non-European states. Questions were asked regarding reference levels for dwellings, workplaces and drinking water, and about regulations or recommendations for building materials and city planning. All 15 EU Member States, 17 non-EU European countries and 10 non-European countries responded to the questionnaire. Their answers are considered current as of the end of 1998. Most European States and many non-European countries have recommended reference levels for dwellings and workplaces, and some have guidelines for measures against radon incorporated in their building codes and guidelines for construction techniques. However, only a few countries have enforced reference levels or regulations for planning and construction. The reference levels for indoor radon concentration in existing and new dwellings or workplaces are within the range 150-1000 Bq/m{sup 3}. Sweden is the only country (Out of 15 EU member states) which has enforced limits for existing dwellings. Sweden and the UK have both enforced levels for new dwellings. 7 non-European countries (Out of 17 responding countries) have enforced levels for existing dwellings and 9 have them for new dwellings. At the end of 1998, only Finland, Sweden, the Czech Republic, Romania, Russia and the Slovak Republic had limits for radon in water, although 8 countries were planning to introduce such limits. The present limits are within the range for

  7. Concussions in soccer: a current understanding.

    Science.gov (United States)

    Levy, Michael L; Kasasbeh, Aimen S; Baird, Lissa Catherine; Amene, Chiazo; Skeen, Jeff; Marshall, Larry

    2012-11-01

    these concussions, and because almost half of concussed soccer players were noncompliant with recommended American Academy of Neurology return-to-play guidelines, further measures must be taken to protect players, in addition to understanding those criteria that result in removing an injured player from competition and the steps by which to safely return an athlete to competition after injury. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Guidelines for Reporting Medical Research

    DEFF Research Database (Denmark)

    Johansen, Mathilde; Thomsen, Simon Francis

    2016-01-01

    accepted and used guidelines: PRISMA, CONSORT, STROBE, MOOSE, STARD, and SPIRIT. It is concluded that the implementation of these guidelines has led to only a moderate improvement in the quality of the reporting of medical research. There is still much work to be done to achieve accurate and transparent...

  9. Specialty Guidelines for Forensic Psychology

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    In the past 50 years forensic psychological practice has expanded dramatically. Because the practice of forensic psychology differs in important ways from more traditional practice areas (Monahan, 1980) the "Specialty Guidelines for Forensic Psychologists" were developed and published in 1991 (Committee on Ethical Guidelines for Forensic…

  10. IT governance guidelines for directors

    CERN Document Server

    Calder, Alan

    2005-01-01

    This important new book – 'IT Governance: Guidelines for Directors' provides directors, executives, managers and professional advisers with clear, pragmatic guidelines for ensuring that IT and the business work together for the same strategic objectives. 

  11. Specialty Guidelines for Forensic Psychology

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    In the past 50 years forensic psychological practice has expanded dramatically. Because the practice of forensic psychology differs in important ways from more traditional practice areas (Monahan, 1980) the "Specialty Guidelines for Forensic Psychologists" were developed and published in 1991 (Committee on Ethical Guidelines for Forensic…

  12. Journal of Wildlife Management guidelines

    Science.gov (United States)

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

    2011-01-01

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

  13. Guidelines to thermographic inspection of electrical installations

    Science.gov (United States)

    Perch-Nielsen, Thomas; Sorensen, Jens C.

    1994-03-01

    Under the leadership of Danish Technological Institute, Dept. of Energy Technology the initiative was taken in 1991 to coordinate a project to explain and produce documented material for the interpretation of thermograms and to develop practical guidelines for thermographic inspection in electrical plants. Representatives include insurance companies, electricity utility companies, thermography contractors, industrial companies, and suppliers of electrical components and materials from 20 different firms. The project report describes the causes for thermally related defects in electric plants, statistical adaption of already detected defects, defect sources of electric thermography and practical tests charting excess temperature as a function of the current at different typical defects. The guidelines describe how a thermographic examination of larger electrical plants should be carried out in practice. This includes the agreement between customer and thermography contractor, report elaboration, and how different defects are interpreted. This paper describes the project's main contents and its expected effect on industry and insurance companies.

  14. ESPEN Guidelines on Parenteral Nutrition: gastroenterology

    DEFF Research Database (Denmark)

    A., Van Gossum; Cabre, E.; Hebuterne, X.;

    2009-01-01

    Undernutrition as well as specific nutrient deficiencies has been described in patients with Crohn's disease (CD), ulcerative colitis (UC) and short bowel syndrome. In the latter, water and electrolytes disturbances may be a major problem. The present guidelines provide evidence-based recommendat......Undernutrition as well as specific nutrient deficiencies has been described in patients with Crohn's disease (CD), ulcerative colitis (UC) and short bowel syndrome. In the latter, water and electrolytes disturbances may be a major problem. The present guidelines provide evidence....... There is a lack of data supporting specific nutrients in these conditions. Parenteral nutrition is mandatory in case of intestinal failure, at least in the acute period. In patients with short bowel, specific attention should be paid to water and electrolyte supplementation. Currently, the use of growth hormone...

  15. EAACI Food Allergy and Anaphylaxis Guidelines

    DEFF Research Database (Denmark)

    Muraro, A; Werfel, T; Hoffmann-Sommergruber, K

    2014-01-01

    Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building...... on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists......, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management...

  16. ESUR prostate MR guidelines 2012

    DEFF Research Database (Denmark)

    Barentsz, Jelle O; Richenberg, Jonathan; Clements, Richard

    2012-01-01

    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...... provides guidelines for magnetic resonance imaging (MRI) in prostate cancer. Clinical indications, and minimal and optimal imaging acquisition protocols are provided. A structured reporting system (PI-RADS) is described....

  17. Guidelines on Building Regulations 2008

    DEFF Research Database (Denmark)

    Thse guidelines clarify and intepret the provisions of the Building Regulations of 2008 (BR08). The Guidelines, which match BR08 in terms of organisation into Parts, are accompanied by the full text of the regulations and the explanatory notes issued by the Danish Enterprise and Construction...... Authority. The Guidelines refer the reader to sources such as relevant standards, instructions and other background material which provides more detailed information. The Guidelines cover the same ground as BR08, including building control regulations, layout, fitting out, structures, fire safety, indoor...... climate, energy consumotion and services. The Guidelines are aimed at all professionals involved in building projects, particularly building design consultants, contractors and municipal application officers....

  18. Guideline-based management of male infertility: Why do we need it?

    Directory of Open Access Journals (Sweden)

    Landon W Trost

    2011-01-01

    Full Text Available The current clinical guidelines for the management of infertility as presented by the American Urologic Association and European Association of Urology represent consensus opinions for the management of male-factor infertility. The goal of the present study is to define the currently available guidelines for male-factor infertility, provide a rationale for why guidelines should be implemented, and review concerns and shortcomings towards their incorporation into clinical practice. Successfully integrating guidelines into clinical practice offers the potential benefit of creating a standardized, efficient, and cost-effective algorithm for the evaluation of infertility and facilitates future research. Despite their availability and ease of use, many clinicians fail to adopt clinical guidelines for numerous reasons including decreased awareness of available guidelines, insufficient time, lack of interest, and personal financial considerations. The current guidelines are limited by the inability to generalize recommendations to a heterogeneous patient sample, the lack of interdisciplinary adoption of guidelines, and the need for additional emphasis on prevention and lifestyle modifications. Future direction for the current guidelines will likely incorporate a multidisciplinary approach with increasing utilization of genetic analysis and novel treatment strategies. As the field of infertility continues to expand, the utility of guidelines combined with physician clinical judgment will remain prominent in the treatment of male-factor infertility.

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

    Directory of Open Access Journals (Sweden)

    S S Vasan

    2006-01-01

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

  20. Do current sports nutrition guidelines conflict with good oral health?

    Science.gov (United States)

    Broad, Elizabeth M; Rye, Leslie A

    2015-01-01

    For optimal athletic performance, an athlete requires good oral health to reduce the risk of oral pain, inflammation, and infection and thereby minimize the use of analgesics and antimicrobial agents. Increased intake, frequency, and dental contact time of carbohydrate-rich foods, sports nutrition products, and acidic carbohydrate-containing sports and energy drinks may contribute to risks of dental erosion, caries, and inflammatory periodontal conditions in the athlete, especially when he or she also exhibits dehydration and poor oral hygiene habits. Examining the athlete before he or she begins participating in a sport allows the dental care provider to determine the patient's existing oral health, hygiene, and susceptibility to risk factors for erosion, caries, and inflammatory periodontal disease. This oral profile, in conjunction with the individual athlete's dietary needs, can be used to establish a treatment and preventive program, including oral health education. Good oral hygiene practices and application of topical fluoride, especially via fluoridated toothpastes and topical fluoride varnishes, must be available to the athlete. Rinsing with water or a neutral beverage after exposure to carbohydrates or acidic sports nutrition products may reduce carbohydrate contact time and bring oral pH levels back to neutral more quickly, reducing the risk of caries and erosion. Finally, the dentist should encourage the athlete to consult with an experienced sports dietitian to ensure that principles of sports nutrition are being appropriately applied for the type, frequency, and duration of exercise in consideration of the individual's oral health needs.

  1. [Update on Current Care Guidelines. Rheumatoid Arthritis (RA)].

    Science.gov (United States)

    2015-01-01

    Patients with signs and symptoms of early rheumatoid arthritis (RA) should be referred to a multidisciplinary rheumatology clinic. The ACR-EULAR criteria help in identification of patients with risk for erosive RA. Treatment should aim at early remission. Start with the combination of methotrexate, hydroxychloroquine, sulfasalazine, and low-dose glucocorticoid is recommended if contraindications exist. Methotrexate has better bioavailability as injection. Glucocorticoids are injected into active joints. Patient education with shared decision is essential. Exercise training is recommended. If treatment target is not achieved by the DMARD combination, a biological drug is added.

  2. [Update on current care guidelines: knee and hip osteoarthriti].

    Science.gov (United States)

    2012-01-01

    The goal of OA (osteoarthritis) treatment is to relieve pain and maintain/improve patient's functional capacity. First line medication is paracetamol and topical NSAIDs, and oral NSAIDs when needed. Tramadol and codeine may be considered in most severe cases. Glucosamine and chondroitin do not differ from placebo, but intra-articular glucocorticoids and hyaluronate may be useful. Supervised exercise is recommended especially for knee osteoarthritis. Cold, TENS and ultrasound therapies may offer short-term benefits in knee OA. Arthroscopic debridement does not alleviate OA symptoms. Arthroplasty is indicated if pain is not otherwise manageable.

  3. [Update on current care guidelines: urinary incontinence (female)].

    Science.gov (United States)

    2012-01-01

    Female urinary incontinence (UI) is divided into stress (SUI), urgency (UUI), mixed (MUI) and overflow incontinence (chronic retention). Advanced age, obesity and pregnancy are the most important risk factors. Standardised questionnaires are used in diagnosis. The pad test, cough stress test and bladder diary are objective tools. A gynaecological examination includes pelvic floor muscle palpation and residual urine measurement. Urodynamics, cystoscopy and ultrasonography are complementary tools. Guided pelvic floor-muscle training is the first-line therapy. UUI can be treated with anticholinergic medicines. If conservative treatments are ineffective, SUI and MUI can be treated surgically with mid-urethral slings (TVT TOT and TVT-0).

  4. A critique of current practice: ten foundational guidelines for autoethnographers.

    Science.gov (United States)

    Tolich, Martin

    2010-12-01

    Any research is potentially compromised when researchers address ethical issues retrospectively rather than by anticipating these issues. In this regard, creative analytical practices (CAP) autoethnography has endemic problems. In Part 1 of this article, I detail a case study of an autoethnography in which journal reviewers insisted that an author gain retrospective informed consent from the 23 persons documented in an autoethnography. Yet the journal reviewers' insistence failed to go one step further-acknowledging that a conflict of interest develops when gaining consent retrospectively. In Part 2, I contrast three leading autoethnographers' justifications for not gaining informed consent with the Position Statement on Qualitative Research developed by successive Congresses of Qualitative Inquiry. In Part 3, I identify resources available for autoethnographers, including ethical issues present when researchers use autoethnography to heal themselves, violating the internal confidentiality of relational others. In Part 4, I question if autoethnography is research and, like journalism, exempt from formal ethics review. Throughout the article, 10 foundational ethical considerations for autoethnographers are developed, taking autoethnographers beyond procedural ethics and providing tools for their ethics in practice.

  5. Chest trauma in children: current imaging guidelines and techniques.

    LENUS (Irish Health Repository)

    Moore, Michael A

    2011-09-01

    Given the heterogeneous nature of pediatric chest trauma, the optimal imaging approach is tailored to the specific patient. Chest radiography remains the most important imaging modality for initial triage. The decision to perform a chest computed tomography scan should be based on the nature of the trauma, the child\\'s clinical condition, and the initial radiographic findings, taking the age-related pretest probabilities of serious injury into account. The principles of as low as reasonably achievable and Image Gently should be followed. The epidemiology and pathophysiology, imaging techniques, characteristic findings, and evidence-based algorithms for pediatric chest trauma are discussed.

  6. [Inhaled corticosteroids in patients with COPD: maintain current guidelines

    NARCIS (Netherlands)

    Heijdra, Y.F.

    2007-01-01

    The use of inhaled corticosteroids (ICS) is one of the most controversial issues in COPD treatment. There is evidence that ICS with or without long-acting beta-2-adrenergics (LABA) reduce exacerbation rates and improve the health status of severe COPD patients. The effects on FEV1 are limited and th

  7. Exploring the Safety Margin in Current Guidelines for Electromagnetic Exposure

    NARCIS (Netherlands)

    F. Adibzadeh (Fatemeh)

    2017-01-01

    markdownabstractExposure to radio-frequency (RF) electromagnetic fields (EMF) is unavoidable in today's modern life. This exposure is growing mainly because of rapid growth in telecommunication systems. Awareness of the possible risks of exposure to EMF has raised public concern. To avoid any potent

  8. 10 CFR 960.4 - Postclosure guidelines.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Postclosure guidelines. 960.4 Section 960.4 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Postclosure Guidelines § 960.4 Postclosure guidelines. The guidelines in this subpart specify...

  9. 10 CFR 960.5 - Preclosure guidelines.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Preclosure guidelines. 960.5 Section 960.5 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5 Preclosure guidelines. The guidelines in this subpart specify...

  10. 10 CFR 960.3 - Implementation guidelines.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this...

  11. Emergency Response Guideline Development

    Energy Technology Data Exchange (ETDEWEB)

    Gary D. Storrick

    2007-09-30

    Task 5 of the collaborative effort between ORNL, Brazil, and Westinghouse for the International Nuclear Energy Research Initiative entitled “Development of Advanced Instrumentation and Control for an Integrated Primary System Reactor” focuses on operator control and protection system interaction, with particular emphasis on developing emergency response guidelines (ERGs). As in the earlier tasks, we will use the IRIS plant as a specific example of an integrated primary system reactor (IPSR) design. The present state of the IRIS plant design – specifically, the lack of a detailed secondary system design – precludes establishing detailed emergency procedures at this time. However, we can create a structure for their eventual development. This report summarizes our progress to date. Section 1.2 describes the scope of this effort. Section 2 compares IPSR ERG development to the recent AP1000 effort, and identifies three key plant differences that affect the ERGs and control room designs. The next three sections investigate these differences in more detail. Section 3 reviews the IRIS Safety-by-Design™ philosophy and its impact on the ERGs. Section 4 looks at differences between the IRIS and traditional loop PWR I&C Systems, and considers their implications for both control room design and ERG development. Section 5 examines the implications of having one operating staff control multiple reactor units. Section 6 provides sample IRIS emergency operating procedures (EOPs). Section 7 summarizes our conclusions.

  12. [French guidelines on electroencephalogram].

    Science.gov (United States)

    André-Obadia, N; Sauleau, P; Cheliout-Heraut, F; Convers, P; Debs, R; Eisermann, M; Gavaret, M; Isnard, J; Jung, J; Kaminska, A; Kubis, N; Lemesle, M; Maillard, L; Mazzola, L; Michel, V; Montavont, A; N'Guyen, S; Navarro, V; Parain, D; Perin, B; Rosenberg, S D; Sediri, H; Soufflet, C; Szurhaj, W; Taussig, D; Touzery-de Villepin, A; Vercueil, L; Lamblin, M D

    2014-12-01

    Electroencephalography allows the functional analysis of electrical brain cortical activity and is the gold standard for analyzing electrophysiological processes involved in epilepsy but also in several other dysfunctions of the central nervous system. Morphological imaging yields complementary data, yet it cannot replace the essential functional analysis tool that is EEG. Furthermore, EEG has the great advantage of being non-invasive, easy to perform and allows control tests when follow-up is necessary, even at the patient's bedside. Faced with the advances in knowledge, techniques and indications, the Société de Neurophysiologie Clinique de Langue Française (SNCLF) and the Ligue Française Contre l'Épilepsie (LFCE) found it necessary to provide an update on EEG recommendations. This article will review the methodology applied to this work, refine the various topics detailed in the following chapters. It will go over the summary of recommendations for each of these chapters and underline proposals for writing an EEG report. Some questions could not be answered by the review of the literature; in those cases, an expert advice was given by the working and reading groups in addition to the guidelines.

  13. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2012-07-01

    Full Text Available Abstract Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence. It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

  14. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.

    Science.gov (United States)

    Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven

    2012-07-04

    Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

  15. AHNS Series - Do you know your guidelines? Principles of treatment for nasopharyngeal cancer: A review of the National Comprehensive Cancer Network guidelines.

    Science.gov (United States)

    Gooi, Zhen; Richmon, Jeremy; Agrawal, Nishant; Blair, Elizabeth; Portugal, Louis; Vokes, Everett; Seiwert, Tanguy; de Souza, Jonas; Saloura, Vassiliki; Haraf, Daniel; Goldenberg, David; Chan, Jason

    2017-02-01

    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 the management of nasopharyngeal cancer are reviewed here in a systematic fashion. These guidelines outline the workup, treatment and surveillance of patients with nasopharyngeal cancer. © 2016 Wiley Periodicals, Inc. Head Neck 39: 201-205, 2017.

  16. Guidelines for strategic planning

    Energy Technology Data Exchange (ETDEWEB)

    1991-07-01

    Strategic planning needs to be done as one of the integral steps in fulfilling our overall Departmental mission. The role of strategic planning is to assure that the longer term destinations, goals, and objectives which the programs and activities of the Department are striving towards are the best we can envision today so that our courses can then be set to move in those directions. Strategic planning will assist the Secretary, Deputy Secretary, and Under Secretary in setting the long-term directions and policies for the Department and in making final decisions on near-term priorities and resource allocations. It will assist program developers and implementors by providing the necessary guidance for multi-year program plans and budgets. It is one of the essential steps in the secretary's Strategic Planning Initiative. The operational planning most of us are so familiar with deals with how to get things done and with the resources needed (people, money, facilities, time) to carry out tasks. Operating plans like budgets, capital line item projects, R D budgets, project proposals, etc., are vital to the mission of the Department. They deal, however, with how to carry out programs to achieve some objective or budget assumption. Strategic planning deals with the prior question of what it is that should be attempted. It deals with what objectives the many programs and activities of the Department of Department should be striving toward. The purpose of this document is to provide guidance to those organizations and personnel starting the process for the first time as well as those who have prepared strategic plans in the past and now wish to review and update them. This guideline should not be constructed as a rigid, restrictive or confining rulebook. Each organization is encouraged to develop such enhancements as they think may be useful in their planning. The steps outlined in this document represent a very simplified approach to strategic planning. 9 refs.

  17. 36 CFR 910.67 - Square guidelines.

    Science.gov (United States)

    2010-07-01

    ... DEVELOPMENT AREA Glossary of Terms § 910.67 Square guidelines. Square Guidelines establish the Corporation's... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Square guidelines. 910.67... planning area....

  18. Guideline Implementation: Processing Flexible Endoscopes.

    Science.gov (United States)

    Bashaw, Marie A

    2016-09-01

    The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  19. Guidelines for Reporting Medical Research

    DEFF Research Database (Denmark)

    Johansen, Mathilde; Thomsen, Simon Francis

    2016-01-01

    As a response to a low quality of reporting of medical research, guidelines for several different types of study design have been developed to secure accurate reporting and transparency for reviewers and readers from the scientific community. Herein, we review and discuss the six most widely...... accepted and used guidelines: PRISMA, CONSORT, STROBE, MOOSE, STARD, and SPIRIT. It is concluded that the implementation of these guidelines has led to only a moderate improvement in the quality of the reporting of medical research. There is still much work to be done to achieve accurate and transparent...... reporting of medical research findings....

  20. Managing electronic records: A guideline

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, J.G.

    1994-10-25

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

  1. Managing electronic records: A guideline

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, J.

    1995-07-01

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

  2. Physical examinations and laboratory tests in antenatal care visits in Denmark. Do reported practice and current official guidelines concord with results of literature reviews? A nationwide study of the public scheme of shared antenatal care in general practice, centres of midwifery and hospital

    DEFF Research Database (Denmark)

    Kristensen, F B; Andersen, K V; Andersen, A M

    1995-01-01

    To analyse physical examinations and laboratory tests reported in antenatal care visits in relation to official guidelines and reviews of appropriateness.......To analyse physical examinations and laboratory tests reported in antenatal care visits in relation to official guidelines and reviews of appropriateness....

  3. Physician adherence to ACR gout treatment guidelines: perception versus practice.

    Science.gov (United States)

    Oderda, Gary M; Shiozawa, Aki; Walsh, Michael; Hess, Kyle; Brixner, Diana I; Feehan, Michael; Akhras, Kasem

    2014-05-01

    In October 2012, the American College of Rheumatology (ACR) published recommendations for chronic gout treatment goals and pharmacotherapy. Identify potential gaps between real-world chronic gout treatment, ACR guideline recommendations, and physicians' perceived guideline adherence by evaluating records of patients classified as having "higher" and "lower" guideline adherence as defined by the investigators. A comprehensive quantitative survey was administered between February 11 and February 22, 2013, to physicians treating patients with gout; the survey included a patient record chart review informed by prior qualitative interviews. Eight criteria from the ACR gout management guidelines were used to compose the survey. To assess ACR guideline adherence, information from records of patients with chronic gout treated by primary care physicians (PCPs) and rheumatologists was scored from 0 (no adherence) to 8 (total adherence), in accordance with ACR guideline recommendations. Physicians also indicated how closely they believed patient treatment followed current guidelines on a 10-point scale. Of the 350 records of patients with chronic gout, all but 3 PCP patients were adherent on ≥ 1 guideline recommendation, but nearly all patients could be considered nonadherent, considering all potential recommendations. Patients with chronic gout treated by rheumatologists tended to be managed more closely to ACR guidelines than patients treated by PCPs (mean scores: rheumatologists 5.8/8 ± 1.7 vs 4.3/8 ± 1.7 for PCPs). Among patients classified as having "higher adherence" based on adherence scores, there was low adherence on first-line urate lowering therapy dose, acute prophylaxis dosing, and length of prophylaxis treatment. Among PCPs and rheumatologists, there was a disparity between how closely physicians believed patient treatment followed guidelines and actual adherence with ACR guidelines based on adherence scores. For 16.4% of patients treated by PCPs and 18

  4. Exercise guidelines for gestational diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    The prevalence of gestational diabetes mellitus (GDM)is increasing worldwide. This disease has many detrimentalconsequences for the woman, the unborn foetusand child. The management of GDM aims to mediatethe effects of hyperglycaemia by controlling bloodglucose levels. Along with pharmacology and dietaryinterventions, exercise has a powerful potential to assistwith blood glucose control. Due to the uncertainty ofrisks and benefits of exercise during pregnancy, womentend to avoid exercise. However, under adequatesupervision exercise is both safe and beneficial in thetreatment of GDM. Therefore it is vital that exerciseis incorporated into the continuum of care for womenwith GDM. Medical doctors should be able to refer tocompetently informed exercise professionals to aid inGDM treatment. It is important that exercise treatmentis informed by research. Hence, the developmentof evidence-based guidelines is important to informpractice. Currently there are no guidelines for exercise inGDM. This review aims to assess the efficacy of exercisefor the management of GDM in order to establish anexercise prescription guideline specific to the condition.It is recommended that women with GDM should doboth aerobic and resistance exercise at a moderateintensity, a minimum of three times a week for 30-60min each time.

  5. Advanced lighting guidelines: 1993. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Eley, C.; Tolen, T.M. [Eley Associates, San Francisco, CA (United States); Benya, J.R. [Luminae Souter Lighting Design, San Francisco, CA (United States); Rubinstein, F.; Verderber, R. [Lawrence Berkeley Lab., CA (United States)

    1993-12-31

    The 1993 Advanced Lighting Guidelines document consists of twelve guidelines that provide an overview of specific lighting technologies and design application techniques utilizing energy-efficient lighting practice. Lighting Design Practice assesses energy-efficient lighting strategies, discusses lighting issues, and explains how to obtain quality lighting design and consulting services. Luminaires and Lighting Systems surveys luminaire equipment designed to take advantage of advanced technology lamp products and includes performance tables that allow for accurate estimation of luminaire light output and power input. The additional ten guidelines -- Computer-Aided Lighting Design, Energy-Efficient Fluorescent Ballasts, Full-Size Fluorescent Lamps, Compact Fluorescent Lamps, Tungsten-Halogen Lamps, Metal Halide and HPS Lamps, Daylighting and Lumen Maintenance, Occupant Sensors, Time Scheduling Systems, and Retrofit Control Technologies -- each provide a product technology overview, discuss current products on the lighting equipment market, and provide application techniques. This document is intended for use by electric utility personnel involved in lighting programs, lighting designers, electrical engineers, architects, lighting manufacturers` representatives, and other lighting professionals.

  6. The European Association of Urology (EAU) guidelines methodology: a critical evaluation.

    Science.gov (United States)

    Aus, Gunnar; Chapple, Christopher; Hanûs, Tomas; Irani, Jacques; Lobel, Bernard; Loch, Tillmann; Mitropoulos, Dionysios; Parsons, Keith; Plass, Karin; Schmid, Hans-Peter

    2009-11-01

    Guidelines can be produced and written in numerous ways. The aim of the present article is to describe and evaluate the method currently used to produce the European Association of Urology (EAU) guidelines. The methodology is described in detail, compared to other urologic guidelines by members of the EAU Guidelines Office Board. The new methodology is evaluated by the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. The currently used methodology is adapted to the aims and objectives as established by the EAU for their guidelines; wide coverage (essentially all fields of urology) and useful to urologists all over Europe. The frequent updates are easily accessible in a printed and electronic format. The AGREE instrument supports these strong points, but also identifies potentially weak points, such as no patient involvement, no formal validation of the guidelines texts prior to publication, and lack of discussion of organisational barriers and cost implications. The currently used methodology for the production of EAU guidelines fulfils the association's main objectives related to their guidelines, but the texts will benefit from the inclusion of country-specific cost and organisational data. For the practising clinician, these guidelines will help to take science into clinical practice.

  7. Induction motor starting current

    Energy Technology Data Exchange (ETDEWEB)

    Arneaud, J.M.; Langman, R.A. [Tasmania Univ., Hobart, TAS (Australia)

    1995-12-31

    Large errors may occur if leakage path saturation is neglected when reduced-voltage test results are used to predict the direct-on-line starting current of induction motors. The results of applying three existing and two new methods for starting current prediction are compared with test data from 52 motors. A quantitative assessment is made of the probable reduction in error that would be achieved by increasing the number of available sets of reduced-voltage, locked rotor test results or by including slot design data. Guidelines are given for selecting an appropriate predictive method. (author). 4 tabs., 1 fig., 6 refs.

  8. Some Guidelines for Energy Programs

    Science.gov (United States)

    Kryger, King C.

    1977-01-01

    This article offers guidelines for educational programs developed for the purpose of educating students and adults on the seriousness of the energy crises and the steps that must be taken to cope with it. (JD)

  9. Measure Guideline: Basement Insulation Basics

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, R.; Mantha, P.; Puttagunta, S.

    2012-10-01

    This guideline is intended to describe good practices for insulating basements in new and existing homes, and is intended to be a practical resources for building contractors, designers, and also to homeowners.

  10. Total quality management implementation guidelines

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-01

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

  11. 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

  12. Adapting clinical guidelines in low-resources countries: a study on the guideline on the management and prevention of type 2 diabetes mellitus in Indonesia.

    Science.gov (United States)

    Widyahening, Indah S; Wangge, Grace; van der Graaf, Yolanda; van der Heijden, Geert J M G

    2017-02-01

    Most of the clinical guidelines in low-resource countries are adaptations from preexisting international guidelines. This adaptation can be problematic when those international guidelines are not based on current evidence or original evidence-based international guidelines are not followed. This study aims to evaluate the quality of an Indonesian type 2 diabetes mellitus guideline adapted from selected international guidelines. The "Consensus on the Management and Prevention of type 2 Diabetes in Indonesia 2011" is a guideline by the Indonesian Society of Endocrinology (Perkeni). Four parent guidelines identified from its list of references were from the International Diabetes Federation (IDF), American Association of Clinical Endocrinologist (AACE), American Diabetes Association (ADA), and one jointly released by ADA and European Association for the Study of Diabetes (EASD). Two reviewers independently assessed its quality using the Appraisal of Guidelines, Research and Evaluation Collaboration (AGREE II) instrument. Six recommendations were compared: (1) screening for diabetes; (2) diagnosis; (3) control of hyperglycemia; (4) target blood glucose; (5) target blood pressure; and (6) treatment of dyslipidemia. Perkeni's guideline satisfied 55% of the AGREE II items, while its parent guidelines satisfied 59% to 74%. Perkeni's shows low score on "rigor of development" and "applicability" and the lowest score in the "scope and purpose" domain. Differences were found in 4 recommendations: the screening of diabetes, control of hyperglycemia, target blood glucose, and treatment of dyslipidemia. In 3 of 4, Perkeni followed the ADA's recommendation. Derivation of recommendations from parent guidelines and their adaptation to the context of Indonesian health care lacks transparency. When guidelines are either derived from other guidelines or adapted for use in different context, evidence-based practice principles should be followed and adhered to. © 2016 The Authors

  13. Guidelines for glycol dehydrator design

    Energy Technology Data Exchange (ETDEWEB)

    Manning, W.P. (Coastal Chemical Co., Inc., Houston, TX (United States)); Wood, H.S. (Maloney-Crawford, Tulsa, OK (United States))

    1993-02-01

    Design guidelines can reduce hydrate-pluggage problems in the triethylene glycol (TEG) absorption process, thus eliminating downtime and lost production caused by water in natural gas. In addition, equipment can be properly sized by following prescribed troubleshooting tips. Guidelines are presented along with the instrumentation list to help one correctly size an absorber and reconcentrator. The paper discusses the following: the pump; gas-glycol heat exchanger; instrumentation; operating conditions; and dew point depression. Four design problems are then illustrated.

  14. FDH radiological design review guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Millsap, W.J.

    1998-09-29

    These guidelines discuss in more detail the radiological design review process used by the Project Hanford Management Contractors as described in HNF-PRO-1622, Radiological Design Review Process. They are intended to supplement the procedure by providing background information on the design review process and providing a ready source of information to design reviewers. The guidelines are not intended to contain all the information in the procedure, but at points, in order to maintain continuity, they contain some of the same information.

  15. Immunisation Guidelines for Ireland (2008)

    OpenAIRE

    Department of Health

    2008-01-01

    Immunisation Guidelines for Ireland (2008) This revised report on immunisation guidelines for Ireland has been prepared with the assistance of an active Committee from associated disciplines in Paediatrics, Infectious Diseases, General Practice, Public Health, Microbiology, Occupational Health, Travel Medicine and the Irish Medicines Board. The report itself continues to be simple and concise in design and of course does not claim to contain all information on any pharmacological material....

  16. EAU Guidelines on Urethral Trauma.

    Science.gov (United States)

    Martínez-Piñeiro, Luis; Djakovic, Nenad; Plas, Eugen; Mor, Yoram; Santucci, Richard A; Serafetinidis, Efraim; Turkeri, Levent N; Hohenfellner, Markus

    2010-05-01

    These guidelines were prepared on behalf of the European Association of Urology (EAU) to assist urologists in the management of traumatic urethral injuries. To determine the optimal evaluation and management of urethral injuries by review of the world's literature on the subject. A working group of experts on Urological Trauma was convened to review and summarize the literature concerning the diagnosis and treatment of genitourinary trauma, including urethral trauma. The Urological Trauma guidelines have been based on a review of the literature identified using on-line searches of MEDLINE and other source documents published before 2009. A critical assessment of the findings was made, not involving a formal appraisal of the data. There were few high-powered, randomized, controlled trials in this area and considerable available data was provided by retrospective studies. The Working Group recognizes this limitation. The full text of these guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article comprises the abridged version of a section of the Urological Trauma guidelines. Updated and critically reviewed Guidelines on Urethral Trauma are presented. The aim of these guidelines is to provide support to the practicing urologist since urethral injuries carry substantial morbidity. The diversity of urethral injuries, associated injuries, the timing and availability of treatment options as well as their relative rarity contribute to the controversies in the management of urethral trauma. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  17. Medicare program; Medicare depreciation, useful life guidelines--HCFA. Final rule.

    Science.gov (United States)

    1983-08-18

    These final rules amend Medicare regulations to clarify which useful life guidelines may be used by providers of health care services to determine the useful life of a depreciable asset for Medicare reimbursement purposes. Current regulations state that providers must utilize the Departmental useful life guidelines or, if none have been published by the Department, either the American Hospital Association (AHA) useful life guidelines of 1973 of IRS guidelines. We are eliminating the reference to IRS guidelines because these are now outdated for Medicare purposes since they have been rendered obsolete either by the IRS or by statutory change. We are also deleting the specific reference to the 1973 AHA guidelines since these guidelines are updated by the AHA periodically. In addition, we are clarifying that certain tax legislation on accelerated depreciation, passed by Congress, does not apply to the Medicare program.

  18. Climate friendly dietary guidelines

    DEFF Research Database (Denmark)

    Trolle, Ellen; Mogensen, Lisbeth; Thorsen, Anne Vibeke

    2014-01-01

    The aim of this study was to investigate how the present Danish diet could be changed in a climate friendly direction that follows the recommendations of a healthy diet. The carbon footprint (CF) of an average Danish diet was calculated and compared to CF of a recommended healthy diet by 1......%, if the healthy diet was eaten instead of the average current diet. However, if the diet was climate optimized by choosing foods with a low CF within the food groups; meat, vegetables and fruit, CF of this diet may be reduced by 23 % compared to CF of the average diet....

  19. EAU guidelines on urinary incontinence.

    Science.gov (United States)

    Thüroff, Joachim W; Abrams, Paul; Andersson, Karl-Erik; Artibani, Walter; Chapple, Christopher R; Drake, Marcus J; Hampel, Christian; Neisius, Andreas; Schröder, Annette; Tubaro, Andrea

    2011-03-01

    The first European Association of Urology (EAU) guidelines on incontinence were published in 2001. These guidelines were periodically updated in past years. The aim of this paper is to present a summary of the 2009 update of the EAU guidelines on urinary incontinence (UI). The EAU working panel was part of the 4th International Consultation on Incontinence (ICI) and, with permission of the ICI, extracted the relevant data. The methodology of the 4th ICI was a comprehensive literature review by international experts and consensus formation. In addition, level of evidence was rated according to a modified Oxford system and grades of recommendation were given accordingly. A full version of the EAU guidelines on urinary incontinence is available as a printed document (extended and short form) and as a CD-ROM from the EAU office or online from the EAU Web site (http://www.uroweb.org/guidelines/online-guidelines/). The extent and invasiveness of assessment of UI depends on severity and/or complexity of symptoms and clinical signs and is different for men, women, frail older persons, children, and patients with neuropathy. At the level of initial management, basic diagnostic tests are applied to exclude an underlying disease or condition such as urinary tract infection. Treatment is mostly conservative (lifestyle interventions, physiotherapy, physical therapy, pharmacotherapy) and is of an empirical nature. At the level of specialised management (when primary therapy failed, diagnosis is unclear, or symptoms and/or signs are complex/severe), more elaborate assessment is generally required, including imaging, endoscopy, and urodynamics. Treatment options include invasive interventions and surgery. Treatment options for UI are rapidly expanding. These EAU guidelines provide ratings of the evidence (guided by evidence-based medicine) and graded recommendations for the appropriate assessment and according treatment options and put them into clinical perspective. Copyright

  20. [EAU Guidelines on Urinary Incontinence].

    Science.gov (United States)

    Thüroff, J W; Abrams, P; Andersson, K-E; Artibani, W; Chapple, C R; Drake, M J; Hampel, C; Neisius, A; Schröder, A; Tubaro, A

    2011-01-01

    The first European Association of Urology (EAU) guidelines on incontinence were published in 2001. These guidelines were periodically updated in past years. The aim of this paper is to present a summary of the 2009 update of the EAU guidelines on urinary incontinence (UI). The EAU working panel was part of the 4th International Consultation on Incontinence (ICI) and, with permission of the ICI, extracted the relevant data. The methodology of the 4th ICI was a comprehensive literature review by international experts and consensus formation. In addition, level of evidence was rated according to a modified Oxford system and grades of recommendation were given accordingly. A full version of the EAU guidelines on urinary incontinence is available as a printed document (extended and short form) and as a CD-ROM from the EAU office or online from the EAU Web site (http://www.uroweb.org/guidelines/online-guidelines/). The extent and invasiveness of assessment of UI depends on severity and/or complexity of symptoms and clinical signs and is different for men, women, frail older persons, children, and patients with neuropathy. At the level of initial management, basic diagnostic tests are applied to exclude an underlying disease or condition such as urinary tract infection. Treatment is mostly conservative (lifestyle interventions, physiotherapy, physical therapy, pharmacotherapy) and is of an empirical nature. At the level of specialised management (when primary therapy failed, diagnosis is unclear, or symptoms and/or signs are complex/severe),more elaborate assessment is generally required, including imaging, endoscopy, and urodynamics. Treatment options include invasive interventions and surgery. Treatment options for UI are rapidly expanding. These EAU guidelines provide ratings of the evidence (guided by evidence-based medicine) and graded recommendations for the appropriate assessment and according treatment options and put them into clinical perspective. Copyright

  1. How can we improve guideline use? A conceptual framework of implementability

    Directory of Open Access Journals (Sweden)

    Lemieux-Charles Louise

    2011-03-01

    Full Text Available Abstract Background Guidelines continue to be underutilized, and a variety of strategies to improve their use have been suboptimal. Modifying guideline features represents an alternative, but untested way to promote their use. The purpose of this study was to identify and define features that facilitate guideline use, and examine whether and how they are included in current guidelines. Methods A guideline implementability framework was developed by reviewing the implementation science literature. We then examined whether guidelines included these, or additional implementability elements. Data were extracted from publicly available high quality guidelines reflecting primary and institutional care, reviewed independently by two individuals, who through discussion resolved conflicts, then by the research team. Results The final implementability framework included 22 elements organized in the domains of adaptability, usability, validity, applicability, communicability, accommodation, implementation, and evaluation. Data were extracted from 20 guidelines on the management of diabetes, hypertension, leg ulcer, and heart failure. Most contained a large volume of graded, narrative evidence, and tables featuring complementary clinical information. Few contained additional features that could improve guideline use. These included alternate versions for different users and purposes, summaries of evidence and recommendations, information to facilitate interaction with and involvement of patients, details of resource implications, and instructions on how to locally promote and monitor guideline use. There were no consistent trends by guideline topic. Conclusions Numerous opportunities were identified by which guidelines could be modified to support various types of decision making by different users. New governance structures may be required to accommodate development of guidelines with these features. Further research is needed to validate the proposed

  2. Developing and implementing health and sustainability guidelines for institutional food service.

    Science.gov (United States)

    Kimmons, Joel; Jones, Sonya; McPeak, Holly H; Bowden, Brian

    2012-05-01

    Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability.

  3. [Best practice agreement: implementation of best practice guidelines in HCL hospitals in Lyon, France].

    Science.gov (United States)

    Hédoux, S; Armoiry, X; Dode, X; Stamm, C; Chamouard, V; Pivot, C; Souquet, P-J; Aulagner, G

    2010-05-01

    Since 2004, the Hospices Civils de Lyon (HCL) hospitals are committed to comply with best practice guidelines for healthcare products that are reimbursed in addition to diagnosis related groups' (DRGs) tariffs in France, and that, even before the publication of the law concerning best practice agreement. It has been necessary to adapt national drugs best practice guidelines to every-day practice. A working group, COPIL RBU, has been created in HCL hospitals to manage the best practice guidelines locally. This group has two main activities: it conducts a scientific and regulatory information watch and follows up emerging indications at HCL. The group's best practice guidelines contain a classification of indications into three categories: approved indications (market authorization and temporary protocol of treatment), currently-assessed indications and contra-indications. Our best practice guidelines are more than a rewriting of national guidelines since they include emerging indications validated by prescribing physicians at HCL hospitals. A scientific argumentation is made for each emerging indication that is classified in our guidelines, based on the level of scientific evidence available. The practical use of our best practice guidelines is made through a best practice prescription that enables the traceability of drugs from the prescription to the administration to the patient. These prescriptions are accompanied with best practice guidelines made by medical and pharmaceutical professional groups. Audits will then be conducted to assess the indications' conformity to our guidelines and to have a better knowledge of current medical practice.

  4. 36 CFR 1191.1 - Accessibility guidelines.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Accessibility guidelines... COMPLIANCE BOARD AMERICANS WITH DISABILITIES ACT (ADA) ACCESSIBILITY GUIDELINES FOR BUILDINGS AND FACILITIES; ARCHITECTURAL BARRIERS ACT (ABA) ACCESSIBILITY GUIDELINES § 1191.1 Accessibility guidelines. (a)...

  5. 28 CFR 42.306 - Guidelines.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Guidelines. 42.306 Section 42.306... PROCEDURES Equal Employment Opportunity Program Guidelines § 42.306 Guidelines. (a) Recipient agencies are... guidelines under their equal employment opportunity program which will correct, in a timely manner,...

  6. 28 CFR 42.404 - Guidelines.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Guidelines. 42.404 Section 42.404... Guidelines. (a) Federal agencies shall publish title VI guidelines for each type of program to which they extend financial assistance, where such guidelines would be appropriate to provide detailed...

  7. 7 CFR 622.5 - Guidelines.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Guidelines. 622.5 Section 622.5 Agriculture... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... Environmental Principles and Guidelines for Water and Related Land Resources Implementation Studies issued...

  8. 28 CFR 2.36 - Rescission guidelines.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Rescission guidelines. 2.36 Section 2.36... guidelines. (a) The following guidelines shall apply to the sanctioning of disciplinary infractions or new... such period of confinement has resulted from initial parole to a detainer). These guidelines...

  9. Clinical Practice Guidelines and Industry

    Directory of Open Access Journals (Sweden)

    Ajai R. Singh

    2007-01-01

    Full Text Available In this section we shall see what Clinical Practice Guidelines (CPGs should be and what they are, the recent case of Xigris and a thriller-like manipulation by the concerned company to enter a performance 'bundle', CPG effectiveness/cost effectiveness and other considerations, how they serve Industry needs, and what methods can possibly assist them actualise their enormous potential.Introduction From the early nineties, a number of Clinical Practice Guidelines (CPGs have been created and published by many different associations and organizations at considerable expense. CPGs are supposed to serve an important purpose. They offer objective consensus of expert opinion on treatment and hence are trusted by hospitals and practicing physicians alike. They can reduce the possibility of inappropriate care being delivered, while helping introduce new knowledge into clinical practice (Grimshaw and Russell, 1993; Merritt et al. , 1997; Woolf et al. , 1999. They are a distillate of biomedical wisdom at a certain point of time applied to better and more efficient patient care. Hence, rigorously developed guidelines can translate complicated research findings into actionable recommendations of clinical care (Shiffman et al. , 2003; Haines and Jones, 1994. Clinical practice guidelines have generally been accepted as an objective consensus on evidence (Baird, 2003. Practice guidelines approved by expert panels are intended to standardize care in such a way as to improve health outcomes (Eichacker et al. , 2006. Major hospitals and knowledge updated physicians feel reassured they are doing the very best by following CPGs. State of the art, and such other fancy labels, can be justifiably applied to them.McMaster et al., (2007 have talked recently of getting guidelines to work in practice. In an effort to make CPGs more effective, developers of such guidelines have started grouping evidence-based interventions into what are called 'bundles'. The justification for

  10. How occupational health care professionals experience evidence-based guidelines in Finland: a qualitative study.

    Science.gov (United States)

    Kinnunen-Amoroso, Maritta

    2013-08-01

    Evidence-based guidelines are currently the most relevant source of information in practice. The adherence to and use of guidelines is often influenced by attitudes towards the guidelines themselves, which have not been sufficiently explored in occupational health. This study examines the attitude of Finnish occupational nurses' and doctors' attitudes towards evidence-based guidelines. Ten occupational doctors and eight occupational nurses were interviewed in Southern Finland on their attitudes towards evidence-based guidelines in 2009. The nurses were not very familiar with the concept of evidence-based medicine. Rather, they used recommendations developed in their workplace or by their employer. The evidence base of these recommendations was not clear. The doctors considered the evidence-based guidelines reliable and practical, but did not always act according to them. Participants felt that they did not have time to check guidelines during their working hours. Participants wished for clearer, shorter guidelines on occupational health care topics, which would help in their practical daily work and clarify roles in teamwork. Based on these positive attitudes, the use of guidelines may be more common than it seems. The viewpoints of all occupational health professional groups should be taken into account in guideline development, particularly on the availability and usability of the guidelines. © 2012 John Wiley & Sons Ltd.

  11. Adaptation of Traumatic Brain Injury Guidelines in Iran.

    Science.gov (United States)

    Abdollah Zadegan, Shayan; Ghodsi, Seyed Mohammad; Arabkheradmand, Jalil; Amirjamshidi, Abbas; Sheikhrezaei, Abdolreza; Khadivi, Masoud; Faghih Jouibari, Morteza; Tabatabaeifar, Seyed Mahmood; Sharifi, Guive; Abbaszadeh Ahranjani, Jalal; Motlagh Pirooz, Farhad; Tavakoli, Seyed Fakhredin; Mohit, Parviz; Alimohammadi, Yadollah; Rahimi-Movaghar, Vafa

    2016-05-01

    The National institute for health and care excellence (NICE) and scottish intercollegiate guidelines network (SIGN) are two well-known sources of clinical guideline development. In the past years, they have developed clinical guidelines for the management of head injury. In this report, we will highlight our modifications to these guidelines according to the domestic situation in a developing country. The guidelines were appraised using the appraisal of guidelines for research and evaluation (AGREE) instrument. All key recommendations were reviewed by 14 prominent Iranian neurosurgeons; levels of evidence were evaluated and items with limited evidence were determined. Available evidence for selected items were reviewed and discussed. The following items were the most challenging when accounting for the domestic situation in Iran: age as a risk factor for referral, computed tomography scan, the impact of medical comorbidities, pregnancy, consultation, referral to a neurosurgical unit, and teleconsulting and observation before discharge. The evidence in the discussed topics was limited and controversial. This report is important because it exposes the current knowledge gap in head trauma studies in Iran.

  12. Guidelines: In-office use of conscious sedation in periodontics.

    Science.gov (United States)

    2001-07-01

    In this time of heightened awareness of periodontal diseases and the potential consequences of untreated disease, a deterrent in the delivery of periodontal care continues to be patient anxiety concerning treatment and the fear of pain. These guidelines are intended for periodontists in the in-office use of enteral, inhalation, and/or parenteral conscious sedation in the delivery of care. The definitions, educational guidelines, and policies presented in these guidelines are consistent with the most current American Dental Association (ADA) documents Guidelines for the Use of Conscious Sedation, Deep Sedation and General Anesthesia for Dentists and the Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry available from the American Dental Association, 211 E. Chicago Avenue, Chicago, IL 60611 or http://www.ada.org, and for Revisions to Anesthesia Care Standards Comprehensive Accreditation Manual for Ambulatory Care, effective January 1, 2001, Joint Commission on Accreditation of Health Care Organizations, available through http://www.jcaho.org/standard/anesamb.html. This paper replaces the former position paper entitled "Guidelines for the Use of Conscious Sedation in Periodontics."

  13. American Cancer Society Lung Cancer Screening Guidelines

    Science.gov (United States)

    Wender, Richard; Fontham, Elizabeth T. H.; Barrera, Ermilo; Colditz, Graham A.; Church, Timothy R.; Ettinger, David S.; Etzioni, Ruth; Flowers, Christopher R.; Gazelle, G. Scott; Kelsey, Douglas K.; LaMonte, Samuel J.; Michaelson, James S.; Oeffinger, Kevin C.; Shih, Ya-Chen Tina; Sullivan, Daniel C.; Travis, William; Walter, Louise; Wolf, Andrew M. D.; Brawley, Otis W.; Smith, Robert A.

    2013-01-01

    Findings from the National Cancer Institute’s National Lung Screening Trial established that lung cancer mortality in specific high-risk groups can be reduced by annual screening with low-dose computed tomography. These findings indicate that the adoption of lung cancer screening could save many lives. Based on the results of the National Lung Screening Trial, the American Cancer Society is issuing an initial guideline for lung cancer screening. This guideline recommends that clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about screening with apparently healthy patients aged 55 years to 74 years who have at least a 30-pack-year smoking history and who currently smoke or have quit within the past 15 years. A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose computed tomography should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation. PMID:23315954

  14. Revised dietary guidelines for Koreans.

    Science.gov (United States)

    Jang, Young Ai; Lee, Haeng Shin; Kim, Bok Hee; Lee, Yoonna; Lee, Hae Jeung; Moon, Jae Jin; Kim, Cho-il

    2008-01-01

    With rapidly changing dietary environment, dietary guidelines for Koreans were revised and relevant action guides were developed. First, the Dietary Guidelines Advisory Committee was established with experts and government officials from the fields of nutrition, preventive medicine, health promotion, agriculture, education and environment. The Committee set dietary goals for Koreans aiming for a better nutrition state of all after a thorough review and analysis of recent information related to nutritional status and/or problems of Korean population, changes in food production/supply, disease pattern, health policy and agricultural policy. Then, the revised dietary guidelines were proposed to accomplish these goals in addition to 6 different sets of dietary action guides to accommodate specific nutrition and health problems of respective age groups. Subsequently, these guidelines and guides were subjected to the focus group review, consumer perception surveys, and a public hearing for general and professional comments. Lastly, the language was clarified in terms of public understanding and phraseology. The revised Dietary guidelines for Koreans are as follows: eat a variety of grains, vegetables, fruits, fish, meat, poultry and dairy products; choose salt-preserved foods less, and use less salt when you prepare foods; increase physical activity for a healthy weight, and balance what you eat with your activity; enjoy every meal, and do not skip breakfast; if you drink alcoholic beverages, do so in moderation; prepare foods properly, and order sensible amounts; enjoy our rice-based diet.

  15. Guidelines for Authors

    Directory of Open Access Journals (Sweden)

    Abdullah Demir

    2016-06-01

    Full Text Available Guidelines for Authors cumhuriyet theology journal  reguires writers to use the The Chicago Manual of Style “notes and bibliography” system of referencing.First citation: author(s first name and last name, title, (if applicable first and last name of translator or editor, place of publication, publisher, date of publication, page number.Subsequent citations: author’s last name, the short title, and the page number should be indicated in all subsequent citations. Footnote citations should conform to the following examples.References: References should be placed at the end of the text in alphabetical order. If a source has more than one author, the surname and name of the first author should be written, and the other authors should be indicated by et.al. The titles of books and journals should be italicized; article titles and book chapters should be placed in quotation marks. Translator’s and editor’s names (if there are any should follow the title of the work: BOOKa One Author: 
1. Michael Pollan, The Omnivore’s Dilemma: A Natural History of Four Meals (New York: Penguin, 2006, 99–100.2. Pollan, Omnivore’s Dilemma, 3.Bibliography: Pollan, Michael. The Omnivore’s Dilemma: A Natural History of Four Meals. New York: Penguin, 2006.  b Two Authors1. Geoffrey C. Ward and Ken Burns, The War: An Intimate History 1941–1945 (New York: Knopf, 2007, 52.2. Ward and Burns, War, 59–61. Bibliography: Ward, Geoffrey C., and Ken Burns. The War: An Intimate History 1941–1945. New York: Knopf, 2007.c Three or More Authors
For three or more authors, list all of the authors in the bibliography; in the note, list only the first author, followed by et al. (“and others”:1. Mitchell L. Eisen, Jodi A. Quas, and Gail S. Goodman, eds., Memory and Suggestibility in the Forensic Interview (Mahwah, NJ: L. Erlbaum Assoicates, 2002, 65.2. Eisen and et al., Memory and Suggestibility in the Forensic Interview, 67.Bibliography: Eisen, Mitchell

  16. The practice guideline of non-infectious uveitis and the revelation of current studies on actual treatment modalities%非感染性葡萄膜炎的临床治疗指南及当前实际治疗模式的研究启示

    Institute of Scientific and Technical Information of China (English)

    卢弘; 余烁

    2013-01-01

    The causes and pathophysiology fo uveitis are quite complex, involving autoimmunity, trauma, infection and other factors.It is mainly divided into infectious and non-infectious uveitis. non-infectious uveitis is divided into exogenous and endogenous.Glucocorticoids is the only drug which approved by U.S.Food and Drug Administration for the treatment of non-infectious uveitis.Since long-term glucocorticoid experience will cause serious side effects for uveitis patients,in 2000,an American experts group developed a practice guideline on uveitis,and revised it in 2005.Quan Dong Nguyen and his team conducted a multi-center cross-sectional study across the United States. This study recruited 60 ophthalmologists and rheumatologists in accordance with the International Classification of Diseases,Ninth Revision code (360.12,360.11,363.20,374.3,364.3) from 27states .The goal is to understand the current treatment information of non-infectious anterior uveitis, intermediate uveitis, posterior uveitis and panuveitis, moreover to obtain demographic information, treatment types of uveitis patients and the measurement characteristics relevant to descriptions,record.The study also tried to assess universal degree of the practice guideline in current uveitis treatment.According to the results of the American cross-sectional study about non-infectious uveitis treatment,the author presented a pooled analysis of the current awareness degree of uveitis practice guideline within the professional scope, the range of clinical implementation and personal practice experience in order to arouse counterparts′thinking.%葡萄膜炎的发病原因和机制相当复杂,涉及自身免疫、外伤、感染等多种因素。主要分为感染性和非感染性两大类,非感染性葡萄膜炎又分为外源性和内源性。糖皮质激素是唯一获得美国食品和药物管理局批准用于非感染性葡萄膜炎治疗的药物。由于葡萄膜炎患者长期大量应用糖皮质

  17. Physiotherapy in rheumatoid arthritis: development of a practice guideline.

    Science.gov (United States)

    Hurkmans, E J; van der Giesen, F J; Bloo, H; Boonman, D C; van der Esch, M; Fluit, M; Hilberdink, W K; Peter, W F; van der Stegen, H P; Veerman, E A; Verhoef, J; Vermeulen, H M; Hendriks, H M; Schoones, J W; Vliet Vlieland, T P

    2011-01-01

    To improve the quality of the physiotherapy management in patients with rheumatoid arthritis (RA) a Dutch practice guideline, based on current scientific evidence and best practice, was developed. This guideline comprised all elements of a structured approach (assessment, treatment and evaluation) and was based on the Internatio-nal Classification of Functioning, disability and Health (ICF) and the ICF core sets for RA. A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 10 experts from different professional backgrounds resulting in the final guideline. In total 7 topics were selected. For the initial assessment, three recommendations were made. Based on the ICF core sets for RA a list of health problems relevant for the physiotherapist was made and completed with red flags and points of attention. Concerning treatment, three recommendations were formulated; both exercise therapy and education on physiotherapy were recommended, whereas passive interventions (delivery of heat or cold, mechanical, electric and electromagnetic energy, massage, passive mobilization/manipulation and balneotherapy) were neither recommended nor discouraged. For treatment evaluation at the level of activities and participation, the Health Assessment Questionnaire was recommended. For evaluating specific body structures and functions the handheld dynamometer, 6-minute walk test or Ästrand bicycle test (including Borg-scale for rating the perceived exertion), Escola Paulista de Medicina Range of Motion Scale and a Visual Analog Scale for pain and

  18. Sex differences in health research and clinical guideline development

    NARCIS (Netherlands)

    Keuken, D.G.

    2008-01-01

    In current medical practice, research based evidence is an important foundation for clinical decision making. Clinical practice guidelines are a major instrument for keeping physicians up-to-date about this evidence. In order to provide optimal care to both men and women, it is important that sex di

  19. Guidelines For Health-Based Ventilation In Europe

    DEFF Research Database (Denmark)

    Wargocki, Pawel; Carrer, Paolo; de Oliveira Fernandes, Eduardo

    2014-01-01

    guidelines has been recommended as one of the strategic priorities to reduce this BoD (de Oliveira-Fernandes et al., 2009), also because the current ventilation standards in Europe provide different categories of comfort, not health, as the main criteria for designing ventilation requirements (EN 13779, 2007...

  20. The AGREE Enterprise: a decade of advancing clinical practice guidelines.

    Science.gov (United States)

    Makarski, Julie; Brouwers, Melissa C

    2014-08-15

    The original AGREE (Appraisal of Guidelines for REsearch and Evaluation) Instrument was published in 2003, and its revision, the AGREE II, in 2009. Together, they filled an important gap in the guideline and quality of care fields. Ten years later, the AGREE Enterprise reflects on a trajectory of projects and international collaboration that have contributed to advancing the science and quality of practice guidelines and the uptake of AGREE/AGREE II. The AGREE Enterprise has undertaken activities to improve the tool and to develop resources to support its use. Since 2003, the uptake and adoption of AGREE by the international community has been swift and broad. A total of 33 language translations of the original AGREE Instrument and the current AGREE II are available and were initiated by the international community. A recent scan of the published literature identified over 600 articles that referenced the AGREE tools. The AGREE tools have been widely received and applied, with several organizations having incorporated the AGREE as part of their formal practice guideline programs. Since its redevelopment in 2010, the AGREE Enterprise website (www.agreetrust.org) continues to experience steady increases in visitors per month and currently has over 10,000 registered users. The AGREE Enterprise has contributed to the advancements of guidelines through research activities and international participation by scientific and user communities. As we enter a new decade, we look forward to ongoing collaborations and contributing to further advancements to improve quality of care and health care systems.

  1. Ergonomics standards and guidelines for computer workstation design and the impact on users' health - a review.

    Science.gov (United States)

    Woo, E H C; White, P; Lai, C W K

    2016-03-01

    This paper presents an overview of global ergonomics standards and guidelines for design of computer workstations, with particular focus on their inconsistency and associated health risk impact. Overall, considerable disagreements were found in the design specifications of computer workstations globally, particularly in relation to the results from previous ergonomics research and the outcomes from current ergonomics standards and guidelines. To cope with the rapid advancement in computer technology, this article provides justifications and suggestions for modifications in the current ergonomics standards and guidelines for the design of computer workstations. Practitioner Summary: A research gap exists in ergonomics standards and guidelines for computer workstations. We explore the validity and generalisability of ergonomics recommendations by comparing previous ergonomics research through to recommendations and outcomes from current ergonomics standards and guidelines.

  2. Reporting guidelines for modelling studies

    Directory of Open Access Journals (Sweden)

    Bennett Carol

    2012-11-01

    Full Text Available Abstract Background Modelling studies are used widely to help inform decisions about health care and policy and their use is increasing. However, in order for modelling to gain strength as a tool for health policy, it is critical that key model factors are transparent so that users of models can have a clear understanding of the model and its limitations.Reporting guidelines are evidence-based tools that specify minimum criteria for authors to report their research such that readers can both critically appraise and interpret study findings. This study was conducted to determine whether there is an unmet need for population modelling reporting guidelines. Methods We conducted a review of the literature to identify: 1 guidance for reporting population modelling studies; and, 2 evidence on the quality of reporting of population modelling studies. Guidance for reporting was analysed using a thematic approach and the data was summarised as frequencies. Evidence on the quality of reporting was reviewed and summarized descriptively. Results There were no guidelines that specifically addressed the reporting of population modelling studies. We identified a number of reporting guidelines for economic evaluation studies, some of which had sections that were relevant population modelling studies. Amongst seven relevant records, we identified 69 quality criteria that have distinct reporting characteristics. We identified two papers that addressed reporting practices of modelling studies. Overall, with the exception of describing the data used for calibration, there was little consistency in reporting. Conclusions While numerous guidelines exist for developing and evaluating health technology assessment and economic evaluation models, which by extension could be applicable to population modelling studies, there is variation in their comprehensiveness and in the consistency of reporting these methods. Population modelling studies may be an area which would

  3. Dutch Venous Ulcer guideline update.

    Science.gov (United States)

    Maessen-Visch, M Birgitte; de Roos, Kees-Peter

    2014-05-01

    The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates.

  4. Guidelines for residential commissioning

    Energy Technology Data Exchange (ETDEWEB)

    Wray, Craig P.; Walker, Iain S.; Sherman, Max H.

    2003-01-31

    Currently, houses do not perform optimally or even as many codes and forecasts predict, largely because they are field assembled and there is no consistent process to identify problems or to correct them. Residential commissioning is a solution to this problem. This guide is the culmination of a 30-month project that began in September 1999. The ultimate objective of the project is to increase the number of houses that undergo commissioning, which will improve the quality, comfort, and safety of homes for California citizens. The project goal is to lay the groundwork for a residential commissioning industry in California focused on end-use energy and non-energy issues. As such, we intend this guide to be a beginning and not an end. Our intent is that the guide will lead to the programmatic integration of commissioning with other building industry processes, which in turn will provide more value to a single site visit for people such as home energy auditors and raters, home inspectors, and building performance contractors. Project work to support the development of this guide includes: a literature review and annotated bibliography, which facilitates access to 469 documents related to residential commissioning published over the past 20 years (Wray et al. 2000), an analysis of the potential benefits one can realistically expect from commissioning new and existing California houses (Matson et al. 2002), and an assessment of 107 diagnostic tools for evaluating residential commissioning metrics (Wray et al. 2002). In this guide, we describe the issues that non-experts should consider in developing a commissioning program to achieve the benefits we have identified. We do this by providing specific recommendations about: how to structure the commissioning process, which diagnostics to use, and how to use them to commission new and existing houses. Using examples, we also demonstrate the potential benefits of applying the recommended whole-house commissioning approach to

  5. Guidelines for the selection and application of tantalum electrolytic capacitors in highly reliable equipment

    Science.gov (United States)

    Holladay, A. M.

    1978-01-01

    Guidelines are given for the selection and application of three types of tantalum electrolytic capacitors in current use in the design of electrical and electronic circuits for space flight missions. In addition, the guidelines supplement requirements of existing military specifications used in the procurement of capacitors. A need exists for these guidelines to assist designers in preventing some of the recurring, serious problems experienced with tantalum electrolytic capacitors in the recent past. The three types of capacitors covered by these guidelines are; solid, wet foil, and tantalum cased wet slug.

  6. Canadian Association of Gastroenterology Clinical Practice Guidelines: The Use of Infliximab in Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Remo Panaccione

    2004-01-01

    Full Text Available These guidelines are presented as a follow-up to the original Canadian Association of Gastroenterology Clinical Practice Guidelines: The use of infliximab in Crohn's disease, published in the Canadian Journal of Gastroenterology (1. The original guidelines represented publications between 1998 and 2000. The current guidelines have been updated to reflect knowledge gained from two pivotal randomized clinical trails, with the use of infliximab in the maintenance of inflammatory Crohn's disease in remission (2 and in the maintenance of fistulous Crohn's disease in remission (3.

  7. UK malaria treatment guidelines.

    Science.gov (United States)

    Lalloo, David G; Shingadia, Delane; Pasvol, Geoffrey; Chiodini, Peter L; Whitty, Christopher J; Beeching, Nicholas J; Hill, David R; Warrell, David A; Bannister, Barbara A

    2007-02-01

    Malaria is the tropical disease most commonly imported into the UK, with 1500-2000 cases reported each year, and 10-20 deaths. Approximately three-quarters of reported malaria cases in the UK are caused by Plasmodium falciparum, which is capable of invading a high proportion of red blood cells and rapidly leading to severe or life-threatening multi-organ disease. Most non-falciparum malaria cases are caused by Plasmodium vivax; a few cases are caused by the other two species of Plasmodium: Plasmodium ovale or Plasmodium malariae. Mixed infections with more than 1 species of parasite can occur; they commonly involve P. falciparum with the attendant risks of severe malaria. Management of malaria depends on awareness of the diagnosis and on performing the correct diagnostic tests: the diagnosis cannot be excluded until 3 blood specimens have been examined by an experienced microscopist. There are no typical clinical features of malaria, even fever is not invariably present. The optimum diagnostic procedure is examination of thick and thin blood films by an expert to detect and speciate the malarial parasites; P. falciparum malaria can be diagnosed almost as accurately using rapid diagnostic tests (RDTs) which detect plasmodial antigens or enzymes, although RDTs for other Plasmodium species are not as reliable. The treatment of choice for non-falciparum malaria is a 3-day course of oral chloroquine, to which only a limited proportion of P. vivax strains have gained resistance. Dormant parasites (hypnozoites) persist in the liver after treatment of P. vivax or P. ovale infection: the only currently effective drug for eradication of hypnozoites is primaquine. This must be avoided or given with caution under expert supervision in patients with glucose-6-phosphate dehydrogenase deficiency (G6PD), in whom it may cause severe haemolysis. Uncomplicated P. falciparum malaria can be treated orally with quinine, atovaquone plus proguanil (Malarone) or co-artemether (Riamet

  8. Guidelines on renal cell cancer

    NARCIS (Netherlands)

    Mickisch, G; Carballido, J; Hellsten, S; Schuize, H; Mensink, H

    2001-01-01

    Objectives., On behalf of the European Association of Urology (EAU), Guidelines for Diagnosis, Therapy and. Follow Up of Renal. Cell Carcinoma Patients were established. Criteria for recommendations were evidence based and included aspects of cost-effectiveness and clinical feasibility. Method: A sy

  9. Strategy Guideline. HVAC Equipment Sizing

    Energy Technology Data Exchange (ETDEWEB)

    Burdick, Arlan [IBACOS, Inc., Pittsburgh, PA (United States)

    2012-02-01

    This guide describes the equipment selection of a split system air conditioner and furnace for an example house in Chicago, IL as well as a heat pump system for an example house in Orlando, FL. The required heating and cooling load information for the two example houses was developed in the Department of Energy Building America Strategy Guideline: Accurate Heating and Cooling Load Calculations.

  10. Guidelines for prevention in psychology.

    Science.gov (United States)

    2014-04-01

    The effectiveness of prevention to enhance human functioning and reduce psychological distress has been demonstrated. From infancy through adulthood, access to preventive services and interventions is important to improve the quality of life and human functioning and reduce illness and premature death. The importance of prevention is consistent with the Patient Protection and Affordable Care Act of 2010. Even with the increased focus on prevention, psychology training programs rarely require specific courses on prevention. In particular, conceptualizations about best practices in prevention, particularly at the environmental level, are lacking. Therefore, psychologists engaged in prevention can benefit from a set of guidelines that address and inform prevention practices. Accordingly, the Guidelines for Prevention in Psychology are intended to "inform psychologists, the public, and other interested parties regarding desirable professional practices" in prevention. The Prevention Guidelines are recommended based on their potential benefits to the public and the professional practice of psychology. They support prevention as an important area of practice, research, and training for psychologists. The Guidelines give increased attention to prevention within APA, encouraging psychologists to become involved with preventive activities relevant to their area of practice. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  11. Guidelines for a Changing World

    Science.gov (United States)

    Wood, Jo Nell; Brack, Karen

    2011-01-01

    This article investigates the issues surrounding teachers' use of social networking media and their First Amendment rights. It focuses on the need to develop a school district policy outlining specific guidelines for the use of technology and social networking. It also focuses on the changing world of technology and social networking as well as…

  12. ESUR prostate MR guidelines 2012

    Energy Technology Data Exchange (ETDEWEB)

    Barentsz, Jelle O.; Fuetterer, Jurgen J. [Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen (Netherlands); Richenberg, Jonathan [Brighton and Sussex University Hospital Trust, Brighton (United Kingdom); Clements, Richard [Royal Gwent Hospital, Department of Clinical Radiology, Newport, South Wales (United Kingdom); Choyke, Peter [National Cancer Institute, Molecular Imaging Program, Bethesda, MD (United States); Verma, Sadhna [University Of Cincinnati Medical Center, Cincinnati, OH (United States); Villeirs, Geert [Ghent University Hospital, Division of Genitourinary Radiology, Ghent (Belgium); Rouviere, Olivier [Hopital Edouard Herriot, Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Lyon (France); Universite de Lyon, Lyon (France); Universite Lyon 1, Faculte de Medecine Lyon Est, Lyon (France); Logager, Vibeke [Copenhagen University, Hospital Herlev, Herlev (Denmark)

    2012-04-15

    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.)

  13. Curriculum Guidelines on Forensic Dentistry.

    Science.gov (United States)

    Journal of Dental Education, 1990

    1990-01-01

    The American Association of Dental Schools' guidelines for curriculum design explain the scope of forensic dentistry and interrelationships with other fields, give an overview of the curriculum, and outline suggested primary educational goals, prerequisites, core content, specific behavioral objectives, sequencing, faculty and facility…

  14. Evidence-based guideline update

    DEFF Research Database (Denmark)

    Tfelt-Hansen, Peer Carsten

    2013-01-01

    Peer Carsten Tfelt-Hansen, Glostrup, Denmark: According to the recent American Academy of Neurology (AAN) guideline update, a drug can be recommended as possibly effective for migraine prevention if it had demonstrated efficacy in one Class II study.(1) Eight drugs are recommended as possibly...

  15. Guidelines for Protection in Evaluation.

    Science.gov (United States)

    Mainzer, Richard W.; And Others

    The report examines due process protections and requirements in evaluation as mandated by P.O. 94-142 (The Education for All Handicapped Children Act) and Maryland special education Bylaw. A checklist guide for Admission, Review, and Dismissal (ARD) personnel to ensure protection in evaluation is provided. Self check guidelines touch on 16…

  16. Predoctoral Curriculum Guidelines for Biomaterials.

    Science.gov (United States)

    Journal of Dental Education, 1986

    1986-01-01

    The American Association of Dental Schools' predoctoral guidelines for biomaterials curricula includes notes on interrelationships between this and other fields, a curriculum overview, primary educational goals, prerequisites, a core content outline, specific behavioral objectives for each content area, and information on sequencing, faculty and…

  17. Radiant Professionals Alliance guidelines 2010

    CERN Document Server

    IAPMO

    2010-01-01

    RPA Guidelines for the Design and Installation of Radiant Panel Heating and Snow/Ice Melt Systems. Intended for reference use by code officials, designers and installers. Deals with both hydronic and electric floor, wall and limited ceiling applications. Includes sample schematics and industry recommendations.

  18. Implementing guidelines in nursing homes

    DEFF Research Database (Denmark)

    Diehl, Heinz; Graverholt, Birgitte; Espehaug, Birgitte

    2016-01-01

    BACKGROUND: Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects o...

  19. OML macros Web presentation guidelines and source list

    CERN Document Server

    Sheau Hwang, Chang

    1999-01-01

    More than 100 macros have been written and made available on the Web since the debut of PFW in 1996. Evidently, OML has benefited many OCLC system users in automating their jobs. Nevertheless, finding the desired macros takes considerable time and effort because Web sites that provide macros present them in widely varied formats. This article presents the Web sites that currently provide macros for sharing, initiates the discussion on Web macro presentation guidelines, evaluates the presented Web sites based on these guidelines, and provides a source list of useful macros specifically for OCLC subsystem applications. (0 refs).

  20. Guidelines for resident teaching experiences.

    Science.gov (United States)

    Havrda, Dawn E; Engle, Janet P; Anderson, Keri C; Ray, Shaunta' M; Haines, Seena L; Kane-Gill, Sandra L; Ballard, Stephanie L; Crannage, Andrew J; Rochester, Charmaine D; Parman, Malinda G

    2013-07-01

    Postgraduate year one (PGY1) and postgraduate year two (PGY2) residencies serve to develop pharmacists into skillful clinicians who provide advanced patient-centered care in various general and specialized areas of pharmacy practice. Pharmacy residencies are a minimum requirement for many clinical pharmacy positions, as well as for positions in academia. The role of clinical pharmacists typically includes teaching, regardless of whether they pursue an academic appointment. Common teaching duties of pharmacist-clinicians include giving continuing education or other invited presentations, providing education to colleagues regarding clinical initiatives, precepting pharmacy students (early and advanced experiences) and residents, and educating other health care professionals. Although ASHP provides accreditation standards for PGY1 and PGY2 residencies, the standards pertaining to teaching or education training are vague. Through the years, teaching certificate programs that develop residents' teaching skills and better prepare residents for a diverse pharmacy job market have increased in popularity; moreover, teaching certificate programs serve as an attractive recruitment tool. However, the consistency of requirements for teaching certificate programs is lacking, and standardization is needed. The Task Force on Residencies developed two sets of guidelines to define teaching experiences within residencies. The first guideline defines the minimum standards for teaching experiences in any residency-training program. The second guideline is for programs offering a teaching certificate program to provide standardization, ensuring similar outcomes and quality on program completion. One of the main differences between the guidelines is the recommendation that residency programs offering a teaching certificate program be affiliated with an academic institution to provide the pedagogy and variety of teaching experiences for the resident. Residency program directors should

  1. Management of Sport-Related Concussion in the Pediatric and Adolescent Population.

    Science.gov (United States)

    Provance, Aaron J; Engelman, Glenn H; Terhune, E Bailey; Coel, Rachel A

    2016-01-01

    Concussions make up nearly 10% of all high school athletic injuries. Recent changes in concussion management guidelines and legislation aim to make concussion care more standardized and safe but simultaneously pose a challenge for the primary care and sports medicine physician. Pediatric and adolescent concussions may cause anxiety for the treating physician due to concerns over return-to-play decisions, academic issues, and the potential for second impact syndrome. Determining when to refer a patient to an emergency department acutely, to an outpatient concussion clinic, or to other subspecialists may be a difficult decision for the primary care physician. The aim of this article is to review current evidence regarding concussion treatment and return-to-school and return-to-play recommendations to provide the primary care and sports medicine physician with practical guidelines for managing concussions.

  2. Japanese guidelines for atopic dermatitis 2017

    Directory of Open Access Journals (Sweden)

    Ichiro Katayama

    2017-04-01

    The basics of treatment discussed in this guideline are based on the “Guidelines for the Treatment of Atopic Dermatitis 2008” prepared by the Health and Labour Sciences Research and the “Guidelines for the Management of Atopic Dermatitis 2015 (ADGL2015” prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle. The guidelines for the treatment of atopic dermatitis are summarized in the “Japanese Guideline for the Diagnosis and Treatment of Allergic Disease 2016” together with those for other allergic diseases.

  3. Japanese Guideline for Atopic Dermatitis 2014

    Directory of Open Access Journals (Sweden)

    Ichiro Katayama

    2014-01-01

    The basics of treatment discussed in this guideline are based on the "Guidelines for the Treatment of Atopic Dermatitis 2008" prepared by the Health and Labour Sciences Research and the "Guidelines for the Management of Atopic Dermatitis 2012 (ADGL2012" prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle. The guidelines for the treatment of atopic dermatitis are summarized in the "Japanese Guideline for the Diagnosis and Treatment of Allergic Disease 2013" together with those for other allergic diseases.

  4. IUD patient selection and practice guidelines.

    Science.gov (United States)

    Nelson, A L; Sulak, P

    1998-01-01

    Contraceptive practice guidelines have the potential to assist health care providers in evaluating the needs and expectations of women seeking contraception, educating patients, and monitoring successful contraceptive use. This article presents guidelines for IUD patient selection developed by several members of the editorial board of the US newsletter, "Dialogues in Contraception." Misinformation about the IUD has prevented many clinicians and patients from considering this method, despite recent improvements in its design. The currently available data suggest that the two IUDs available in the US, Copper T 380A and Progestasert, cause a local reaction that is toxic to sperm (and perhaps ova), thereby preventing fertilization. Modern IUDs, which use only monofilament tails, do not increase the risk of pelvic inflammatory disease in women without evidence of lower genital tract infection. Beyond avoiding women at risk for sexually transmitted diseases, there are few barriers to IUD use. The method is appropriate for women who are contemplating but ambivalent about sterilization, aged under 25 years, perimenopausal, nulliparous or parous, postpartum or postabortion, lactating, and cigarette smokers over 35 years of age. Contraindications to IUD use are postpregnancy infection, unresolved acute cervicitis or vaginitis, distorted uterine cavity, uterine or cervical cancer, unexplained abnormal vaginal bleeding, increased susceptibility to infection, genital actinomycosis, immunocompromised patients, and diabetes mellitus (progesterone-releasing IUD only).

  5. Awareness of radiographic guidelines for low back pain: a survey of Australian chiropractors.

    Science.gov (United States)

    Jenkins, Hazel J

    2016-01-01

    Chiropractors have been shown to refer for lumbar radiography in clinical scenarios inconsistent with the current clinical guidelines for low back pain. It is unknown whether this is due to lack of adherence with known guidelines or a lack of awareness of relevant guidelines. Therefore, the aim of this study is to determine Australian chiropractors' awareness of, and reported adherence to, radiographic guidelines for low back pain. Demographic, chiropractic practice and radiographic usage characteristics will be investigated for association with poor guideline adherence. An online survey was distributed to Australian chiropractors from July to September, 2014. Survey questions assessed demographic, chiropractic practice and radiographic usage characteristics, awareness of radiographic guidelines for low back pain and the level of agreement with current guidelines. Results were analysed with descriptive statistics and logistic regression analysis. There were 480 surveys completed online. Only 49.6 % (95 % confidence interval (95 % CI): 44.9, 54.4) reported awareness of radiographic guidelines for low back pain. Chiropractors reported a likelihood of referring for radiographs for low back pain: in new patients (47.6 % (95 % CI: 42.9, 52.3)); to confirm biomechanical pathologies (69.0 % (95 % CI: 64.5, 73.1)); to perform biomechanical analysis (37.5 % (95 % CI: 33.1, 42.0)); or to screen for contraindications (39.4 % (95 % CI: 35.0, 44.0)). Chiropractors agreed that radiographs for low back pain could be useful for: acute low back pain (54.0 % (95 % CI: 49.2, 58.7)); screening for contraindications (55.8 % (95 % CI: 51.0, 60.5)); or to confirm diagnosis and direct treatment (61.3 % (95 % CI: 56.5, 65.9)). Poorer adherence to current guidelines was seen if the chiropractor referred to in-house radiographic facilities, practiced a technique other than diversified technique or was unaware or unsure of current radiographic guidelines for low back pain. Only 50

  6. Guidelines for guidelines: are they up to the task? A comparative assessment of clinical practice guideline development handbooks.

    Science.gov (United States)

    Ansari, Shabnam; Rashidian, Arash

    2012-01-01

    We conducted a comparative review of clinical practice guideline development handbooks. We aimed to identify the main guideline development tasks, assign weights to the importance of each task using expert opinions and identify the handbooks that provided a comprehensive coverage of the tasks. We systematically searched and included handbooks published (in English language) by national, international or professional bodies responsible for evidenced-based guideline development. We reviewed the handbooks to identify the main guideline development tasks and scored each handbook for each task from 0 (the handbook did not mention the task) to 2 (the task suitably addressed and explained), and calculated a weighted score for each handbook. The tasks included in over 75% of the handbooks were considered as 'necessary' tasks. Nineteen guideline development handbooks and twenty seven main tasks were identified. The guideline handbooks' weighted scores ranged from 100 to 220. Four handbooks scored over 80% of the maximum possible score, developed by the National Institute for Health and Clinical Excellence, Swiss Centre for International Health, Scottish Intercollegiate Guidelines Network and World Health Organization. Necessary tasks were: selecting the guideline topic, determining the guideline scope, identifying relevant existing guidelines, involving the consumers, forming guideline development group,, developing clinical questions, systematic search for evidence, selecting relevant evidence, appraising identifies research evidence, making group decision, grading available evidence, creating recommendations, final stakeholder consultation, guideline implementation strategies, updating recommendations and correcting potential errors. Adequate details for evidence based development of guidelines were still lacking from many handbooks. The tasks relevant to ethical issues and piloting were missing in most handbooks. The findings help decision makers in identifying the

  7. EANM 2012 guidelines for radionuclide imaging of phaeochromocytoma and paraganglioma

    Science.gov (United States)

    Timmers, Henri J.; Hindié, Elif; Guillet, Benjamin A.; Neumann, Hartmut P.; Walz, Martin K.; Opocher, Giuseppe; de Herder, Wouter W.; Boedeker, Carsten C.; de Krijger, Ronald R.; Chiti, Arturo; Al-Nahhas, Adil; Pacak, Karel

    2016-01-01

    Purpose Radionuclide imaging of phaeochromocytomas (PCCs) and paragangliomas (PGLs) involves various functional imaging techniques and approaches for accurate diagnosis, staging and tumour characterization. The purpose of the present guidelines is to assist nuclear medicine practitioners in performing, interpreting and reporting the results of the currently available SPECT and PET imaging approaches. These guidelines are intended to present information specifically adapted to European practice. Methods Guidelines from related fields, issued by the European Association of Nuclear Medicine and the Society of Nuclear Medicine, were taken into consideration and are partially integrated within this text. The same was applied to the relevant literature, and the final result was discussed with leading experts involved in the management of patients with PCC/PGL. The information provided should be viewed in the context of local conditions, laws and regulations. Conclusion Although several radionuclide imaging modalities are considered herein, considerable focus is given to PET imaging which offers high sensitivity targeted molecular imaging approaches. PMID:22926712

  8. Risks and guidelines for the consumption of alcohol during pregnancy

    DEFF Research Database (Denmark)

    Kesmodel, Ulrik Schiøler

    2016-01-01

    not been consistently associated with short and long term adverse outcomes. Health authorities in most countries recommend that pregnant women completely abstain from alcohol. Even so, many health professionals including doctors, midwives and nurses do not provide information to pregnant women...... in accordance with the official recommendations, although a large proportion of women of child bearing age and pregnant women drink alcohol, especially before recognition of pregnancy. The discrepancy between guidelines and the information practice of health personnel is likely to continue to exist because...... guidelines of abstinence are not clearly evidence-based and not in line with current focus on autonomy and informed choice for patients, and because guidelines do not consider the everyday clinical communication situation....

  9. Environmental Design Guidelines for Low Crested Coastal Structures

    DEFF Research Database (Denmark)

    Burcharth, Hans F.; Hawkins, Stephen J.; Zanuttigh, Barbara

    methodological tools both for the engineering design of structures and for prediction of performance and environmental impacts of such structures. It is anticipated that the guidelines will provide valuable inputs to coastal zone management plans. The target audience for this set of guidelines is consulting...... engineers or engineering officers and officials of local authorities dealing with coastal protection schemes. The guidelines are also of relevance in providing a briefing of current best practice for local and national planning authorities, statutory agencies and other stakeholders in the coastal zone...... selected to represent a variety of environmental conditions (Chapter 11); the application of the proposed methodology to a real prototype case, in order to give a practical example to designers (Chapter 12). The third part contains all the formulae and tools to help engineers (Chapter 13), ecologists...

  10. 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.

  11. ESPEN guidelines on nutritional support for polymorbid internal medicine patients.

    Science.gov (United States)

    Gomes, Filomena; Schuetz, Philipp; Bounoure, Lisa; Austin, Peter; Ballesteros-Pomar, María; Cederholm, Tommy; Fletcher, Jane; Laviano, Alessandro; Norman, Kristina; Poulia, Kalliopi-Anna; Ravasco, Paula; Schneider, Stephane M; Stanga, Zeno; Weekes, C Elizabeth; Bischoff, Stephan C

    2017-07-24

    Polymorbidity (also known as multimorbidity) - defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards. The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds. From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75-90%) in 32% of recommendations and 25% of statements. At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations. Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical

  12. Quality and methods of developing practice guidelines

    Directory of Open Access Journals (Sweden)

    Clark Otavio

    2002-01-01

    Full Text Available Abstract Background It is not known whether there are differences in the quality and recommendations between evidence-based (EB and consensus-based (CB guidelines. We used breast cancer guidelines as a case study to assess for these differences. Methods Five different instruments to evaluate the quality of guidelines were identified by a literature search. We also searched MEDLINE and the Internet to locate 8 breast cancer guidelines. These guidelines were classified in three categories: evidence based, consensus based and consensus based with no explicit consideration of evidence (CB-EB. Each guideline was evaluated by three of the authors using each of the instruments. For each guideline we assessed the agreement among 14 decision points which were selected from the NCCN (National Cancer Comprehensive Network guidelines algorithm. For each decision point we recorded the level of the quality of the information used to support it. A regression analysis was performed to assess if the percentage of high quality evidence used in the guidelines development was related to the overall quality of the guidelines. Results Three guidelines were classified as EB, three as CB-EB and two as CB. The EB guidelines scored better than CB, with the CB-EB scoring in the middle among all instruments for guidelines quality assessment. No major disagreement in recommendations was detected among the guidelines regardless of the method used for development, but the EB guidelines had a better agreement with the benchmark guideline for any decision point. When the source of evidence used to support decision were of high quality, we found a higher level of full agreement among the guidelines' recommendations. Up to 94% of variation in the quality score among guidelines could be explained by the quality of evidence used for guidelines development. Conclusion EB guidelines have a better quality than CB guidelines and CB-EB guidelines. Explicit use of high quality evidence

  13. Human papillomavirus vaccination guideline update: American Cancer Society guideline endorsement.

    Science.gov (United States)

    Saslow, Debbie; Andrews, Kimberly S; Manassaram-Baptiste, Deana; Loomer, Lacey; Lam, Kristina E; Fisher-Borne, Marcie; Smith, Robert A; Fontham, Elizabeth T H

    2016-09-01

    Answer questions and earn CME/CNE The American Cancer Society (ACS) reviewed and updated its guideline on human papillomavirus (HPV) vaccination based on a methodologic and content review of the Advisory Committee on Immunization Practices (ACIP) HPV vaccination recommendations. A literature review was performed to supplement the evidence considered by the ACIP and to address new vaccine formulations and recommendations as well as new data on population outcomes since publication of the 2007 ACS guideline. The ACS Guideline Development Group determined that the evidence supports ACS endorsement of the ACIP recommendations, with one qualifying statement related to late vaccination. The ACS recommends vaccination of all children at ages 11 and 12 years to protect against HPV infections that lead to several cancers and precancers. Late vaccination for those not vaccinated at the recommended ages should be completed as soon as possible, and individuals should be informed that vaccination may not be effective at older ages. CA Cancer J Clin 2016;66:375-385. © 2016 American Cancer Society. © 2016 American Cancer Society.

  14. American Clinical Neurophysiology Society Guideline 5: Minimum Technical Standards for Pediatric Electroencephalography.

    Science.gov (United States)

    Kuratani, John; Pearl, Phillip L; Sullivan, Lucy; Riel-Romero, Rosario Maria S; Cheek, Janna; Stecker, Mark; San-Juan, Daniel; Selioutski, Olga; Sinha, Saurabh R; Drislane, Frank W; Tsuchida, Tammy N

    2016-08-01

    This revision to the EEG Guidelines is an update incorporating the current electroencephalography technology and practice. It was previously published as Guideline 2. Similar to the prior guideline, it delineates the aspects of Guideline 1 that should be modified for neonates and young children. Recording conditions for photic stimulation and hyperventilation are revised to enhance the provocation of epileptiform discharges. Revisions recognize the difficulties involved in performing an EEG under sedation in young children. Recommended neonatal EEG montages are displayed for the reduced set of electrodes only since the montages in Guideline 3 should be used for a 21-electrode 10-20 system array. Neonatal documentation is updated to use current American Academy of Pediatrics term "postmenstrual age" rather than "conceptional age." Finally, because therapeutic hypothermia alters the prognostic value of neonatal EEG, the necessity of documenting the patient's temperature at the time of recording is emphasized.

  15. Update of ACR guidelines for osteoarthritis: role of the coxibs.

    Science.gov (United States)

    Schnitzer, Thomas J

    2002-04-01

    The American College of Rheumatology (ACR) recently provided an update to the guidelines published in 1995 on the management of osteoarthritis (OA) of the knee and hip. Members of the Ad Hoc Committee on OA Guidelines followed an evidence-based medicine approach to revise the guidelines by reviewing an extensive literature search of the Cochrane and Medline databases and published abstracts, and discussing evidence with expert rheumatologists. The goal of the guidelines is to provide recommendations to control patients' OA pain, improve function and health-related quality of life, and avoid therapeutic toxicity. As in the original guidelines, nonpharmacologic interventions involving patient education and physical measures are recommended following initial diagnosis of OA. The pharmacologic algorithm was updated to include currently available therapeutic agents. Acetaminophen remains first-line therapy because of its cost, efficacy, and safety profiles. Cyclooxygenase-2-selective inhibitors (coxibs) have been included as an alternative to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in patients at risk for upper gastrointestinal adverse events. Tramadol is an available alternative for patients who have a contraindication to coxibs or nonselective NSAIDs or for those who have not responded to previous oral therapy. Intra-articular injections or topical therapy may be used as monotherapy, or as an adjunct to oral analgesia. Surgical treatment of OA remains a last resort for patients who have failed to respond to nonpharmacologic and pharmacologic treatment approaches, and have progressive limitation in their activities of daily living. Several therapies for the prevention or treatment of OA are currently under investigation, including nutritional supplements, such as glucosamine and chondroitin, disease-modifying OA drugs, and devices, such as acupuncture and electromagnetic therapy. It is anticipated that the guidelines for the management of OA will

  16. [Clinical guideline for detection and diagnosis of hypertensive pregnancy disease].

    Science.gov (United States)

    Lagunes-Espinosa, Alma Luisa; Ríos-Castillo, Brenda; Peralta-Pedrero, María Luisa; del Rocío Cruz-Cruz, Polita; Sánchez-Ambríz, Slivia; Sánchez-Santana, Joaquín Renato; Ramírez-Mota, Carolina; Zavaleta-Vargas, Norma Octavia; López-Cisneros, Gabriela

    2011-01-01

    Hypertensive disorders in pregnancy (HDP) are the main complication and cause of maternal and perinatal death. Pre-eclampsia represents a 34%, according to the Secretaría de Salud de México. To offer the family physicians tools for the opportune detection and diagnosis of HDP a clinical guideline was developmented. Clinical questions were formulated and structured. A standardized sequence to search for Practice Guidelines, based on the key words: hypertensive disorders in pregnancy, pre-eclampsia. Tripdatabase, MDConsult, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence were used. In addition, Cochrane Library Plus, Science Direct and OVID were used. Most of the recommendations were taken from guidelines selected and supplemented with the remaining material. The information is expressed in levels of evidence and grade of recommendation according to the characteristics of the study design and type of publications. To reduce morbidity and mortality from HDP health professionals should identify risk factors; conduct a close monitoring and early diagnosis. It is essential to provide information to the pregnant patient on alarm data and behavior to follow. This clinical practice guide offers current evidence for screening and diagnosis of HDP in primary care.

  17. Home Mechanical Ventilation: A Canadian Thoracic Society Clinical Practice Guideline

    Directory of Open Access Journals (Sweden)

    Douglas A McKim

    2011-01-01

    Full Text Available Increasing numbers of patients are surviving episodes of prolonged mechanical ventilation or benefitting from the recent availability of user-friendly noninvasive ventilators. Although many publications pertaining to specific aspects of home mechanical ventilation (HMV exist, very few comprehensive guidelines that bring together all of the current literature on patients at risk for or using mechanical ventilatory support are available. The Canadian Thoracic Society HMV Guideline Committee has reviewed the available English literature on topics related to HMV in adults, and completed a detailed guideline that will help standardize and improve the assessment and management of individuals requiring noninvasive or invasive HMV. The guideline provides a disease-specific review of illnesses including amyotrophic lateral sclerosis, spinal cord injury, muscular dystrophies, myotonic dystrophy, kyphoscoliosis, post-polio syndrome, central hypoventilation syndrome, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease as well as important common themes such as airway clearance and the process of transition to home. The guidelines have been extensively reviewed by international experts, allied health professionals and target audiences. They will be updated on a regular basis to incorporate any new information.

  18. Evaluating the effectiveness of pediatric pain management guidelines.

    Science.gov (United States)

    Habich, Michele; Wilson, Deeanna; Thielk, Dana; Melles, Grace L; Crumlett, Hillary S; Masterton, Joyce; McGuire, Julie

    2012-08-01

    In response to unit nursing quality and patient satisfaction concerns, the shared governance councils identified opportunities to improve overall assessment and management of pain in hospitalized pediatric patients. Together, the unit-shared governance councils evaluated current practice and reviewed the literature to develop comprehensive Pediatric Pain Assessment and Management Guidelines. The purpose of this study was to evaluate the effectiveness of implementing an evidence-based pain assessment and management guideline on nurses' knowledge, ability to assess and manage the patients' pain, and patient/family satisfaction with staff's management of pain. This intervention study with a pre-post design included three assessment intervals described as baseline and 3 and 6 months after guideline implementation. The sample included pediatric and pediatric intensive care unit (PICU) nursing staff, retrospective chart reviews of pediatric and PICU patients, and patient/parent satisfaction scores. No differences were found between nurses' knowledge and attitudes regarding pain before and after implementation of the guideline. Significant increases in pain assessment, use of correct tool, and reassessment were found following implementation. Although improving, there was no difference in patient/family satisfaction after guideline implementation. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. A guideline for the inpatient care of children with pyelonephritis

    Science.gov (United States)

    Chishti, Aftab S.; Maul, Erich C.; Nazario, Rubén J.; Bennett, Jeffrey S.; Kiessling, Stefan G.

    2010-01-01

    BACKGROUND AND OBJECTIVES: Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxic. The American Academy of Pediatrics (AAP) practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children provides experience and evidence-based guidelines for the practitioner caring for children between the ages of 2 months to 2 years. No established guideline exists for older children and the AAP guideline does not specifically focus on inpatient care. METHODS: We conducted a comprehensive review of recently published literature and practice guidelines to develop a consensus on the inpatient diagnosis and management of children with pyelonephritis. RESULTS: Eight recommendations are proposed for the diagnosis and management, including revised guidelines for the imaging studies postpyelonephritis on the basis of current best evidence. CONCLUSION: Proper diagnosis of pyelonephritis, timely initiation of appropriate therapy and identification of children at risk for renal injury will help to reduce immediate as well as long-term complications due to chronic kidney disease. PMID:20716830

  20. Design guidelines for mini-roundabouts

    CSIR Research Space (South Africa)

    Emslie, I

    1997-03-01

    Full Text Available This report presents guidelines to assist local authorities and traffic engineers with a uniform approach to the design and implementation of mini-roundabouts. It is recommended that these guidelines be read in conjunction with the National...