WorldWideScience

Sample records for guidelines nutrient recommendations

  1. Do Nutrient-Based Front-of-Pack Labelling Schemes Support or Undermine Food-Based Dietary Guideline Recommendations? Lessons from the Australian Health Star Rating System.

    Science.gov (United States)

    Lawrence, Mark A; Dickie, Sarah; Woods, Julie L

    2018-01-05

    Food-based Dietary Guidelines (FBDGs) promote healthy dietary patterns. Nutrient-based Front-of-Pack Labelling (NBFOPL) schemes rate the 'healthiness' of individual foods. This study aimed to investigate whether the Australian Health Star Rating (HSR) system aligns with the Australian Dietary Guidelines (ADGs). The Mintel Global New Products Database was searched for every new food product displaying a HSR entering the Australian marketplace from 27 June 2014 (HSR system endorsement) until 30 June 2017. Foods were categorised as either a five food group (FFG) food or 'discretionary' food in accordance with ADG recommendations. Ten percent (1269/12,108) of new food products displayed a HSR, of which 57% were FFG foods. The median number of 'health' stars displayed on discretionary foods (2.5; range: 0.5-5) was significantly lower ( p < 0.05) than FFG foods (4.0; range: 0.5-5), although a high frequency of anomalies and overlap in the number of stars across the two food categories was observed, with 56.7% of discretionary foods displaying ≥2.5 stars. The HSR system is undermining the ADG recommendations through facilitating the marketing of discretionary foods. Adjusting the HSR's algorithm might correct certain technical flaws. However, supporting the ADGs requires reform of the HSR's design to demarcate the food source (FFG versus discretionary food) of a nutrient.

  2. Is “Processed” a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations123

    Science.gov (United States)

    Dwyer, Johanna T.; Fulgoni, Victor L.; Clemens, Roger A.; Schmidt, David B.

    2012-01-01

    This paper, based on the symposium “Is ‘Processed’ a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations in the U.S.” describes ongoing efforts and challenges at the nutrition–food science interface and public health; addresses misinformation about processed foods by showing that processed fruits and vegetables made important dietary contributions (e.g., fiber, folate, potassium, vitamins A and C) to nutrient intake among NHANES 2003–2006 participants, that major sources of vitamins (except vitamin K) were provided by enrichment and fortification and that enrichment and fortification helped decrease the percentage of the population below the Estimated Average Requirement for vitamin A, thiamin, folate, and iron; describes how negative consumer perceptions and consumer confusion about processed foods led to the development of science-based information on food processing and technology that aligns with health objectives; and examines challenges and opportunities faced by food scientists who must balance consumer preferences, federal regulations, and issues surrounding food safety, cost, unintended consequences, and sustainability when developing healthful foods that align with dietary guidelines. PMID:22797990

  3. Recommended Guidelines for PKU Programs.

    Science.gov (United States)

    Children's Bureau (DHEW), Washington, DC.

    A discussion of screening tests for phenylketonuria recommends and provides some data on two tests, lists five disadvantages of urine tests, and discusses three new tests. Also considered are the role of the central laboratory facility and seven suggestions for screening different types of infants at different times. Treatment or followup programs…

  4. Safe handling of cytotoxics: guideline recommendations.

    Science.gov (United States)

    Easty, A C; Coakley, N; Cheng, R; Cividino, M; Savage, P; Tozer, R; White, R E

    2015-02-01

    This evidence-based practice guideline was developed to update and address new issues in the handling of cytotoxics, including the use of oral cytotoxics; the selection and use of personal protective equipment; and treatment in diverse settings, including the home setting. The guideline was developed primarily from an adaptation and endorsement of an existing guideline and from three systematic reviews. Before publication, the guideline underwent a series of peer and external reviews to gather feedback. All comments were addressed, and the guideline was amended when required. The guideline applies to health care workers who could come into contact with cytotoxic drugs at any point in the medication circuit. The intended users are hospital administrators, educators, and managers; occupational health and safety services; and pharmacy and health care workers. The recommendations represent a reasonable and practical set of procedures that the intended users of this guideline should implement to minimize opportunities for accidental exposure. They are not limited to just the point of care; they cover the entire chain of cytotoxics handling from the time such agents enter the institution until they leave in the patient or as waste. Reducing the likelihood of accidental exposure to cytotoxic agents within the medication circuit is the main objective of this evidenced-based guideline. The recommendations differ slightly from earlier guidelines because of the availability of new evidence.

  5. Contemporaneous International Asthma Guidelines Present Differing Recommendations: An Analysis

    Directory of Open Access Journals (Sweden)

    Samir Gupta

    2016-01-01

    Full Text Available Background. Several international groups develop asthma guidelines. Conflicting recommendations across guidelines have been described in several disease areas and may contribute to practice variability. Accordingly, we compared the latest Canadian Thoracic Society (CTS asthma guideline with contemporaneous international asthma guidelines to evaluate conflicting recommendations and their causes. Methods. We identified the latest CTS asthma guideline update (2012 and the following societies which also updated their guidelines in 2012: the British Thoracic Society and Scottish Intercollegiate Guidelines Network and the Global Initiative for Asthma. We compared these three guidelines on (1 key methodological factors and (2 adult pharmacotherapy recommendations. Results. Methods used and documentation provided for literature search strategy and dates, evidence synthesis, outcomes considered, evidence appraisal, and recommendation formulation varied between guidelines. Criteria used to define suboptimal asthma control varied widely between guidelines. Inhaled corticosteroid dosing recommendations diverged, as did recommendations surrounding use of budesonide/formoterol as a reliever and controller and recommendations in the subsequent step. Conclusions. There are important differences between recommendations provided in contemporaneous asthma guidelines. Causes include differences in methods used for interpreting evidence and formulating recommendations. Adopting a common set of valid and explicit methods across international societies could harmonize recommendations and facilitate guideline implementation.

  6. Grain Foods Are Contributors of Nutrient Density for American Adults and Help Close Nutrient Recommendation Gaps: Data from the National Health and Nutrition Examination Survey, 2009?2012

    OpenAIRE

    Papanikolaou, Yanni; Fulgoni, Victor L.

    2017-01-01

    The 2015?2020 Dietary Guidelines for Americans (2015-2020 DGA) maintains recommendations for increased consumption of whole grains while limiting intake of enriched/refined grains. A variety of enriched grains are sources of several shortfall nutrients identified by 2015-2020 DGA, including dietary fiber, folate, iron, and magnesium. The purpose of this study was to determine food sources of energy and nutrients for free-living U.S. adults using data from the National Health and Nutrition Exa...

  7. Guideline recommendations and antimicrobial resistance: the need for a change.

    Science.gov (United States)

    Elias, Christelle; Moja, Lorenzo; Mertz, Dominik; Loeb, Mark; Forte, Gilles; Magrini, Nicola

    2017-07-26

    Antimicrobial resistance has become a global burden for which inappropriate antimicrobial use is an important contributing factor. Any decisions on the selection of antibiotics use should consider their effects on antimicrobial resistance. The objective of this study was to assess the extent to which antibiotic prescribing guidelines have considered resistance patterns when making recommendations for five highly prevalent infectious syndromes. We used Medline searches complemented with extensive use of Web engine to identify guidelines on empirical treatment of community-acquired pneumonia, urinary tract infections, acute otitis media, rhinosinusitis and pharyngitis. We collected data on microbiology and resistance patterns and identified discrete pattern categories. We assessed the extent to which recommendations considered resistance, in addition to efficacy and safety, when recommending antibiotics. We identified 135 guidelines, which reported a total of 251 recommendations. Most (103/135, 79%) were from developed countries. Community-acquired pneumonia was the syndrome mostly represented (51, 39%). In only 16 (6.4%) recommendations, selection of empirical antibiotic was discussed in relation to resistance and specific microbiological data. In a further 69 (27.5%) recommendations, references were made in relation to resistance, but the attempt was inconsistent. Across syndromes, 12 patterns of resistance with implications on recommendations were observed. 50% to 75% of recommendations did not attempt to set recommendation in the context of these patterns. There is consistent evidence that guidelines on empirical antibiotic use did not routinely consider resistance in their recommendations. Decision-makers should analyse and report the extent of local resistance patterns to allow better decision-making. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless

  8. Usability Guidelines for Product Recommenders Based on Example Critiquing Research

    Science.gov (United States)

    Pu, Pearl; Faltings, Boi; Chen, Li; Zhang, Jiyong; Viappiani, Paolo

    Over the past decade, our group has developed a suite of decision tools based on example critiquing to help users find their preferred products in e-commerce environments. In this chapter, we survey important usability research work relative to example critiquing and summarize the major results by deriving a set of usability guidelines. Our survey is focused on three key interaction activities between the user and the system: the initial preference elicitation process, the preference revision process, and the presentation of the systems recommendation results. To provide a basis for the derivation of the guidelines, we developed a multi-objective framework of three interacting criteria: accuracy, confidence, and effort (ACE). We use this framework to analyze our past work and provide a specific context for each guideline: when the system should maximize its ability to increase users' decision accuracy, when to increase user confidence, and when to minimize the interaction effort for the users. Due to the general nature of this multi-criteria model, the set of guidelines that we propose can be used to ease the usability engineering process of other recommender systems, especially those used in e-commerce environments. The ACE framework presented here is also the first in the field to evaluate the performance of preference-based recommenders from a user-centric point of view.

  9. Added sugar intake that exceeds current recommendations is associated with nutrient dilution in older Australians.

    Science.gov (United States)

    Moshtaghian, Hanieh; Louie, Jimmy Chun Yu; Charlton, Karen E; Probst, Yasmine C; Gopinath, Bamini; Mitchell, Paul; Flood, Victoria M

    2016-09-01

    A nutrient dilution effect of diets high in added sugar has been reported in some older populations, but the evidence is inconsistent. The aim of this study was to investigate the association between added sugar intakes (according to recommended guidelines) and nutrient intake, food consumption, and body mass index (BMI). A cross-sectional analysis of data collected between 2007 and 2009 from participants of the Blue Mountains Eye study 4 was performed (n = 879). Dietary intake was assessed using a semiquantitative food frequency questionnaire. Added sugar content of foods was determined by applying a systematic step-wise method. BMI was calculated from measured weight and height. Food and nutrient intakes and BMI were assessed according to categories of percentage energy from added sugar (EAS% 10%) using analysis of covariance for multivariate analysis. Micronutrient intake including retinol equivalents, vitamins B6, B12, C, E, and D, and minerals including calcium, iron, and magnesium showed a significant inverse association with EAS% intakes (Ptrend intake of added sugars (intake of alcohol, fruits, and vegetables were higher and intake of sugar sweetened beverages was lower compared to other participants (all Ptrend intake from added sugar greater than the recommended level of 10% is associated with lower micronutrient intakes, indicating micronutrient dilution. Conversely, added sugar intakes intake are associated with higher micronutrient intakes. This information may inform dietary messages targeted at optimizing diet quality in older adults. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Optimizing Guideline-Recommended Antibiotic Doses for Pediatric Infective Endocarditis.

    Science.gov (United States)

    Nichols, Kristen R; Israel, Emily N; Thomas, Christopher A; Knoderer, Chad A

    2016-05-01

    The American Heart Association recently published an updated scientific statement on the management of infective endocarditis in childhood. The recommendations included for vancomycin, aminoglycoside, and β-lactam dosing and monitoring are based primarily on expert opinion and do not consider available evidence for dose optimization based on pharmacokinetic and pharmacodynamic principles in pediatric patients. This is concerning because even when clinically necessary, some practitioners may be hesitant to deviate from guideline-recommended doses. In this perspective, we highlight potential areas for improvement in the statement-recommended doses and summarize evidence supporting antibiotic dosing optimization. The addition of a pediatric clinical pharmacist with expertise in antibiotic dosing to the panel would be beneficial for future updates. © The Author(s) 2016.

  11. Analysis of foreign physical activity recommendations and guidelines for schools

    Directory of Open Access Journals (Sweden)

    Jan Pavelka

    2014-06-01

    Full Text Available Background:An adequate level of physical activity is an important part of children's lifestyle. The school environment plays a significant role in the area of interventions and strategies aiming to increase the level of physical activity in children. Objectives: The aim of this study is to analyse foreign recommendations leading to an increased level of physical activity in children and young people in Czech schools. Methods: A systematic search of studies published between 1988 and 2012 in the English language was completed in library databases Medline, Sport Discus, ProQuest, PsychInfo, ERIC, Wiley InterScience using the following keywords: physical activity, guidelines, recommendations, school and youth. The studies were then classified based on abstract and full-text analyses. Using a content analysis the expert team formulated the final recommendations to increase the level of physical activity for schools in the Czech Republic (CR. Results: Out of the total number of 91 identified foreign studies, 25 met the predetermined criteria and were used as a basis for formulating the recommendations. These foreign studies included 15 papers published in USA, two in Australia, two in Great Britain, two in Canada, one in the European Union, one in New Zealand and one international paper (an international consensus of experts from 34 countries. Based on the interpretation of the evidence, its justification and final consensus of the expert team, the basic areas for the recommendations to increase the level of physical activity in schools in the CR were identified. Conclusions: An analysis of foreign recommendations to increase the level of physical activity designed for schools and school facilities is one of the possible methods of formulating domestic recommendations. This recommendation could contribute to deeper understanding of the issue of the deteriorating lifestyle of school-aged children in the CR and reflects the efforts for improvement.

  12. Strategy Guideline: Advanced Construction Documentation Recommendations for High Performance Homes

    Energy Technology Data Exchange (ETDEWEB)

    Lukachko, A.; Gates, C.; Straube, J.

    2011-12-01

    As whole house energy efficiency increases, new houses become less like conventional houses that were built in the past. New materials and new systems require greater coordination and communication between industry stakeholders. The Guideline for Construction Documents for High Performance Housing provides advice to address this need. The reader will be presented with four changes that are recommended to achieve improvements in energy efficiency, durability and health in Building America houses: create coordination drawings, improve specifications, improve detail drawings, and review drawings and prepare a Quality Control Plan.

  13. Adherence to GOLD guideline treatment recommendations among pulmonologists in Turkey.

    Science.gov (United States)

    Sen, Elif; Guclu, Salih Zeki; Kibar, Isil; Ocal, Ulku; Yilmaz, Veysel; Celik, Onur; Cimen, Filiz; Topcu, Fusun; Orhun, Meltem; Tereci, Hikmet; Konya, Aylin; Ar, Idilhan; Saryal, Sevgi

    2015-01-01

    Low adherence to Global initiative for chronic Obstructive Lung Disease (GOLD) guideline recommendations has been reported worldwide. There has been no study on the adherence to GOLD guidelines for COPD treatment in Turkey. To investigate the rates of adherence to GOLD 2010 guidelines for COPD treatment among pulmonologists. A multi-center, cross-sectional, observational study was carried out in eleven pulmonary outpatient clinics across Turkey. Adherence to GOLD was evaluated through hospital records. Demographic and clinical data were recorded. Study included 719 patients (mean age: 62.9±9.7 years; males 85.4%) of whom 16 was classified as GOLD Stage I, 238 as II, 346 as III, and 119 as IV, and only 59.5% received appropriate treatment. Rates of guideline adherence varied across GOLD stages (I, 6.3%; II, 14.7%; III, 84.4%; and IV, 84%). Causes of inappropriate therapies were overtreatment (Stage I, 100% and Stage II, 91.1%), undertreatment (Stage III, 3.3% and Stage IV, 10.9%) and lack of treatment (Stage II, 3.8%; Stage III, 2.3%; and Stage IV, 5.9%). The most preferred regimen (43.4%) was long-acting β2-agonist-inhaled corticosteroid-long-acting muscarinic antagonist. Overall, 614 patients (89%) received treatment containing inhaled corticosteroid. Pulmonologists in Turkey have low rates of adherence to GOLD guidelines in COPD treatment. Inappropriateness of therapies was due to overtreatment in early stages and excessive use of inhaled corticosteroid (ICS) in all disease stages.

  14. Do patients discussed at a lung cancer multidisciplinary team meeting receive guideline-recommended treatment?

    Science.gov (United States)

    Boxer, Miriam M; Duggan, Kirsten J; Descallar, Joseph; Vinod, Shalini K

    2016-03-01

    Clinical guidelines provide evidence-based management recommendations to guide practice. This study aimed to evaluate whether patients discussed at a lung cancer multidisciplinary team meeting received guideline-recommended treatment and determine reasons for not receiving guideline-recommended treatment. All new lung cancer patients discussed at the Liverpool/Macarthur lung cancer multidisciplinary team meeting between 1 December 2005 and 31 December 2010 were included. Guideline-recommended treatment was assigned according to pathology, stage and ECOG (Eastern Co-operative Oncology Group) performance status as per the 2004 Australian Lung Cancer Guidelines. This was compared with actual treatment received to determine adherence to guidelines. For those patients who did not receive guideline-recommended treatment, the medical record was reviewed to determine the reason(s) for this. Survival was compared between those who did and did not receive guideline-recommended treatment. 808 new patients were discussed at the multidisciplinary team meeting. Guideline-recommended treatment could not be assigned in 2% of patients due to missing data. 435 patients (54%) received guideline-recommended treatment, and 356 (44%) did not. The most common reasons for not receiving guideline-recommended treatment were a decline in ECOG performance status (24%), large tumor volume precluding radical radiotherapy (17%), comorbidities (15%) and patient preference (13%). Patients less than 70 years who received guideline-recommended treatment had improved survival compared with those who did not. A significant proportion of lung cancer patients did not receive guideline-recommended treatment due to legitimate reasons. Alternative guidelines are needed for patients not suitable for current best practice. Treatment according to guidelines was a predictor for survival. © 2015 Wiley Publishing Asia Pty Ltd.

  15. Quality of Cancer Surveillance Clinical Practice Guidelines: Specificity and Consistency of Recommendations.

    Science.gov (United States)

    Merkow, Ryan P; Korenstein, Deborah; Yeahia, Rubaya; Bach, Peter B; Baxi, Shrujal S

    2017-05-01

    Primary care clinicians, who are increasingly responsible for caring for the growing population of cancer survivors, may be unfamiliar with appropriate cancer surveillance strategies. Clinical practice guidelines can inform cancer follow-up care and surveillance testing. Vague recommendations and inconsistencies among guidelines can lead to overuse and underuse of health care resources and have a negative impact on cost and quality of survivorship care. To examine the specificity and consistency of recommendations for surveillance after active treatment across cancer guidelines. Retrospective cross-sectional analysis of national cancer guidelines from North America and Europe published since 2010 addressing posttreatment care for survivors of the 9 most common cancers. We categorized surveillance modalities into history and physical examinations, tumor markers, diagnostic procedures (eg, colonoscopy), and imaging. Within each guideline, we classified individual recommendations into 5 categories: (1) risk-based recommendation, (2) recommendation for surveillance, (3) addressed but no clear recommendation, (4) recommendation against surveillance, or (5) cases in which surveillance was not addressed. We reviewed each surveillance recommendation for frequency and a stop date, evaluated consistency among guidelines, and analyzed associations between the organizations proposing the guidelines and recommendation characteristics. Description of guideline recommendations for cancer surveillance. We identified 41 guidelines published between January 1, 2010, and March 1, 2016. Eighty-five percent of guidelines (35) were from professional organizations. Ambiguous recommendations (ie, modality not discussed or discussed without a clear recommendation) were present in 83% of guidelines (34), and 44% (18) recommended against at least 1 test. European guidelines were more likely than North American guidelines to contain ambiguous recommendations (100% vs 68%; P guidelines for

  16. Classification and Clinical Diagnosis of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines

    OpenAIRE

    Fitzcharles, Mary-Ann; Shir, Yoram; Ablin, Jacob N.; Buskila, Dan; Amital, Howard; Henningsen, Peter; Häuser, Winfried

    2013-01-01

    Objectives. Fibromyalgia syndrome (FMS), characterized by subjective complaints without physical or biomarker abnormality, courts controversy. Recommendations in recent guidelines addressing classification and diagnosis were examined for consistencies or differences. Methods. Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network, and Medline for evidence-ba...

  17. Guidelines and recommendations on yeast cell death nomenclature

    Directory of Open Access Journals (Sweden)

    Didac Carmona-Gutierrez

    2018-01-01

    Full Text Available Elucidating the biology of yeast in its full complexity has major implications for science, medicine and industry. One of the most critical processes determining yeast life and physiology is cellular demise. However, the investigation of yeast cell death is a relatively young field, and a widely accepted set of concepts and terms is still missing. Here, we propose unified criteria for the definition of accidental, regulated, and programmed forms of cell death in yeast based on a series of morphological and biochemical criteria. Specifically, we provide consensus guidelines on the differential definition of terms including apoptosis, regulated necrosis, and autophagic cell death, as we refer to additional cell death routines that are relevant for the biology of (at least some species of yeast. As this area of investigation advances rapidly, changes and extensions to this set of recommendations will be implemented in the years to come. Nonetheless, we strongly encourage the authors, reviewers and editors of scientific articles to adopt these collective standards in order to establish an accurate framework for yeast cell death research and, ultimately, to accelerate the progress of this vibrant field of research.

  18. Nutrient Intake by Ultramarathon Runners: Can They Meet Recommendations?

    NARCIS (Netherlands)

    Wardenaar, F.C.; Vries, de J.H.M.; Witkamp, R.F.; Mensink, M.R.

    2015-01-01

    Purpose: The objective of this study was to investigate whether ultramarathon runners were able to meet nutrition recommendations during a training period and on a competition day. Methods: In preparation for a 60 or 120 km ultramarathon covering a varied terrain, male and female ultramarathon

  19. Headache neuroimaging: Routine testing when guidelines recommend against them.

    Science.gov (United States)

    Callaghan, Brian C; Kerber, Kevin A; Pace, Robert J; Skolarus, Lesli; Cooper, Wade; Burke, James F

    2015-11-01

    The aim of this article is to determine the patient-level factors associated with headache neuroimaging in outpatient practice. Using data from the 2007-2010 National Ambulatory Medical Care Surveys (NAMCS), we estimated headache neuroimaging utilization (cross-sectional). Multivariable logistic regression was used to explore associations between patient-level factors and neuroimaging utilization. A Markov model with Monte Carlo simulation was used to estimate neuroimaging utilization over time at the individual patient level. Migraine diagnoses (OR = 0.6, 95% CI 0.4-0.9) and chronic headaches (routine, chronic OR = 0.3, 95% CI 0.2-0.6; flare-up, chronic OR = 0.5, 95% CI 0.3-0.96) were associated with lower utilization, but even in these populations neuroimaging was ordered frequently. Red flags for intracranial pathology did not increase use of neuroimaging studies (OR = 1.4, 95% CI 0.95-2.2). Neurologist visits (OR = 1.7, 95% CI 0.99-2.9) and first visits to a practice (OR = 3.2, 95% CI 1.4-7.4) were associated with increased imaging. A patient with new migraine headaches has a 39% (95% CI 24-54%) chance of receiving a neuroimaging study after five years and a patient with a flare-up of chronic headaches has a 51% (32-68%) chance. Neuroimaging is routinely ordered in outpatient headache patients including populations where guidelines specifically recommend against their use (migraines, chronic headaches, no red flags). © International Headache Society 2015.

  20. FORM: An Australian method for formulating and grading recommendations in evidence-based clinical guidelines

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    Salisbury Janet

    2011-02-01

    Full Text Available Abstract Background Clinical practice guidelines are an important element of evidence-based practice. Considering an often complicated body of evidence can be problematic for guideline developers, who in the past may have resorted to using levels of evidence of individual studies as a quasi-indicator for the strength of a recommendation. This paper reports on the production and trial of a methodology and associated processes to assist Australian guideline developers in considering a body of evidence and grading the resulting guideline recommendations. Methods In recognition of the complexities of clinical guidelines and the multiple factors that influence choice in health care, a working group of experienced guideline consultants was formed under the auspices of the Australian National Health and Medical Research Council (NHMRC to produce and pilot a framework to formulate and grade guideline recommendations. Consultation with national and international experts and extensive piloting informed the process. Results The FORM framework consists of five components (evidence base, consistency, clinical impact, generalisability and applicability which are used by guideline developers to structure their decisions on how to convey the strength of a recommendation through wording and grading via a considered judgement form. In parallel (but separate from the grading process guideline developers are asked to consider implementation implications for each recommendation. Conclusions The framework has now been widely adopted by Australian guideline developers who find it to be a logical and intuitive way to formulate and grade recommendations in clinical practice guidelines.

  1. Nutrient composition of important fish species in Bangladesh and potential contribution to recommended nutrient intakes

    DEFF Research Database (Denmark)

    Bogard, Jessica R.; Thilsted, Shakuntala H.; Marks, Geoffrey C.

    2015-01-01

    Fish, in Bangladesh where malnutrition remains a significant development challenge, is an irreplaceable animal-source food in the diet of millions. However, existing data on the nutrient composition of fish do not reflect the large diversity available and have focused on only a few select nutrien...... indigenous species, which should guide policy and programmes to improve food and nutrition security in Bangladesh....

  2. Including patient preferences and applying guideline recommendations: a conflict?

    NARCIS (Netherlands)

    Brabers, A.; Esch, T.E.M. van; Groenewegen, P.P.; Hek, K.; Mullenders, P.; Dijk, L. van; Jong, J.D. de

    2017-01-01

    Background: One perceived barrier to adherence to guidelines is the existence of patient preferences which may conflict with them. We examined whether patient preferences influence the prescription of antibiotics in general practice, and how this affects adherence to guidelines. We hypothesised that

  3. General guidelines for recommendation of sites for nuclear waste repositories

    International Nuclear Information System (INIS)

    1983-01-01

    These guidelines were developed in accordance with the requirements of Section 112(a) of the Nuclear Waste Policy Act of 1982 for use by the Secretary of Energy in evaluating the suitability of sites for the development of repositories. The guidelines will be used for suitability evaluations and determinations made pursuant to Section 112(b) and any preliminary suitability determinations required by Section 114(f). The guidelines set forth in this Part are intended to complement the requirements set forth in the Act, 10 CFR Part 60, and 40 CFR Part 191. In applying these guidelines, the DOE will resolve any inconsistencies between these guidelines and the above documents in a manner determined by the DOE to most closely agree with the intent of the Act

  4. Trialling nutrient recommendations for slow lorises (Nycticebus spp.) based on wild feeding ecology.

    Science.gov (United States)

    Cabana, F; Dierenfeld, E; Wirdateti, W; Donati, G; Nekaris, K A I

    2018-02-01

    Slow loris (Nycticebus spp.) captive diets have been based on routine and anecdotes rather than scientific fact. The growing body of evidence contradicts the high fruit diet supported by such anecdotes. Non-human primate nutrient requirements are grouped into new (based on the common marmoset Callithrix jacchus) or old world (based on rhesus macaques Macaca mulatta) primates. Slow lorises are known to suffer from many health ailments in captivity such as dental disease, obesity, wasting and kidney issues all of which have been linked to diet. This study aimed to estimate nutrient intake from free-ranging slow lorises and to determine whether this intake can be used as nutrient recommendations. We collected data of nutrient intake, food passage rate and digestibility of captive slow lorises on three diet treatments 1: current captive type diet which is mostly fruits, 2: wild-type diet made only of food items from their natural diet, 3: new diet made to reflect wild slow loris nutrient intake. In order to validate our nutrient recommendations, diets 2 and 3 would have to be significantly different to Diet 1 in terms of nutrients, but not different from each other. Captive diets were significantly higher in soluble carbohydrates and lower in minerals and fibre fractions than both diets 2 and 3. Diets 2 and 3 led to a significantly increased food passage time and to more effective fibre and calcium digestion compared to Diet 1. We also observed obese individuals lost weight and underweight individuals gained weight. Our nutrient recommendations have been validated by our trials, and new or old world monkey nutrient recommendations are not consistent with our results. Diets should be high in protein and fibre and low in soluble carbohydrates and fats. © 2017 Blackwell Verlag GmbH.

  5. [Guidelines and recommendations in the treatment of eating disorders].

    Science.gov (United States)

    Túry, Ferenc; Szumska, Irena; Pászthy, Bea; Purebl, György

    2017-01-01

    The importance of eating disorders is increasing in the psychiatric practice, underlined by the epidemiological data and the severity of these disorders. In the treatment several approaches can be found, and some of these are controversial. Following the rules of evidence-based medicine an increasing number of guidelines were published. Eating disorders are prevalent and often show a serious course, the guidelines summarizing the recent knowledge in the literature are very useful for the therapists. The present guideline aims to help the everyday practice. It overviews the principles of the treatment of eating disordered patients, the steps of diagnostics, and the therapeutical methods. Many basic and practical techniques are also presented. It discusses the skills which are necessary for the treatment of eating disorders, and the therapeutical traps as well.

  6. Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions

    DEFF Research Database (Denmark)

    Lord, E; Stockdale, A J; Malek, R

    2017-01-01

    to review specialty guidelines and ascertain if HIV was discussed and testing recommended. METHODS: UK and European HIV testing guidelines were reviewed to produce a list of 25 ADCs and 49 ICs. UK guidelines for these conditions were identified from searches of the websites of specialist societies......, the National Institute of Clinical Excellence (NICE) website, the NICE Clinical Knowledge Summaries (CKS) website, the Scottish Intercollegiate Guidance Network (SIGN) website and the British Medical Journal Best Practice database and from Google searches. RESULTS: We identified guidelines for 12 of 25 ADCs......%). There was no association between recommendation to test and publication year (P = 0.62). CONCLUSIONS: The majority of guidelines for ICs do not recommend testing. Clinicians managing ICs may be unaware of recommendations produced by HIV societies or the prevalence of undiagnosed HIV infection among these patients. We...

  7. Recommendations and guidelines on shoreline development and hazards to navigation.

    Science.gov (United States)

    2010-12-01

    This guidebook addresses recommendations regarding encroachment into the Gulf Coast : Intracoastal Waterway (GIWW). Encroachment of hazards to navigation creates operational : inefficiencies that impede commerce. The shippers who rely on the waterway...

  8. Evaluation of the Haney Soil Health Nutrient Tool for corn nitrogen recommendations across eight Midwest states

    Science.gov (United States)

    Use and development of soil biological tests for estimating soil N availability and subsequently corn (Zea mays L.) fertilizer N recommendations is garnering considerable interest. The objective of this research was to evaluate relationships between the Soil Health Nutrient Tool (SHNT), also known a...

  9. Evaluation of the soil health nutrient tool for corn nitrogen recommendations across the Midwest

    Science.gov (United States)

    Use and development of soil biological tests for estimating soil N availability and subsequently corn (Zea mays L.) fertilizer N recommendations is garnering considerable interest. The objective of this research was to evaluate relationships between the Soil Health Nutrient Tool (SHNT), also known a...

  10. Application of the GRADE Approach in the Development of Guidelines and Recommendations in Genomic Medicine

    Science.gov (United States)

    Rafiq, Muhammad; Boccia, Stefania

    2018-01-01

    A great deal of ambiguity exists in the development of guidelines for genomic applications used in clinical practice. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach has the potential to be applied in the guidelines and recommendations development process in genomics. Here, we discuss whether and how GRADE can be applied to address the challenges posed by the evidence-based guidelines and recommendations development process in genomics. To see how GRADE can complement to the current guidelines development in genomics, we compare and contrast GRADE with other approaches. GRADE differed from other methods by incorporating patient values and preferences and balance of consequences. We conclude that the groups trying to implement genomics into practice may gleam more information from applying the GRADE framework. However, it is not clear yet whether GRADE can address the issue of timeliness in terms of the differences between the time required for guidelines development and the rapid pace of genomics. PMID:29410601

  11. Strategy Guideline. Advanced Construction Documentation Recommendations for High Performance Homes

    Energy Technology Data Exchange (ETDEWEB)

    Lukachko, A. [Building Science Corporation, Somerville, MA (United States); Gates, C. [Building Science Corporation, Somerville, MA (United States); Straube, J. [Building Science Corporation, Somerville, MA (United States)

    2011-12-01

    As whole house energy efficiency increases, new materials and new systems require greater coordination and communication between industry stakeholders. This report presents four changes that are recommended to achieve improvements in energy efficiency, durability and health in Building America houses: create coordination drawings, improve specifications, improve detail drawings, and review drawings and prepare a Quality Control Plan.

  12. Preconception care policy, guidelines, recommendations and services across six European countries

    DEFF Research Database (Denmark)

    Shawe, Jill; Delbaere, Ilse; Ekstrand, Maria

    2015-01-01

    : Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. Results All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations...... supplementation. Conclusions Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing...

  13. Lupus anticoagulant : performance of the tests as recommended by the latest ISTH guidelines

    NARCIS (Netherlands)

    Swadzba, J.; Iwaniec, T.; Pulka, M.; De Laat, B.; De Groot, P. G.; Musial, J.

    Objectives: Lupus anticoagulant (LA) is clinically the most relevant among all antiphospholipid antibody tests. Recently, new guidelines for LA detection were published. The objective of this retrospective cohort study was to compare tests recommended under these guidelines with other methods used

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

    Centers for Disease Control (CDC) Podcasts

    2009-10-15

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

  15. To meet nutrient recommendations, most French adults need to expand their habitual food repertoire.

    Science.gov (United States)

    Maillot, Matthieu; Vieux, Florent; Ferguson, Elaine F; Volatier, Jean-Luc; Amiot, Marie Josèphe; Darmon, Nicole

    2009-09-01

    Simultaneous dietary achievement of a comprehensive set of nutrient recommendations is difficult. Our objective was to assess the feasibility of achieving a set of 30 nutrient recommendations at the individual level and characterize factors associated with feasibility. Seven-day food records collected from adults participating in the French national food consumption survey (n = 1171) were modified using an individualized diet optimization approach. For each individual, departure from his/her recorded diet was minimized, using only foods reported in his/her weekly diet record to fulfill a set of nutritional constraints. These constraints aimed to achieve or exceed the French Estimated Average Requirements and varied depending on the individual's gender, age, and observed nutrient intake levels. Acceptability constraints ensured realistic food portion sizes and food patterns. Model feasibility (i.e. percentage of feasible optimized diets) was calculated for all diets and by tertiles of dietary variety (i.e. the number of foods in the weekly food repertoire). Among the 1171 modeled diets, only 22% were mathematically feasible, showing that 78% of French adults would need to expand their weekly food repertoire to fulfill nutrient recommendations. Model feasibility increased from 6.6 to 50.3% and from 2.7 to 42.9% in tertiles 1 and 3 of dietary variety for men and women, respectively. The vitamin D constraint was the most difficult to fulfill (feasibility doubled after its removal), followed by sodium (maximum), magnesium (minimum), and SFA (maximum). The new approach developed in this study provides a method for identifying nutrient levels to carefully evaluate when establishing recommendations.

  16. Foods, Nutrients, and Dietary Patterns: Interconnections and Implications for Dietary Guidelines12

    Science.gov (United States)

    Satija, Ambika; Hu, Frank B

    2016-01-01

    Dietary guidelines provide evidence-based statements on food choices to meet nutritional requirements and reduce the risk of prevailing chronic disease. They involve a substantial amount of research translation, and their implementation has important health consequences. Foods, however, are complex combinations of nutrients and other compounds that act synergistically within the food and across food combinations. In addition, the evidence base underpinning dietary guidelines accesses research that reflects different study designs, with inherent strengths and limitations. We propose a systematic approach for the review of evidence that begins with research on dietary patterns. This research will identify the combinations of foods that best protect, or appear deleterious to, health. Next, we suggest that evidence be sought from research that focuses on the effects of individual foods. Finally, nutrient-based research should be considered to explain the mechanisms by which these foods and dietary patterns exert their effects, take into account the effects of ingredients added to the food supply, and enable assessments of dietary sufficiency. The consideration of individual nutrients and food components (e.g., upper limits for saturated fat, added sugar, and sodium) provides important benchmarks for evaluating overall diet quality. The concepts of core and discretionary foods (nutrient-rich and nutrient-poor foods, respectively) enable distinctions between foods, and this has implications for the relation between food policy and food manufacturing. In summary, evidence supporting healthy dietary patterns provides the foundation for the development of dietary guidelines. Further reference to individual foods and nutrients follows from the foundation of healthy dietary patterns. PMID:27184272

  17. Hospital outcomes associated with guideline-recommended antibiotic therapy for pediatric pneumonia.

    Science.gov (United States)

    Thomson, Joanna; Ambroggio, Lilliam; Murtagh Kurowski, Eileen; Statile, Angela; Graham, Camille; Courter, Joshua D; Sheehan, Brieanne; Iyer, Srikant; White, Christine M; Shah, Samir S

    2015-01-01

    Recent national guidelines recommend use of narrow-spectrum antibiotic therapy as empiric treatment for children hospitalized with community-acquired pneumonia (CAP). However, clinical outcomes associated with adoption of this recommendation have not been studied. This retrospective cohort study included children age 3 months to 18 years, hospitalized with CAP from May 2, 2011 through July 30, 2012. Primary exposure of interest was empiric antibiotic therapy, classified as guideline recommended or not. Primary outcomes were length of stay (LOS), total hospital costs, and inpatient pharmacy costs. Secondary outcomes included broadened antibiotic therapy, emergency department revisits, and readmissions. Multivariable linear regression and Fisher exact test were performed to determine the association of guideline-recommended antibiotic therapy on outcomes. Empiric guideline-recommended therapy was prescribed to 168 (76%) of 220 patients. Median hospital LOS was 1.3 days (interquartile range [IQR]: 0.9-1.9 days), median total cost of index hospitalization was $4097 (IQR: $2657-$6054), and median inpatient pharmacy cost was $91 (IQR: $40-$183). Between patients who did and did not receive guideline-recommended therapy, there were no differences in LOS (adjusted -5.8% change; 95% confidence interval [CI]: -22.1 to 12.8), total costs (adjusted -10.9% change; 95% CI: -27.4 to 9.4), or inpatient pharmacy costs (adjusted 14.8% change; 95% CI: -43.4 to 27.1). Secondary outcomes were rare, with no difference in unadjusted analysis between patients who did and did not receive guideline-recommended therapy. Use of guideline-recommended antibiotic therapy was not associated with unintended negative consequences; there were no changes in LOS, total costs, or inpatient pharmacy costs. © 2014 Society of Hospital Medicine.

  18. Antibiotics for acute respiratory infections in general practice: comparison of prescribing rates with guideline recommendations.

    Science.gov (United States)

    McCullough, Amanda R; Pollack, Allan J; Plejdrup Hansen, Malene; Glasziou, Paul P; Looke, David Fm; Britt, Helena C; Del Mar, Christopher B

    2017-07-17

    To compare the current rate of antibiotic prescribing for acute respiratory infections (ARIs) in Australian general practice with the recommendations in the most widely consulted therapeutic guidelines in Australia (Therapeutic Guidelines). Comparison of general practice activity data for April 2010 - March 2015 (derived from Bettering the Evaluation and Care of Health [BEACH] study) with estimated rates of prescribing recommended by Therapeutic Guidelines. Antibiotic prescribing rates and estimated guideline-recommended rates per 100 encounters and per full-time equivalent (FTE) GP per year for eight ARIs; number of prescriptions nationally per year. An estimated mean 5.97 million (95% CI, 5.69-6.24 million) ARI cases per year were managed in Australian general practice with at least one antibiotic, equivalent to an estimated 230 cases per FTE GP/year (95% CI, 219-240 cases/FTE/year). Antibiotics are not recommended by the guidelines for acute bronchitis/bronchiolitis (current prescribing rate, 85%) or influenza (11%); they are always recommended for community-acquired pneumonia (current prescribing rate, 72%) and pertussis (71%); and they are recommended for 0.5-8% of cases of acute rhinosinusitis (current prescribing rate, 41%), 20-31% of cases of acute otitis media (89%), and 19-40% cases of acute pharyngitis or tonsillitis (94%). Had GPs adhered to the guidelines, they would have prescribed antibiotics for 0.65-1.36 million ARIs per year nationally, or at 11-23% of the current prescribing rate. Antibiotics were prescribed more frequently than recommended for acute rhinosinusitis, acute bronchitis/bronchiolitis, acute otitis media, and acute pharyngitis/tonsillitis. Antibiotics are prescribed for ARIs at rates 4-9 times as high as those recommended by Therapeutic Guidelines. Our data provide the basis for setting absolute targets for reducing antibiotic prescribing in Australian general practice.

  19. Grain Foods Are Contributors of Nutrient Density for American Adults and Help Close Nutrient Recommendation Gaps: Data from the National Health and Nutrition Examination Survey, 2009-2012.

    Science.gov (United States)

    Papanikolaou, Yanni; Fulgoni, Victor L

    2017-08-14

    The 2015-2020 Dietary Guidelines for Americans (2015-2020 DGA) maintains recommendations for increased consumption of whole grains while limiting intake of enriched/refined grains. A variety of enriched grains are sources of several shortfall nutrients identified by 2015-2020 DGA, including dietary fiber, folate, iron, and magnesium. The purpose of this study was to determine food sources of energy and nutrients for free-living U.S. adults using data from the National Health and Nutrition Examination Survey, 2009-2012. Analyses of grain food sources were conducted using a single 24-h recall collected in adults ≥19 years of age ( n = 10,697). Sources of nutrients contained in all grain foods were determined using United States Department of Agriculture nutrient composition databases and the food grouping scheme for grains (excluding mixed dishes). Mean energy and nutrient intakes from the total diet and from various grain food groups were adjusted for the sample design using appropriate weights. All grains provided 285 ± 5 kcal/day or 14 ± 0.2% kcal/day in the total diet in adult ≥19 years of age. In the total daily diet, the grain category provided 7.2 ± 0.2% (4.9 ± 0.1 g/day) total fat, 5.4 ± 0.2% (1.1 ± 0.03 g/day) saturated fat, 14.6 ± 0.3% (486 ± 9 mg/day) sodium, 7.9 ± 0.2% (7.6 ± 0.2 g/day) total sugar, 22.8 ± 0.4% (3.9 ± 0.1 g/day) dietary fiber, 13.2 ± 0.3% (122 ± 3 mg/day) calcium, 33.6 ± 0.5% (219 ± 4 mcg dietary folate equivalents (DFE)/day) folate, 29.7 ± 0.4% (5.3 ± 0.1 mg/day) iron, and 13.9 ± 0.3% (43.7 ± 1.1 mg/day) magnesium. Individual grain category analyses showed that breads, rolls and tortillas and ready-to-eat cereals provided minimal kcal/day in the total diet in men and women ≥19 years of age. Similarly, breads, rolls and tortillas, and ready-to-eat cereals supplied meaningful contributions of shortfall nutrients, including dietary fiber, folate and iron, while concurrently providing minimal amounts of nutrients to

  20. NSPWG-recommended safety requirements and guidelines for SEI nuclear propulsion

    International Nuclear Information System (INIS)

    Marshall, A.C.; Lee, J.H.; McCulloch, W.H.; Sawyer, J.C. Jr.; Bari, R.A.; Brown, N.W.; Cullingford, H.S.; Hardy, A.C.; Remp, K.; Sholtis, J.A.

    1992-01-01

    An Interagency Nuclear Safety Policy Working Group (NSPWG) was chartered to recommend nuclear safety policy, requirements, and guidelines for the Space Exploration Initiative (SEI) nuclear propulsion program to facilitate the implementation of mission planning and conceptual design studies. The NSPWG developed a top- level policy to provide the guiding principles for the development and implementation of the nuclear propulsion safety program and the development of Safety Functional Requirements. In addition the NSPWG reviewed safety issues for nuclear propulsion and recommended top-level safety requirements and guidelines to address these issues. Safety requirements were developed for reactor start-up, inadvertent criticality, radiological release and exposure, disposal, entry, and safeguards. Guidelines were recommended for risk/reliability, operational safety, flight trajectory and mission abort, space debris and meteoroids, and ground test safety. In this paper the specific requirements and guidelines will be discussed

  1. Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions

    DEFF Research Database (Denmark)

    Lord, E; Stockdale, A J; Malek, R

    2017-01-01

    , the National Institute of Clinical Excellence (NICE) website, the NICE Clinical Knowledge Summaries (CKS) website, the Scottish Intercollegiate Guidance Network (SIGN) website and the British Medical Journal Best Practice database and from Google searches. RESULTS: We identified guidelines for 12 of 25 ADCs...... to review specialty guidelines and ascertain if HIV was discussed and testing recommended. METHODS: UK and European HIV testing guidelines were reviewed to produce a list of 25 ADCs and 49 ICs. UK guidelines for these conditions were identified from searches of the websites of specialist societies...

  2. Preconception care of women with diabetes: a review of current guideline recommendations

    Directory of Open Access Journals (Sweden)

    Mazza Danielle

    2010-01-01

    Full Text Available Abstract Background The prevalence of type 2 diabetes mellitus (T2DM continues to rise worldwide. More women from developing countries who are in the reproductive age group have diabetes resulting in more pregnancies complicated by T2DM, and placing both mother and foetus at higher risk. Management of these risks is best achieved through comprehensive preconception care and glycaemic control, both prior to, and during pregnancy. The aim of this review was to compare the quality and content of current guidelines concerned with the preconception care of women with diabetes and to develop a summary of recommendations to assist in the management of diabetic women contemplating pregnancy. Methods Relevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE instrument. Guideline recommendations were extracted, compared and contrasted. Results All guidelines were assessed as being of high quality and strongly recommended for use in practice. All were consistent in counselling about the risk of congenital malformation related to uncontrolled blood sugar preconceptionally, ensuring adequate contraception until glycaemic control is achieved, use of HBA1C to monitor metabolic control, when to commence insulin and switching from ACE inhibitors to other antihypertensives. Major differences were in the targets recommended for optimal metabolic control and opinion regarding the usage of metformin as an adjunct or alternative treatment before or during pregnancy. Conclusions International guidelines for the care of women with diabetes who are contemplating pregnancy are consistent in their recommendations; however some are more comprehensive than others. Having established current standards for the preconception care of diabetic women, there is now a need to focus on guideline

  3. EuroFIR Guideline on calculation of nutrient content of foods for food business operators.

    Science.gov (United States)

    Machackova, Marie; Giertlova, Anna; Porubska, Janka; Roe, Mark; Ramos, Carlos; Finglas, Paul

    2018-01-01

    This paper presents a Guideline for calculating nutrient content of foods by calculation methods for food business operators and presents data on compliance between calculated values and analytically determined values. In the EU, calculation methods are legally valid to determine the nutrient values of foods for nutrition labelling (Regulation (EU) No 1169/2011). However, neither a specific calculation method nor rules for use of retention factors are defined. EuroFIR AISBL (European Food Information Resource) has introduced a Recipe Calculation Guideline based on the EuroFIR harmonized procedure for recipe calculation. The aim is to provide food businesses with a step-by-step tool for calculating nutrient content of foods for the purpose of nutrition declaration. The development of this Guideline and use in the Czech Republic is described and future application to other Member States is discussed. Limitations of calculation methods and the importance of high quality food composition data are discussed. Copyright © 2017. Published by Elsevier Ltd.

  4. Classification and Clinical Diagnosis of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines

    Directory of Open Access Journals (Sweden)

    Mary-Ann Fitzcharles

    2013-01-01

    Full Text Available Objectives. Fibromyalgia syndrome (FMS, characterized by subjective complaints without physical or biomarker abnormality, courts controversy. Recommendations in recent guidelines addressing classification and diagnosis were examined for consistencies or differences. Methods. Systematic searches from January 2008 to February 2013 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, Guidelines International Network, and Medline for evidence-based guidelines for the management of FMS were conducted. Results. Three evidence-based interdisciplinary guidelines, independently developed in Canada, Germany, and Israel, recommended that FMS can be clinically diagnosed by a typical cluster of symptoms following a defined evaluation including history, physical examination, and selected laboratory tests, to exclude another somatic disease. Specialist referral is only recommended when some other physical or mental illness is reasonably suspected. The diagnosis can be based on the (modified preliminary American College of Rheumatology (ACR 2010 diagnostic criteria. Discussion. Guidelines from three continents showed remarkable consistency regarding the clinical concept of FMS, acknowledging that FMS is neither a distinct rheumatic nor mental disorder, but rather a cluster of symptoms, not explained by another somatic disease. While FMS remains an integral part of rheumatology, it is not an exclusive rheumatic condition and spans a broad range of medical disciplines.

  5. Pathologic diagnosis of malignant mesothelioma: chronological prospect and advent of recommendations and guidelines

    Directory of Open Access Journals (Sweden)

    Valeria Ascoli

    2015-03-01

    Full Text Available Malignant mesothelioma (MM is rare and difficult to diagnose. Its identification depends upon pathological investigation (cyto-histological assessment and immunohistochemistry supported by clinical and radiological evidence. In the last decade, the standardization of diagnostic methods has become a major focus of debate among pathologists and clinicians. This has led to the writing of guidelines and recommendation for the diagnosis to achieve the goal of a standard diagnosis. In this article, a chronological view relating to the pathological diagnosis of MM is presented together with a review of guidelines and recommendations.

  6. Relationship between attainment of recommended physical activity guidelines and academic achievement: undergraduate students in Egypt.

    Science.gov (United States)

    El Ansari, Walid; Stock, Christiane

    2014-07-14

    We assessed and compared by gender, students' achievement of recommended guidelines of four PA forms, and the association between guideline achievement of each of the four PA forms and students' academic performance. Data (2009-2010) comprised 3,271 students (11 faculties) at Assiut University, Egypt. A self-administered questionnaire measured: moderate PA (MPA), vigorous PA (VPA), moderate to vigorous PA (MVPA), muscle-strengthening PA; five socio-demographic variables (gender, age, year of study, father's education, living arrangements during semester); self-rated health; and, academic performance. We compared the levels of four PA forms, socio-demographic variables, and academic performance by gender. Binary logistic regression examined the factors associated with achieving the guidelines of the four PA forms. Linear regression examined the association between frequency of four PA forms and level of academic performance. Nearly equal proportions of males and females (37%, 36%) achieved the MPA guidelines. Significantly more males achieved the VPA, MVPA, and muscle strengthening PA guidelines. Father's education was positively associated with achieving all four PA guidelines (with each increasing educational achievement of the father, student's odds of achieving PA guidelines increased by 7-9%). Students living with their parents or room mates off campus were more likely to achieve the VPA and MVPA guidelines. Students who achieved VPA and MVPA guidelines were more likely to report better academic performance. For all PA forms (except MPA), increasing academic achievement was positively associated with increasing frequency of PA, but standardised Beta (0.05-0.07) suggested a modest correlation between academic achievement and PA frequency. The linear association between frequency of PA and academic achievement, and the finding that the proportions of students who achieved the recommended levels of several forms of PA were below half of the sample call for higher

  7. Investigation of barriers to clinical practice guideline-recommended pharmacotherapy in the treatment of COPD.

    Directory of Open Access Journals (Sweden)

    Price L

    2007-06-01

    Full Text Available Background: The adoption of clinical practice guideline recommendations for COPD is suboptimal. Determining the barriers to the implementation of these practice guidelines may help improve patient care.Objective: To determine whether barriers to the use of pharmacotherapy according to practice guidelines are related primarily to patient or prescriber factors.Methods: Retrospective cohort study. Members of a health maintenance organization identified as having spirometry-defined COPD ranging from stage II to IV. Electronic medical records were reviewed for documentation of the following: 1 patient affordability issues, 2 history of an adverse drug reaction, 3 history of inefficacy to therapy, and 4 prescription history.Results: A total of 111 medical records were reviewed. There were 51% of patients who had not filled medications that had been prescribed in accordance with guidelines and 43% did not have the guideline recommended medications prescribed in the previous year. Only 4% and 2% of patients had documented inefficacy and affordability issues, respectively. There were no reported cases of adverse drug reactions. Conclusions: This study provides insight to the acceptance of COPD treatment recommendations by patients and providers. Further research is needed to design interventions to reduce barriers and optimize COPD treatment.

  8. Evidence-based clinical guidelines: a new system to better determine true strength of recommendation.

    Science.gov (United States)

    Roddy, Edward; Zhang, Weiya; Doherty, Michael; Arden, Nigel K; Barlow, Julie; Birrell, Fraser; Carr, Alison; Chakravarty, Kuntal; Dickson, John; Hay, Elaine; Hosie, Gillian; Hurley, Michael; Jordan, Kelsey M; McCarthy, Christopher; McMurdo, Marion; Mockett, Simon; O'Reilly, Sheila; Peat, George; Pendleton, Adrian; Richards, Selwyn

    2006-06-01

    Clinical practice guidelines often grade the 'strength' of their recommendations according to the robustness of the supporting research evidence. The existing methodology does not allow the strength of recommendation (SOR) to be upgraded for recommendations for which randomized controlled trials are impractical or unethical. The purpose of this study was to develop a new method of determining SOR, incorporating both research evidence and expert opinion. A Delphi technique was employed to produce 10 recommendations for the role of exercise therapy in the management of osteoarthritis of the hip or knee. The SOR for each recommendation was determined by the traditional method, closely linked to the category of research evidence found on a systematic literature search, and on a visual analogue scale (VAS). Recommendations were grouped A-D according to the traditional SOR allocated and the mean VAS calculated. Difference across the groups was assessed by one-way ANOVA variance analysis. Mean VAS scores for the traditional SOR groups A-D and one proposition which was 'not recommended' showed significant linearity on one-way ANOVA. However, certain recommendations which, for practical reasons, could not assessed in randomized controlled trials and therefore could not be recommended strongly by the traditional methodology, were allocated a strong recommendation by VAS. This new system of grading strength of SOR is less constrained than the traditional methodology and offers the advantage of allowing SOR for procedures which cannot be assessed in RCTs for practical or ethical reasons to be upgraded according to expert opinion.

  9. Barriers and facilitators to meeting aphasia guideline recommendations: what factors influence speech pathologists' practice?

    Science.gov (United States)

    Shrubsole, Kirstine; Worrall, Linda; Power, Emma; O'Connor, Denise A

    2018-01-29

    To explore factors influencing Australian speech pathologists' guideline recommended aphasia management practices. Semi-structured interviews were conducted with hospital-based speech pathologists (n = 20). Interviews focused on barriers and facilitators to implementing recommendations related to five practice areas: Aphasia-friendly Information; Collaborative Goal Setting; Timing of Therapy; Amount and Intensity of Therapy; and Conversation Partner Training. Speech pathologists working only in inpatient rehabilitation settings reported performing the recommended behaviours consistently, and identified few implementation barriers. However, clinicians working in the acute setting reported performing the majority of behaviours inconsistently or rarely. Seven (of 14) Theoretical Domains Framework domains were identified as key influencing factors. Three of these - "Environmental Context and Resources," "Beliefs about Consequences," and "Social Influences" - were consistently reported as influencing practice across all five behaviours. Other important domains included "Knowledge", "Beliefs about Capabilities," "Goals," and "Social/Professional Role and Identity", which each influenced at least two practice behaviours. Speech pathologists report a number of key factors influencing their practice, which differ in how they influence behaviours (i.e., a factor may be a barrier or a facilitator) depending on the behaviour and clinical setting. Future implementation interventions need to account for the strong influence of beliefs and social influences on speech pathology practice, which may facilitate successful implementation. Implications for rehabilitation Speech pathologists' aphasia management practices are often inconsistent with guideline recommendations. Environmental and contextual barriers were identified for all guideline-recommended practices that were investigated; however, these barriers did not necessarily impede implementation for speech pathologists

  10. Assessing national nutrition security: The UK reliance on imports to meet population energy and nutrient recommendations

    Science.gov (United States)

    Clark, Heather; Whybrow, Stephen; de Ruiter, Henri; McNeill, Geraldine

    2018-01-01

    Nutrition security describes the adequacy of the food supply to meet not only energy but also macronutrient and micronutrient requirements for the population. The aim of this study was to develop a method to assess trends in national nutrition security and the contribution of imports to nutrition security, using the UK as a case study. Food supply data from FAO food balance sheets and national food composition tables were used to estimate the nutrient content of domestically produced food, imported food and exported food. Nutrition security was defined as the total nutrient supply (domestic production, minus exports, plus imports) to meet population-level nutrient requirements. The results showed that the UK was nutrition secure over the period 1961–2011 for energy, macronutrients and key micronutrients, with the exception of total carbohydrates and fibre, which may be due to the loss of fibre incurred by processing cereals into refined products. The supply of protein exceeded population requirements and could be met with domestic production alone. Even excluding all meat there was sufficient protein for population requirements. The supply of total fat, saturated fat and sugar considerably exceeded the current dietary recommendation. As regards nutrition security in 2010, the UK was reliant on imported foods to meet energy, fibre, total carbohydrate, iron, zinc and vitamin A requirements. This analysis demonstrates the importance of including nutrients other than energy to determine the adequacy of the food supply. The methodology also provides an alternative perspective on food security and self-sufficiency by assessing the dependency on imports to meet population level nutritional requirements. PMID:29489830

  11. Assessing national nutrition security: The UK reliance on imports to meet population energy and nutrient recommendations.

    Science.gov (United States)

    Macdiarmid, Jennie I; Clark, Heather; Whybrow, Stephen; de Ruiter, Henri; McNeill, Geraldine

    2018-01-01

    Nutrition security describes the adequacy of the food supply to meet not only energy but also macronutrient and micronutrient requirements for the population. The aim of this study was to develop a method to assess trends in national nutrition security and the contribution of imports to nutrition security, using the UK as a case study. Food supply data from FAO food balance sheets and national food composition tables were used to estimate the nutrient content of domestically produced food, imported food and exported food. Nutrition security was defined as the total nutrient supply (domestic production, minus exports, plus imports) to meet population-level nutrient requirements. The results showed that the UK was nutrition secure over the period 1961-2011 for energy, macronutrients and key micronutrients, with the exception of total carbohydrates and fibre, which may be due to the loss of fibre incurred by processing cereals into refined products. The supply of protein exceeded population requirements and could be met with domestic production alone. Even excluding all meat there was sufficient protein for population requirements. The supply of total fat, saturated fat and sugar considerably exceeded the current dietary recommendation. As regards nutrition security in 2010, the UK was reliant on imported foods to meet energy, fibre, total carbohydrate, iron, zinc and vitamin A requirements. This analysis demonstrates the importance of including nutrients other than energy to determine the adequacy of the food supply. The methodology also provides an alternative perspective on food security and self-sufficiency by assessing the dependency on imports to meet population level nutritional requirements.

  12. Contribution of folic acid-fortified foods to fertile women's folate Recommended Nutrient Intake through breakfast simulation models.

    Science.gov (United States)

    Samaniego-Vaesken, María de Lourdes; Alonso-Aperte, Elena; Varela-Moreiras, Gregorio

    2015-08-01

    To assess the potential contribution of foods fortified with folic acid (FA) to target population intakes when included as part of a healthy breakfast. Breakfast models aligned with the Spanish Dietary Guidelines were studied using the recommended, average and 95th percentile of serving sizes consumed by women of childbearing age. Food composition data were obtained from a database including FA analytical data from sixty-eight products and the Spanish food composition tables. Different scenarios were assessed with the inclusion of one, two or three FA-fortified products and with two different fortification levels: ≤ 33 µg/serving (L1) and ≥ 70 µg/serving (L4). FA contents provided by the different models for each scenario were compared with the Recommended Nutrient Intake (RNI) for folate and the Upper Level (UL) of intake for FA. Madrid Region, Spain. Women aged 16-49 years were considered. Overall, simulation of ten breakfast models and three scenarios of product inclusion accounted for 20-25% of total daily energy recommendations for women. Unfortified breakfast models provided on average 4-23% of the folate RNI. Inclusion of one L4 FA-fortified food contributed 20-60% of the RNI. Fortified yoghurt and milk had the highest FA contents per serving. Scenarios with two or three fortified products delivered 40-80% of the RNI. None of the evaluated models exceeded the FA UL. At existing levels of FA fortification, inclusion of fortified products as part of a regular breakfast meal could positively impact the nutritional quality of women's diet without involving a risk of excessive FA exposure.

  13. 2014 Hypertension Guideline: Recommendation for a Change in Goal Systolic Blood Pressure

    Science.gov (United States)

    Handler, Joel

    2015-01-01

    The 2014 Kaiser Permanente Care Management Institute National Hypertension Guideline was developed to assist primary care physicians and other health care professionals in the outpatient treatment of uncomplicated hypertension in adult men and nonpregnant women aged 18 years and older. The new guideline reflects general acceptance, with minor modifications, of the “Evidence-Based Guideline” report by the panel members appointed to the National Heart, Lung, and Blood Institute 8th Joint National Committee. A major practice change is the recommendation for goal systolic blood pressure less than 150 mmHg in patients aged 60 years and older who are treated for hypertension in the absence of diabetes or chronic kidney disease. This article describes the reasons for, evidence for, and consequences of the change, and is followed by the National Guidelines handout. PMID:26057683

  14. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version)

    DEFF Research Database (Denmark)

    Dietrich, Christoph F; Bamber, Jeffrey; Berzigotti, Annalisa

    2017-01-01

    We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography, focused on the assessment of diffuse liver disease. The first part (long version) of these Guidelines...... and Recommendations deals with the basic principles of elastography and provides an update of how the technology has changed. The practical advantages and disadvantages associated with each of the techniques are described, and guidance is provided regarding optimization of scanning technique, image display, image...... Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both beginners and advanced clinical users....

  15. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version)

    DEFF Research Database (Denmark)

    Dietrich, Christoph F; Bamber, Jeffrey; Berzigotti, Annalisa

    2017-01-01

    We present here the first update of the 2013 EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology) Guidelines and Recommendations on the clinical use of elastography with a focus on the assessment of diffuse liver disease. The short version provides clinical information...... and in several clinical scenarios is also discussed. All of the recommendations are judged with regard to their evidence-based strength according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. This updated document is intended to act as a reference and to provide a practical guide for both...

  16. Patient Nonadherence to Guideline-Recommended Care in Acute Low Back Pain.

    Science.gov (United States)

    Bier, Jasper D; Kamper, Steven J; Verhagen, Arianne P; Maher, Christopher G; Williams, Christopher M

    2017-12-01

    To describe the magnitude of patient-reported nonadherence with guideline-recommended care for acute low back pain. Secondary analysis of data from participants enrolled in the Paracetamol for Acute Low Back Pain study trial, a randomized controlled trial evaluating the effectiveness of paracetamol for acute low back pain. Primary care, general practitioner. Data from participants with acute low back pain (N=1643). Guideline-recommended care, including reassurance, simple analgesia, and the advice to stay active and avoid bed rest. Also, advice against additional treatments and referral for imaging. Proportion of nonadherence with guideline-recommended care. Nonadherence was defined as (1) failure to consume the advised paracetamol dose, or (2) receipt of additional health care, tests, or medication during the trial treatment period (4wk). Multivariable logistic regression analysis was performed to determine the factors associated with nonadherence. In the first week of treatment, 39.7% of participants were classified as nonadherent. Over the 4-week treatment period, 70.0% were nonadherent, and 57.5% did not complete the advised paracetamol regimen. Higher perceived risk of persistent pain, lower level of disability, and not claiming workers' compensation were associated with nonadherence, with odds ratios ranging from .46 to 1.05. Adherence to guideline-recommended care for acute low back pain was poor. Most participants do not complete the advised paracetamol regimen. Higher perceived risk of persistence of complaints, lower baseline disability, and participants not claiming workers' compensation were independently associated with nonadherence. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  17. Guideline-recommended medications: variation across Medicare Advantage plans and associated mortality.

    Science.gov (United States)

    Selim, Alfredo J; Fincke, Benjamin G; Rogers, William H; Qian, Shirley; Selim, Bernardo J; Kazis, Lewis E

    2013-03-01

    To evaluate variation in the prescription of guideline-recommended medications across Medicare Advantage (MA) plans and to determine whether such variation is associated with increased mortality. Observational study of 111,667 patients aged 65 years or older receiving care in 203 MA plans. We linked data from the Medicare Health Outcomes (HOS) Survey cohort 9 (April 2006-May 2008) with the Medicare Part D prescription benefit files (January 1, 2006-December 31, 2007) to examine variation in treatment across MA plans and its association with differences in observed (O)/expected (E) mortality ratio for 5 high-volume chronic conditions: diabetes, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD)/asthma, and depression. Analysis of variance confirmed that the 203 MA plans differed significantly in their use of guideline-recommended treatment (P≤0.02). Those MA plans with higher use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (r=-0.40; Pratios. Those MA plans with higher use of multiple guideline-recommended medications were significantly associated with lower O/E mortality ratios in CHF (r=-0.45; Pratios in patients with CAD and COPD/asthma. Those MA plans with higher use of antidepressant medications had significantly higher O/E mortality ratios (r=0.28, P<0.0001). There was wide variation across MA plans in the prescription of guideline-recommended medications that had a measurable relationship to the mortality of elderly patients with CHF and diabetes. These findings can serve to both motivate and target quality improvement programs.

  18. Helping hospital patients quit: what the evidence supports and what guidelines recommend.

    Science.gov (United States)

    Wolfenden, Luke; Campbell, Elizabeth; Wiggers, John; Walsh, Raoul A; Bailey, Laura J

    2008-04-01

    The study aimed to critically appraise the extent and strength of systematic review evidence for, and guideline recommendations regarding hospital smoking cessation interventions. Systematic reviews of smoking cessation interventions were identified via an electronic search of the Cochrane Library. Meta-analyses from Cochrane reviews were categorised as those that incorporated only studies of hospital based interventions, and those which incorporated interventions which were not hospital based. Smoking cessation guidelines for hospital health professionals were identified via a search of the World Wide Web. The review found that evidence from meta-analyses restricted to hospital studies was insufficient to evaluate a number of specific intervention strategies and at times conflicted with the findings of meta-analyses without such restrictions. The majority of guidelines recommended the provision of brief advice, counseling, nicotine replacement therapy despite the absence of clear supporting evidence. Further hospital-based research addressing specific cessation strategies is required. Furthermore, smoking cessation guidelines for hospital based health professionals should more specifically reflect evidence from this setting.

  19. Recommendations for Guidelines for EMF Personal Exposure Measurements, Rapid Project #4

    Energy Technology Data Exchange (ETDEWEB)

    T. Dan Bracken, Inc.

    1997-08-01

    The purpose of developing guidelines for electric and magnetic field (EMF) personal exposure measurements (lF'EM) is to ensure reliable and comparable data across I?EM studies. Study techniques may vary due to different populations or objectives, but the resulting data should be consistently reported and comparable, to the extent possible. Any guideline must allow creativity by the research-oriented investigator and provide specific guidance to industrial hygienists or other results-oriented investigators, requiring a standard protocol. Recognizing measurement studies with different purposes is an important aspect of these recommendations. The guidelines presented here intend to produce comparable data across studies while remaining flexible. The recommendations for designing and implementing an EMF PEM program describe a three-stage process. The first step is to clearly state the purpose of the PEM program. The next stage addresses the fundamental elements of an EMF PEM study, including an assessment of the scientific and organizational resources that will be required. This process is codified in a written study plan. These stages are described in 1 Section 5 of this report. The third stage of a PEM study involves the design, implementation and documentation of specific procedures and protocols fo~ sampling strategies, selection of measurement parameters; instrumentation, measurement and data collection, data management, data analysis, quality assurance, uncertainty evaluation, and archiving the study methods and results. The methods for designing these elements of an EMF PEM study are described in Section 6: Specific Guidelines for EMF I?EM Study Design.

  20. The multiple myeloma treatment landscape: international guideline recommendations and clinical practice in Europe.

    Science.gov (United States)

    Cavo, Michele; Terpos, Evangelos; Bargay, Joan; Einsele, Hermann; Cavet, Jim; Greil, Richard; de Wit, Edwin

    2018-03-01

    Guidelines provide recommendations on the management of multiple myeloma (MM), but there are no standard algorithms for the choice and sequencing of treatments. As a result, there is widespread variation in the interpretation and implementation of these guidelines. Areas covered: This review will cover: the real-world data on MM treatment patterns; the approved agents available for the treatment of MM; a comparative summary of the national and international clinical guidelines; a discussion on the impact reimbursement decisions have on treatment availability. Expert commentary: In the future, treatment choices may become even more complex as clonal heterogeneity is better understood in the context of response to treatment, and next-generation agents become available. Although information on real-world practice patterns can provide further guidance, to date, few studies have generated data on patients treated with the newer agents in real-world settings. Furthermore, the translation of guideline recommendations into clinical practice across Europe is inconsistent. Additional real-world data are therefore vital to understanding current clinical practice patterns, so that new agents can be effectively incorporated into existing treatment strategies. Such information may aid the development of better guidance, which will ultimately help to ensure that patients receive the best possible care.

  1. How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines

    Directory of Open Access Journals (Sweden)

    Favre Madeleine

    2010-05-01

    Full Text Available Abstract Background Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1 simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2 can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended. Methods We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases. Results Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base. Conclusion We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices.

  2. Using decision support for population tracking of adherence to recommended asthma guidelines.

    Science.gov (United States)

    Ahmed, Sara; Tamblyn, Robyn; Winslade, Nancy

    2014-03-04

    Decision support systems linked to administrative databases provide a unique opportunity to monitor adherence to guidelines and target disease management strategies towards patients not receiving guideline-based therapy. The objective of this study was to evaluate the discrepancy between actual asthma treatments prescribed by primary care physicians compared to those recommended by evidence-based guidelines using a decision support tool linked to a provincial health administrative database. The drug and medical services information of individuals with asthma was identified from the provincial health database and was pushed through an asthma decision support system (ADSS). Recommendations aimed at optimising asthma treatment were generated on two index dates, 15 September 2007 (index date 1) and 15 March 2008 (index date 2). Primary care settings in a large Canadian metropolitan area. Individuals with asthma and provincial health insurance primary and secondary outcome measures: well controlled asthma. 16 803 eligible individuals were identified on index date 1, and 18 103 on index date 2. The distribution of recommendation categories was similar on both index dates. 94% were classified as well controlled and 7% as not well controlled. Among well-controlled individuals, the largest proportion was in the maintain treatment category (63.8%), followed by the maintain/decrease treatment category (28.2%) and the decrease treatment category (2.7%). Almost all individuals who were not well controlled had the recommendation to increase treatment (88%) with a small proportion in the refer category (1%). The ADSS was able to identify subgroups of patients from an administrative database that could benefit from a medication review and possible change. Decision support systems linked to an administrative database can be used to identify individuals with uncontrolled asthma or prescriptions that deviate from recommended treatment. When connected to the point of care, this can

  3. Are the current guideline recommendations for neonatal cardiopulmonary resuscitation safe and effective?

    Science.gov (United States)

    Rottenberg, Eric M

    2016-08-01

    A recently published review of approaches to optimize chest compressions in the resuscitation of asphyxiated newborns discussed the current recommendations and explored potential determinants of effective neonatal cardiopulmonary resuscitation (CPR). However, not all potential determinants of effective neonatal CPR were explored. Chest compression shallower than the current guideline recommendation of approximately 33% of the anterior-posterior (AP) chest diameter may be safer and more effective. From a physiological standpoint, high-velocity brief duration shallower compression may be more effective than current recommendations. The application of a 1- or 2-finger method of high-impulse CPR, which would depend on the size of the subject, may be more effective than using a 2-thumb (TT) encircling hands method of CPR. Adrenaline should not be used in the treatment of asphyxiated neonates and when necessary titrated vasopressin should be used. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Treatment of Fibromyalgia Syndrome: Recommendations of Recent Evidence-Based Interdisciplinary Guidelines with Special Emphasis on Complementary and Alternative Therapies

    Directory of Open Access Journals (Sweden)

    Jacob Ablin

    2013-01-01

    Full Text Available Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS. First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques.

  5. [Pressure ulcer prevention in German hospitals. An analysis of nursing practice with regard to guideline recommendations].

    Science.gov (United States)

    Bielitz, Harald; Hertel, Frank; Mertens, Elke; Halfens, Ruud

    2007-03-01

    Pressure ulcers are still a common health problem. Prevention and therapy of pressure ulcers require extensive nursing resources. Based on epidemiological data the use of preventive interventions and devices in hospital patients at risk was analysed. One object of this study was to compare the nursing practice with the recommendations given by a national practice guideline about pressure ulcer prevention by the German Network for Quality Development in Nursing (DNQP). Since 2002 each year a study has been conducted in order to investigate the prevalence of pressure ulcers in German hospitals. For the present study data of 9159 patients at pressure ulcer risk collected in three years (from 2002 to 2004) were analysed. In the course of the investigated period interventions and devices were increasingly adjusted to the recommendations of the guideline. This trend appears to be slightly, but it is noticeable. The number of process requirements realised for each patient increased particularly if patients showed a high risk or a pressure ulcer was already present. To improve the quality of care preferably all process criteria according to the guideline should be considered if preventive measures are planned.

  6. Canadian National Guidelines and Recommendations for Integrating Career Advising Into Medical School Curricula.

    Science.gov (United States)

    Howse, Kelly; Harris, June; Dalgarno, Nancy

    2017-11-01

    Career planning, decision making about specialty choice, and preparation for residency matching are significant sources of stress for medical students. Attempts have been made to structure and formalize career advising by including it in accreditation standards. There is an expressed need for national guidelines on career advising for medical students. The Future of Medical Education in Canada Postgraduate (FMEC PG) Implementation Project was created to ensure Canadian medical trainees receive the best education possible. From this, a diverse sub-working group (SWG), representing different Canadian regions, was formed to review career advising processes across the country. The SWG developed, through a modified formal consensus methodology, a strategy for medical student career advising that is adaptable to all schools in alignment with existing accreditation standards. The SWG outlined five guiding principles and five essential elements for Canadian universities offering an MD degree with recommendations on how to integrate the elements into each school's career advising system. The five essential elements are a structured approach to career advising, information about available career options, elective guidance, preparation for residency applications, and social accountability. This Perspective endorses the view of the FMEC PG Implementation Project that national guidelines are important to ensure Canadian medical schools are consistently meeting accreditation standards by providing reliable and quality career advising to all medical students. The SWG's position, based on national and provincial feedback, is that these guidelines will stimulate discourse and action regarding the requirements and processes to carry out these recommendations nationwide and share across borders.

  7. Direct-to-consumer genetic testing: a systematic review of european guidelines, recommendations, and position statements.

    Science.gov (United States)

    Rafiq, Muhammad; Ianuale, Carolina; Ricciardi, Walter; Boccia, Stefania

    2015-10-01

    Personalized healthcare is expected to yield promising results, with a paradigm shift toward more personalization in the practice of medicine. This emerging field has wide-ranging implications for all the stakeholders. Commercial tests in the form of multiplex genetic profiles are currently being provided to consumers, without the physicians' consultation, through the Internet, referred to as direct-to-consumer genetic tests (DTC GT). The objective was to review all the existing European guidelines on DTC GT, and its associated interventions, to list all the supposed benefits and harms, issues and concerns, and recommendations. We conducted a systematic review of position statements, policies, guidelines, and recommendations, produced by professional organizations or other relevant bodies for use of DTC GT in Europe. Seventeen documents met the inclusion criteria, which were subjected to thematic analysis, and the texts were coded for statements related to use of DTC GT. Professional societies and associations are currently more suggestive of potential disadvantages of DTC GT, recommending improved genetic literacy of both populations and health professionals, and implementation research on the genetic tests to integrate public health genomics into healthcare systems.

  8. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations.

    Science.gov (United States)

    Mortensen, K; Nilsson, M; Slim, K; Schäfer, M; Mariette, C; Braga, M; Carli, F; Demartines, N; Griffin, S M; Lassen, K

    2014-09-01

    Application of evidence-based perioperative care protocols reduces complication rates, accelerates recovery and shortens hospital stay. Presently, there are no comprehensive guidelines for perioperative care for gastrectomy. An international working group within the Enhanced Recovery After Surgery (ERAS®) Society assembled an evidence-based comprehensive framework for optimal perioperative care for patients undergoing gastrectomy. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and were discussed until consensus was reached within the group. The quality of evidence was rated 'high', 'moderate', 'low' or 'very low'. Recommendations were graded as 'strong' or 'weak'. The available evidence has been summarized and recommendations are given for 25 items, eight of which contain procedure-specific evidence. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. The present evidence-based framework provides comprehensive advice on optimal perioperative care for the patient undergoing gastrectomy and facilitates multi-institutional prospective cohort registries and adequately powered randomized trials for further research. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  9. iPhone app adherence to expert-recommended guidelines for pediatric obesity prevention.

    Science.gov (United States)

    Wearing, Jessica R; Nollen, Nikki; Befort, Christie; Davis, Ann M; Agemy, Carolina K

    2014-04-01

    Pediatric obesity is a serious and prevalent problem. Smartphone technology, which is becoming increasingly available to children of diverse backgrounds, presents a unique opportunity to instill healthy behaviors before the onset of obesity. Past studies have examined the use of smartphone applications as tools of health behavior modification for adults. The present study examines the content of children's exercise and nutrition smartphone apps. Sixty-two iPhone apps were identified and coded by two independent raters for adherence to expert-recommended behaviors (e.g., five fruits/vegetables per day) and strategies (e.g., self-monitoring diet/physical activity) for the prevention of pediatric obesity. App behavioral and strategy index scores were uniformly low. Apps were more likely to address expert-recommended behaviors for the prevention of pediatric obesity (93.5%), whereas few apps addressed recommended strategies (20.9%). The most common behaviors addressed included physical activity (53.2%) and fruit/vegetable consumption (48.3%). Other important behaviors (e.g., screen time [1.6%] and family meals together [1.6%]) were rarely addressed. Current children's diet and exercise apps could be improved with increased adherence to expert-recommended guidelines, especially expert-recommended strategies.

  10. Strategies for disseminating recommendations or guidelines to patients: a systematic review.

    Science.gov (United States)

    Schipper, K; Bakker, M; De Wit, M; Ket, J C F; Abma, T A

    2016-06-07

    The aim of this systematic literature review was to assess what dissemination strategies are feasible to inform and educate patients about recommendations (also known as guidelines). The search was performed in February 2016 in PubMed, Ebsco/PsycINFO, Ebsco/CINAHL and Embase. Studies evaluating dissemination strategies, involving patients and/or reaching patients, were included. A hand search and a search in the grey literature, also done in February 2016, were added. Searches were not restricted by language or publication type. Publications that referred to (1) guideline(s) or recommendation(s), (2) dissemination, (3) dissemination with patients/patient organisations and (4) dissemination to patients/patient organisations were included in this article. Criteria 1 AND 2 were mandatory together with criteria 3 OR 4. The initial search revealed 3753 unique publications. Forty-seven articles met the inclusion criteria and were selected for detailed review. The hand search and grey literature resulted in four relevant articles. After reading the full text of the 47 articles, 21 were relevant for answering our research question. Most publications had low levels of evidence, 3 or 4 of the Oxford levels of evidence. One article had a level of evidence of 2(b). This article gives an overview of tools and strategies to disseminate recommendations to patients. Key factors of success were a dissemination plan, written at the start of the recommendation development process, involvement of patients in this development process and the use of a combination of traditional and innovative dissemination tools. The lack of strong evidence calls for more research of the effectiveness of different dissemination strategies as well as the barriers for implementing a strategic approach of dissemination. Our findings provide the first systematic overview of tools and strategies to disseminate recommendations to patients and patient organisations. Participation of patients in the whole

  11. Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations.

    Science.gov (United States)

    Woolf, Steven; Schünemann, Holger J; Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul

    2012-07-04

    Clinical practice guidelines are one of the foundations of efforts to improve healthcare. 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 clearinghouses 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 second paper, we discuss issues of identifying and synthesizing evidence: deciding what type of evidence and outcomes to include in guidelines; integrating values into a guideline; incorporating economic considerations; synthesis, grading, and presentation of evidence; and moving from evidence to recommendations.

  12. Climate friendly dietary guidelines

    DEFF Research Database (Denmark)

    Trolle, Ellen; Mogensen, Lisbeth; Thorsen, Anne Vibeke

    2014-01-01

    ) modifying the average diet according to the Danish food based dietary guidelines, 2) and adjusting to ensure an iso-energy content and a nutrient content according to the Nordic Nutrient Recommendations. Afterwards the healthy diet were changed further to reduce CF. CF from the diet was reduced by 4...

  13. Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system.

    Science.gov (United States)

    Kahn, Ben; Freeland, Zachary; Gopal, Purva; Agrawal, Deepak; Mayorga, Christian A; Mithani, Rozina; Skinner, Celette Sugg; Halm, Ethan A; Singal, Amit G

    2015-11-01

    Appropriate surveillance intervals for colorectal cancer (CRC) screening is one of the Centers for Medicare and Medicaid Services 2014 physician quality reporting system measures. Appropriateness of surveillance intervals will continue to be monitored closely, particularly as reimbursements become tied to quality measures. Quantify and identify predictors for guideline-concordant surveillance recommendations after adenoma polypectomy. We conducted a retrospective cohort study of patients who had colonoscopy with polypectomy at a safety-net health system between June 2011 and December 2013. Surveillance recommendations shorter and longer than guideline recommendations were defined as potential overuse and underuse. We used multivariate logistic regression to identify correlates of guideline-concordant surveillance recommendations, overuse, and underuse. Among 1,822 patients with polypectomy, 1,329 had ≥1 adenoma. Surveillance interval recommendations were guideline-concordant in 1,410 (77.4%) patients, potential overuse in 263 (14.4%), potential underuse in 85 (4.7%), and missing in 64 (3.5%) patients. Predictors of guideline-concordant recommendations in multivariate analyses included age >65 years (OR 1.36, 95% CI 1.02-1.80), incomplete resection (OR 3.58, 95% CI 1.41-9.09), and good/excellent prep quality (OR 2.22, 95% CI 1.72-2.86). Underuse recommendations were more likely in patients with ≥3 adenomas; overuse recommendations were more likely in patients with high-grade dysplasia or fair prep quality and less likely in those with piecemeal resection, ≥3 adenomas, age >65, or Hispanic ethnicity. Surveillance recommendations are not concordant with guidelines in one of four cases. Interventions to improve prep quality and guideline concordance of surveillance recommendations can improve cost-effectiveness of CRC screening.

  14. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations.

    Science.gov (United States)

    Thorell, A; MacCormick, A D; Awad, S; Reynolds, N; Roulin, D; Demartines, N; Vignaud, M; Alvarez, A; Singh, P M; Lobo, D N

    2016-09-01

    During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based "enhanced" perioperative protocol. The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.

  15. [Key recommendations of the clinical guidelines of arterial hypertension in primary care].

    Science.gov (United States)

    Valenzuela-Flores, Adriana Abigail; Solórzano-Santos, Fortino; Valenzuela-Flores, Alma Gabriela; Durán-Arenas, Luis G; Ponce de León-Rosales, Samuel; Oropeza-Martínez, M Patricia; Gómez-García, Jesús Alejandro; Moreno-Ruiz, Luis A; Martínez-Vargas, Romel; Hernández-Amezcua, Lucía; Escobar-Rodríguez, David; Martínez-Flores, Enrique; Viniegra-Osorio, Arturo; Oest-Dávila, Cecilio Walterio; Soria-Guerra, Mariana

    2016-01-01

    Hypertension ranks first medical care in first level units. It is estimated that half of the patients with hypertension are uncontrolled. The purpose of this document is to provide recommendations to guide diagnosis and treatment of arterial hypertension in primary care, which have been considered key to the process of care, in order to help health professionals in the clinical decision-making. The guide is integrated with recommendations of international guidelines and evidence of published studies indicated the changes regarding the management and treatment of hypertension, as well as differences between the target populations of the guide. Searching for information it is performed by means of a standardized sequence in PubMed and Cochrane Library Plus, from the questions asked. The key recommendations were chosen by a consensus of a group of professionals and health managers. The key recommendations evidence-based standardized help you make decisions about prevention, diagnosis and treatment in patients with hypertension, and will contribute to reducing cardiovascular risk, promote changes in lifestyle, control the disease and reduce complications.

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

    Directory of Open Access Journals (Sweden)

    Dheeraj Gupta

    2013-01-01

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

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

    Science.gov (United States)

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

    2013-07-01

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

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

    Science.gov (United States)

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

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence. PMID:24049265

  19. A lipidologist perspective of global lipid guidelines and recommendations, part 1: Lipid treatment targets and risk assessment.

    Science.gov (United States)

    Bays, Harold E

    2016-01-01

    Having knowledge of worldwide lipid guidelines and recommendations may provide clinicians a more global perspective on lipid management. This perspective reviews 8 international scientific and/or medical organizations' lipid guidelines, recommendations, and position papers: the National Lipid Association (2014), National Institute for Health and Care Excellence (2014), International Atherosclerosis Society (2013), American College of Cardiology/American Heart Association (2013), Canadian Cardiovascular Society (2013), Japan Atherosclerosis Society (2012), European Society of Cardiology/European Atherosclerosis Society (2012), and Adult Treatment Panel III (2001/2004). Part 1 of this perspective focuses on sentinel components of these lipid guidelines and recommendations as applied to the role of atherogenic lipoprotein cholesterol levels, primary lipid target of therapy, other primary and secondary lipid treatment targets, and assessment of atherosclerotic cardiovascular disease (ASCVD) risk. Part 2 examines goals of lipid-altering therapy to reduce ASCVD events. Both parts 1 and 2 include the author's perspective on sentinel topics. In general, some guidelines and recommendations differ with regard to ASCVD risk assessment and lipid treatment goals. However, lipid guidelines and recommendations have significant concordance regarding the need to reduce atherogenic lipoprotein cholesterol levels, and are in general agreement on the primary lipid treatment targets. Finally, a substantial degree of agreement exists among guidelines and recommendations in their emphasis on the need for aggressive treatment of hypercholesterolemia, for which the predominance of ASCVD outcomes studies suggests statins as the first-line treatment of choice. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  20. Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study.

    Science.gov (United States)

    McCluskey, Annie; Vratsistas-Curto, Angela; Schurr, Karl

    2013-08-19

    Translating evidence into practice is an important final step in the process of evidence-based practice. Medical record audits can be used to examine how well practice compares with published evidence, and identify evidence-practice gaps. After providing audit feedback to professionals, local barriers to practice change can be identified and targetted with focussed behaviour change interventions. This study aimed to identify barriers and enablers to implementing multiple stroke guideline recommendations at one Australian stroke unit. A qualitative methodology was used. A sample of 28 allied health, nursing and medical professionals participated in a group or individual interview. These interviews occurred after staff had received audit feedback and identified areas for practice change. Questions focused on barriers and enablers to implementing guideline recommendations about management of: upper limb sensory impairments, mobility including sitting balance; vision; anxiety and depression; neglect; swallowing; communication; education for stroke survivors and carers; advice about return to work and driving. Qualitative data were analysed for themes using theoretical domains described by Michie and colleagues (2005). Six group and two individual interviews were conducted, involving six disciplines. Barriers were different across disciplines. The six key barriers identified were: (1) Beliefs about capabilities of individual professionals and their discipline, and about patient capabilities (2) Beliefs about the consequences, positive and negative, of implementing the recommendations (3) Memory of, and attention to, best practices (4) Knowledge and skills required to implement best practice; (5) Intention and motivation to implement best practice, and (6) Resources. Some barriers were also enablers to change. For example, occupational therapists required new knowledge and skills (a barrier), to better manage sensation and neglect impairments while physiotherapists

  1. Interests and values in the Recommended Dietary Allowances and nutritional guidelines for Americans.

    Science.gov (United States)

    Kunkel, H O

    1996-09-01

    Evidence is provided showing that interests, values and belief systems have affected the development of Recommended Dietary Allowances (RDAs) and nutrition guidelines for Americans in the past and can be expected to do so in the future. The conflicts of the 1980s relative to the nutritional guidelines for Americans and the RDAs illustrate the tension among values that can parallel a conflict of interests. In the conflicts of the 1980s, we saw an apparent conflict between those policies that attempt to optimize outcomes for a large class of affected parties and those policies that attempt to establish constraints on actions which appear to threaten individual autonomy and freedom of choice. The former approach derives from utilitarian, consequential moral philosophy which evaluates policies by evaluating costs and harms, and weighing them against benefits to all parties. The latter has its strongest advocates in contemporary libertarianism which takes individual freedom to be the bottom line. Ethical vegetarianism, a belief system which would limit RDAs and guidelines to those that can be translated to vegan and other vegetarian diets, has been a more recent entry into the discussions. Such human value issues suggest that a set of RDAs or of nutrition guidelines is analogous to and may be considered to be an ethic. An ethic is a theory reached via the method of reflective equilibrium that is a coherent ordered triple set of beliefs: a set of considered moral judgments, a set of moral principles, and a set of relevant scientific background theories. The reasoning, however, can become circular and unsound when the considered moral judgments, moral principles and relevant background are not independent sources of information. If they are mixed or, for example, an intuition is mistaken for a scientific conclusion, the reasoning can be flawed.

  2. Matrix vaccination guidelines : 2015 ABCD recommendations for indoor/outdoor cats, rescue shelter cats and breeding catteries

    NARCIS (Netherlands)

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

    OVERVIEW: In 2013, the ABCD published 'Matrix vaccination guidelines: ABCD recommendations for indoor/outdoor cats, rescue shelter cats and breeding catteries' in a Special Issue of the Journal of Feline Medicine and Surgery (Volume 15, Issue 7, pages 540-544). The ABCD's vaccination recommendations

  3. Review and evaluation of the methodological quality of the existing guidelines and recommendations for inherited neurometabolic disorders

    DEFF Research Database (Denmark)

    Cassis, Linda; Cortès-Saladelafont, Elisenda; Molero-Luis, Marta

    2015-01-01

    of existing guidelines and recommendations for iNMDs. METHODS: We performed a systematic search on PubMed, the National Guideline Clearinghouse (NGC), the Guidelines International Network (G-I-N), the Scottish Intercollegiate Guideline Network (SIGN) and the National Institute for Health and Care Excellence...... and timely treatments are often pivotal for the favorable course of the disease. Thus, the elaboration of new evidence-based recommendations for iNMD diagnosis and management is increasingly requested by health care professionals and patients, even though the methodological quality of existing guidelines...... is largely unclear. InNerMeD-I-Network is the first European network on iNMDs that was created with the aim of sharing and increasing validated information about diagnosis and management of neurometabolic disorders. One of the goals of the project was to determine the number and the methodological quality...

  4. 2015 Guidelines for Osteoporosis in Saudi Arabia: Recommendations from the Saudi Osteoporosis Society.

    Science.gov (United States)

    Al-Saleh, Yousef; Sulimani, Riad; Sabico, Shaun; Raef, Hussein; Fouda, Mona; Alshahrani, Fahad; Al Shaker, Mohammad; Al Wahabi, Basma; Sadat-Ali, Mir; Al Rayes, Hanan; Al Aidarous, Salwa; Saleh, Siham; Al Ayoubi, Fakhr; Al-Daghri, Nasser M

    2015-01-01

    To provide guidelines for medical professionals in Saudi Arabia regarding osteoporosis. A panel of 14 local experts in osteoporosis assembled to provide consensus based on the strength of evidence and expert opinions on osteoporosis treatment. The Saudi Osteoporosis Society (SOS) formed a panel of experts who performed an extensive published studies search to formulate recommendations regarding prevention, diagnosis, and treatment of osteoporosis in Saudi Arabia. Both local and international published studies were utilized whenever available. Dual x-ray absorptiometry (DXA) scanning is still the golden standard for assessing bone mineral density (BMD). In the absence of local, country-specific fracture risk assessment tool (FRAX), the SOS recommends using the USA (White) version of the FRAX tool. All women above 60 years of age should be evaluated for BMD. This is because the panel recognized that osteoporosis and osteoporotic fractures occur at a younger age in Saudi Arabia. Hormone replacement therapy (HRT) is not recommended for treating postmenopausal women with osteoporosis. BMD evaluation should be performed 1-2 years after initiating intervention, and the assessment of bone turnover biomarkers should be performed whenever available to determine the efficacy of intervention. All Saudi women above the age of 60 years must undergo a BMD assessment using DXA. Therapy decisions should be formulated with the use of the USA (White) version of the FRAX tool.

  5. [Treatment with psychotropic agents in patients with dementia and delirium : Gap between guideline recommendations and treatment practice].

    Science.gov (United States)

    Hewer, Walter; Thomas, Christine

    2017-02-01

    Psychiatric symptoms in dementia and delirium are associated with a substantially reduced quality of life of patients and their families and often challenging for professionals. Pharmacoepidemiological surveys have shown that, in particular, patients living in nursing homes receive prescriptions of psychotropic agents in significant higher frequency than recommended by current guidelines. This article focuses on a critical appraisal of this gap from the point of view of German healthcare services. Narrative review with special reference to the German dementia guideline from 2016 and recently published practice guidelines for delirium in old age in German and English language. The indications for use of psychotropic agents, especially antipsychotics, are defined narrowly in the German dementia guideline. According to this guideline for several psychopathological symptoms evidence based recommendations cannot be given, currently. For delirium several practice guidelines related to different treatment settings have been published recently. Comparable to the German dementia guideline they recommend general medical interventions and nonpharmacological treatment as first line measures and the use of psychotropic agents only under certain conditions. These guidelines differ to some extent regarding the strength of recommendation for psychopharmacological treatment. The guidelines discussed here advocate well-founded a cautious prescription of psychotropic agents in patients with dementia and delirium. This contrasts to everyday practice which is characterized by significantly higher prescription rates. This gap may explained partially by a lack of evidence-based recommendations regarding certain psychopathological symptoms. Most notably, however, epidemiological data disclose an unacceptable rate of hazardous overtreatment with psychotropic agents, especially in long-term care of persons with dementia. In this situation counteractive measures by consequent implementation

  6. Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion.

    Science.gov (United States)

    Heffernan, Kayla Joanne; Chang, Shanton; Maclean, Skye Tamara; Callegari, Emma Teresa; Garland, Suzanne Marie; Reavley, Nicola Jane; Varigos, George Andrew; Wark, John Dennis

    2016-02-09

    The now ubiquitous catchphrase, "There's an app for that," rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of "do no harm." There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). This research has

  7. Medical Physics Practice Guidelines - the AAPM's minimum practice recommendations for medical physicists.

    Science.gov (United States)

    Mills, Michael D; Chan, Maria F; Prisciandaro, Joann I; Shepard, Jeff; Halvorsen, Per H

    2013-11-04

    The AAPM has long advocated a consistent level of medical physics practice, and has published many recommendations and position statements toward that goal, such as Science Council Task Group reports related to calibration and quality assurance, Education Council and Professional Council Task Group reports related to education, training, and peer review, and Board-approved Position Statements related to the Scope of Practice, physicist qualifications, and other aspects of medical physics practice. Despite these concerted and enduring efforts, the profession does not have clear and concise statements of the acceptable practice guidelines for routine clinical medical physics. As accreditation of clinical practices becomes more common, Medical Physics Practice Guidelines (MPPGs) will be crucial to ensuring a consistent benchmark for accreditation programs. To this end, the AAPM has recently endorsed the development of MPPGs, which may be generated in collaboration with other professional societies. The MPPGs are intended to be freely available to the general public. Accrediting organizations, regulatory agencies, and legislators will be encouraged to reference these MPPGs when defining their respective requirements. MPPGs are intended to provide the medical community with a clear description of the minimum level of medical physics support that the AAPM would consider prudent in clinical practice settings. Support includes, but is not limited to, staffing, equipment, machine access, and training. These MPPGs are not designed to replace extensive Task Group reports or review articles, but rather to describe the recommended minimum level of medical physics support for specific clinical services. This article has described the purpose, scope, and process for the development of MPPGs.

  8. Characteristics of Smoothing Filters to Achieve the Guideline Recommended Positron Emission Tomography Image without Harmonization

    Directory of Open Access Journals (Sweden)

    Yuji Tsutsui

    2018-01-01

    Full Text Available Objective(s: The aim of this study is to examine the effect of different smoothing filters on the image quality and SUVmax to achieve the guideline recommended positron emission tomography (PET image without harmonization. Methods: We used a Biograph mCT PET scanner. A National Electrical Manufacturers Association (NEMA the International Electrotechnical Commission (IEC body phantom was filled with 18F solution with a background activity of 2.65 kBq/mL and a sphere-to-background ratio of 4. PET images obtained with the Biograph mCT PET scanner were reconstructed using the ordered subsets-expectation maximization (OSEM algorithm with time-of-flight (TOF models (iteration, 2; subset, 21; smoothing filters including the Gaussian, Butterworth, Hamming, Hann, Parzen, and Shepp-Logan filters with various full width at half maximum (FWHM values (1-15 mm were applied. The image quality was physically assessed according to the percent contrast (QH,10, background variability (N10, standardized uptake value (SUV, and recovery coefficient (RC. The results were compared with the guideline recommended range proposed by the Japanese Society of Nuclear Medicine and the Japanese Society of Nuclear Medicine Technology. The PET digital phantom was developed from the digital reference object (DRO of the NEMA IEC body phantom smoothed using a Gaussian filter with a 10-mm FWHM and defined as the reference image. The difference in the SUV between the PET image and the reference image was evaluated according to the root mean squared error (RMSE. Results: The FWHMs of the Gaussian, Butterworth, Hamming, Hann, Parzen, and Shepp-Logan filters that satisfied the image quality of the FDG-PET/CT standardization guideline criteria were 8-12 mm, 9-11 mm, 9-13 mm, 10-13 mm, 9-11 mm, and 12- 15 mm, respectively. The FWHMs of the Gaussian, Butterworth, Hamming, Hann, Parzen, and Shepp-Logan filters that provided the smallest RMSE between the PET images and the 3D digital phantom

  9. Characteristics of Smoothing Filters to Achieve the Guideline Recommended Positron Emission Tomography Image without Harmonization.

    Science.gov (United States)

    Tsutsui, Yuji; Awamoto, Shinichi; Himuro, Kazuhiko; Umezu, Yoshiyuki; Baba, Shingo; Sasaki, Masayuki

    2018-01-01

    The aim of this study is to examine the effect of different smoothing filters on the image quality and SUV max to achieve the guideline recommended positron emission tomography (PET) image without harmonization. We used a Biograph mCT PET scanner. A National Electrical Manufacturers Association (NEMA) the International Electrotechnical Commission (IEC) body phantom was filled with 18 F solution with a background activity of 2.65 kBq/mL and a sphere-to-background ratio of 4. PET images obtained with the Biograph mCT PET scanner were reconstructed using the ordered subsets-expectation maximization (OSEM) algorithm with time-of-flight (TOF) models (iteration, 2; subset, 21); smoothing filters including the Gaussian, Butterworth, Hamming, Hann, Parzen, and Shepp-Logan filters with various full width at half maximum (FWHM) values (1-15 mm) were applied. The image quality was physically assessed according to the percent contrast (Q H,10 ), background variability (N 10 ), standardized uptake value (SUV), and recovery coefficient (RC). The results were compared with the guideline recommended range proposed by the Japanese Society of Nuclear Medicine and the Japanese Society of Nuclear Medicine Technology. The PET digital phantom was developed from the digital reference object (DRO) of the NEMA IEC body phantom smoothed using a Gaussian filter with a 10-mm FWHM and defined as the reference image. The difference in the SUV between the PET image and the reference image was evaluated according to the root mean squared error (RMSE). The FWHMs of the Gaussian, Butterworth, Hamming, Hann, Parzen, and Shepp-Logan filters that satisfied the image quality of the FDG-PET/CT standardization guideline criteria were 8-12 mm, 9-11 mm, 9-13 mm, 10-13 mm, 9-11 mm, and 12-15 mm, respectively. The FWHMs of the Gaussian, Butterworth, Hamming, Hann, Parzen, and Shepp-Logan filters that provided the smallest RMSE between the PET images and the 3D digital phantom were 7 mm, 8 mm, 8 mm, 8 mm, 7

  10. A statistical method to base nutrient recommendations on meta-analysis of intake and health-related status biomarkers.

    Directory of Open Access Journals (Sweden)

    Hilko van der Voet

    Full Text Available Nutrient recommendations in use today are often derived from relatively old data of few studies with few individuals. However, for many nutrients, including vitamin B-12, extensive data have now become available from both observational studies and randomized controlled trials, addressing the relation between intake and health-related status biomarkers. The purpose of this article is to provide new methodology for dietary planning based on dose-response data and meta-analysis. The methodology builds on existing work, and is consistent with current methodology and measurement error models for dietary assessment. The detailed purposes of this paper are twofold. Firstly, to define a Population Nutrient Level (PNL for dietary planning in groups. Secondly, to show how data from different sources can be combined in an extended meta-analysis of intake-status datasets for estimating PNL as well as other nutrient intake values, such as the Average Nutrient Requirement (ANR and the Individual Nutrient Level (INL. For this, a computational method is presented for comparing a bivariate lognormal distribution to a health criterion value. Procedures to meta-analyse available data in different ways are described. Example calculations on vitamin B-12 requirements were made for four models, assuming different ways of estimating the dose-response relation, and different values of the health criterion. Resulting estimates of ANRs and less so for INLs were found to be sensitive to model assumptions, whereas estimates of PNLs were much less sensitive to these assumptions as they were closer to the average nutrient intake in the available data.

  11. A Statistical Method to Base Nutrient Recommendations on Meta-Analysis of Intake and Health-Related Status Biomarkers

    Science.gov (United States)

    van der Voet, Hilko; de Boer, Waldo J.; Souverein, Olga W.; Doets, Esmée L.; van 't Veer, Pieter

    2014-01-01

    Nutrient recommendations in use today are often derived from relatively old data of few studies with few individuals. However, for many nutrients, including vitamin B-12, extensive data have now become available from both observational studies and randomized controlled trials, addressing the relation between intake and health-related status biomarkers. The purpose of this article is to provide new methodology for dietary planning based on dose-response data and meta-analysis. The methodology builds on existing work, and is consistent with current methodology and measurement error models for dietary assessment. The detailed purposes of this paper are twofold. Firstly, to define a Population Nutrient Level (PNL) for dietary planning in groups. Secondly, to show how data from different sources can be combined in an extended meta-analysis of intake-status datasets for estimating PNL as well as other nutrient intake values, such as the Average Nutrient Requirement (ANR) and the Individual Nutrient Level (INL). For this, a computational method is presented for comparing a bivariate lognormal distribution to a health criterion value. Procedures to meta-analyse available data in different ways are described. Example calculations on vitamin B-12 requirements were made for four models, assuming different ways of estimating the dose-response relation, and different values of the health criterion. Resulting estimates of ANRs and less so for INLs were found to be sensitive to model assumptions, whereas estimates of PNLs were much less sensitive to these assumptions as they were closer to the average nutrient intake in the available data. PMID:24682145

  12. Nutritionally recommended food for semi- to strict vegetarian diets based on large-scale nutrient composition data.

    Science.gov (United States)

    Kim, Seunghyeon; Fenech, Michael F; Kim, Pan-Jun

    2018-03-12

    Diet design for vegetarian health is challenging due to the limited food repertoire of vegetarians. This challenge can be partially overcome by quantitative, data-driven approaches that utilise massive nutritional information collected for many different foods. Based on large-scale data of foods' nutrient compositions, the recent concept of nutritional fitness helps quantify a nutrient balance within each food with regard to satisfying daily nutritional requirements. Nutritional fitness offers prioritisation of recommended foods using the foods' occurrence in nutritionally adequate food combinations. Here, we systematically identify nutritionally recommendable foods for semi- to strict vegetarian diets through the computation of nutritional fitness. Along with commonly recommendable foods across different diets, our analysis reveals favourable foods specific to each diet, such as immature lima beans for a vegan diet as an amino acid and choline source, and mushrooms for ovo-lacto vegetarian and vegan diets as a vitamin D source. Furthermore, we find that selenium and other essential micronutrients can be subject to deficiency in plant-based diets, and suggest nutritionally-desirable dietary patterns. We extend our analysis to two hypothetical scenarios of highly personalised, plant-based methionine-restricted diets. Our nutrient-profiling approach may provide a useful guide for designing different types of personalised vegetarian diets.

  13. Recommendations for international gambling harm-minimisation guidelines: comparison with effective public health policy.

    Science.gov (United States)

    Gainsbury, Sally M; Blankers, Matthijs; Wilkinson, Claire; Schelleman-Offermans, Karen; Cousijn, Janna

    2014-12-01

    Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basing policy on empirical evidence, international conventions exist for policy on alcohol, tobacco, and illegal substances. This paper examines the evidence of best practice policies to provide recommendations for international guidelines for harm-minimisation policy for gambling, including specific consideration of the specific requirements for policies on Internet gambling. Evidence indicates that many of the public health policies implemented for addictive substances can be adapted to address gambling-related harms. Specifically, a minimum legal age of at least 18 for gambling participation, licensing of gambling venues and activities with responsible gambling and consumer protection strategies mandated, and brief interventions should be available for those at-risk for and experiencing gambling-related problems. However, there is mixed evidence on the effectiveness of limits on opening hours and gambling venue density and increased taxation to minimise harms. Given increases in trade globalisation and particularly the global nature of Internet gambling, it is recommended that jurisdictions take actions to harmonise gambling public health policies.

  14. Clinical guidelines from the American Society for Parenteral and Enteral Nutrition: best practice recommendations for patient care.

    Science.gov (United States)

    Malone, Ainsley

    2014-01-01

    The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is an interdisciplinary society whose vision is to ensure that every patient receives safe, efficacious, and high-quality nutrition care. The society has produced clinical guidelines to assist practitioners in enteral and parenteral nutrition decision making. A.S.P.E.N. clinical guideline development has evolved through the years, and recently has incorporated a rigorous and transparent development process using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) process. This article will examine A.S.P.E.N.'s guideline development process, discuss current population- and disease-specific practice guidelines, and highlight recommendations useful for the clinician involved in nutrition therapy decision making.

  15. Navigating barriers: two-year follow up on recommendations to improve the use of maternal health guidelines in Kosovo.

    Science.gov (United States)

    Moore, Julia E; Uka, Sami; Vogel, Joshua P; Timmings, Caitlyn; Rashid, Shusmita; Gülmezoglu, A Metin; Straus, Sharon E

    2016-09-15

    Although there are a growing number of initiatives aimed at supporting guideline implementation in resource-constrained settings, few studies assess progress on achieving next steps and goals after the initial activities are completed and the initial funding period has ended. The aim of the current study was to conduct a qualitative process evaluation of progress, barriers, facilitators, and proposed solutions to operationalize nine recommendations to prepare Kosovo to implement the 2012 World Health Organization (WHO) prevention and treatment of postpartum haemorrhage guideline. In 2012, we co-created nine recommendations designed to support implementing the WHO's guideline on the prevention and treatment of postpartum haemorrhage in Kosovo. The current study uses a realist evaluation approach to assess activities and progress two years after the recommendations were developed. The study involved conducting qualitative focus groups and one-on-one interviews with participants from the first meeting to evaluate the activities and progress on the nine recommendations. Forty-three participants provided insights into the barriers and opportunities experienced to date and proposed future directions. Although progress has been made towards implementation of a number of the recommendations, scaling up has been limited by barriers, such as lack of awareness, limited resources, and evaluation challenges. Participants proposed addressing these barriers by building within- and between-country partnerships to facilitate guideline implementation. In addition, participants reported less progress on implementing recommendations related to broader cultural changes, which indicates a need for specific and actionable recommendations to operationalize implementation efforts. In the two years since the initial meeting, there has been mixed progress on the recommendations. Based on participant feedback, we refined the recommendations so that they can be operationalized by health care

  16. Meta-analysis constrained by data: Recommendations to improve relevance of nutrient management research

    Science.gov (United States)

    Five research teams received funding through the North American 4R Research Fund to conduct meta-analyses of the air and water quality impacts of on-farm 4R nutrient management practices. In compiling or expanding databases for these analyses on environmental and crop production effects, researchers...

  17. Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations.

    Science.gov (United States)

    Fischer, Benedikt; Russell, Cayley; Sabioni, Pamela; van den Brink, Wim; Le Foll, Bernard; Hall, Wayne; Rehm, Jürgen; Room, Robin

    2017-08-01

    Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE

  18. The contribution of school meals to energy and nutrient intake of Swedish children in relation to dietary guidelines

    Directory of Open Access Journals (Sweden)

    Christine Persson Osowski

    2015-10-01

    Full Text Available Background: In Sweden, school meals are served free of charge and Swedish law states that school meals must be nutritious. Nevertheless, data on children's energy and nutrient intake from school meals are scarce. Objective: The aim was to describe the contribution of school meals to Swedish children's nutrient and energy intake during weekdays and compare this to the reference values based on the Nordic Nutrition Recommendations (NNR, which have been adopted as the official Swedish recommendations. Design: A cross-sectional food consumption survey was performed on 1,840 Swedish children attending Grade 2 (mean age 8.6 and Grade 5 (mean age 11.7. The children's nutrient and energy intake was compared to the reference values based on the NNR. Results: The mean intake from school meals of energy, carbohydrates, dietary fiber, polyunsaturated fatty acids (PUFA, and vitamins D and E did not reach the reference values and the intake of saturated fatty acids (SFA and sodium exceeded the reference values in both age groups (significant differences, all p≤0.001. Additionally, the pupils in Grade 5 did not reach the reference values for folate, potassium, calcium, magnesium, iron, selenium, and zinc (significant differences, all p≤0.001. Standardized for energy, dietary fiber, PUFA, and vitamins D and E did not reach the reference values, whereas the reference values for SFA and sodium were exceeded in both age groups (significant differences, all p≤0.001. Conclusions: The study pointed to some central nutrients in need of improvement as regards school meals in Sweden, namely the quality of fat, dietary fiber, sodium, vitamin D, and iron. Some of these results may be attributed to the children not reporting eating the recommended number of calories, the children omitting some components of the meal, or underreporting, as a consequence of which the reference values for several nutrients were not met.

  19. Guidelines for sustainable building design: Recommendations from the Presidio of San Francisco energy efficiency design charrette

    Energy Technology Data Exchange (ETDEWEB)

    Brown, K.; Sartor, D.; Greenberg, S. [and others

    1996-05-01

    In 1994, the Bay Chapter of the Association of Energy Engineers{reg_sign} organized a two-day design charrette for energy-efficient redevelopment of buildings by the National Park Services (NPS) at the Presidio of San Francisco. This event brought together engineers, researchers, architects, government officials, and students in a participatory environment to apply their experience to create guidelines for the sustainable redesign of Presidio buildings. The venue for the charrette was a representative barracks building located at the Main Post of the Presidio. Examination of this building allowed for the development of design recommendations, both for the building and for the remainder of the facilities. The charrette was organized into a committee structure consisting of: steering, measurement and monitoring, modeling, building envelope and historic preservation (architectural), HVAC and controls, lighting, and presentation. Prior to the charrette itself, the modeling and measurement/monitoring committees developed substantial baseline data for the other committees during the charrette. An integrated design approach was initiated through interaction between the committees during the charrette. Later, committee reports were cross-referenced to emphasize whole building design and systems integration.

  20. Assessing the effectiveness of a guideline recommendation for pre-operative radiochemotherapy in rectal cancer

    International Nuclear Information System (INIS)

    Manchon-Walsh, Paula; Borras, Josep Maria; Espinas, Josep Alfons; Aliste, Luisa

    2011-01-01

    Aim: To ascertain the degree of adherence to the guideline recommendation on pre-operative RT/ChT for stage-II and -III patients in Catalonian public hospitals, and its impact on local recurrence among rectal cancer patients. Methods: Data were derived from a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Results: The study covered 1229 patients with TNM stage-II or -III primary rectal cancer. Of these patients, 54.5% underwent pre-operative RT/ChT; 14.9% underwent post-operative RT (± chemotherapy); and 30.6% did not undergo any RT. The crude local recurrence rate at 2 years was 4.1% and the crude distant recurrence rate at 2 years was 6.5%. The results of the univariate analyses showed a local-recurrence hazard ratio of 1.84 for the group of patients that received no RT versus the group that received pre-operative RT/ChT (p < 0.01). Conclusions: This is the first population-based study in Catalonia to support the use of pre-operative RT/ChT in rectal cancer patients because, in line with the results of population-based studies reported from other countries, its application, compared to non-application of RT, was found to lead to a clear reduction in the probability of local recurrence.

  1. Recommendations on vaccination for Asian small animal practitioners: a report of the WSAVA Vaccination Guidelines Group.

    Science.gov (United States)

    Day, M J; Karkare, U; Schultz, R D; Squires, R; Tsujimoto, H

    2015-02-01

    -core vaccines to adult animals, with little understanding that "herd immunity" is more important than frequent revaccination of individual animals within the population. In this paper, the VGG presents the findings of this project and makes key recommendations for the Asian countries. The VGG recommends that (1) Asian veterinary schools review and increase as needed the amount of instruction in small animal vaccinology within their undergraduate curriculum and increase the availability of pertinent postgraduate education for practitioners; (2) national small animal veterinary associations, industry veterinarians and academic experts work together to improve the scientific evidence base concerning small animal infectious diseases and vaccination in their countries; (3) national small animal veterinary associations take leadership in providing advice to practitioners based on improved local knowledge and global vaccination guidelines; (4) licensing authorities use this enhanced evidence base to inform and support the registration of improved vaccine product ranges for use in their countries, ideally with DOI for core vaccines similar or equal to those of equivalent products available in western countries (i.e. 3 or 4 years). The VGG also endorses the efforts made by Asian governments, non-governmental organisations and veterinary practitioners in working towards the goal of global elimination of canine rabies virus infection. In this paper, the VGG offers both a current pragmatic and future aspirational approach to small animal vaccination in Asia. As part of this project, the VGG delivered continuing education to over 800 Asian practitioners at seven events in four countries. Accompanying this document is a list of 80 frequently asked questions (with answers) that arose during these discussions. The VGG believes that this information will be of particular value to Asian veterinarians as they move towards implementing global trends in small companion animal vaccinology. © 2014

  2. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012

    DEFF Research Database (Denmark)

    Claudon, Michel; Dietrich, Christoph F; Choi, Byung Ihn

    2013-01-01

    Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some...

  3. Psychological Interventions in the Rehabilitation of Patients with Chronic Low Back Pain: Evidence and Recommendations from Systematic Reviews and Guidelines

    Science.gov (United States)

    Reese, Christina; Mittag, Oskar

    2013-01-01

    The purpose of the article is to summarize evidence and recommendations for psychological interventions in the rehabilitation of patients with chronic low back pain. We carried out a systematic literature search in several databases and on the websites of professional associations to identify relevant reviews and guidelines. In addition to the…

  4. Evidence-based guidelines for the pharmacological treatment of anxiety disorders : recommendations from the British Association for Psychopharmacology

    NARCIS (Netherlands)

    Baldwin, DS; Anderson, IM; Nutt, DJ; Bandelow, B; Bond, A; Davidson, JRT; den Boer, JA; Fineberg, NA; Knapp, M; Scott, J; Wittchen, HU

    2005-01-01

    These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve

  5. Guideline-recommended use of asthma medication by children is associated with parental information and knowledge : the PIAMA birth cohort

    NARCIS (Netherlands)

    Wijga, Alet H.; Zuidgeest, Mira G. P.; Kerkhof, Marjan; Koppelman, Gerard H.; Smit, Henriette A.; de Jongste, Johan C.

    PurposeWe investigated the use of asthma medication by children and the association of use as recommended by guidelines with modifiable risk factors: parental attitudes, knowledge of asthma medication and information provided by health care providers. MethodsQuestionnaire data were obtained from

  6. Guideline recommendations for long-term treatment of depression with antidepressants in primary care-a critical review

    NARCIS (Netherlands)

    Piek, Ellen; van der Meer, Klaas; Nolen, Willem A.

    Background: Long-term treatment with antidepressants is considered effective in preventing recurrence of major depressive disorder (MDD). It is unclear whether this is true for primary care. Objectives: We investigated whether current guideline recommendations for long-term treatment with

  7. The use of lithium for the treatment of bipolar disorder: Recommendations from clinical practice guidelines.

    Science.gov (United States)

    Malhi, Gin S; Gessler, Danielle; Outhred, Tim

    2017-08-01

    Lithium is an effective mood stabilizer that is used principally for the management of bipolar disorder (BD). Its administration is complex and often requires sophisticated management and assiduous monitoring. When considering the use of lithium therapy for bipolar disorder, clinicians are advised to refer to recommendations outlined in clinical practice guidelines (CPGs); but because of varying emphases placed by different international CPGs, recommendations addressing the practical use of lithium lack consistency. In order to inform clinicians of optimal lithium therapy for bipolar disorder, we compared and synthesized recommendations for the treatment of bipolar disorder made by recognized CPGs internationally. We conducted a search of the literature and extracted guidance across multiple clinical issues, including clinical indications, disorder subtypes, additional uses, special populations, practical aspects, and side effects. Collectively, CPGs consider lithium most robustly as a first-line intervention for maintenance treatment of bipolar disorder and strongly for the treatment of mania, with relatively modest support for the management of acute bipolar depression. Additionally, there is consensus across the CPGs that lithium tangibly reduces the risk of suicide. Generally, CPGs provide guidance on the many facets of initiating and maintaining patients on lithium therapy, but individually the CPGs varied in terms of depth and practical guidance they provide across these areas. However, consensus was established across many key areas of practice such as the ideal lithium plasma concentration for maintenance and monitoring (0.6-0.8mmol/L), along with the need for regular monitoring of renal and endocrine function. However, with more complex aspects (e.g., atypical presentations) and in special populations (e.g., youth; pregnancy and post-partum; older adults), guidance varied considerably and clear consensus recommendations were more difficult to achieve. In

  8. 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.

  9. [Intraosseous infusion in the German Air Rescue Service : Guideline recommendations versus mission reality].

    Science.gov (United States)

    Helm, M; Schlechtriemen, T; Haunstein, B; Gäßler, M; Lampl, L; Braun, J

    2013-12-01

    In emergency medicine intraosseous access (IOA) has been established as an alternative to conventional intravenous access. Originally the use of IOA was strictly limited to children up to 6 years of age and to adults for cardiopulmonary resuscitation. These limitations have been relaxed and the indications for IOA have been expanded. A retrospective nationwide analysis of rescue missions by all helicopter emergency medical services of the German Automobile Club (ADAC) Air Rescue Service as well as the German Air Rescue (DRF) over a 7-year period was carried out. A total of 466,813 patients were treated during the study period and an IOA was established in 1,498 (0.32 %) patients. There was a significant increase in using an IOA from 0.1-0.5 % (p < 0.05) from 2005 to 2011. Furthermore, there was an increase in using an IOA in elderly patients and in patients with lower degrees of severity according to the National Advisory Committee for Aeronautics (NACA) scales (2005-2011): decreased use of IOA in patients up to 6 years of age from 92.4 % to 19.7 % (p < 0.05) and in patients with NACA grades VII/VI from 74.4 % to 46.6 % (p < 0.05) and temporarily limited increase of non-indicated IOA use in patients with NACA grade III between 2008 and 2010. Furthermore, there was an increase in the number of the different drug groups used for intraosseous infusion over the study period. The current guidelines and recommendations for the use of IOA in the prehospital setting are reflected more and more in mission reality for helicopter emergency medical services.

  10. Evidence-based guidelines for treating bipolar disorder: revised third edition Recommendations from the British Association for Psychopharmacology

    Science.gov (United States)

    Goodwin, G.M.; Haddad, P. M.; Ferrier, I.N.; Aronson, J.K.; Barnes, T.R.H.; Cipriani, A.; Coghill, D.R.; Fazel, S.; Geddes, J.R.; Grunze, H.; Holmes, E.A.; Howes, O.; Hudson, S.; Hunt, N.; Jones, I.; Macmillan, I.C.; McAllister-Williams, H.; Miklowitz, D.M.; Morriss, R.; Munafò, M.; Paton, C.; Saharkian, B.J.; Saunders, K.E.A.; Sinclair, J.M.A.; Taylor, D.; Vieta, E.; Young, A.H.

    2016-01-01

    The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines: in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change. PMID:26979387

  11. Record of responses to public comments on proposed general guidelines for recommendation of sites for nuclear waste repositories

    International Nuclear Information System (INIS)

    1983-01-01

    The Nuclear Waste Policy Act of 1982 (Public Law 97-425, referred to in this document as the Act) assigned to the US Department of Energy (DOE) the authority for the disposal of high-level radioactive waste and spent nuclear fuel. Among other provisions, the Act specifies a process and schedule for the siting of two geologic repositories for this purpose. The Act requires that the DOE issue general guidelines for the recommendation of sites for repositories. The guidelines are to be developed in consultation with three Federal agencies (the Council on Environmental Quality, the US Environmental Protection Agency, and the US Geological Survey) and with interested Governors and issued with the concurrence of the US Nuclear Regulatory Commission. To meet this directive, the DOE convened a task force of program experts to develop proposed guidelines, issued the proposed guidelines on February 7, 1983, and invited comments from the specified Federal agencies, interested Governors, and the general public. Public hearings on the proposed guidelines were held in March at the following locations: Chicago, New Orleans, Washington, DC, Salt Lake City, and Seattle. After considering the resulting comments and preparing responses to them, the task force prepared a draft of this comment-response document and a set of alternative guidelines; these documents were issued on May 27, 1983. This document summarizes the record of comments that directly led to the alternative guidelines of May 27, 1983. It contains synopses of comments, presents the responses of the task force to the comments, and briefly describes how the proposed guidelines of February 7, 1983, were revised to produce the alternative guidelines of May 27, 1983. 13 references

  12. Lower-Risk Cannabis Use Guidelines: A Comprehensive Update of Evidence and Recommendations.

    Science.gov (United States)

    Fischer, Benedikt; Russell, Cayley; Sabioni, Pamela; van den Brink, Wim; Le Foll, Bernard; Hall, Wayne; Rehm, Jürgen; Room, Robin

    2017-08-01

    Cannabis use is common in North America, especially among young people, and is associated with a risk of various acute and chronic adverse health outcomes. Cannabis control regimes are evolving, for example toward a national legalization policy in Canada, with the aim to improve public health, and thus require evidence-based interventions. As cannabis-related health outcomes may be influenced by behaviors that are modifiable by the user, evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG)-akin to similar guidelines in other health fields-offer a valuable, targeted prevention tool to improve public health outcomes. To systematically review, update, and quality-grade evidence on behavioral factors determining adverse health outcomes from cannabis that may be modifiable by the user, and translate this evidence into revised LRCUG as a public health intervention tool based on an expert consensus process. We used pertinent medical search terms and structured search strategies, to search MEDLINE, EMBASE, PsycINFO, Cochrane Library databases, and reference lists primarily for systematic reviews and meta-analyses, and additional evidence on modifiable risk factors for adverse health outcomes from cannabis use. We included studies if they focused on potentially modifiable behavior-based factors for risks or harms for health from cannabis use, and excluded studies if cannabis use was assessed for therapeutic purposes. We screened the titles and abstracts of all studies identified by the search strategy and assessed the full texts of all potentially eligible studies for inclusion; 2 of the authors independently extracted the data of all studies included in this review. We created Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-charts for each of the topical searches. Subsequently, we summarized the evidence by behavioral factor topic, quality-graded it by following standard (Grading of Recommendations Assessment, Development, and Evaluation; GRADE

  13. General adherence to guideline recommendations on initial diagnosis of bladder cancer in the United States and influencing factors.

    Science.gov (United States)

    Karl, Alexander; Adejoro, Oluwakayode; Saigal, Christopher; Konety, Badrinath

    2014-08-01

    Because international guidelines recommend best practices regarding staging of incident bladder cancer, we determined the adherence to such recommendations in the United States, performing a large retrospective database analysis. Patients with the diagnosis of urothelial cancer were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1992 and 2007. Staging procedures were identified and analyzed. As reference for published recommendations, we used the American Urological Association (AUA), European Association of Urology (EAU), and National Comprehensive Cancer Network (NCCN) guidelines. Based on these sources, recommended initial staging of bladder cancer was analyzed. Of all 56,130 patients, 6148 (10.9%) had a cytologic examination, 29,677 (52.9%) had a standard urinalysis, 2882 (5.1%) underwent intravenous pyelography (IVP), 6950 (12.4%) underwent retrograde pyelography (RPG), and 8145 (14.5%) had computed tomography/magnetic resonance imaging (CT/MRI). There was a significant trend over the years to a higher use of cytologic analysis, standard urinalysis, and CT/MRI. We observed a significant trend toward a lower rate of IVP and a stable use of RPG. The limitation of our study is that claims data are designed for payment processing, not quality measurement. Despite published recommendations on the initial diagnosis of bladder cancer, our data show that less than half of the included patients received all the elements thought to be required for an initial diagnosis of bladder cancer as recommended by guidelines. Greater adherence to recommendations may ensure optimal treatment strategies. Appropriate treatment is critical to patient outcomes, because evidence-based therapeutic management can be practiced only if an accurate assessment of the disease takes place at the time of initial diagnosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Food and dietary pattern-based recommendations: an emerging approach to clinical practice guidelines for nutrition therapy in diabetes.

    Science.gov (United States)

    Sievenpiper, John L; Dworatzek, Paula D N

    2013-02-01

    Clinical practice guidelines (CPGs) for the nutritional management of diabetes mellitus have evolved considerably over the last 25 years. As major diabetes associations have focussed on the individualization of nutrition therapy, there has been a move toward a broader more flexible macronutrient distribution that emphasizes macronutrient quality over quantity. There is now a call for the integration of food- and dietary pattern-based approaches into diabetes association CPGs. The main argument has been that an approach that focuses on nutrients alone misses important nutrient interactions oversimplifying the complexity of foods and dietary patterns, both of which have been shown to have a stronger influence on disease risk than nutrients alone. Although cancer and heart associations have begun to integrate this approach into their dietary guidelines, diabetes associations have not yet adopted this approach. We provide a rationale for the adoption of this approach for The Canadian Diabetes Association (CDA) 2013 CPGs for nutrition therapy. The systematic review for the development of these guidelines revealed emerging evidence to support the use of vegetarian, Mediterranean, and Dietary Approaches to Stop Hypertension (DASH) dietary patterns as well as specific foods such as dietary pulses and nuts in people with diabetes. Popular and conventional weight loss diets were also found to have similar advantages in people with diabetes, although poor dietary adherence remains an issue with these diets. The CDA 2013 CPGs will support an even greater individualization of nutrition therapy for people with diabetes and appeal to a broader range of practice styles of health professionals. Copyright © 2013 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  15. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults

    Science.gov (United States)

    Molina-Infante, Javier; Arias, Ángel; von Arnim, Ulrike; Bredenoord, Albert J; Bussmann, Christian; Amil Dias, Jorge; Bove, Mogens; González-Cervera, Jesús; Larsson, Helen; Miehlke, Stephan; Papadopoulou, Alexandra; Rodríguez-Sánchez, Joaquín; Ravelli, Alberto; Ronkainen, Jukka; Santander, Cecilio; Schoepfer, Alain M; Storr, Martin A; Terreehorst, Ingrid; Straumann, Alex; Attwood, Stephen E

    2017-01-01

    Introduction Eosinophilic esophagitis (EoE) is one of the most prevalent esophageal diseases and the leading cause of dysphagia and food impaction in children and young adults. This underlines the importance of optimizing diagnosys and treatment of the condition, especially after the increasing amount of knowledge on EoE recently published. Therefore, the UEG, EAACI ESPGHAN, and EUREOS deemed it necessary to update the current guidelines regarding conceptual and epidemiological aspects, diagnosis, and treatment of EoE. Methods General methodology according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted up to August 2015 and periodically updated. The working group consisted of gastroenterologists, allergists, pediatricians, otolaryngologists, pathologists, and epidemiologists. Systematic evidence-based reviews were performed based upon relevant clinical questions with respect to patient-important outcomes. Results The guidelines include updated concept of EoE, evaluated information on disease epidemiology, risk factors, associated conditions, and natural history of EoE in children and adults. Diagnostic conditions and criteria, the yield of diagnostic and disease monitoring procedures, and evidence-based statements and recommendation on the utility of the several treatment options for patients EoE are provided. Recommendations on how to choose and implement treatment and long-term management are provided based on expert opinion and best clinical practice. Conclusion Evidence-based recommendations for EoE diagnosis, treatment modalities, and patients’ follow up are proposed in the guideline. PMID:28507746

  16. Recommendations to the NRC on human engineering guidelines for nuclear power plant maintainability

    Energy Technology Data Exchange (ETDEWEB)

    Badalamente, R.V.; Fecht, B.A.; Blahnik, D.E.; Eklund, J.D.; Hartley, C.S.

    1986-03-01

    This document contains human engineering guidelines which can enhance the maintainability of nuclear power plants. The guidelines have been derived from general human engineering design principles, criteria, and data. The guidelines may be applied to existing plants as well as to plants under construction. They apply to nuclear power plant systems, equipment and facilities, as well as to maintenance tools and equipment. The guidelines are grouped into seven categories: accessibility and workspace, physical environment, loads and forces, maintenance facilities, maintenance tools and equipment, operating equipment design, and information needs. Each chapter of the document details specific maintainability problems encountered at nuclear power plants, the safety impact of these problems, and the specific maintainability design guidelines whose application can serve to avoid these problems in new or existing plants.

  17. Recommendations to the NRC on human engineering guidelines for nuclear power plant maintainability

    International Nuclear Information System (INIS)

    Badalamente, R.V.; Fecht, B.A.; Blahnik, D.E.; Eklund, J.D.; Hartley, C.S.

    1986-03-01

    This document contains human engineering guidelines which can enhance the maintainability of nuclear power plants. The guidelines have been derived from general human engineering design principles, criteria, and data. The guidelines may be applied to existing plants as well as to plants under construction. They apply to nuclear power plant systems, equipment and facilities, as well as to maintenance tools and equipment. The guidelines are grouped into seven categories: accessibility and workspace, physical environment, loads and forces, maintenance facilities, maintenance tools and equipment, operating equipment design, and information needs. Each chapter of the document details specific maintainability problems encountered at nuclear power plants, the safety impact of these problems, and the specific maintainability design guidelines whose application can serve to avoid these problems in new or existing plants

  18. Evidence-based recommendations on care for breast cancer survivors for primary care providers: a review of evidence-based breast cancer guidelines.

    NARCIS (Netherlands)

    Spronk, I.; Korevaar, J.C.; Schellevis, F.G.; Albreht, T.; Burgers, J.S.

    2017-01-01

    Objective: To review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines. Design and setting Guidelines were collected via experts and via literature database, guideline database and cancer agency websites searches. Method: EB

  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

    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......OBJECTIVE: 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...... 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....

  20. Implementing Recommendations From Web Accessibility Guidelines: A Comparative Study of Nondisabled Users and Users With Visual Impairments.

    Science.gov (United States)

    Schmutz, Sven; Sonderegger, Andreas; Sauer, Juergen

    2017-09-01

    The present study examined whether implementing recommendations of Web accessibility guidelines would have different effects on nondisabled users than on users with visual impairments. The predominant approach for making Web sites accessible for users with disabilities is to apply accessibility guidelines. However, it has been hardly examined whether this approach has side effects for nondisabled users. A comparison of the effects on both user groups would contribute to a better understanding of possible advantages and drawbacks of applying accessibility guidelines. Participants from two matched samples, comprising 55 participants with visual impairments and 55 without impairments, took part in a synchronous remote testing of a Web site. Each participant was randomly assigned to one of three Web sites, which differed in the level of accessibility (very low, low, and high) according to recommendations of the well-established Web Content Accessibility Guidelines 2.0 (WCAG 2.0). Performance (i.e., task completion rate and task completion time) and a range of subjective variables (i.e., perceived usability, positive affect, negative affect, perceived aesthetics, perceived workload, and user experience) were measured. Higher conformance to Web accessibility guidelines resulted in increased performance and more positive user ratings (e.g., perceived usability or aesthetics) for both user groups. There was no interaction between user group and accessibility level. Higher conformance to WCAG 2.0 may result in benefits for nondisabled users and users with visual impairments alike. Practitioners may use the present findings as a basis for deciding on whether and how to implement accessibility best.

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

    Science.gov (United States)

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

    2016-04-11

    Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers' leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention's potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers' behaviors or clinical practice at the units. Future interventions directed towards managers should have a

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

    Science.gov (United States)

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

    2016-01-01

    Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future

  3. A Guideline for Parkinson's Disease Nurse Specialists, with Recommendations for Clinical Practice

    NARCIS (Netherlands)

    Lennaerts, Herma; Groot, Marieke; Rood, Berna; Gilissen, Koen; Tulp, Hella; van Wensen, Erik; Munneke, Marten; van Laar, Teus; Bloem, Bastiaan R.

    2017-01-01

    Background: Parkinson's Disease Nurse Specialists (PDNS) play an important role in the care for patients with Parkinson's disease (PD) and their caregivers. Until now, there were no nursing guidelines in PD, and interventions were based solely on daily clinical practice because there is no evidence

  4. Treatment of acute rhinosinusitis: discrepancy between guideline recommendations and clinical practice

    NARCIS (Netherlands)

    Venekamp, R.P.; Rovers, M.M.; Verheij, T.J.; Bonten, M.J.; Sachs, A.P.

    2012-01-01

    Background A revised primary care guideline on acute rhinosinusitis (ARS) has been introduced in the Netherlands in 2005, which advocates a more judicious use of antibiotics. Objective To investigate whether consultation and prescription rates for ARS in adults changed over recent years in order to

  5. A Conceptual Model for Detecting Interactions among Medical Recommendations in Clinical Guidelines

    NARCIS (Netherlands)

    Carretta Zamborlini, Veruska; Da Silveira, Marcos; Pruski, Cedric; Hoekstra, Rinke; ten Teije, Annette; van Harmelen, Frank

    2014-01-01

    Representation of clinical knowledge is still an open research topic. In particular, classical languages designed for representing clinical guidelines, which were meant for producing diagnostic and treatment plans, present limitations such as for re-using, combining, and reasoning over existing

  6. Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recommended statin uses

    Directory of Open Access Journals (Sweden)

    Naveen Garg

    2017-07-01

    Conclusion: FRS-CVD appears to be the most useful for CVD risk assessment in Indians, but the difference may be because FRS-CVD estimates risk for several additional outcomes as compared with other risk scores. For statin eligibility, however, NICE guideline use is the most appropriate.

  7. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use.

    Science.gov (United States)

    Heidari, Shirin; Babor, Thomas F; De Castro, Paola; Tort, Sera; Curno, Mirjam

    2016-01-01

    Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literature search on sex and gender policies in scientific publishing. The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.

  8. [Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use].

    Science.gov (United States)

    Heidari, Shirin; Babor, Thomas F; Castro, Paola De; Tort, Sera; Curno, Mirjam

    2017-01-01

    Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literature search on sex and gender policies in scientific publishing. The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.

  9. Evaluation of venous thromboembolism prophylaxis after the introduction of an institutional guideline: Extent of application and implementation of its recommendations.

    Science.gov (United States)

    Gharaibeh, Lubna; Albsoul-Younes, Abla; Younes, Nidal

    2015-06-01

    Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism. Although much is known about risk factors for VTE, there is failure in administration of appropriate prophylaxis to patients who are at risk for VTE. A paper-based reminder system is considered to be among the most effective methods of improving VTE prophylaxis in hospitalized patients. However, their success relies on choosing an evidence-based institutional guideline and implementation of its recommendations. This study was carried out to detect the extent of application of the institutional guideline (Caprini score risk assessment sheet). The study was carried out in the Jordan University Hospital; 354 patients were enrolled in the study and distributed among the following wards: nonorthopedic surgical (n = 119), medical (n = 220), and surgical orthopedic wards (n = 15). The risk assessment sheet was present in only 47.2% of the patient's' files, and the scores in the files were estimated correctly in only 52.1% of cases. Prophylaxis received by patients matched the recommendation of the Caprini score in 67.1% of the patients. The degree of concordance of the VTE prophylaxis with the Caprini score was 59.9%. This study showed that the institutional guideline was poorly implemented in the hospital. Copyright © 2015 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.

  10. When and for how long should glucocorticoids be used in rheumatoid arthritis? International guidelines and recommendations.

    Science.gov (United States)

    Gaujoux-Viala, Cécile; Gossec, Laure

    2014-05-01

    Glucocorticoids are widely used in rheumatoid arthritis (RA); however, their effectiveness and safety is still a subject of debate. In particular, when to introduce glucocorticoids, but also when and how to taper them, are important questions for clinicians. In this paper, we will discuss the place of glucocorticoids in the European League Against Rheumatism (EULAR) recommendations for the management of RA and review the literature that was the basis for these recommendations. The recommendations cover the introduction of glucocorticoids (and for whom they are recommended), doses and duration of treatment, and tapering strategies. Items still on the research agenda include more data on safety, particularly for long-term use, and small doses of glucocorticoids. © 2014 New York Academy of Sciences.

  11. Analyzing Recommendations Interactions in Clinical Guidelines : Impact of action type hierarchies and causation beliefs

    NARCIS (Netherlands)

    Carretta Zamborlini, Veruska; Da Silveira, Marcos; Pruski, Cedric; ten Teije, Annette; van Harmelen, Frank

    2015-01-01

    Accounting for patients with multiple health conditions is a complex task that requires analysing potential interactions among recommendations meant to address each condition. Although some approaches have been proposed to address this issue, important features still require more investigation, such

  12. Nuclear Waste Policy Act of 1982; proposed general guidelines for recommendation of sites for nuclear waste repositories

    International Nuclear Information System (INIS)

    Anon.

    1983-01-01

    In accordance with the requirements of the Nuclear Waste Policy Act of 1982 (Pub. L. 97-425), hereinafter referred to as the Act, the Department of Energy is proposing general guidelines for the recommendation of sites for repositories for disposal of high-level radioactive waste and spent nuclear fuel in geologic formations. These guidelines are based on the criteria that the Department has used in its National Waste Terminal Storage program, the criteria proposed by the Nuclear Regulatory Commission (NRC), and the environmental standards proposed by the Environmental Protection Agency. These guidelines establish the performance requirements for a geologic repository system, specify how the Department will implement its site-selection program, and define the technical qualifications that candidate sites must meet in the various steps of the site-selection process mandated by the Act. After considering comments from the public; consulting with the Council on Environmental Quality, the Administrator of the Environmental Protection Agency, the Director of the Geological Survey, and interested Governors; and obtaining NRC concurrence, the Department will issue these guidelines in final form as a new Part 960 to Title 10 of the Code of Federal Regulations (10 CFR Part 960)

  13. Current recommendations for the diagnosis and treatment of concussion in sport: a comparison of three new guidelines.

    Science.gov (United States)

    West, Therese A; Marion, Donald W

    2014-01-15

    Currently, there is considerable debate within the sports medicine community about the role of concussion and the risk of chronic neurological sequelae. This concern has led to significant confusion among primary care providers and athletic trainers about how to best identify those athletes at risk and how to treat those with concussion. During the first quarter of 2013, several new or updated clinical practice guidelines and position statements were published on the diagnosis, treatment, and management of mild traumatic brain injury/concussion in sports. Three of these guidelines were produced by the American Medical Society for Sports Medicine, The American Academy of Neurology, and the Zurich Consensus working group. The goal of each group was to clearly define current best practices for the definition, diagnosis, and acute and post-acute management of sports-related concussion, including specific recommendations for return to play. In this article, we compare the recommendations of each of the three groups, and highlight those topics for which there is consensus regarding the definition of concussion, diagnosis, and acute care of athletes suspected of having a concussion, as well as return-to-play recommendations.

  14. Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recommended statin uses.

    Science.gov (United States)

    Garg, Naveen; Muduli, Subrat K; Kapoor, Aditya; Tewari, Satyendra; Kumar, Sudeep; Khanna, Roopali; Goel, Pravin Kumar

    The accuracy of various 10-year cardiovascular disease (CVD) risk calculators in Indians may not be the same as in other populations. Present study was conducted to compare the various calculators for CVD risk assessment and statin eligibility according to different guidelines. Consecutive 1110 patients who presented after their first myocardial infarction were included. Their CVD risk was calculated using Framingham Risk score- Coronary heart disease (FRS-CHD), Framingham Risk Score- Cardiovascular Disease (FRS-CVD), QRISK2, Joint British Society risk calculator 3 (JBS3), American College of Cardiology/American Heart Association (ACC/AHA), atherosclerotic cardiovascular disease (ASCVD) and WHO risk charts, assuming that they had presented one day before cardiac event for risk assessment. Eligibility for statin uses was also looked into using ACC/AHA, NICE and Canadian guidelines. FRS-CVD risk assessment model has performed the best as it could identify the highest number of patients (51.9%) to be at high CVD risk while WHO and ASCVD calculators have performed the worst (only 16.2% and 28.3% patients respectively were stratified into high CVD risk) considering 20% as cut off for high risk definition. QRISK2, JBS3 and FRS-CHD have performed intermediately. Using NICE, ACC/AHA and Canadian guidelines; 76%, 69% and 44.6% patients respectively were found to be eligible for statin use. FRS-CVD appears to be the most useful for CVD risk assessment in Indians, but the difference may be because FRS-CVD estimates risk for several additional outcomes as compared with other risk scores. For statin eligibility, however, NICE guideline use is the most appropriate. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  15. Recommended practices and guidelines for procurement of magnetic-fusion-energy electrical equipment

    International Nuclear Information System (INIS)

    1982-06-01

    The followng three chapters are included: (1) administrative guidelines, (2) technical practices, and (3) check list. The first two chapters contain detailed information which is to be used as a reference by specification writers in preparing specifications. Chapter 3 is intended to provide a uniform specification format for specification writers, and is further intended to satisfy equipment manufactures' complaints that different specification formats are used to describe essentially identical equipment

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

    Directory of Open Access Journals (Sweden)

    Alexander H. G. Paterson

    2013-12-01

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

  17. Recommendations for Guidelines for Environment-Specific Magnetic-Field Measurements, Rapid Program Engineering Project #2

    Energy Technology Data Exchange (ETDEWEB)

    Electric Research and Management, Inc.; IIT Research Institute; Magnetic Measurements; Survey Research Center, University of California; T. Dan Bracken, Inc.

    1997-03-11

    The purpose of this project was to document widely applicable methods for characterizing the magnetic fields in a given environment, recognizing the many sources co-existing within that space. The guidelines are designed to allow the reader to follow an efficient process to (1) plan the goals and requirements of a magnetic-field study, (2) develop a study structure and protocol, and (3) document and carry out the plan. These guidelines take the reader first through the process of developing a basic study strategy, then through planning and performing the data collection. Last, the critical factors of data management, analysis reporting, and quality assurance are discussed. The guidelines are structured to allow the researcher to develop a protocol that responds to specific site and project needs. The Research and Public Information Dissemination Program (RAPID) is based on exposure to magnetic fields and the potential health effects. Therefore, the most important focus for these magnetic-field measurement guidelines is relevance to exposure. The assumed objective of an environment-specific measurement is to characterize the environment (given a set of occupants and magnetic-field sources) so that information about the exposure of the occupants may be inferred. Ideally, the researcher seeks to obtain complete or "perfect" information about these magnetic fields, so that personal exposure might also be modeled perfectly. However, complete data collection is not feasible. In fact, it has been made more difficult as the research field has moved to expand the list of field parameters measured, increasing the cost and complexity of performing a measurement and analyzing the data. The guidelines address this issue by guiding the user to design a measurement protocol that will gather the most exposure-relevant information based on the locations of people in relation to the sources. We suggest that the "microenvironment" become the base unit of area in a study, with

  18. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations.

    Science.gov (United States)

    Gustafsson, U O; Scott, M J; Schwenk, W; Demartines, N; Roulin, D; Francis, N; McNaught, C E; MacFie, J; Liberman, A S; Soop, M; Hill, A; Kennedy, R H; Lobo, D N; Fearon, K; Ljungqvist, O

    2012-12-01

    This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol. Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (quality of evidence and recommendations according to the GRADE system). Based on the evidence available for each item of the multimodal perioperative-care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolism (ESPEN) present a comprehensive evidence-based consensus review of perioperative care for colonic surgery. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  19. Limited percentages of adults in Washington State meet the Dietary Guidelines for Americans recommended intakes of fruits and vegetables.

    Science.gov (United States)

    Ta, Myduc L; VanEenwyk, Juliet; Bensley, Lillian

    2012-05-01

    Nutritious diets that include sufficient intake of fruits and vegetables promote health and reduce risk for chronic diseases. The 2005 Dietary Guidelines for Americans recommend four to 13 servings of fruits and vegetables daily for energy intake levels of 1,000 to 3,200 kcal, including seven to 13 servings for 1,600 to 3,000 kcal/day as recommended for adults aged ≥25 years. The 2006-2007 Washington Adult Health Survey, a cross-sectional study designed to measure risk factors for cardiovascular disease among a representative sample of Washington State residents aged ≥25 years, included a food frequency questionnaire (FFQ). The FFQ included approximately 120 food items and summary questions for fruits and vegetables that were used to compute energy intake and two measures of fruit and vegetable intake. Measure 1 was computed as the sum of intake of individual FFQ fruit and vegetable items; Measure 2 combined the summary questions with selected individual FFQ fruit and vegetable items. Depending on the measure used, approximately 14% to 22% of 519 participants with complete information met the guidelines for fruits, 11% to 15% for vegetables, and 5% to 6% for both fruits and vegetables. Participants aged ≥65 years and women were more likely to meet recommendations, compared with younger participants and men. Despite decades of public health attention, the vast majority of Washington State residents do not consume the recommended amount of fruits or vegetables daily. These findings underscore the need for developing and evaluating new approaches to promote fruit and vegetable consumption. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  20. Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol.

    Science.gov (United States)

    Van Spall, Harriette G C; Shanbhag, Deepti; Gabizon, Itzhak; Ibrahim, Quazi; Graham, Ian D; Harlos, Karen; Haynes, R Brian; Connolly, Stuart J

    2016-03-31

    The uptake of Clinical Practice Guideline (CPG) recommendations that improve outcomes in heart failure (HF) remains suboptimal. We will conduct a systematic review to identify implementation strategies that improve physician adherence to class I recommendations, those with clear evidence that benefits outweigh the risks. We will use American, Canadian and European HF guidelines as our reference. We will conduct a literature search in the databases of MEDLINE, EMBASE, HEALTHSTAR, CINAHL, Cochrane Library, Campbell Collaboration, Joanna Briggs Institute Evidence Based Practice, Centre for Reviews and Dissemination and Evidence Based Practice Centres. We will include prospective studies evaluating implementation interventions aimed at improving uptake of class I CPG recommendations in HF. We will extract data in duplicate. We will classify interventions according to their level of application (ie, provider, organisation, systems level) and common underlying characteristics (eg, education, decision-support, financial incentives) using the Cochrane Effective Practice and Organisation of Care Taxonomy. We will assess the impact of the intervention on adherence to the CPGs. Outcomes will include proportion of eligible patients who were: prescribed a CPG-recommended pharmacological treatment; referred for device consideration; provided self-care education at discharge; and provided left ventricular function assessment. We will include clinical outcomes such as hospitalisations, readmissions and mortality, if data is available. We will identify the common elements of successful and failing interventions, and examine the context in which they were applied, using the Process Redesign contextual framework. We will synthesise the results narratively and, if appropriate, will pool results for meta-analysis. In this review, we will assess the impact of implementation strategies and contextual factors on physician adherence to HF CPGs. We will explore why some interventions may

  1. Orbital sarcomas in retinoblastoma patients: recommendations for screening and treatment guidelines.

    Science.gov (United States)

    Baker, Meredith S; McConnell, Lindsay K; Kleinberg, Teri T; Shriver, Erin M; Bilyk, Jurij R; Allen, Richard C

    2016-09-01

    Retinoblastoma is the most common primary ocular malignancy in children. Although currently retinoblastoma has an excellent survival rate in developed countries, hereditary retinoblastoma survivors as well as those with a history of radiation therapy as children are at an increased risk for second primary tumors (SPTs), and specifically, for orbital sarcomas. Despite the known increased risk for SPTs in retinoblastoma survivors and the associated morbidity and mortality, no screening or treatment guidelines exist. Understanding of retinoblastoma tumorigenesis and genomic expression has expanded significantly, and treatment has evolved with a shift away from radiotherapy. Until the last two decades, however, radiation was the therapy of choice for patients with bilateral disease. Because both hereditary retinoblastoma and radiation are independent risk factors for the development of SPTs such as sarcomas and these SPTs are often fatal, appropriate surveillance for retinoblastoma survivors is crucial. As a result of the excellent survival rates for retinoblastoma patients, it is important to: recognize the risk of sarcoma, particularly in patients with hereditary retinoblastoma and/or prior radiation therapy; establish a screening protocol, such as the one proposed, to maximize early detection; and discuss and develop treatment guidelines for high-risk patients. Future directions of research for these patients will involve the development of molecularly targeted agents and the use of proton radiotherapy.

  2. The CIPM list of recommended frequency standard values: guidelines and procedures

    Science.gov (United States)

    Riehle, Fritz; Gill, Patrick; Arias, Felicitas; Robertsson, Lennart

    2018-04-01

    A list of standard reference frequency values (LoF) of quantum transitions from the microwave to the optical regime has been recommended by the International Committee for Weights and Measures (Comité international des poids et mesures, CIPM) for use in basic research, technology, and for the metrology of time, frequency and length. The CIPM LoF contains entries that are recommended as secondary representations of the second in the International System of Units, and entries that can be used to serve as realizations of the definition of the metre. The historical perspective that led to the CIPM LoF is outlined. Procedures have been developed for updating existing, and validating new, entries into the CIPM LoF. The CIPM LoF might serve as an entry for a future redefinition of the second by an optical transition.

  3. European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice

    DEFF Research Database (Denmark)

    Johansen, Jeanne D; Aalto-Korte, Kristiina; Agner, Tove

    2015-01-01

    and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special...... considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made...

  4. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations.

    Science.gov (United States)

    Melloul, Emmanuel; Hübner, Martin; Scott, Michael; Snowden, Chris; Prentis, James; Dejong, Cornelis H C; Garden, O James; Farges, Olivier; Kokudo, Norihiro; Vauthey, Jean-Nicolas; Clavien, Pierre-Alain; Demartines, Nicolas

    2016-10-01

    Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations. A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia. The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.

  5. Effectively working with challenging clients who receive hunger service assistance: Case examples and eight recommended guidelines

    Directory of Open Access Journals (Sweden)

    Sharon E. Moore

    2006-12-01

    Full Text Available Those who provide services for people who experience food insecurity come into contact with people who do not always present themselves courteously and favorably. Using case examples from the food bank industry, the authors of this paper will: (1 discuss why people sometimes behave discourteously when seeking assistance from human services professionals; (2 give case examples of how social workers could properly respond to these situations and, (3 give recommendations for effectively working with this client population.

  6. Clinical practice guidelines: 2004 standards, options and recommendations for the management of patient with adenocarcinoma of the stomach - radiotherapy

    International Nuclear Information System (INIS)

    Ychou, M.; Duffour, J.; Lemanski, C.; Masson, B.; Gory-Delabaere, G.; Bosquet, L.; Blanc, P.; Giovannini, M.; Monge, G.; Guillemin, F.; Marchal, F.; Conroy, T.; Merrouche, Y.; Adenis, A.; Bosset, J.F.; Bouche, O.; Pezet, D.; Triboulet, J.P.

    2004-01-01

    Context. - The 'Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French regional cancer centers, and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. Objectives. - To elaborate clinical practice guidelines for patients with stomach adenocarcinoma. These recommendations cover the diagnosis, treatment and follow-up of these tumors. Methods. - The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. The Standards, Options and Recommendations are thus based on the best available evidence and expert agreement. Results. - Adjuvant radiation therapy alone is not a standard treatment for patients with stomach adenocarcinoma. Adjuvant concomitant chemoradiotherapy is not a standard treatment for patients with stage II or III stomach adenocarcinoma R0, with D1 or D2 lymphadenectomy who have undergone surgery. Following surgical resection, adjuvant concomitant chemoradiotherapy should be proposed to patients without de-nutrition with a lymphadenectomy < D1 (fewer than 15 lymph nodes examined) and those with T3 and/or N+ tumours following the protocol used in the MacDonald trials (SWOG-9008) (Level of evidence B1). Adjuvant concomitant chemoradiotherapy can be administered to patients without de-nutrition with D1 or D2 lymphadenectomy and with involvement of regional lymph nodes (N2 or N3). (authors)

  7. The state of school-based bilingual assessment: actual practice versus recommended guidelines.

    Science.gov (United States)

    Caesar, Lena G; Kohler, Paula D

    2007-07-01

    This study was designed to investigate the frequency with which school-based speech-language pathologists (SLPs) used recommended practices when assessing the language skills of bilingual students. The study also investigated the frequency with which SLPs used formal, standardized tests versus informal, alternative procedures with this population. A total of 596 surveys were mailed out to school-based SLPs in the state of Michigan who were members of the Michigan Speech, Language, and Hearing Association (MSHA) during the 2003-2004 academic year. Of the 409 usable surveys that were returned, 130 respondents indicated being involved in assessing bilingual children and comprised the sample used in this study. Results indicated that SLPs used formal, standardized English tests more frequently than informal assessment procedures when assessing bilingual students. Further in-depth analyses of SLPs' responses indicated that neither factors related to their years of experience or factors related to their academic preparation were significantly related to their use of recommended assessment practices. However, significant differences in use were noted based on respondents' employment settings. This study underscores the need for academic training programs and professional organizations to intentionally disseminate information regarding the expediency of alternative testing procedures. Implications for the adequate nonbiased assessment of bilingual children are discussed.

  8. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease.

    Science.gov (United States)

    Cameron, Daniel J; Johnson, Lorraine B; Maloney, Elizabeth L

    2014-09-01

    Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.

  9. A recommended guideline for the development of mHealth Apps.

    Science.gov (United States)

    Chatzipavlou, Ioannis A; Christoforidou, Sofia A; Vlachopoulou, Maro

    2016-01-01

    Mobile Health or mHealth applications cope with medical or health issues supported by smartphones. Being a part of great importance in healthcare, mHealth apps are able to improve both the quality of medical services and the safety of the patients. It is regarded to be a new field with great prospect that attracts the interest of the stakeholders and the developers, above all. Of all the entities involved, developers have to face many challenges classified in four pillars: the regulation framework, the market, the technical issues and society. This paper aims to describe the role of the developers in the mHealth apps' market, the barriers they deal with and also, the impact of their work in the mobile healthcare domain. In our viewpoint, we propose a guideline with all of the developers' requirements for the buildup of mHealth apps. The methodology followed includes a Boolean search strategy used in academic libraries (PubMed, IEEE Xplore, JMIR, The Cochrane Library) and search engines additionally (Google and Google Scholar), aiming to identify the developers' perspective. Our research from October until December of 2014 led us to academic papers referring to the various demands that developers have to confront. The major outcome of our research is the general acknowledgement of the dominant role that developers own in the mHealth apps' process. Mobile technology allies multiple groups such as users, patients, providers of medical services, software developers, governments and even, non-governmental organizations. In particular, the developers' perspective involves the legal boundaries, the side of the market, the technological requirements (programming, devices, designing) and the moral aspects, as well. Developers should define the purposes of their apps-either diagnostic or therapeutic-and gain the confidence of the users in order to dominate the market, yet comply with the regulations.

  10. Summary and recommendations from the Australasian guidelines for the management of pancreatic exocrine insufficiency.

    Science.gov (United States)

    Smith, Ross C; Smith, Sarah F; Wilson, Jeremy; Pearce, Callum; Wray, Nick; Vo, Ruth; Chen, John; Ooi, Chee Y; Oliver, Mark; Katz, Tamarah; Turner, Richard; Nikfarjam, Mehrdad; Rayner, Christopher; Horowitz, Michael; Holtmann, Gerald; Talley, Nick; Windsor, John; Pirola, Ron; Neale, Rachel

    2016-01-01

    Because of increasing awareness of variations in the use of pancreatic exocrine replacement therapy, the Australasian Pancreatic Club decided it was timely to re-review the literature and create new Australasian guidelines for the management of pancreatic exocrine insufficiency (PEI). A working party of expert clinicians was convened and initially determined that by dividing the types of presentation into three categories for the likelihood of PEI (definite, possible and unlikely) they were able to consider the difficulties of diagnosing PEI and relate these to the value of treatment for each diagnostic category. Recent studies confirm that patients with chronic pancreatitis receive similar benefit from pancreatic exocrine replacement therapy (PERT) to that established in children with cystic fibrosis. Severe acute pancreatitis is frequently followed by PEI and PERT should be considered for these patients because of their nutritional requirements. Evidence is also becoming stronger for the benefits of PERT in patients with unresectable pancreatic cancer. However there is as yet no clear guide to help identify those patients in the 'unlikely' PEI group who would benefit from PERT. For example, patients with coeliac disease, diabetes mellitus, irritable bowel syndrome and weight loss in the elderly may occasionally be given a trial of PERT, but determining its effectiveness will be difficult. The starting dose of PERT should be from 25,000-40,000 IU lipase taken with food. This may need to be titrated up and there may be a need for proton pump inhibitors in some patients to improve efficacy. Copyright © 2016 IAP and EPC. Published by Elsevier India Pvt Ltd. All rights reserved.

  11. Education for radiological protection in radiotherapy ESTRO recommendations for EU Euratom guidelines

    International Nuclear Information System (INIS)

    McKenzie, A.; Barrett, A.

    2001-01-01

    The practice of radiation oncology (radiotherapy) encompasses the clinical care of patients as well as the technical aspects of radiotherapy. Benefits to patients accruing from radiotherapy depend upon the accurate delivery of high doses to the tumour with doses to normal tissues being kept to a minimum. In addition to these patient-centred aspects of radiation protection in radiotherapy, appropriate measures must also be taken to reduce the amount of radiation to staff and the general public to as low a level as is reasonably achievable. In order to achieve these aims, a broad basic training is required in all of the disciplines involved in the delivery of ionising radiation. ESTRO has recommendations for core curricula for the disciplines involved, but this annex lists the elements from these curricula which relate specifically to radiation protection. It is important to reiterate that the extent of training required will depend upon the existing levels of knowledge and training of different groups of professionals in physics, radiobiology etc., and this may vary from state to state specific training objectives for radiation protection in radiotherapy will cover the following subjects: Radiotherapy equipment, safety and accuracy, dosimetric and geometric quantities for accuracy in radiotherapy, radiobiology and radiation risks, radiation treatment planning for optimising delivery of radiation dose, optimal and safe use of radionuclides in radiotherapy, radiation hazards in radiotherapy facilities. (author)

  12. Investigation of metal toxicity to tropical biota. Recommendations for revision of Australian water quality guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Marchich, S. [Australian Nuclear Science and Technology Organisation (ANSTO), Lucas Heights, NSW (Australia). Environment Div.; Camilleri, C. [Environmental Research Inst of the Supervising Scientist, Jabiru, NT (Australia)

    1997-12-31

    The specific objectives of this study were to: review available data on the toxicity of metals to aquatic biota in tropical Australia; identify metals considered to be priority toxicants to aquatic biota in tropical Australia; and employ previously developed toxicity testing protocols for two tropical freshwater species to obtain preliminary toxicity data for two priority metals. From the literature review, it was concluded that insufficient metal toxicity data exist for Australian tropical species. Data were absent for a range of metals (eg Ag, As, Al, Cr, Hg, Ni, Sb and Se) listed in the current Australian water quality guidelines. Aluminium, Cd, Co, Cu, Ni, Mn, Pb, U, V and Zn were identified as priority metals of potential ecotoxicological concern in aquatic ecosystems of tropical Australia, largely as a consequence of mining activities, but also from urban impacts. Instead of testing the toxicity of the priority metals for which data do not currently exist (ie Al, Co, Ni and V), it was deemed more important to conduct further experimental work on Cu and U, in the context of elucidating the relatively high variability in the toxic response of these two metals. As a result, Cu and U were selected and toxicity tests conducted using two tropical freshwater species (green hydra (Hydra viridissima) and gudgeon fish (Mogurnda mogurnda)) from the Australian wet/dry tropics using test protocols designed to maximise the greatest sensitivity of metal response in the shortest period of time. Hydra viridissima was about eight times more sensitive to Cu than U, whereas M. mogurnda was about twenty times more sensitive. Once differences between the sublethal and lethal endpoints of the two organisms were corrected by statistical extrapolation, H. viridissima was approximately seven times more sensitive than M. mogurnda to U, but only about three times more sensitive to Cu. Both species were more sensitive to Cu than U. These results are generally consistent with those from

  13. Investigation of metal toxicity to tropical biota. Recommendations for revision of Australian water quality guidelines

    International Nuclear Information System (INIS)

    Marchich, S.

    1997-01-01

    The specific objectives of this study were to: review available data on the toxicity of metals to aquatic biota in tropical Australia; identify metals considered to be priority toxicants to aquatic biota in tropical Australia; and employ previously developed toxicity testing protocols for two tropical freshwater species to obtain preliminary toxicity data for two priority metals. From the literature review, it was concluded that insufficient metal toxicity data exist for Australian tropical species. Data were absent for a range of metals (eg Ag, As, Al, Cr, Hg, Ni, Sb and Se) listed in the current Australian water quality guidelines. Aluminium, Cd, Co, Cu, Ni, Mn, Pb, U, V and Zn were identified as priority metals of potential ecotoxicological concern in aquatic ecosystems of tropical Australia, largely as a consequence of mining activities, but also from urban impacts. Instead of testing the toxicity of the priority metals for which data do not currently exist (ie Al, Co, Ni and V), it was deemed more important to conduct further experimental work on Cu and U, in the context of elucidating the relatively high variability in the toxic response of these two metals. As a result, Cu and U were selected and toxicity tests conducted using two tropical freshwater species (green hydra (Hydra viridissima) and gudgeon fish (Mogurnda mogurnda)) from the Australian wet/dry tropics using test protocols designed to maximise the greatest sensitivity of metal response in the shortest period of time. Hydra viridissima was about eight times more sensitive to Cu than U, whereas M. mogurnda was about twenty times more sensitive. Once differences between the sublethal and lethal endpoints of the two organisms were corrected by statistical extrapolation, H. viridissima was approximately seven times more sensitive than M. mogurnda to U, but only about three times more sensitive to Cu. Both species were more sensitive to Cu than U. These results are generally consistent with those from

  14. Barriers to implementing the "2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis" in primary healthcare practice.

    Science.gov (United States)

    Loyola-Sanchez, Adalberto; Richardson, Julie; Pelaez-Ballestas, Ingris; Sánchez, José Guadalupe; González, Martha Alicia; Sánchez-Cruz, Juan; Jiménez-Baez, María Valeria; Nolasco-Alonso, Nancy; Alvarado, Idolina; Rodríguez-Amado, Jacqueline; Alvarez-Nemegyei, José; Wilson, Mike G

    2014-01-01

    To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  15. Recommendations and Strategies for the Establishment of a Guideline for Monument Documentation Harmonized with the Existing European Standards and Codes

    Directory of Open Access Journals (Sweden)

    Anastasia Kioussi

    2011-12-01

    Full Text Available Information on current state of immovable cultural heritage is important for specifying measures necessary to preserve the heritage in an appropriate condition and ensure that the maintenance required to keep it at this level is well defined. In this framework, EU-CHIC project aims to set-up a system introducing a concept of the “Cultural Heritage Identity Card”, which will develop into a systematic collection and storage of data on immovable heritage objects across European and neighboring countries. This work supports sustainable maintenance, preservation and revitalization of historic sites and monuments. This is achieved through the development of a guideline for the assessment of efficient documentation systems that identify the parameters needed for the characterisation of the preservation state of a monument and its possible alterations during its entire lifetime. In order to develop and test the recommendations for efficient compilation of the data pertinent to each monument under observation, the development of criteria, indicators and protocols as part of a common methodology that encourages the exchange of document between European countries is initiated. The criteria encompass all potential factors affecting the building structure, the non-structural elements, the architectural value and any other aspects ranging from the functionality of the monument/building, to its historic value. This has been achieved through an integrated survey of existing documentation protocols in the field of cultural heritage protection, and through implementation of recommendations about criteria for harmonizing these protocols, both which provide a new documentation methodology. This new methodology is an upgrade of current documentation methodologies, and responds to criteria and indicators for risk assessment and the technology state of diagnostics and data management. A guideline will provide the essential document for further development of

  16. Height growth in children with asthma treated with guideline-recommended dosages of fluticasone and electronically assessed adherence.

    Science.gov (United States)

    Wardenier, Nele R A; Klok, Ted; de Groot, Eric P; Brand, Paul L P

    2016-07-01

    Inhaled corticosteroids (ICS) reduce growth during the first year of treatment, but this growth suppressing effect does not continue during further treatment. Decreasing adherence may play a role in explaining this. The aim of this study was to examine the relationship between cumulative real exposure (with objectively assessed adherence) to ICS and height growth in children with asthma. We investigated 99 prepubertal children with asthma, 2-13 years of age, who had been using ICS in guideline-recommended dosages for ≥3 months, and continued to do so during 1-year follow-up. ICS adherence was assessed by electronic monitoring devices, allowing calculation of true cumulative exposure to ICS. We analysed the relationship between cumulative ICS dose and height growth velocity (assessed as change in height SD score) over 1 year. Median (IQR) adherence over 1 year was 84 (68-92) %. Mean cumulative fluticasone dose was 64.6 (SD, 27.8) mg, reflecting a daily dose of 167 (SD, 7) µg. The negative correlation between cumulative ICS dose and height growth velocity (r=-0.266; p=0.008) became non-significant after adjustment for age and sex in a multiple regression model (adjusted r=-0.188; p=0.066). One year of ICS treatment in guideline-recommended dosages with high adherence did not result in significant or relevant growth suppression. Unaffected growth can be maintained for at least 1 year in children with asthma during ICS treatment with high adherence. 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/

  17. Empiric guideline-recommended weight-based vancomycin dosing and mortality in methicillin-resistant Staphylococcus aureus bacteremia: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Hall Ronald G

    2012-04-01

    Full Text Available Abstract Background No studies have evaluated the effect of guideline-recommended weight-based dosing on in-hospital mortality of patients with methicillin-resistant Staphylococcus aureus bacteremia. Methods This was a multicenter, retrospective, cohort study of patients with methicillin-resistant Staphylococcus aureus bacteremia receiving at least 48 hours of empiric vancomycin therapy between 01/07/2002 and 30/06/2008. We compared in-hospital mortality for patients treated empirically with weight-based, guideline-recommended vancomycin doses (at least 15 mg/kg/dose to those treated with less than 15 mg/kg/dose. We used a general linear mixed multivariable model analysis with variables identified a priori through a conceptual framework based on the literature. Results A total of 337 patients who were admitted to the three hospitals were included in the cohort. One-third of patients received vancomycin empirically at the guideline-recommended dose. Guideline-recommended dosing was not associated with in-hospital mortality in the univariable (16% vs. 13%, OR 1.26 [95%CI 0.67-2.39] or multivariable (OR 0.71, 95%CI 0.33-1.55 analysis. Independent predictors of in-hospital mortality were ICU admission, Pitt bacteremia score of 4 or greater, age 53 years or greater, and nephrotoxicity. Conclusions Empiric use of weight-based, guideline-recommended empiric vancomycin dosing was not associated with reduced mortality in this multicenter study.

  18. [Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation].

    Science.gov (United States)

    Hernández-Bou, S; Álvarez Álvarez, C; Campo Fernández, M N; García Herrero, M A; Gené Giralt, A; Giménez Pérez, M; Piñeiro Pérez, R; Gómez Cortés, B; Velasco, R; Menasalvas Ruiz, A I; García García, J J; Rodrigo Gonzalo de Liria, C

    2016-05-01

    Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  19. National Guidelines for Colorectal Cancer Screening in Saudi Arabia with strength of recommendations and quality of evidence.

    Science.gov (United States)

    Alsanea, Nasser; Almadi, Majid A; Abduljabbar, Alaa S; Alhomoud, Samar; Alshaban, Taghreed A; Alsuhaibani, Abdullah; Alzahrani, Ahmad; Batwa, Faisal; Hassan, Abdul-Hameed; Hibbert, Denise; Nooh, Randa; Alothman, Mohammed; Rochwerg, Bram; Alhazzani, Waleed; Morgan, Rebecca L

    2015-01-01

    Colorectal cancer is the most common cancer among Saudi men and the third commonest among Saudi women. Given the predominance of colorectal cancer compared with other cancers in Saudi Arabia, context-specific guidelines are needed for screening. Experts from the Saudi Society of Colon and Rectal Surgery, Saudi Gastroenterology Association, Saudi Oncology Society, Saudi Chapter of Enterostomal Therapy, Family Medicine and Department of Public Health at the Saudi Arabian Ministry of Health and a patient advocate was assembled by the Saudi Centre for Evidence-Based Healthcare, a subsidiary of the Saudi Arabian Ministry of Health. The panel collaborated with a methodological team from McMaster University, Canada to develop national guidelines for colorectal cancer screening. After identifying key questions, the panel conducted a systematic review of all reports on the utility of screening, the cost of screening for colorectal cancer in Saudi Arabia and on the values and preferences of Saudi patients. Meta- analyses, when appropriate, were performed to generate pooled estimates of effect. Using the GRADE approach, the panel used the evidence-to-decision (EtD) framework to assess all domains important in determining the strength and direction of the recommendations (benefits and harms, values and preferences, resource implications, equity, acceptability, and feasibility). Judgments related to the EtD domains were resolved through consensus or voting, if consensus was not reached. The final recommendations were developed during a two-day meeting held in Riyadh, Saudi Arabia in March 2015. Conflicts of interests among the panel members were handled according to the World Health Organization rules. There is lack of national data on the incidence of adenomatous polyps or the age groups in which the incidence surges. There were no national clinical trials assessing the effectiveness of the different modalities of screening for colorectal cancer and their impact on mortality

  20. People who perceive themselves as active cannot identify the intensity recommended by the international physical activity guidelines

    Directory of Open Access Journals (Sweden)

    Prokop NW

    2014-10-01

    Full Text Available Neal W Prokop,1 Travis JR Hrubeniuk,1 Martin Sénéchal,2,3 Danielle R Bouchard1,4 1Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada; 2Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada; 3Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; 4Health, Leisure, and Human Performance Research Institute, Winnipeg, Manitoba, Canada Background: Many national and international organizations recommend that adults achieve at least 150 minutes of aerobic physical activity (PA weekly, at a minimum moderate intensity to optimize health benefits. It is unknown if people who consider themselves as active have the ability to identify what is considered moderate intensity. Methods: Fifty-one participants who reported achieving a minimum 150 minutes per week at a minimum of moderate intensity PA were recruited through a local fitness facility. All participants underwent a single assessment involving questionnaires, clinical measures, and a treadmill test to measure the ability to perceive moderate intensity. Following the visit, participants' PA level was evaluated by heart rate monitor, while exercising, for 7 consecutive days. Results: Eighty percent of participants overestimated moderate intensity on the treadmill test; they were at vigorous intensity compared to what is considered moderate. Only 11.8% of participants accurately identified moderate intensity; all of them were women (P=0.03, had a high level of education (P=0.04, and knew that moderate intensity was the minimum intensity recommended by health organizations (P<0.01. Only 69.2% of participants reached the aerobic component of the International Physical Activity Guidelines with no significant advantage for those correctly identifying moderate intensity. Conclusion: Most people who perceive themselves as active are exercising at vigorous intensity while believing they are

  1. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence.

    Science.gov (United States)

    Zhang, W; Moskowitz, R W; Nuki, G; Abramson, S; Altman, R D; Arden, N; Bierma-Zeinstra, S; Brandt, K D; Croft, P; Doherty, M; Dougados, M; Hochberg, M; Hunter, D J; Kwoh, K; Lohmander, L S; Tugwell, P

    2007-09-01

    As a prelude to developing updated, evidence-based, international consensus recommendations for the management of hip and knee osteoarthritis (OA), the Osteoarthritis Research Society International (OARSI) Treatment Guidelines Committee undertook a critical appraisal of published guidelines and a systematic review (SR) of more recent evidence for relevant therapies. Sixteen experts from four medical disciplines (primary care two, rheumatology 11, orthopaedics one and evidence-based medicine two), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. Three additional experts were invited to take part in the critical appraisal of existing guidelines in languages other than English. MEDLINE, EMBASE, Science Citation Index, CINAHL, AMED, Cochrane Library, seven Guidelines Websites and Google were searched systematically to identify guidelines for the management of hip and/or knee OA. Guidelines which met the inclusion/exclusion criteria were assigned to four groups of four appraisers. The quality of the guidelines was assessed using the AGREE (Appraisal of Guidelines for Research and Evaluation) instrument and standardised percent scores (0-100%) for scope, stakeholder involvement, rigour, clarity, applicability and editorial independence, as well as overall quality, were calculated. Treatment modalities addressed and recommended by the guidelines were summarised. Agreement (%) was estimated and the best level of evidence to support each recommendation was extracted. Evidence for each treatment modality was updated from the date of the last SR in January 2002 to January 2006. The quality of evidence was evaluated using the Oxman and Guyatt, and Jadad scales for SRs and randomised controlled trials (RCTs), respectively. Where possible, effect size (ES), number needed to treat, relative risk (RR) or odds ratio and cost per quality-adjusted life year gained (QALY) were estimated. Twenty-three of 1462

  2. Using data mining techniques to explore physicians' therapeutic decisions when clinical guidelines do not provide recommendations: methods and example for type 2 diabetes.

    Science.gov (United States)

    Toussi, Massoud; Lamy, Jean-Baptiste; Le Toumelin, Philippe; Venot, Alain

    2009-06-10

    Clinical guidelines carry medical evidence to the point of practice. As evidence is not always available, many guidelines do not provide recommendations for all clinical situations encountered in practice. We propose an approach for identifying knowledge gaps in guidelines and for exploring physicians' therapeutic decisions with data mining techniques to fill these knowledge gaps. We demonstrate our method by an example in the domain of type 2 diabetes. We analyzed the French national guidelines for the management of type 2 diabetes to identify clinical conditions that are not covered or those for which the guidelines do not provide recommendations. We extracted patient records corresponding to each clinical condition from a database of type 2 diabetic patients treated at Avicenne University Hospital of Bobigny, France. We explored physicians' prescriptions for each of these profiles using C5.0 decision-tree learning algorithm. We developed decision-trees for different levels of detail of the therapeutic decision, namely the type of treatment, the pharmaco-therapeutic class, the international non proprietary name, and the dose of each medication. We compared the rules generated with those added to the guidelines in a newer version, to examine their similarity. We extracted 27 rules from the analysis of a database of 463 patient records. Eleven rules were about the choice of the type of treatment and thirteen rules about the choice of the pharmaco-therapeutic class of each drug. For the choice of the international non proprietary name and the dose, we could extract only a few rules because the number of patient records was too low for these factors. The extracted rules showed similarities with those added to the newer version of the guidelines. Our method showed its usefulness for completing guidelines recommendations with rules learnt automatically from physicians' prescriptions. It could be used during the development of guidelines as a complementary source from

  3. Using data mining techniques to explore physicians' therapeutic decisions when clinical guidelines do not provide recommendations: methods and example for type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Toussi Massoud

    2009-06-01

    Full Text Available Abstract Background Clinical guidelines carry medical evidence to the point of practice. As evidence is not always available, many guidelines do not provide recommendations for all clinical situations encountered in practice. We propose an approach for identifying knowledge gaps in guidelines and for exploring physicians' therapeutic decisions with data mining techniques to fill these knowledge gaps. We demonstrate our method by an example in the domain of type 2 diabetes. Methods We analyzed the French national guidelines for the management of type 2 diabetes to identify clinical conditions that are not covered or those for which the guidelines do not provide recommendations. We extracted patient records corresponding to each clinical condition from a database of type 2 diabetic patients treated at Avicenne University Hospital of Bobigny, France. We explored physicians' prescriptions for each of these profiles using C5.0 decision-tree learning algorithm. We developed decision-trees for different levels of detail of the therapeutic decision, namely the type of treatment, the pharmaco-therapeutic class, the international non proprietary name, and the dose of each medication. We compared the rules generated with those added to the guidelines in a newer version, to examine their similarity. Results We extracted 27 rules from the analysis of a database of 463 patient records. Eleven rules were about the choice of the type of treatment and thirteen rules about the choice of the pharmaco-therapeutic class of each drug. For the choice of the international non proprietary name and the dose, we could extract only a few rules because the number of patient records was too low for these factors. The extracted rules showed similarities with those added to the newer version of the guidelines. Conclusion Our method showed its usefulness for completing guidelines recommendations with rules learnt automatically from physicians' prescriptions. It could be used

  4. Preliminary guidelines for the evaluation and management of dyslipidemia in adults infected with human immunodeficiency virus and receiving antiretroviral therapy: Recommendations of the Adult AIDS Clinical Trial Group Cardiovascular Disease Focus Group

    NARCIS (Netherlands)

    Dubé, M. P.; Sprecher, D.; Henry, W. K.; Aberg, J. A.; Torriani, F. J.; Hodis, H. N.; Schouten, J. [=Judith; Levin, J.; Myers, G.; Zackin, R.; Nevin, T.; Currier, J. S.

    2000-01-01

    Dyslipidemia is a prevalent condition that affects patients infected with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy, These preliminary recommendations summarize the current understanding in this area and propose guidelines for management. Existing guidelines for the

  5. Guidelines for education and training of medical physicists in radiotherapy. Recommendations from an ESTRO/EFOMP working group.

    NARCIS (Netherlands)

    Eudaldo, T.; Huizenga, H.; Lamm, I.L.; McKenzie, A.; Milano, F.; Schlegel, W.; Thwaites, D.; Heeren, G.

    2004-01-01

    PURPOSE: To provide a guideline curriculum covering theoretical and practical aspects of education and training for medical physicists in radiotherapy within Europe. MATERIAL AND METHODS: Guidelines have been developed for the specialist theoretical knowledge and practical experience required to

  6. Safety Considerations and Guideline-Based Safe Use Recommendations for "Bolus-Dose" Vasopressors in the Emergency Department.

    Science.gov (United States)

    Holden, Devin; Ramich, Jessica; Timm, Edward; Pauze, Denis; Lesar, Timothy

    2018-01-01

    The use of intermittently administered doses of vasopressors to correct hypotension in the emergency department (ED), commonly referred to as bolus-dose pressors, push-dose pressors, Neo-sticks, or phenyl sticks, has been widely advocated outside of the traditional printed medical literature. No outcomes data of this practice exist to demonstrate benefits over traditional continuous infusion of vasopressors. Use of bolus-dose vasopressors in the ED setting raises a number of patient safety concerns, and misuse and errors in the preparation and administration of bolus-dose vasopressors may result in patient harm. A systems-based approach should be implemented to maximize safety and patient benefits if bolus-dose vasopressors are used. This article discusses the wide range of issues to consider when evaluating the role of bolus-dose vasopressors in the ED and provides recommendations based on current safe medication practices guidelines. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  7. European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition--Principles of evidence assessment and methods for reaching recommendations.

    Science.gov (United States)

    Minozzi, S; Armaroli, P; Segnan, N

    2012-09-01

    Multidisciplinary, evidence-based guidelines for quality assurance in colorectal cancer screening and diagnosis have been developed by experts in a project coordinated by the International Agency for Research on Cancer. The full guideline document covers the entire process of population-based screening. It consists of 10 chapters and over 250 recommendations, graded according to the strength of the recommendation and the supporting evidence. The 450-page guidelines and the extensive evidence base have been published by the European Commission. The principles of evidence assessment and methods for reaching recommendations are presented here to promote international discussion and collaboration by making the principles and methods used in developing the guidelines known to a wider professional and scientific community. Following this methodology in the future updating of the guidelines has the potential to enhance the control of colorectal cancer through improvement in the quality and effectiveness of the screening process, including multidisciplinary diagnosis and management of the disease. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Age- and sex-related differences in use of guideline-recommended care and mortality among patients with incident heart failure in Denmark

    DEFF Research Database (Denmark)

    Nakano, Anne; Egstrup, Kenneth; Svendsen, Marie Louise Overgaard

    2016-01-01

    BACKGROUND: data are sparse on age- and sex-related differences in use of guideline-recommended care and subsequent mortality among patients with heart failure (HF). METHODS: we identified 24,308 incident patients with a verified primary diagnosis of HF recorded during 2003-2010 in the Danish Hea...

  9. Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Van Horn, Linda; Carson, Jo Ann S; Appel, Lawrence J; Burke, Lora E; Economos, Christina; Karmally, Wahida; Lancaster, Kristie; Lichtenstein, Alice H; Johnson, Rachel K; Thomas, Randal J; Vos, Miriam; Wylie-Rosett, Judith; Kris-Etherton, Penny

    2016-11-29

    In 2013, the American Heart Association and American College of Cardiology published the "Guideline on Lifestyle Management to Reduce Cardiovascular Risk," which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the American Heart Association's 2020 Strategic Impact Goals for cardiovascular health promotion and disease reduction by providing more specific details for adopting evidence-based diet and lifestyle behaviors to achieve those goals. In addition, the 2015-2020 Dietary Guidelines for Americans issued updated evidence relevant to reducing cardiovascular risk and provided additional recommendations for adopting healthy diet and lifestyle approaches. This scientific statement, intended for healthcare providers, summarizes relevant scientific and translational evidence and offers practical tips, tools, and dietary approaches to help patients/clients adapt these guidelines according to their sociocultural, economic, and taste preferences. © 2016 American Heart Association, Inc.

  10. Processing recommendations for using low-solids digestate as nutrient solution for poly-ß-hydroxybutyrate production with Synechocystis salina.

    Science.gov (United States)

    Meixner, K; Fritz, I; Daffert, C; Markl, K; Fuchs, W; Drosg, B

    2016-12-20

    Within the last decades, environmental pollution with persistent plastics steadily increased; therefore the production of biodegradable materials like poly-ß-hydroxybutyrate (PHB) is essential. Currently, PHB is produced with heterotrophic bacteria from crops. This leads to competition with food and feed production, which can be avoided by using photoautotrophic cyanobacteria, as Synechocystis salina, synthesizing PHB from CO 2 at nutrient limitation. This study aims to increase the economic efficiency of PHB production with cyanobacteria by using nutrients from anaerobic digestate. First, growth and PHB production of S. salina in digestate fractions (supernatant and permeate, with/without precipitating agents) and dilutions thereof and then the scale-up (photobioreactor, 200 L working volume) were evaluated. With precipitated and centrifuged digestate diluted 1/3 the highest biomass (1.55gL -1 ) and PHB concentrations (95.4mgL -1 ), being 78% of those in mineral media, were achieved. In the photobioreactor-experiments biomass (1.63gL -1 ) and PHB concentrations (88.7mgL -1 ), being 79% and 72% of those in mineral medium, were reached, but in a cultivation time 10days longer than in mineral medium. The possibility to use digestate as sustainable and low cost nutrient solution for microalgae cultivation and photoautotrophic PHB production, instead of applying it on fields or processing it to achieve discharge limits, makes this application a highly valid option. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS(®)) society recommendations.

    Science.gov (United States)

    Cerantola, Yannick; Valerio, Massimo; Persson, Beata; Jichlinski, Patrice; Ljungqvist, Olle; Hubner, Martin; Kassouf, Wassim; Muller, Stig; Baldini, Gabriele; Carli, Francesco; Naesheimh, Torvind; Ytrebo, Lars; Revhaug, Arthur; Lassen, Kristoffer; Knutsen, Tore; Aarsether, Erling; Wiklund, Peter; Patel, Hitendra R H

    2013-12-01

    Enhanced recovery after surgery (ERAS) pathways have significantly reduced complications and length of hospital stay after colorectal procedures. This multimodal concept could probably be partially applied to major urological surgery. The primary objective was to systematically assess the evidence of ERAS single items and protocols applied to cystectomy patients. The secondary objective was to address a grade of recommendation to each item, based on the evidence and, if lacking, on consensus opinion from our ERAS Society working group. A systematic literature review was performed on ERAS for cystectomy by searching EMBASE and Medline. Relevant articles were selected and quality-assessed by two independent reviewers using the GRADE approach. If no study specific to cystectomy was available for any of the 22 given items, the authors evaluated whether colorectal guidelines could be extrapolated. Overall, 804 articles were retrieved from electronic databases. Fifteen articles were included in the present systematic review and 7 of 22 ERAS items were studied. Bowel preparation did not improve outcomes. Early nasogastric tube removal reduced morbidity, bowel recovery time and length of hospital stay. Doppler-guided fluid administration allowed for reduced morbidity. A quicker bowel recovery was observed with a multimodal prevention of ileus, including gum chewing, prevention of PONV and minimally invasive surgery. ERAS has not yet been widely implemented in urology and evidence for individual interventions is limited or unavailable. The experience in other surgical disciplines encourages the development of an ERAS protocol for cystectomy. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  12. Time at treatment of severe retinopathy of prematurity in China: recommendations for guidelines in more mature infants.

    Directory of Open Access Journals (Sweden)

    Yi Chen

    Full Text Available To investigate the postmenstrual (PMA age at treatment of severe retinopathy of prematurity (i.e. Type 1 prethreshold or threshold in infants in a tertiary referral center in China.76.6% (359/469 of infants were treated for threshold disease. 67.5% (317/469 of infants had a birth weight (BW of 1250 g or above and almost 30% (126 had a gestational age (GA of 32 weeks or above. There was little difference in the characteristics of infants treated for Type 1 prethreshold or threshold ROP. After controlling for GA, PMA age at treatment was highest in infants with BW ≥2000 g (mean PMA 40.3±4.4 weeks, p34 weeks, p<0.001. For every three weeks increase in GA there was a two-week increase in PMA at treatment (R2 = 0.20, p<0.001. The time at treatment of Type 1 prethreshold disease was similar to that for threshold disease i.e. chronological age 5.6∓7.4 weeks, or PMA 34.1∓40.2 weeks but the lower end of the 95% confidence interval for chronological age for Type 1 prethreshold disease among infants with BW ≥2000 g was 3.7 weeks (i.e. before the recommended interval of 4∓6 weeks after birth.The Chinese guidelines regarding timing of the first examination are appropriate for infants with BW <2000 g, but more mature infants should be examined a little earlier, at 3 weeks after birth, in order to detect Type 1 prethreshold disease which has a better prognosis than threshold.

  13. The role of Cochrane reviews in informing international guidelines: a case study of using the Grading of Recommendations, Assessment, Development and Evaluation system to develop World Health Organization guidelines for the psychosocially assisted pharmacological treatment of opioid dependence.

    Science.gov (United States)

    Davoli, Marina; Amato, Laura; Clark, Nicolas; Farrell, Michael; Hickman, Matthew; Hill, Suzanne; Magrini, Nicola; Poznyak, Vladimir; Schünemann, Holger J

    2015-06-01

    The World Health Organization (WHO), and a growing number of other organizations, have adopted the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system in order to both assess the quality of research evidence and develop clinical practice guidelines. In 2009 WHO published a guideline on psychosocially assisted pharmacological treatment of opioid dependence, based on the results of Cochrane Reviews summarized using the GRADE methodology. The main features of this system are an a priori definition of outcomes and their relevance, and distinction between the quality of evidence (also referred to as confidence in the estimate of intervention effect) and the strength of recommendations. We consider how successful this approach has been. We discuss the merits and limitations of using Cochrane Reviews and GRADE framework in developing guidelines in the field of drug addiction. In 2009 a panel of multi-disciplinary international experts identified 15 clinical questions and eight relevant outcomes. Cochrane reviews were available for each clinical question and four outcomes. The panel formulated 15 recommendations. Eight recommendations were classified as strong, two of which were based on high-quality evidence and three on very low-quality evidence. For example, the strong recommendation to use methadone in adequate doses in preference to buprenorphine was based on high-quality evidence, while the strong recommendation not to use the combination of opioid antagonists with heavy sedation in the management of opioid withdrawal was based on low-quality evidence. An explicit stepwise process of moving from evaluation of the quality of evidence to the definition of the strength of recommendations is important in providing practical and clear clinical guidance for practitioners and policy-makers in addiction. © 2014 Society for the Study of Addiction.

  14. The Intake of Energy and Selected Nutrients by Thai Urban Sedentary Workers: An Evaluation of Adherence to Dietary Recommendations

    Directory of Open Access Journals (Sweden)

    Katiya Ivanovitch

    2014-01-01

    Full Text Available Rapid changes in Thailand’s nutrition and lifestyles have led to increasing diet-related pathologies among people with sedentary occupations. This study examines the extent to which the dietary intake of nutrients and energy by a sample of Thai sedentary workers conforms to the Thai Dietary Reference Intakes (Thai DRIs. The nutrients and energy intake estimates were based on self-reported information collected with a single 24-hour dietary recall and nonweighed 2-day food record. The study participants were Thai adults aged 20–50 years employed in sedentary occupations. A convenience sample of 215 healthy individuals (75 males and 140 females was based on four randomly selected worksites in the Bangkok metropolitan area. For male participants, the study found a median energy intake of 1,485 kcal/day, with 54.4% of energy coming from carbohydrate, 15.9% from protein, and 29.6% from fat. Females’ median energy intake was 1,428 kcal/day, 56% of which came from carbohydrate, 16.2% from protein, and 28.6% from fat. Both genders showed insufficient intake of fiber and most micronutrients. This study provides the material for preventive public health interventions focusing on nutrition-related diseases affecting Thailand’s rapidly growing sedentary workforce.

  15. Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines

    Science.gov (United States)

    In 2013, the American Heart Association and American College of Cardiology published the "Guideline on Lifestyle Management to Reduce Cardiovascular Risk," which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the America...

  16. Systematic review of guidelines on cardiovascular risk assessment: Which recommendations should clinicians follow for a cardiovascular health check?

    NARCIS (Netherlands)

    Ferket, Bart S.; Colkesen, Ersen B.; Visser, Jacob J.; Spronk, Sandra; Kraaijenhagen, Roderik A.; Steyerberg, Ewout W.; Hunink, M. G. Myriam

    2010-01-01

    To appraise guidelines on cardiovascular risk assessment to guide selection of screening interventions for a health check. Guidelines in the English language published between January 1, 2003, and May 2, 2009, were retrieved using MEDLINE and CINAHL. This was supplemented by searching the National

  17. [Recommendations for Diagnostics and Therapy of Children with Cancer Presenting with Fever and Neutropenia - Comparison of Two Current Guidelines].

    Science.gov (United States)

    Lehrnbecher, Thomas; Groll, Andreas; Agyeman, Philipp; Ammann, Roland A; Attarbaschi, Andishe; Behrends, Uta; Berger, Christoph; Hamprecht, Axel; Hufnagel, Markus; Laws, Hans-Jürgen; Scheler, Max; Temme, Christian; Vieth, Simon; Simon, Arne

    2018-03-27

    Immunocompromised children and adolescents receiving treatment for cancer have a considerably increased risk for infection. Neutropenia is the most important single risk factor for infectious complications, and fever in neutropenia is considered as an emergency. Whereas guidelines for the management of fever in neutropenic adults have been established for decades, specific pediatric guidelines have not been developed until recently. As children differ in many aspects from adults such as in the underlying malignancy or in the availability and dosing of antimicrobial compounds, guidelines for pediatric patients are important. This article reviews similarities and differences between the recently published German interdisciplinary guideline of the German Societies of Pediatric Infectious Diseases and Pediatric Oncology and Hematology and a guideline developed by a panel of international experts for the management of fever in neutropenia in children and adolescents. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Practice guideline: joint CCMG-SOGC recommendations for the use of chromosomal microarray analysis for prenatal diagnosis and assessment of fetal loss in Canada

    Science.gov (United States)

    Armour, Christine M; Dougan, Shelley Danielle; Brock, Jo-Ann; Chari, Radha; Chodirker, Bernie N; DeBie, Isabelle; Evans, Jane A; Gibson, William T; Kolomietz, Elena; Nelson, Tanya N; Tihy, Frédérique; Thomas, Mary Ann; Stavropoulos, Dimitri J

    2018-01-01

    Background The aim of this guideline is to provide updated recommendations for Canadian genetic counsellors, medical geneticists, maternal fetal medicine specialists, clinical laboratory geneticists and other practitioners regarding the use of chromosomal microarray analysis (CMA) for prenatal diagnosis. This guideline replaces the 2011 Society of Obstetricians and Gynaecologists of Canada (SOGC)-Canadian College of Medical Geneticists (CCMG) Joint Technical Update. Methods A multidisciplinary group consisting of medical geneticists, genetic counsellors, maternal fetal medicine specialists and clinical laboratory geneticists was assembled to review existing literature and guidelines for use of CMA in prenatal care and to make recommendations relevant to the Canadian context. The statement was circulated for comment to the CCMG membership-at-large for feedback and, following incorporation of feedback, was approved by the CCMG Board of Directors on 5 June 2017 and the SOGC Board of Directors on 19 June 2017. Results and conclusions Recommendations include but are not limited to: (1) CMA should be offered following a normal rapid aneuploidy screen when multiple fetal malformations are detected (II-1A) or for nuchal translucency (NT) ≥3.5 mm (II-2B) (recommendation 1); (2) a professional with expertise in prenatal chromosomal microarray analysis should provide genetic counselling to obtain informed consent, discuss the limitations of the methodology, obtain the parental decisions for return of incidental findings (II-2A) (recommendation 4) and provide post-test counselling for reporting of test results (III-A) (recommendation 9); (3) the resolution of chromosomal microarray analysis should be similar to postnatal microarray platforms to ensure small pathogenic variants are detected. To minimise the reporting of uncertain findings, it is recommended that variants of unknown significance (VOUS) smaller than 500 Kb deletion or 1 Mb duplication not be routinely

  19. Practice guideline: joint CCMG-SOGC recommendations for the use of chromosomal microarray analysis for prenatal diagnosis and assessment of fetal loss in Canada.

    Science.gov (United States)

    Armour, Christine M; Dougan, Shelley Danielle; Brock, Jo-Ann; Chari, Radha; Chodirker, Bernie N; DeBie, Isabelle; Evans, Jane A; Gibson, William T; Kolomietz, Elena; Nelson, Tanya N; Tihy, Frédérique; Thomas, Mary Ann; Stavropoulos, Dimitri J

    2018-04-01

    The aim of this guideline is to provide updated recommendations for Canadian genetic counsellors, medical geneticists, maternal fetal medicine specialists, clinical laboratory geneticists and other practitioners regarding the use of chromosomal microarray analysis (CMA) for prenatal diagnosis. This guideline replaces the 2011 Society of Obstetricians and Gynaecologists of Canada (SOGC)-Canadian College of Medical Geneticists (CCMG) Joint Technical Update. A multidisciplinary group consisting of medical geneticists, genetic counsellors, maternal fetal medicine specialists and clinical laboratory geneticists was assembled to review existing literature and guidelines for use of CMA in prenatal care and to make recommendations relevant to the Canadian context. The statement was circulated for comment to the CCMG membership-at-large for feedback and, following incorporation of feedback, was approved by the CCMG Board of Directors on 5 June 2017 and the SOGC Board of Directors on 19 June 2017. Recommendations include but are not limited to: (1) CMA should be offered following a normal rapid aneuploidy screen when multiple fetal malformations are detected (II-1A) or for nuchal translucency (NT) ≥3.5 mm (II-2B) (recommendation 1); (2) a professional with expertise in prenatal chromosomal microarray analysis should provide genetic counselling to obtain informed consent, discuss the limitations of the methodology, obtain the parental decisions for return of incidental findings (II-2A) (recommendation 4) and provide post-test counselling for reporting of test results (III-A) (recommendation 9); (3) the resolution of chromosomal microarray analysis should be similar to postnatal microarray platforms to ensure small pathogenic variants are detected. To minimise the reporting of uncertain findings, it is recommended that variants of unknown significance (VOUS) smaller than 500 Kb deletion or 1 Mb duplication not be routinely reported in the prenatal context. Additionally

  20. Recommendations for developing the optimum method for da installations to comply with 40 CFR 246-source separation for materials recovery guidelines. Interim report

    Energy Technology Data Exchange (ETDEWEB)

    Donahue, B.A.; Gershman, H.W.; Gardner, W.P.; Price, J.D.

    1977-05-01

    This report is the end-product of a study which involved both an examination of source separation techniques for materials recovery and an evaluation of current Department of the Army (DA) operations, especially those related to solid waste management. The purpose of the study was to arrive at the optimum method or methods by which DA installations could integrate source separation procedures into their current solid waste management activities, as required by the U.S. Environmental Protection Agency's 40 CFR 246 -- Source Separation for Materials Recovery Guidelines. The report was written with the goal of providing assistance -- both background information and specific instructions for procedures -- to the managing activities faced with compliance with the guidelines at the installation level. The procedures recommended in the report are those which can most easily be included in current operations while still producing significant resource recovery results. It is considered advisable for DA to institute only the 'Required' procedures from the guidelines, acting on the 'Recommended' procedures only where they can be handled with existing equipment, personnel, and funds. Procedural changes at the installation level must be preceded by DA and Department of Defense policy and guidance alterations, for which Recommendations are also provided.

  1. The Impact of Implementation of the European Association of Urology Guidelines Panel Recommendations on Reporting and Grading Complications on Perioperative Outcomes after Robot-assisted Radical Prostatectomy.

    Science.gov (United States)

    Gandaglia, Giorgio; Bravi, Carlo Andrea; Dell'Oglio, Paolo; Mazzone, Elio; Fossati, Nicola; Scuderi, Simone; Robesti, Daniele; Barletta, Francesco; Grillo, Luca; Maclennan, Steven; N'Dow, James; Montorsi, Francesco; Briganti, Alberto

    2018-03-12

    The rate of postoperative complications might vary according to the method used to collect perioperative data. We aimed at assessing the impact of the prospective implementation of the European Association of Urology (EAU) guidelines on reporting and grading of complications in prostate cancer patients undergoing robot-assisted radical prostatectomy (RARP). From September 2016, an integrated method for reporting surgical morbidity based on the EAU guidelines was implemented at a single, tertiary center. Perioperative data were prospectively and systematically collected during a patient interview at 30 d after surgery as recommended by the EAU Guidelines Panel Recommendations on Reporting and Grading Complications. The rate and grading of complications of 167 patients who underwent RARP±pelvic lymph node dissection (PLND) after the implementation of the prospective collection system (Group 1) were compared with 316 patients treated between January 2015 and August 2016 (Group 2) when a system based on patient chart review was used. No differences were observed in disease characteristics and PLND between the two groups (all p≥0.1). Postoperative complications were graded according to the Clavien-Dindo classification system. Overall, the complication rate was higher when the prospective collection system based on the EAU guidelines was used (29%) than when retrospective chart review (10%; preporting perioperative outcomes roughly doubled the complication rate after RARP and allowed for the detection of complications after discharge in more than 15% of patients that would have been otherwise missed, where patients assessed with the EAU implemented protocol had a threefold higher likelihood of reporting complications. The implementation of the European Association of Urology guidelines on reporting and grading of complications after urologic procedures in prostate cancer patients roughly doubled the complication rate after robot-assisted radical prostatectomy compared

  2. Effect of plants in constructed wetlands for organic carbon and nutrient removal: a review of experimental factors contributing to higher impact and suggestions for future guidelines.

    Science.gov (United States)

    Jesus, João M; Danko, Anthony S; Fiúza, António; Borges, Maria-Teresa

    2018-02-01

    Constructed wetland is a proven technology for water pollution removal, but process mechanisms and their respective contribution are not fully understood. The present review details the effect of plants on removal efficiency of constructed wetlands by focusing on literature that includes experiments with unplanted controls for organic carbon and nutrient (N and P) removal. The contribution of plant direct uptake is also assessed. Although it was found that several studies, mostly at laboratory or pilot scales, showed no statistical differences between planted and unplanted controls, some factors were found that help maximize the effect of plants. This study intends to contribute to a better understanding of the significance of the effect of plants in a constructed wetland, as well as to suggest a set of experimental guidelines in this field.

  3. Rural-urban differences in receiving guideline-recommended diabetes care and experiencing avoidable hospitalizations under a universal coverage health system: evidence from the past decade.

    Science.gov (United States)

    Chen, C-C; Chen, L-W; Cheng, S-H

    2017-10-01

    Rural-urban differences in health remain a concern worldwide. Few studies have investigated the dynamic changes in health between rural and urban areas. This study aims to examine whether the rural-urban gap in patients' receipt of guideline-recommended care and avoidable hospitalizations has decreased in 10 years under a universal coverage health system. A retrospective cohort study design. This study utilized nationwide health insurance claims data of 3 representative cohorts of patients with newly diagnosed type 2 diabetes in 2000, 2005, and 2010 in Taiwan. The two outcome variables were receipt of guideline-recommended care and avoidable hospitalizations for diabetes. Generalized estimating equations models were used to estimate the rural-urban differences while controlling for physician-clustering effects. Rural diabetic patients were less likely to receive guideline-recommended examinations/tests in 2000 (e β  = 0.97; 95% confidence interval [CI]: 0.96-0.99); however, the average number of examinations/tests increased and the rural-urban difference had diminished in 2010. The likelihood of avoidable hospitalizations for diabetes among rural diabetic patients was higher than that for their urban counterparts in 2000 (odds ratio [OR]: 1.13; 95% CI: 1.01-1.25). Although the likelihood of avoidable hospitalizations for diabetes decreased from 2000 to 2010, the rural-urban gap remained during this period. The rural-urban disparity in receiving recommended diabetes care diminished over the past decade. However, significant gaps between rural and urban areas in avoidable hospitalizations for diabetes persisted despite the universal health system. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  4. Performance and carcass yield of broilers fed with different digestible amino acid profiles recommended by nutrients requirements tables

    Directory of Open Access Journals (Sweden)

    Pedroso AC

    2003-01-01

    Full Text Available An experiment was conducted to evaluate the effect of different digestible amino acid profiles on the performance of broilers in two phases: from 1 to 21 days and from 22 to 42 days of age. At the end of the experiment, carcass yield and cut percentages were evaluated. Nine hundred and sixty AgRoss birds were distributed in a randomized block design with four treatments (four digestible amino acid profiles: Rostagno et al. (2000, Baker & Han (1994b, Degussa (1997 and those recommended by AgRoss (2000, with six repetitions and 40 birds per repetition (20 males and 20 females. The results showed that the four diets were able to provide the requirements of the birds, since no significant differences were seen among the treatments on the performance in the two phases and on the carcass yield and cuts at 42 days of age. Males had better yields of feet, head and neck, and lower percentage of abdominal fat (p<0.05. The best cost/benefit ratio was seen for the profile established by Rostagno et al. (2000 when diets were evaluated in an ideal protein situation.

  5. Adapted Physical Education, Occupational Therapy, and Physical Therapy in the Public School. Procedures and Recommended Guidelines (Revised 1997).

    Science.gov (United States)

    Colorado State Dept. of Education, Denver.

    This manual is designed to assist Colorado personnel in developing and providing adapted physical education, occupational therapy, and physical therapy to Colorado public school students who have needs in the motor area. Guidelines are presented that have been developed to focus on the problems encountered by students with needs in the physical…

  6. Recreational drug use among individuals living with HIV in Europe: review of the prevalence, comparison with the general population and HIV guidelines recommendations

    Directory of Open Access Journals (Sweden)

    Noe eGarin

    2015-07-01

    Full Text Available BACKGROUNDAdherence problems, interactions and higher rate of risk activities have been observed in HIV individuals using recreational drugs. Our aim was to describe recreational drug use in both HIV individuals and general population in Europe, and to assess at what extent HIV guidelines address this issue.METHODSData on recreational drug use across Europe were obtained from the European Monitoring Centre for Drugs and Drug Addiction for the general population, and through Pubmed search. for HIV patients. We assessed the incorporation of recreational drug issues in HIV treatment guidelines for the following topics: a recreational drugs; b adherence to antiretrovirals; c interactions; d transmission risk. Guidelines included: World Health Organization; European Aids Clinical Society; U.S. Department of Health and Human Services; International Antiviral Society-USA; and seven European national guidelines.RESULTS29 countries reported recreational drug use in general population. The highest prevalences were observed for Cannabis (i.e. 8-10% in Spain, France and Czech Republic followed by cocaine, amphetamines and ecstasy. The 13 studies selected in the systematic review showed a great variability in recreational drug use on the HIV population. Apart from classical recreational drugs, we found a relevant use of new drugs including sexual experience enhancers. Polydrug consumption was about 50% in some studies. Most guidelines included general information about recreational drugs, showing great variability on the inclusion of the evaluated topics. We found more specific, evidence-based recommendations on interactions, followed by medication adherence and transmission risk.CONCLUSIONSAvailable data on the people living with HIV suggest a higher use of recreational drugs than in the general population, which is already relevant. However, recreational drug issues should be included or addressed more thoroughly in most guidelines.

  7. Guidelines for Diagnosis and Management of Bronchial Asthma: Joint Recommendations of National College of Chest Physicians (India) and Indian Chest Society.

    Science.gov (United States)

    Agarwal, Ritesh; Dhooria, Sahajal; Aggarwal, Ashutosh Nath; Maturu, Venkata N; Sehgal, Inderpaul S; Muthu, Valliappan; Prasad, K T; Yenge, Lakshmikant B; Singh, Navneet; Behera, Digambar; Jindal, Surinder K; Gupta, Dheeraj; Balamugesh, Thanagakunam; Bhalla, Ashish; Chaudhry, Dhruva; Chhabra, S K; Chokhani, Ramesh; Chopra, Vishal; Dadhwal, Devendra S; D'Souza, George; Garg, Mandeep; Gaur, S N; Gopal, Bharat; Ghoshal, Aloke G; Guleria, Randeep; Gupta, K B; Haldar, Indranil; Jain, Sanjay; Jain, Nirmal K; Jain, V K; Janmeja, A K; Kant, Surya; Kashyap, Surender; Khilnani, G C; Kishan, Jai; Kumar, Raj; Koul, Parvaiz; Mahashur, Ashok; Mandal, Amit K; Malhotra, Samir; Mohammed, Sabir; Mohapatra, Prasanta R; Patel, Dharmesh; Prasad, Rajendra; Samaria, J K; Sarat, P; Sawhney, Honey; Shafiq, Nusrat; Sidhu, U P S; Singla, Rupak; Suri, J C; Talwar, Deepak; Varma, Subhash

    2015-01-01

    Bronchial asthma is an important public health problem in India with significant morbidity. Several international guidelines for diagnosis and management of asthma are available, however there is a need for country-specific guidelines due to vast differences in availability and affordability of health-care facilities across the globe. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have collaborated to develop evidence-based guidelines with an aim to assist physicians at all levels of health-care in diagnosis and management of asthma in a scientific manner. Besides a systematic review of the literature, Indian studies were specifically analysed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (1) definitions, epidemiology and impact, (2) diagnosis, (3) pharmacologic management of stable disease, (4) management of acute exacerbations, and (5) non-pharmacologic management and special situations. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.

  8. Combining food-based dietary recommendations using Optifood with zinc-fortified water potentially improves nutrient adequacy among 4- to 6-year-old children in Kisumu West district, Kenya.

    Science.gov (United States)

    Kujinga, Prosper; Borgonjen-van den Berg, Karin J; Superchi, Cecilia; Ten Hove, Hermine J; Onyango, Elizabeth Opiyo; Andang'o, Pauline; Galetti, Valeria; Zimmerman, Michael B; Moretti, Diego; Brouwer, Inge D

    2018-04-01

    Children in developing countries often face multiple micronutrient deficiencies. Introduction of zinc-fortified water can increase zinc intake, but additional recommendations are required to address overall diet nutrient adequacy. We developed and tested food-based recommendations (FBRs) that included zinc-fortified water for children aged between 4 and 6 years from rural Kenya to achieve the best possible nutrient adequacy. Dietary intakes of 60 children aged 4-6 years, from Kisumu West district, Kenya, were assessed using a quantitative multipass 24-hr recall. Linear programming model parameters were derived, including a list of foods consumed, median serving sizes, and distribution of frequency of consumption. By using the Optifood linear programming tool, we developed FBRs for diets including zinc-fortified water. FBRs with nutrient levels achieving ≥70% recommended nutrient intake (RNI) of the World Health Organization/Food and Agriculture Organization of the United Nations RNI for most of the 12 considered nutrients were selected as the final recommendations for the children. With no FBRs and no zinc-fortified water, percent RNI coverage range was between 40% and 76% for zinc, improving to 66-101% after introduction of zinc-fortified water. The final set of FBRs achieved nutrient adequacy for all nutrients except for vitamin A (25% RNI) and folate (68% RNI). Introduction of zinc-fortified water combined with FBRs will likely improve the nutrient adequacy of diets consumed by children in Kenya but needs to be complemented with alternative interventions to ensure dietary adequacy. © 2017 John Wiley & Sons Ltd.

  9. Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the NICU. Part B: Recommendations and Justification. A Joint Position Statement From the CANN, CAPWHN, NANN, and COINN.

    Science.gov (United States)

    Milette, Isabelle; Martel, Marie-Josée; da Silva, Margarida Ribeiro; Coughlin McNeil, Mary

    2017-06-01

    The use of age-appropriate care as an organized framework for care delivery in the NICU is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the "universe of developmental care" conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the NICU. These guidelines were recently revised and expanded. In alignment with the Joint Commission's requirement for healthcare professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of these core measures require a strong framework for institutional operationalization presented in these guidelines. Part B will present the recommendations and justification of each steps behind the present guidelines to facilitate their implementation.

  10. Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines.

    Science.gov (United States)

    van der Molen, Aart J; Reimer, Peter; Dekkers, Ilona A; Bongartz, Georg; Bellin, Marie-France; Bertolotto, Michele; Clement, Olivier; Heinz-Peer, Gertraud; Stacul, Fulvio; Webb, Judith A W; Thomsen, Henrik S

    2018-02-09

    The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. AREAS COVERED IN PART 1: Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs. • PC-AKI is the preferred term for renal function deterioration after contrast medium. • PC-AKI has many possible causes. • The risk of AKI caused by intravascular contrast medium has been overstated. • Important patient risk factors for PC-AKI are CKD and dehydration.

  11. Diagnosis and treatment of male patients with lower urinary tract symptoms in Spain - The MERCURY Study. Do urologists follow the recommendations of the European guidelines?

    Science.gov (United States)

    Errando-Smet, C; Müller-Arteaga, C; Hernández, M; Roset, M

    2018-02-07

    To explore the management of lower urinary tract symptoms (LUTS) in men in Spain and assess the compliance with recommendations established in the European Association of Urology (EAU) guidelines. MERCURY was an epidemiological and cross-sectional study which involved 227 Urology Units across Spain assessing adult male patients with mixed LUTS and persisting storage symptoms. Sociodemographic, clinical and resource use data for the 6 months prior to study inclusion were collected. Additionally, through a theoretical clinical case, clinicians described their attitude toward the diagnostic and therapeutic management of males with mixed LUTS and persisting storage symptoms during the first and second visits. Answer options given to clinicians about LUTS management were aligned with those recommended by EAU guidelines. 610 patients included in the study were evaluated. 87.7% of them consumed some health resource mainly due to: urologist visits (79.7%), PSA determination (76.6%) and treatment with alpha-blockers (37.5%) and alpha-blockers plus antimuscarinics (37.2%). According to the theoretical clinical case, urologists preference toward diagnostic tools and pharmacological treatment in first visit were mainly PSA determination (97.7%), digital rectal examination (91.4%) and treatment with alphablockers as monotherapy (56.6%), whereas in the second visit uroflowmetry (48.9%), voiding diary (40.3%) and treatment with alpha-blockers plus antimuscarinics (70.6%) were mainly preferred. Urologists attitude toward management of male patients with mixed LUTS and persisting storage symptoms is aligned with that recommended in the EAU guidelines. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Guidelines and recommended terms for expression of stable-isotope-ratio and gas-ratio measurement results

    Science.gov (United States)

    Coplen, Tyler B.

    2011-01-01

    To minimize confusion in the expression of measurement results of stable isotope and gas-ratio measurements, recommendations based on publications of the Commission on Isotopic Abundances and Atomic Weights of the International Union of Pure and Applied Chemistry (IUPAC) are presented. Whenever feasible, entries are consistent with the Système International d'Unités, the SI (known in English as the International System of Units), and the third edition of the International Vocabulary of Basic and General Terms in Metrology (VIM, 3rd edition). The recommendations presented herein are approved by the Commission on Isotopic Abundances and Atomic Weights and are designed to clarify expression of quantities related to measurement of isotope and gas ratios to ensure that quantity equations instead of numerical value equations are used for quantity definitions. Examples of column headings consistent with quantity calculus (also called the algebra of quantities) and examples of various deprecated usages connected with the terms recommended are presented.

  13. The strains recommended for use in the bacterial reverse mutation test (OECD guideline 471) can be certified as non-genetically modified organisms.

    Science.gov (United States)

    Sugiyama, Kei-Ichi; Yamada, Masami; Awogi, Takumi; Hakura, Atsushi

    2016-01-01

    The bacterial reverse mutation test, commonly called Ames test, is used worldwide. In Japan, the genetically modified organisms (GMOs) are regulated under the Cartagena Domestic Law, and organisms obtained by self-cloning and/or natural occurrence would be exempted from the law case by case. The strains of Salmonella typhimurium and Escherichia coli recommended for use in the bacterial reverse mutation test (OECD guideline 471), have been considered as non-GMOs because they can be constructed by self-cloning or naturally occurring bacterial strains, or do not disturb the biological diversity. The present article explains the reasons why these tester strains should be classified as non-GMOs.

  14. Guidelines for safe work practices in human and animal medical diagnostic laboratories. Recommendations of a CDC-convened, Biosafety Blue Ribbon Panel.

    Science.gov (United States)

    Miller, J Michael; Astles, Rex; Baszler, Timothy; Chapin, Kimberle; Carey, Roberta; Garcia, Lynne; Gray, Larry; Larone, Davise; Pentella, Michael; Pollock, Anne; Shapiro, Daniel S; Weirich, Elizabeth; Wiedbrauk, Danny

    2012-01-06

    Prevention of injuries and occupational infections in U.S. laboratories has been a concern for many years. CDC and the National Institutes of Health addressed the topic in their publication Biosafety in Microbiological and Biomedical Laboratories, now in its 5th edition (BMBL-5). BMBL-5, however, was not designed to address the day-to-day operations of diagnostic laboratories in human and animal medicine. In 2008, CDC convened a Blue Ribbon Panel of laboratory representatives from a variety of agencies, laboratory organizations, and facilities to review laboratory biosafety in diagnostic laboratories. The members of this panel recommended that biosafety guidelines be developed to address the unique operational needs of the diagnostic laboratory community and that they be science based and made available broadly. These guidelines promote a culture of safety and include recommendations that supplement BMBL-5 by addressing the unique needs of the diagnostic laboratory. They are not requirements but recommendations that represent current science and sound judgment that can foster a safe working environment for all laboratorians. Throughout these guidelines, quality laboratory science is reinforced by a common-sense approach to biosafety in day-to-day activities. Because many of the same diagnostic techniques are used in human and animal diagnostic laboratories, the text is presented with this in mind. All functions of the human and animal diagnostic laboratory--microbiology, chemistry, hematology, and pathology with autopsy and necropsy guidance--are addressed. A specific section for veterinary diagnostic laboratories addresses the veterinary issues not shared by other human laboratory departments. Recommendations for all laboratories include use of Class IIA2 biological safety cabinets that are inspected annually; frequent hand washing; use of appropriate disinfectants, including 1:10 dilutions of household bleach; dependence on risk assessments for many activities

  15. Local food-based complementary feeding recommendations developed by the linear programming approach to improve the intake of problem nutrients among 12-23-month-old Myanmar children.

    Science.gov (United States)

    Hlaing, Lwin Mar; Fahmida, Umi; Htet, Min Kyaw; Utomo, Budi; Firmansyah, Agus; Ferguson, Elaine L

    2016-07-01

    Poor feeding practices result in inadequate nutrient intakes in young children in developing countries. To improve practices, local food-based complementary feeding recommendations (CFR) are needed. This cross-sectional survey aimed to describe current food consumption patterns of 12-23-month-old Myanmar children (n 106) from Ayeyarwady region in order to identify nutrient requirements that are difficult to achieve using local foods and to formulate affordable and realistic CFR to improve dietary adequacy. Weekly food consumption patterns were assessed using a 12-h weighed dietary record, single 24-h recall and a 5-d food record. Food costs were estimated by market surveys. CFR were formulated by linear programming analysis using WHO Optifood software and evaluated among mothers (n 20) using trial of improved practices (TIP). Findings showed that Ca, Zn, niacin, folate and Fe were 'problem nutrients': nutrients that did not achieve 100 % recommended nutrient intake even when the diet was optimised. Chicken liver, anchovy and roselle leaves were locally available nutrient-dense foods that would fill these nutrient gaps. The final set of six CFR would ensure dietary adequacy for five of twelve nutrients at a minimal cost of 271 kyats/d (based on the exchange rate of 900 kyats/USD at the time of data collection: 3rd quarter of 2012), but inadequacies remained for niacin, folate, thiamin, Fe, Zn, Ca and vitamin B6. TIP showed that mothers believed liver and vegetables would cause worms and diarrhoea, but these beliefs could be overcome to successfully promote liver consumption. Therefore, an acceptable set of CFR were developed to improve the dietary practices of 12-23-month-old Myanmar children using locally available foods. Alternative interventions such as fortification, however, are still needed to ensure dietary adequacy of all nutrients.

  16. Healthcare system-wide implementation of opioid-safety guideline recommendations: the case of urine drug screening and opioid-patient suicide- and overdose-related events in the Veterans Health Administration

    OpenAIRE

    Brennan, Penny L.; Del Re, Aaron C.; Henderson, Patricia T.; Trafton, Jodie A.

    2016-01-01

    This study provides an example of how healthcare system-wide progress in implementation of opioid-therapy guideline recommendations can be longitudinally assessed and then related to subsequent opioid-prescribed patient health and safety outcomes. Using longitudinal linear mixed effects analyses, we determined that in the Department of Veterans Affairs (VA) healthcare system (n = 141 facilities), over the 4-year interval from 2010 to 2013, a key opioid therapy guideline recommendation, urine ...

  17. What do most erectile dysfunction guidelines have in common? No evidence-based discussion or recommendation of heart-healthy lifestyle changes and/or Panax ginseng

    Science.gov (United States)

    Moyad, Mark A; Park, Kwangsung

    2012-01-01

    Sexual health or erectile dysfunction (ED) state of the art guidelines provide a thorough overview of conventional prescription or other notable extrinsic treatment options. Yet, over the past 10–15 years, a plethora of international researchers have established that individual and comprehensive lifestyle changes can prevent and potentially improve ED. We review the lifestyle evidence that should equate to grade A or level 1 evidence recommendations for ED. We also review the evidence for Panax ginseng, an over-the-counter (OTC) dietary supplement with a 35-year history of laboratory investigations, multiple positive randomized trials over approximately 15 years and several independent meta-analyses and systematic reviews. Perhaps it is time to at least discuss and even emphasize lifestyle and other non-conventional interventions in ED guidelines so that patients can explore a diversity of potentially synergistic choices with their physicians and can improve their quality and quantity of life. Ignoring the consistent, positive data on lifestyle modifications in ED guidelines, for example, is tantamount to ignoring diet and lifestyle changes to reduce the risk of or ameliorate cardiovascular diseases. PMID:23001440

  18. The European Federation of Organisations for Medical Physics Policy Statement No. 6.1: Recommended Guidelines on National Registration Schemes for Medical Physicists.

    Science.gov (United States)

    Christofides, Stelios; Isidoro, Jorge; Pesznyak, Csilla; Bumbure, Lada; Cremers, Florian; Schmidt, Werner F O

    2016-01-01

    This EFOMP Policy Statement is an update of Policy Statement No. 6 first published in 1994. The present version takes into account the European Union Parliament and Council Directive 2013/55/EU that amends Directive 2005/36/EU on the recognition of professional qualifications and the European Union Council Directive 2013/59/EURATOM laying down the basic safety standards for protection against the dangers arising from exposure to ionising radiation. The European Commission Radiation Protection Report No. 174, Guidelines on Medical Physics Expert and the EFOMP Policy Statement No. 12.1, Recommendations on Medical Physics Education and Training in Europe 2014, are also taken into consideration. The EFOMP National Member Organisations are encouraged to update their Medical Physics registration schemes where these exist or to develop registration schemes taking into account the present version of this EFOMP Policy Statement (Policy Statement No. 6.1"Recommended Guidelines on National Registration Schemes for Medical Physicists"). Copyright © 2016. Published by Elsevier Ltd.

  19. Liposomal Nasal Spray versus Guideline-Recommended Steroid Nasal Spray in Patients with Chronic Rhinosinusitis: A Comparison of Tolerability and Quality of Life

    Directory of Open Access Journals (Sweden)

    Anna Eitenmüller

    2014-01-01

    Full Text Available Objective. To investigate the tolerability and impact on quality of life of liposomal nasal spray compared to guideline-recommended steroid-based therapy in patients with chronic rhinosinusitis. Symptom reduction and use of antisymptomatic medication were also examined. Methods. In this monocenter, prospective, controlled, open, and noninterventional study, 60 patients with chronic rhinosinusitis were treated with liposomal nasal spray and 30 patients received steroid-based therapy. The study comprised five visits occurring at intervals of two to four weeks. Efficacy was determined according to the sinusitis symptom score documented daily. The polyp score was recorded at the initial and final visits. Tolerability was determined through the Nasal Spray Evaluation Questionnaire, and quality of life was ascertained with the SNOT-20 Score. Results. Both treatments achieved a significant reduction of sinusitis symptoms (P<0.05 and also rhinoscopic improvement (P<0.05. The majority of patients assessed the treatments as “good” or “very good,” and the quality of life improved significantly (P<0.05. There was no significant difference in symptom reduction, QoL, and endoscopic exams between both treatments. Conclusion. The treatment of chronic rhinosinusitis with liposomal nasal spray results in a similar, significant reduction of symptoms and significant improvement in quality of life as guideline-recommended treatment and is therefore a comparable alternative.

  20. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations.

    Science.gov (United States)

    Nygren, J; Thacker, J; Carli, F; Fearon, K C H; Norderval, S; Lobo, D N; Ljungqvist, O; Soop, M; Ramirez, J

    2012-12-01

    This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol. Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (evidence grade: high or moderate). Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Association for Surgical Metabolism and Nutrition (IASMEN) present a comprehensive evidence-based consensus review of perioperative care for rectal surgery. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  1. Guideline Recommended Medical Therapy for Cardiovascular Diseases in the Obese: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program.

    Science.gov (United States)

    Valle, Javier A; O'Donnell, Colin I; Armstrong, Ehrin J; Bradley, Steven M; Maddox, Thomas M; Ho, P Michael

    2016-05-16

    Stigma against the obese is well described in health care and may contribute to disparities in medical decision-making. It is unknown whether similar disparity exists for obese patients in cardiovascular care. We evaluated the association between body mass index (BMI) and prescription of guideline-recommended medications in patients undergoing elective percutaneous coronary intervention. Using data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking System Program, we identified patients undergoing elective percutaneous coronary intervention from 2007 to 2012, stratifying them by category of BMI. We described rates of prescription for class I guideline recommended medications for each BMI category (normal, overweight, and obese). Multivariable logistic regression assessed the association between BMI category and medication prescription. Seventeen thousand thirty-seven patients were identified, with 35.3% having overweight BMI, and 50.8% obese BMI. Obese patients were more likely than normal BMI patients to be prescribed β-blockers (OR 1.34), statins (OR 1.39), or ACE/ARB (odds ratio [OR] 1.52; all significant) when indicated. Overweight patients were more likely than normal BMI patients to be prescribed statins (OR 1.29) and angiotensin-converting enzymes/angiotensin II receptor blockers (OR 1.41) when indicated. There was no association between BMI category and prescription of anticoagulants. Over 85% of patients undergoing elective percutaneous coronary intervention in the Veterans Affairs are overweight or obese. Rates of guideline-indicated medication prescription were cardiovascular conditions. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. Linear programming to build food-based dietary guidelines: Romanian food baskets

    DEFF Research Database (Denmark)

    Parlesak, Alexandr; Robertson, Aileen; Hondru, Gabriela

    basket that incorporates only WHO food-based dietary guidelines does not meet all the recommended nutrient intake values for, for example, vitamins A, D, K, iodine and calcium. • The version of a Romanian fully nutritious, health-promoting food basket for a family (two adults, two children) costs 19......, potatoes and fish and considerably less meat, fats, oils and sugar. In conclusion, the linear programming methodology can facilitate the development of national dietary recommendations that meet both recommended nutrient intake values and WHO food-based dietary guidelines in a cost-efficient manner. How...

  3. Effective teaching strategies and methods of delivery for patient education: a systematic review and practice guideline recommendations.

    Science.gov (United States)

    Friedman, Audrey Jusko; Cosby, Roxanne; Boyko, Susan; Hatton-Bauer, Jane; Turnbull, Gale

    2011-03-01

    The objective of this study was to determine effective teaching strategies and methods of delivery for patient education (PE). A systematic review was conducted and reviews with or without meta-analyses, which examined teaching strategies and methods of delivery for PE, were included. Teaching strategies identified are traditional lectures, discussions, simulated games, computer technology, written material, audiovisual sources, verbal recall, demonstration, and role playing. Methods of delivery focused on how to deliver the teaching strategies. Teaching strategies that increased knowledge, decreased anxiety, and increased satisfaction included computer technology, audio and videotapes, written materials, and demonstrations. Various teaching strategies used in combination were similarly successful. Moreover, structured-, culturally appropriate- and patient-specific teachings were found to be better than ad hoc teaching or generalized teaching. Findings provide guidance for establishing provincial standards for the delivery of PE. Recommendations concerning the efficacy of the teaching strategies and delivery methods are provided.

  4. Abdominal organ donation: surgical aspects and recommended practice guidelines for controlled donation of brain-dead donor.

    Science.gov (United States)

    Matevossian, E; Kordzaia, D; Chkhaidze, Z; Khodeli, N; Partsakashvili, J; Khachiperadze, Z; Doll, D; Lobzhanidze, G

    2015-02-01

    The shortage of organ donors along with the increased number of waiting recipients have created the need for new strategies to expand the organ pool from donations after brain death. Organ procurement from brain-dead deceased donors is a complex task. Multiple, complicated operations are performed simultaneously. Very often, this involves numerous physicians and transplant coordinators. An extensive coordination between the thoracic and abdominal surgical teams is crucial for the successful procurement of all suitable organs. The quality of donor organs and the successful recovery therefore depends on a good communication. Organ procurement for transplantation should generally be performed in a calm and dignified atmosphere. The last wishes of the organ donor itself or the relatives must be respected unconditionally. In general, a dignified and respectful treatment of the organ donor is a condition sine qua non for each person involved in the process of organ procurement. The purpose of this article was to focus on the surgical aspects of organ donation after brain death. The proposed recommendations, in cases where they are applicable, are acceptable, however, one should never forget the importance of the ethical side of the issue with respect to the doctor-donating side relationship.

  5. Overweight, elevated blood pressure, acanthosis nigricans and adherence to recommended dietary and physical activity guidelines among Hmong and white middle school students.

    Science.gov (United States)

    Voorhees, Julia; Goto, Keiko; Wolff, Cindy

    2014-04-01

    This cross-sectional study was conducted among low-income middle-school students (N = 426) in rural northern California to compare rates of overweight, elevated blood pressure and acanthosis nigricans (AN) between Hmong and white students. Associations among rates of overweight, elevated blood pressure, AN, and scores for adherence to recommended dietary guidelines were also examined. Fifty-two percent (52%) of white students were overweight/obese compared to 38% of Hmong students. Higher fruit consumption was associated with a lower BMI among white, but not Hmong students. Whereas 7% of white students were classified as pre-hypertensive/hypertensive, the rate for Hmong students was 17%. Additionally, at 13 versus 2%, six-fold more Hmong students had an elevated blood pressure with a normal BMI compared to white students, respectively. Ethnicity was also an independent predictive factor for AN. Hmong students appear to be at higher risk for both hypertension and AN than white students irrespective of BMI.

  6. Noise from high speed maglev systems: Noise sources, noise criteria, preliminary design guidelines for noise control, and recommendations for acoustical test facility for maglev research

    Science.gov (United States)

    Hanson, C. E.; Abbot, P.; Dyer, I.

    1993-01-01

    Noise levels from magnetically-levitated trains (maglev) at very high speed may be high enough to cause environmental noise impact in residential areas. Aeroacoustic sources dominate the sound at high speeds and guideway vibrations generate noticeable sound at low speed. In addition to high noise levels, the startle effect as a result of sudden onset of sound from a rapidly moving nearby maglev vehicle may lead to increased annoyance to neighbors of a maglev system. The report provides a base for determining the noise consequences and potential mitigation for a high speed maglev system in populated areas of the United States. Four areas are included in the study: (1) definition of noise sources; (2) development of noise criteria; (3) development of design guidelines; and (4) recommendations for a noise testing facility.

  7. Compliance with Australian stroke guideline recommendations for outdoor mobility and transport training by post-inpatient rehabilitation services: An observational cohort study.

    Science.gov (United States)

    McCluskey, Annie; Ada, Louise; Kelly, Patrick J; Middleton, Sandy; Goodall, Stephen; Grimshaw, Jeremy M; Logan, Pip; Longworth, Mark; Karageorge, Aspasia

    2015-07-29

    Community participation is often restricted after stroke, due to reduced confidence and outdoor mobility. Australian clinical guidelines recommend that specific evidence-based interventions be delivered to target these restrictions, such as multiple escorted outdoor journeys. The aim of this study was to describe post-inpatient outdoor mobility and transport training delivered to stroke survivors in New South Wales, Australia and whether therapy differed according to type, sector or location of service provider. Using an observational retrospective cohort study design, 24 rehabilitation service providers were audited. Provider types included outpatient (n = 8), day therapy (n = 9), home-based rehabilitation (n = 5) and transitional aged care services (TAC, n = 2). Records of 15 stroke survivors who had received post-hospital rehabilitation were audited per service, for wait time, duration, amount of therapy and outdoor-related therapy. A total of 311 records were audited. Median wait time for post-hospital therapy was 13 days (IQR, 5-35). Median duration of therapy was 68 days (IQR, 35-109), consisting of 11 sessions (IQR 4-19). Overall, a median of one session (IQR 0-3) was conducted outdoors per person. Outdoor-related therapy was similar across service providers, except that TAC delivered an average of 5.4 more outdoor-related sessions (95% CI 4.4 to 6.4), and 3.5 more outings into public streets (95% CI 2.8 to 4.3) per person, compared to outpatient services. The majority of service providers in the sample delivered little evidence-based outdoor mobility and travel training per stroke participant, as recommended in national stroke guidelines. Australian and New Zealand Clinical Trials Registry ACTRN12611000554965.

  8. Nutrients for the aging eye

    Directory of Open Access Journals (Sweden)

    Rasmussen HM

    2013-06-01

    Full Text Available Helen M Rasmussen,1 Elizabeth J Johnson2 1Educational Studies, Lesley University, Cambridge, MA, USA; 2Carotenoid and Health Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA Abstract: The incidence of age-related eye diseases is expected to rise with the aging of the population. Oxidation and inflammation are implicated in the etiology of these diseases. There is evidence that dietary antioxidants and anti-inflammatories may provide benefit in decreasing the risk of age-related eye disease. Nutrients of interest are vitamins C and E, β-carotene, zinc, lutein, zeaxanthin, and the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid. While a recent survey finds that among the baby boomers (45–65 years old, vision is the most important of the five senses, well over half of those surveyed were not aware of the important nutrients that play a key role in eye health. This is evident from a national survey that finds that intake of these key nutrients from dietary sources is below the recommendations or guidelines. Therefore, it is important to educate this population and to create an awareness of the nutrients and foods of particular interest in the prevention of age-related eye disease. Keywords: nutrition, aging, eye health

  9. Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework.

    Science.gov (United States)

    Bussières, André E; Patey, Andrea M; Francis, Jill J; Sales, Anne E; Grimshaw, Jeremy M; Brouwers, Melissa; Godin, Gaston; Hux, Jan; Johnston, Marie; Lemyre, Louise; Pomey, Marie-Pascale; Sales, Anne; Zwarenstein, Merrick

    2012-08-31

    The Theoretical Domains Framework (TDF) was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors' beliefs about managing uncomplicated back pain without x-rays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine x-rays. A secondary objective was to compare chiropractors in the United States and Canada on their beliefs regarding the use of spine x-rays. Six focus groups exploring beliefs about managing back pain without x-rays were conducted with a purposive sample. The interview guide was based upon the TDF. Focus groups were digitally recorded, transcribed verbatim, and analyzed by two independent assessors using thematic content analysis based on the TDF. Five domains were identified as likely relevant. Key beliefs within these domains included the following: conflicting comments about the potential consequences of not ordering x-rays (risk of missing a pathology, avoiding adverse treatment effects, risks of litigation, determining the treatment plan, and using x-ray-driven techniques contrasted with perceived benefits of minimizing patient radiation exposure and reducing costs; beliefs about consequences); beliefs regarding professional autonomy, professional credibility, lack of standardization, and agreement with guidelines widely varied ( social/professional role & identity); the influence of formal training, colleagues, and patients also appeared to be important factors ( social influences); conflicting comments regarding levels of confidence and comfort in managing patients without x-rays ( belief about capabilities); and

  10. Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

    Directory of Open Access Journals (Sweden)

    Bussières André E

    2012-08-01

    Full Text Available Abstract Background The Theoretical Domains Framework (TDF was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors’ beliefs about managing uncomplicated back pain without x-rays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine x-rays. A secondary objective was to compare chiropractors in the United States and Canada on their beliefs regarding the use of spine x-rays. Methods Six focus groups exploring beliefs about managing back pain without x-rays were conducted with a purposive sample. The interview guide was based upon the TDF. Focus groups were digitally recorded, transcribed verbatim, and analyzed by two independent assessors using thematic content analysis based on the TDF. Results Five domains were identified as likely relevant. Key beliefs within these domains included the following: conflicting comments about the potential consequences of not ordering x-rays (risk of missing a pathology, avoiding adverse treatment effects, risks of litigation, determining the treatment plan, and using x-ray-driven techniques contrasted with perceived benefits of minimizing patient radiation exposure and reducing costs; beliefs about consequences; beliefs regarding professional autonomy, professional credibility, lack of standardization, and agreement with guidelines widely varied ( social/professional role & identity; the influence of formal training, colleagues, and patients also appeared to be important factors ( social influences; conflicting comments regarding levels of confidence and comfort in managing patients

  11. Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

    Science.gov (United States)

    2012-01-01

    Background The Theoretical Domains Framework (TDF) was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors’ beliefs about managing uncomplicated back pain without x-rays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine x-rays. A secondary objective was to compare chiropractors in the United States and Canada on their beliefs regarding the use of spine x-rays. Methods Six focus groups exploring beliefs about managing back pain without x-rays were conducted with a purposive sample. The interview guide was based upon the TDF. Focus groups were digitally recorded, transcribed verbatim, and analyzed by two independent assessors using thematic content analysis based on the TDF. Results Five domains were identified as likely relevant. Key beliefs within these domains included the following: conflicting comments about the potential consequences of not ordering x-rays (risk of missing a pathology, avoiding adverse treatment effects, risks of litigation, determining the treatment plan, and using x-ray-driven techniques contrasted with perceived benefits of minimizing patient radiation exposure and reducing costs; beliefs about consequences); beliefs regarding professional autonomy, professional credibility, lack of standardization, and agreement with guidelines widely varied ( social/professional role & identity); the influence of formal training, colleagues, and patients also appeared to be important factors ( social influences); conflicting comments regarding levels of confidence and comfort in managing patients without x-rays ( belief

  12. Guideline-recommended therapy, including beta-blocker utilization, in patients with chronic heart failure: results from a Canadian community hospital heart function clinic

    Directory of Open Access Journals (Sweden)

    Heffernan M

    2016-06-01

    Full Text Available Michael Heffernan Division of Cardiology, Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada Abstract: A comprehensive analysis of beta-blocker utilization and other guideline-recommended therapies for the treatment of chronic heart failure in a Canadian community hospital heart function clinic has not been undertaken and was, therefore, the focus of this study. The proportion of patients who would be potential candidates for ivabridine and sacubitril–valsartan therapy as a result of fulfilling the criteria for enrollment in either the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT study (left-ventricular ejection fraction [LVEF] >35%, sinus rhythm, New York Heart Association II–IV or the Prospective Comparison of angiotensin receptor-neprilysin inhibitor (ARNI with angiotensin-converting enzyme inhibitor (ACEI to determine impact on global Mortality and Morbidity in Heart Failure (PARADIGM-HF study (LVEF <40%, New York Heart Association II–IV, glomerular filtration rate >30 mL/min, was also assessed. A retrospective cross-sectional analysis was carried out in all 371 patients treated in this community heart function clinic for at least a 12-month period. The patients were elderly (mean age 74±13.3 years and predominately male (61.5% with symptomatic (82.5% moderate left-ventricular dysfunction (LVEF 45.4%±15.6%. A substantial proportion of the patients also had a diagnosis of atrial fibrillation (52.8%. The total use of beta blockers exceeded 87%, while 100% of patients without a documented contraindication or intolerance to a beta blocker received therapy. Adherence to other guideline-recommended pharmacotherapies specifically for heart failure with reduced left ventricular ejection was high: 86.1% of the eligible patients were treated with an ACEI/angiotensin receptor blocker and 61.9% received a mineralcorticoid receptor antagonist. We determined that 13.7% of the complement of this heart

  13. 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.

  14. Risk management system in the natural gas distribution of Lima and Callao according guidelinesRecommendations on transmission and distribution practice” and risk management of the PMI Project (2008)

    OpenAIRE

    Luján Ruiz, Roger Orlando

    2014-01-01

    The purpose of this research study is to analyze quantitative operational risk according to the guidelines of the practice recommendationRecommendations on Transmission and Distribution Practice” , published by The Institution of Gas Engineers of Great Britain and the PMBOK . Chapter 11 , Managing Project Risk . This study was conducted in the Trunk pipeline system operated by Cálidda the Peru - Natural Gas from the City Gate located in Lurín , to Callao Terminal Station . The purpose of th...

  15. 2015 Revised Utstein-Style Recommended Guidelines for Uniform Reporting of Data From Drowning-Related Resuscitation : An ILCOR Advisory Statement

    NARCIS (Netherlands)

    Idris, Ahamed H; Bierens, Joost J L M; Perkins, Gavin D; Wenzel, Volker; Nadkarni, Vinay; Morley, Peter; Warner, David S; Topjian, Alexis; Venema, Allart M; Branche, Christine M; Szpilman, David; Morizot-Leite, Luiz; Nitta, Masahiko; Løfgren, Bo; Webber, Jonathon; Gräsner, Jan-Thorsten; Beerman, Stephen B; Youn, Chun Song; Jost, Ulrich; Quan, Linda; Dezfulian, Cameron; Handley, Anthony J; Hazinski, Mary Fran

    BACKGROUND: Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago.

  16. The European Federation of Organisations for Medical Physics Policy Statement No. 10.1: Recommended Guidelines on National Schemes for Continuing Professional Development of Medical Physicists.

    Science.gov (United States)

    Christofides, Stelios; Isidoro, Jorge; Pesznyak, Csilla; Cremers, Florian; Figueira, Rita; van Swol, Christiaan; Evans, Stephen; Torresin, Alberto

    2016-01-01

    Continuing Professional Development (CPD) is vital to the medical physics profession if it is to embrace the pace of change occurring in medical practice. As CPD is the planned acquisition of knowledge, experience and skills required for professional practice throughout one's working life it promotes excellence and protects the profession and public against incompetence. Furthermore, CPD is a recommended prerequisite of registration schemes (Caruana et al. 2014) and is implied in the Council Directive 2013/59/EURATOM (EU BSS) and the International Basic Safety Standards (BSS). It is to be noted that currently not all national registration schemes require CPD to maintain the registration status necessary to practise medical physics. Such schemes should consider adopting CPD as a prerequisite for renewing registration after a set period of time. This EFOMP Policy Statement, which is an amalgamation and an update of the EFOMP Policy Statements No. 8 and No. 10, presents guidelines for the establishment of national schemes for CPD and activities that should be considered for CPD. Copyright © 2016. Published by Elsevier Ltd.

  17. Vitamin B12 status in women of childbearing age in the UK and its relationship with national nutrient intake guidelines: results from two National Diet and Nutrition Surveys

    Science.gov (United States)

    Adaikalakoteswari, Antonysunil; Venkataraman, Hema; Maheswaran, Hendramoorthy; Saravanan, Ponnusamy

    2016-01-01

    Objective To assess serum B12, folate and the associated homocysteine (Hcy) levels among women of childbearing age in the UK and examine their association with dietary intake in relation to the UK Recommended Nutrient Intakes (RNIs) for B12 and folate. Design Cross-sectional study. Setting Data from two publicly available National Diet and Nutrition Surveys (NDNS 2000/2001 and 2008/2012) were used. These were population-based surveys of randomly selected samples of adults which were carried out in their households. Participants Women of childbearing age (aged 19–39 years), representative of the UK population. Those who were pregnant or breastfeeding were excluded. Outcome measures The associations between micronutrient intakes and blood levels of B12, folate and Hcy were assessed by correlation and stepwise linear regression. B12 intake was divided into quintiles and plotted against blood B12 and Hcy concentrations to determine the threshold of any associations. Results 299 women from the first NDNS cohort had complete intake and biomarker data. The prevalence of serum vitamin B12 (≤150 pmol/L) and serum folate (≤10 nmol/L) deficiency and hyperhomocysteinemia (≥12 µmol/L) was 12.4%, 6.4% and 21.2%, respectively, despite seemingly adequate B12 intakes (median 3.8 μg/day, 96% consumed more than the UK RNI of 1.5 μg/day). B12 concentrations increased across all quintiles of intake with serum levels in quintiles 4 and 5 (median intake 4.9 and 7.1 μg/day, respectively) significantly higher than quintile 1. However, Hcy concentrations levelled off between quintiles 4 and 5. Comparison of micronutrient intake between the two surveys found that folate intake has reduced in the more recent cohort. Conclusions The UK RNI for B12 intake should be increased for women of childbearing age with intakes of around 5–7 μg/day likely to be associated with stable biomarker levels. B12 levels should also be measured in women preconceptionally or in early

  18. Prescription of Guideline-Recommended Implantable Cardioverter Defibrillator and Cardiac Resynchronization Therapy Among Patients Hospitalized With Heart Failure and Varying Degrees of Renal Function.

    Science.gov (United States)

    Pun, Patrick H; Sheng, Shubin; Sanders, Gillian; DeVore, Adam D; Friedman, Daniel; Fonarow, Gregg C; Heidenreich, Paul A; Yancy, Clyde W; Hernandez, Adrian F; Al-Khatib, Sana M

    2017-03-15

    Implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) reduce mortality in many patients with heart failure (HF), but the current use and effectiveness of ICD/CRT in patients with chronic kidney disease (CKD) are uncertain. We examined associations between kidney function and guideline-recommended prescription of ICD/CRT in the Get With The Guidelines-Heart Failure registry, a performance improvement program for hospitalized patients with HF. We compared differences in ICD and CRT prescription between the following categories of estimated glomerular filtration rate (eGFR; mL/min/1.73 m 2 ): ≥60, 59 to 30, <30, and dialysis dependent. From 2008 through 2014, 26,286 patients were eligible for ICD or CRT, and 16,123(61%) had an eGFR <60. De novo ICD and CRT prescription in this group was low at 45% and 30.5%, respectively. Compared to patients with eGFR ≥60, patients with eGFR 30 to 59 were more likely to receive an ICD (adjusted odds ratio [aOR] 1.08, 95% confidence intervals [CI] 1.01 to 1.14), whereas dialysis patients were less likely (aOR 0.61, 95% CI 0.5 to 0.76). Worse kidney function was associated with a decreased likelihood of CRT prescription (aOR 0.97 per 10 ml/min eGFR decrease, p = 0.03). During the study period, the likelihood of both ICD and CRT prescription increased over time among patients with CKD (ICD aOR 1.12, 95% CI 1.07 to 1.18; CRT aOR 1.14, 95% CI 1.06 to 1.23, per year). Prescription of an ICT/CRT was associated with greater 1-year survival in all eGFR groups. In conclusion, there are significant CKD-based differences in prescription of ICD and CRT in HF. However, given the current state of evidence, it is unclear whether improved prescription of ICD and CRT in the CKD population will result in improvement in outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Nurse-coordinated collaborative disease management improves the quality of guideline-recommended heart failure therapy, patient-reported outcomes, and left ventricular remodelling.

    Science.gov (United States)

    Güder, Gülmisal; Störk, Stefan; Gelbrich, Goetz; Brenner, Susanne; Deubner, Nikolas; Morbach, Caroline; Wallenborn, Julia; Berliner, Dominik; Ertl, Georg; Angermann, Christiane E

    2015-04-01

    Heart failure (HF) pharmacotherapy is often not prescribed according to guidelines. This longitudinal study investigated prescription rates and dosages of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), beta-blockers, and mineralocorticoid receptor antagonists (MRA), and concomitant changes of symptoms, echocardiographic parameters of left ventricular (LV) function and morphology and results of the Short Form-36 (SF-36) Health Survey in participants of the Interdisciplinary Network Heart Failure (INH) programme. The INH study evaluated a nurse-coordinated management, HeartNetCare-HF(TM) (HNC), against Usual Care (UC) in patients hospitalized for decompensated HF [LV ejection fraction (LVEF) ≤40% before discharge). A total of 706 subjects surviving >18 months (363 UC, 343 HNC) were examined 6-monthly. At baseline, 92% received ACEi/ARB, (HNC/UC 91/93%, P = 0.28), 86% received beta-blockers (86/86%, P = 0.83), and 44% received MRA (42/47%, P = 0.07). After 18 months, beta-blocker use had increased only in HNC (+7.6%, P < 0.001). Guideline-recommended target doses were achieved more frequently in HNC for ACEi/ARB (HNC/UC: 50/25%, P < 0.001) and beta-blockers (39/15%, P < 0.001). The following variables were more improved and/or better in subjects undergoing HNC compared with UC: LVEF (47 ± 12 vs. 44 ± 12%, P = 0.004, change +17/+14%, P = 0.010), LV end-diastolic diameter (59 ± 9 vs. 61 ± 9.6 mm, P = 0.024, change -2.3/-1.4 mm, P = 0.13), New York Heart Association class (1.9 ± 0.7 vs. 2.1 ± 0.7, P = 0.001, change -0.44/-0.25, P = 0.002) and SF-36 physical component summary score (41.6 ± 11.2 vs. 38.5 ± 11.8, P = 0.004, change +3.3 vs. +1.1 score points, P < 0.02). Prescription rates and dosages of ACEi/ARB and beta-blockers improved more in HNC than UC patients. Concomitantly, participation in HNC was associated with significantly better clinical outcomes and more favourable echocardiographic changes after 18 months.

  20. Practice Paper of the Academy of Nutrition and Dietetics: Selecting Nutrient-Dense Foods for Good Health.

    Science.gov (United States)

    Hingle, Melanie D; Kandiah, Jayanthi; Maggi, Annette

    2016-09-01

    The 2015 Dietary Guidelines for Americans encourage selection of nutrient-dense foods for health promotion and disease prevention and management. The purpose of this Academy of Nutrition and Dietetics practice paper is to provide an update regarding the science and practice of nutrient-dense food identification and selection. Characterization of tools used to identify nutrient density of foods is provided and recommendations for how registered dietitian nutritionists and nutrition and dietetics technicians, registered, might use available profiling tools to help consumers select nutrient-dense foods is discussed. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  1. Awareness of the Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2000) and compliance to its recommendations: surveys in 2000 and 2004.

    Science.gov (United States)

    Ikeda, N; Hasegawa, T; Hasegawa, T; Saito, I; Saruta, T

    2006-04-01

    Clinic physicians' awareness of the Japanese hypertension guideline (JSH 2000) and compliance with its recommendations were assessed to derive policy implications for effective blood pressure control. Data were obtained from two postal questionnaire surveys conducted in 2000 and 2004, and subjects were 896 and 1425 clinic physicians, respectively, who were engaged in general internal medicine. Recognition rates of JSH 2000 were 63.1% (n = 822) before its announcement in 2000 and 94.4% (n = 1400) in 2004. Rates of access, familiarity and utilisation of JSH 2000 were 87.0, 81.6 and 68.9%, respectively (n = 1400) in 2004. As for major management strategies for low-risk hypertension: in 2000, for patients with 140-149/90-94 mmHg, 81.5% of 812 respondents performed lifestyle modification, and 11.2% prescribed medicines, whereas for patients with 150-159/95-99 mmHg, 71.7% of 807 respondents prescribed medicines, and 24.3% conducted lifestyle modification; in 2004, 90.0% of 1384 respondents conducted lifestyle modification, 22.6% prescribed medicines, 2.5% referred patients to other facilities, and 6.4% did nothing. In 2004, 68.9% of 1388 respondents agreed with the new definition of hypertension, whereas 17.1% preferred 160/95 mmHg. Respondents' age (Phypertensives in daily patient load (Phypertension management. One of the strategies for further enhancement in their compliance with JSH 2004 would be its dissemination to those who are old and/or do not see hypertensive patients so frequently.

  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...... to food and eating and the emergence of proposals for integrated guidelines. It explores the conflicts and controversies that have arisen in the wake of the various proposals and identifies a number of different types of conflicts. These relate to conflicts of interests between the various actors involved...

  3. Role of Nutritional Supplements Complementing Nutrient-Dense Diets: General Versus Sport/Exercise-Specific Dietary Guidelines Related to Energy Expenditure

    Science.gov (United States)

    Kleiner, Susan; Greenwood, Mike

    A nutrient-dense diet is a critical aspect in attaining optimal exercise training and athletic performance outcomes. Although including safe and effective nutritional supplements in the dietary design can be extremely helpful in promoting adequate caloric ingestion, they are not sufficient for promoting adequate caloric ingestion based on individualized caloric expenditure needs without the proper diet. Specifically, a strategic and scientifically based nutrient-dense dietary profile should be created by qualified professionals to meet the sport/exercise-specific energy demands of any individual involved in select training intensity protocols. Finally, ingesting the right quantity and quality of nutrient dense calories at precise windows of opportunity becomes vital in attaining desired training and/or competitive performance outcomes.

  4. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression.

    Science.gov (United States)

    Fehlings, Michael G; Tetreault, Lindsay A; Riew, K Daniel; Middleton, James W; Aarabi, Bizhan; Arnold, Paul M; Brodke, Darrel S; Burns, Anthony S; Carette, Simon; Chen, Robert; Chiba, Kazuhiro; Dettori, Joseph R; Furlan, Julio C; Harrop, James S; Holly, Langston T; Kalsi-Ryan, Sukhvinder; Kotter, Mark; Kwon, Brian K; Martin, Allan R; Milligan, James; Nakashima, Hiroaki; Nagoshi, Narihito; Rhee, John; Singh, Anoushka; Skelly, Andrea C; Sodhi, Sumeet; Wilson, Jefferson R; Yee, Albert; Wang, Jeffrey C

    2017-09-01

    Guideline development. The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM). Our recommendations were as follows: (1) "We recommend surgical intervention for patients with moderate and severe DCM." (2) "We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve." (3) "We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically." (4) "Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of

  5. Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis. Vol. 47/No. RR-7

    National Research Council Canada - National Science Library

    Chiarello, Linda

    1998-01-01

    ...); it includes recommendations for HlV post exposure prophylaxis (PEP) and discusses the scientific rationale for PEP The decision to recommend HIV postexposure prophylaxis must take into account the nature of the exposure (ag...

  6. Olmesartan vs ramipril in the treatment of hypertension and associated clinical conditions in the elderly: a reanalysis of two large double-blind, randomized studies at the light of the most recent blood pressure targets recommended by guidelines.

    Science.gov (United States)

    Omboni, Stefano; Malacco, Ettore; Mallion, Jean-Michel; Volpe, Massimo

    2015-01-01

    In this paper, we present the results of a reanalysis of the data of two large randomized, double-blind, parallel group studies with a similar design, comparing the efficacy of an angiotensin-receptor blocker (olmesartan medoxomil) with that of an angiotensin-converting enzyme inhibitor (ramipril), by applying two different blood pressure targets recently recommended by hypertension guidelines for all patients, irrespective of the presence of diabetes (elderly hypertensive patients (elderly hypertensives even when new blood pressure targets for antihypertensive treatment are considered. Such results may be relevant for the clinical practice, providing some hint on the possible different response of elderly hypertensive patients to two different drugs acting on the renin-angiotensin system, when patients are targeted according to the blood pressure levels recommended by recent hypertension guidelines.

  7. Does enrollment in multidisciplinary team-based primary care practice improve adherence to guideline-recommended processes of care? Quebec's Family Medicine Groups, 2002-2010.

    Science.gov (United States)

    Diop, Mamadou; Fiset-Laniel, Julie; Provost, Sylvie; Tousignant, Pierre; Borgès Da Silva, Roxane; Ouimet, Marie-Jo; Latimer, Eric; Strumpf, Erin

    2017-04-01

    We investigated whether multidisciplinary team-based primary care practice improves adherence to process of care guidelines, in the absence of financial incentives related to pay-for-performance. We conducted a natural experiment including 135,119 patients, enrolled with a general practitioner (GP) in a multidisciplinary team Family Medicine Group (FMG) or non-FMG practice, using longitudinal data from Quebec's universal insurer over the relevant time period (2000-2010). All study subjects had diabetes, chronic obstructive pulmonary disease, or heart failure and were followed over a 7-year period, 2 years prior to enrollment and 5 years after. We constructed indicators on adherence to disease-specific guidelines and composite indicators across conditions. We evaluated the effect of FMGs using propensity score methods and Difference-in-Differences (DD) models. Rates of adherence to chronic disease guidelines increased for both FMG and non-FMG patients after enrollment, but not differentially so. Adherence to prescription-related guidelines improved less for FMG patients (DD [95% CI]=-2.83% [-4.08%, -1.58%]). We found no evidence of an FMG effect on adherence to consultation-related guidelines, (DD [95% CI]=-0.24% [-2.24%; 1.75%]). We found no evidence that FMGs increased adherence to the guidelines we evaluated. Future research is needed to assess why this reform did not improve performance on these quality-of-care indicators. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Healthcare system-wide implementation of opioid-safety guideline recommendations: the case of urine drug screening and opioid-patient suicide- and overdose-related events in the Veterans Health Administration.

    Science.gov (United States)

    Brennan, Penny L; Del Re, Aaron C; Henderson, Patricia T; Trafton, Jodie A

    2016-12-01

    This study provides an example of how healthcare system-wide progress in implementation of opioid-therapy guideline recommendations can be longitudinally assessed and then related to subsequent opioid-prescribed patient health and safety outcomes. Using longitudinal linear mixed effects analyses, we determined that in the Department of Veterans Affairs (VA) healthcare system (n = 141 facilities), over the 4-year interval from 2010 to 2013, a key opioid therapy guideline recommendation, urine drug screening (UDS), increased from 29 to 42 %, with an average within-facility increase rate of 4.5 % per year. Higher levels of UDS implementation from 2010 to 2013 were associated with lower risk of suicide and drug overdose events among VA opioid-prescribed patients in 2013, even after adjusting for patients' 2012 demographic characteristics and medical and mental health comorbidities. Findings suggest that VA clinicians and healthcare policymakers have been responsive to the 2010 VA/Department of Defense (DOD) UDS treatment guideline recommendation, resulting in improved patient safety for VA opioid-prescribed patients.

  9. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.

    Science.gov (United States)

    Kaplan, Jonathan E; Benson, Constance; Holmes, King K; Brooks, John T; Pau, Alice; Masur, Henry

    2009-04-10

    This report updates and combines earlier versions of guidelines for the prevention and treatment of opportunistic infections (OIs) in HIV-infected adults (i.e., persons aged >/=18 years) and adolescents (i.e., persons aged 13--17 years), last published in 2002 and 2004, respectively. It has been prepared by the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by clinicians and other health-care providers, HIV-infected patients, and policy makers in the United States. These guidelines address several OIs that occur in the United States and five OIs that might be acquired during international travel. Topic areas covered for each OI include epidemiology, clinical manifestations, diagnosis, prevention of exposure; prevention of disease by chemoprophylaxis and vaccination; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; discontinuation of secondary prophylaxis after immune reconstitution; and special considerations during pregnancy. These guidelines were developed by a panel of specialists from the United States government and academic institutions. For each OI, a small group of specialists with content-matter expertise reviewed the literature for new information since the guidelines were last published; they then proposed revised recommendations at a meeting held at NIH in June 2007. After these presentations and discussion, the revised guidelines were further reviewed by the co-editors; by the Office of AIDS Research, NIH; by specialists at CDC; and by HIVMA of IDSA before final approval and publication. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of

  10. Methodology for developing evidence-based clinical imaging guidelines: Joint recommendations by Korea society of radiology and national evidence-based healthcare collaborating agency

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sol Ji; Jo, Ae Jeong; Choi, Jin A [Div. for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul (Korea, Republic of); and others

    2017-01-15

    This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure.

  11. 2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement.

    Science.gov (United States)

    Idris, Ahamed H; Bierens, Joost J L M; Perkins, Gavin D; Wenzel, Volker; Nadkarni, Vinay; Morley, Peter; Warner, David S; Topjian, Alexis; Venema, Allart M; Branche, Christine M; Szpilman, David; Morizot-Leite, Luiz; Nitta, Masahiko; Løfgren, Bo; Webber, Jonathon; Gräsner, Jan-Thorsten; Beerman, Stephen B; Youn, Chun Song; Jost, Ulrich; Quan, Linda; Dezfulian, Cameron; Handley, Anthony J; Hazinski, Mary Fran

    2017-09-01

    Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations. Copyright © 2017 European Resuscitation Council, American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

  12. Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

    Science.gov (United States)

    Fawaz, Rima; Baumann, Ulrich; Ekong, Udeme; Fischler, Björn; Hadzic, Nedim; Mack, Cara L; McLin, Valérie A; Molleston, Jean P; Neimark, Ezequiel; Ng, Vicky L; Karpen, Saul J

    2017-01-01

    Cholestatic jaundice in infancy affects approximately 1 in every 2500 term infants and is infrequently recognized by primary providers in the setting of physiologic jaundice. Cholestatic jaundice is always pathologic and indicates hepatobiliary dysfunction. Early detection by the primary care physician and timely referrals to the pediatric gastroenterologist/hepatologist are important contributors to optimal treatment and prognosis. The most common causes of cholestatic jaundice in the first months of life are biliary atresia (25%-40%) followed by an expanding list of monogenic disorders (25%), along with many unknown or multifactorial (eg, parenteral nutrition-related) causes, each of which may have time-sensitive and distinct treatment plans. Thus, these guidelines can have an essential role for the evaluation of neonatal cholestasis to optimize care. The recommendations from this clinical practice guideline are based upon review and analysis of published literature and the combined experience of the authors. The committee recommends that any infant noted to be jaundiced after 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin, and that an elevated serum direct bilirubin level (direct bilirubin levels >1.0 mg/dL or >17 μmol/L) warrants timely consideration for evaluation and referral to a pediatric gastroenterologist or hepatologist. Of note, current differential diagnostic plans now incorporate consideration of modern broad-based next-generation DNA sequencing technologies in the proper clinical context. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all infants with cholestasis. Broad implementation of these recommendations is expected to reduce the time to the diagnosis of pediatric liver diseases, including biliary atresia, leading to improved outcomes.

  13. 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,…

  14. Dietary recommendations: comparing dietary guidelines from Brazil and the United States Recomendações dietéticas: comparação entre os guias alimentares brasileiro e americano

    Directory of Open Access Journals (Sweden)

    Rosely Sichieri

    2010-11-01

    Full Text Available The Brazilian dietary guidelines are based in part on mainstream United States' recommendations, in spite of the criticisms and shortcomings of the American guidelines. In this paper, Brazilian food guidelines are summarized and discussed in comparison with the USA recommendations. American and Brazilian dietary recommendations are quite similar in many aspects, particularly those related to variety in the diet, the importance of physical activity and weight management. Different to American guidelines, those from Brazil advise people to choose fresh foods, to prefer healthier types of fat, to limit trans fat intake and to eat good sources of protein, but does not recommend the consumption of whole grains. Besides the challenges related to their implementation, indicators for the evaluation of the effectiveness of these guidelines should be established from the beginning, particularly those related to changes in dietary habits and the prevalence of obesity.O guia alimentar brasileiro é baseado parcialmente nas recomendações americanas a despeito das críticas e problemas identificados no documento dos Estados Unidos. Neste artigo, as recomendações alimentares para o Brasil são resumidas e discutidas em comparação com as recomendações estadunidenses. Os guias alimentares brasileiro e americano são bastante similares em diversos aspectos, particularmente aqueles relacionados com a variação da dieta, a importância da atividade física e o gerenciamento do peso. Diferentemente dos Estados Unidos, o guia brasileiro estimula o consumo de alimentos frescos, aconselha o uso de fontes saudáveis de gorduras, a limitação do consumo de gordura trans, o consumo de boas fontes de proteínas, mas não indica o consumo de grãos integrais. Além dos desafios relacionados com a sua implantação, os indicadores para a avaliação da eficácia dos guias alimentares devem ser estabelecidos desde sua implantação, particularmente, os relacionados

  15. Several grain dietary patterns are associated with better diet quality and improved shortfall nutrient intakes in US children and adolescents: a study focusing on the 2015-2020 Dietary Guidelines for Americans.

    Science.gov (United States)

    Papanikolaou, Yanni; Jones, Julie Miller; Fulgoni, Victor L

    2017-02-20

    The present study identified the most commonly consumed grain food patterns in US children and adolescents (2-18 years-old; N = 8,367) relative to those not consuming grains and compared diet quality and nutrient intakes, with focus on 2015-2020 Dietary Guidelines for Americans (2015-2020 DGA) shortfall nutrients. Cluster analysis using data from the National Health and Nutrition Examination Survey 2005-2010, identified 8 unique grain food patterns: a) no consumption of main grain groups, b) cakes, cookies and pies, c) yeast bread and rolls, d) cereals, e) pasta, cooked cereals and rice, f) crackers and salty snacks, g) pancakes, waffles and French toast and other grains, and h) quick breads. Energy intake was higher for all grain cluster patterns examined, except 'cereals', compared to no grains. Children and adolescents in the 'yeast bread and rolls', 'cereals', 'pasta, cooked cereals and rice', and 'crackers and salty snacks' patterns had a higher diet quality relative to no grains (all p dietary fiber intake was greater in five of the seven grain patterns, ranging from 1.8 - 2.8 g more per day (all p patterns, except cakes, cookies and pies had higher EA daily folate relative to children in the no grains pattern (all p pattern (all p patterns relative to no grains (all p patterns in children and adolescents were associated with improved 2015-2020 DGA shortfall nutrient intakes and diet quality as compared to those consuming no grains.

  16. Preliminary guidelines and recommendations for the development of material and process specifications for carbon fiber-reinforced liquid resin molded materials.

    Science.gov (United States)

    2007-05-01

    This document recommends guidance and criteria for the development of material and process specifications and material acceptance documents for liquid resins and continuous carbon fiber reinforcement materials used in liquid molding processes to manu...

  17. Population compliance with national dietary recommendations and its determinants: findings from the ORISCAV-LUX study.

    Science.gov (United States)

    Alkerwi, Ala'a; Sauvageot, Nicolas; Nau, Anne; Lair, Marie-Lise; Donneau, Anne-Françoise; Albert, Adelin; Guillaume, Michèle

    2012-12-14

    The objective of the present study was to determine the proportion of adults meeting national recommendations for food and nutrient intake and to identify the demographic, socio-economic and behavioural factors that may contribute to weaken dietary compliance. ORISCAV-LUX is a cross-sectional study that took place in Luxembourg (2007-8). A representative stratified random sample of 1352 adults aged 18-69 years participated in the nationwide cardiovascular health survey. A FFQ was used to estimate food intake. Radar charts were built to compare graphically the compliance of the participants with different key dietary guidelines on the same set of axes. The thirteen food- and nutrient-based recommendations were scored and summed to create a recommendation compliance index (range -0·5 to 14). Ordinal logistic regression analyses were performed to determine the factors contributing to poor dietary compliance. Several food- and nutrient-based guidelines were insufficiently respected compared with others. The greatest gaps occurred in the adherence to grain and dairy product consumption guidelines, as well as to total fat and notably to SFA recommendations. Age, country of birth, economic status, smoking status and subject's awareness of the importance of balanced meals emerged as independently associated with weak dietary compliance. Obese subjects conformed more to dietary recommendations compared with normal-weight subjects. The findings underscore the need for specific nutrition education messages along with targeted interventions. Efforts should be continued to increase population awareness of the importance of a healthy lifestyle and a balanced diet.

  18. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

    Science.gov (United States)

    Rosen, Rachel; Vandenplas, Yvan; Singendonk, Maartje; Cabana, Michael; DiLorenzo, Carlo; Gottrand, Frederic; Gupta, Sandeep; Langendam, Miranda; Staiano, Annamaria; Thapar, Nikhil; Tipnis, Neelesh; Tabbers, Merit

    2018-03-01

    This document serves as an update of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) 2009 clinical guidelines for the diagnosis and management of gastroesophageal reflux disease (GERD) in infants and children and is intended to be applied in daily practice and as a basis for clinical trials. Eight clinical questions addressing diagnostic, therapeutic and prognostic topics were formulated. A systematic literature search was performed from October 1, 2008 (if the question was addressed by 2009 guidelines) or from inception to June 1, 2015 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Clinical Trials. The approach of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to define and prioritize outcomes. For therapeutic questions, the quality of evidence was also assessed using GRADE. Grading the quality of evidence for other questions was performed according to the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) and Quality in Prognostic Studies (QUIPS) tools. During a 3-day consensus meeting, all recommendations were discussed and finalized. In cases where no randomized controlled trials (RCT; therapeutic questions) or diagnostic accuracy studies were available to support the recommendations, expert opinion was used. The group members voted on each recommendation, using the nominal voting technique. With this approach, recommendations regarding evaluation and management of infants and children with GERD to standardize and improve quality of care were formulated. Additionally, 2 algorithms were developed, 1 for infants <12 months of age and the other for older infants and children.

  19. a food-based dietary guideline for South Africa

    African Journals Online (AJOL)

    2013-04-11

    Apr 11, 2013 ... Table V: Nutrient-based dietary guidelines for the intake of fat (calculated for an 8 400 kJ diet) and food-based dietary guidelines to meet nutrient goals. Nutrient. Guideline. Fat (g). Examples of food source. Total fat (% energy). < 30. 68. All foods containing fat in their natural form, processed fat-containing.

  20. Balancing the benefits and harms of thyroid cancer surveillance in survivors of Childhood, adolescent and young adult cancer: Recommendations from the international Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium.

    Science.gov (United States)

    Clement, S C; Kremer, L C M; Verburg, F A; Simmons, J H; Goldfarb, M; Peeters, R P; Alexander, E K; Bardi, E; Brignardello, E; Constine, L S; Dinauer, C A; Drozd, V M; Felicetti, F; Frey, E; Heinzel, A; van den Heuvel-Eibrink, M M; Huang, S A; Links, T P; Lorenz, K; Mulder, R L; Neggers, S J; Nieveen van Dijkum, E J M; Oeffinger, K C; van Rijn, R R; Rivkees, S A; Ronckers, C M; Schneider, A B; Skinner, R; Wasserman, J D; Wynn, T; Hudson, M M; Nathan, P C; van Santen, H M

    2018-02-01

    Radiation exposure to the thyroid gland during treatment of childhood, adolescent and young adult cancer (CAYAC) may cause differentiated thyroid cancer (DTC). Surveillance recommendations for DTC vary considerably, causing uncertainty about optimum screening practices. The International Late Effects of Childhood Cancer Guideline Harmonization Group, in collaboration with the PanCareSurFup Consortium, developed consensus recommendations for thyroid cancer surveillance in CAYAC survivors. These recommendations were developed by an international multidisciplinary panel that included 33 experts in relevant medical specialties who used a consistent and transparent process. Recommendations were graded according to the strength of underlying evidence and potential benefit gained by early detection and appropriate management. Of the two available surveillance strategies, thyroid ultrasound and neck palpation, neither was shown to be superior. Consequently, a decision aid was formulated to guide the health care provider in counseling the survivor. The recommendations highlight the need for shared decision making regarding whether to undergo surveillance for DTC and in the choice of surveillance modality. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Nutrient intake among US adults with disabilities.

    Science.gov (United States)

    An, R; Chiu, C Y; Zhang, Z; Burd, N A

    2015-10-01

    Physical, mental and financial barriers among persons with disabilities limit their access to healthier diet. The present study investigated the relationship between disabilities and nutrient intake among US adults. Data originated from National Health and Nutrition Examination Survey 2007-2008 and 2009-2010 waves (n = 11,811). Five disability categories include activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSAs), lower extremity mobility (LEM) and general physical activities (GPAs). Nutrient intakes from food and dietary supplements were calculated from 24-h dietary recalls. Adherence to dietary reference intakes and dietary guideline recommendations was compared between people with and without disabilities and across disability categories in the statistical analysis. GPAs, IADLs, LSAs, LEM and ADLs occupied 24.5%, 13.3%, 9.9%, 9.2% and 9.2% of US adults, respectively (not mutually exclusive). Only 42.3%, 11.3%, 63.8%, 47.7%, 48.7%, 9.7%, 48.7%, 90.7%, 21.7% and 4.7% of adults had saturated fat, fibre, cholesterol, vitamin A, vitamin C, vitamin D, calcium, iron, sodium and potassium intakes from food within recommended levels, respectively. Dietary supplement use moderately improved vitamin C, vitamin D and calcium intakes. People with disabilities were less likely to meet recommended levels on saturated fat, fibre (except GPAs), vitamin A (except GPAs), vitamin C (except GPAs), calcium and potassium intakes than persons without disability. Nutrient intake differed across disability categories, with ADLs least likely to meet recommended intakes. Interventions targeting persons with disabilities through nutrition education and financial assistance are warranted to promote healthy diet and reduce disparities. © 2014 The British Dietetic Association Ltd.

  2. Alignment of Children's Food Advertising With Proposed Federal Guidelines.

    Science.gov (United States)

    Hingle, Melanie D; Castonguay, Jessica S; Ambuel, Danielle A; Smith, Rachel M; Kunkel, Dale

    2015-06-01

    It is well established that children are exposed to food marketing promoting calorically dense, low-nutrient products. Reducing exposure to obesogenic marketing presents an opportunity to improve children's health. The purpose of this study was to determine the extent to which televised food advertising practices targeting children (aged ≤12 years) were consistent with guidelines proposed by a coalition of federal authorities known as the Interagency Working Group on Foods Marketed to Children (IWG). A sample of children's TV programming aired on five national broadcast networks and two cable channels (N=103 shows) was recorded February to April 2013. The sample contained 354 food ads. Advertised products were identified and categorized using industry classification codes and nutrient data obtained from manufacturers. Product compliance with IWG saturated fat, trans fat, added sugar, and sodium guidelines was evaluated. Analyses conducted in 2013 revealed that nearly all food ads (94%) met guidelines for trans fats; 68% and 62% met guidelines for sodium and saturated fat, respectively; and 20% complied with added sugar guidelines. Overall, 1.4% of all child-targeted food ads met all aspects of IWG guidelines. Nearly all food advertisements exceeded guidelines for at least one recommended nutrient to limit. Individually, conformity was high for guidelines for trans fats, moderate for sodium and saturated fats, and poor for added sugar. These findings suggest that child-targeted food advertising remains strongly biased toward less healthy options. Policymakers wishing to regulate food marketing should understand the amount and types of advertisements that children view. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  3. [Preventive bone mineral density measurement in postmenopausal women. Differentiation of treatment of recommendations Guidelines of the Umbrella Organization for Osteology ("Dachverband Osteologie")].

    Science.gov (United States)

    Piatek, S; Wex, T; Adolf, D; Klose, S; Westphal, S; Amthauer, H; Halangk, W; Jahn, O; Riebau, C; Winckler, S

    2013-07-01

    Osteopenia (OP) or osteoporosis (OST) was diagnosed by bone densitometry (DXA) in postmenopausal women free of known skeletal disorders and without acute fracture. DVO guidelines were applied to define therapeutic indication. The study included 94 women aged 59-81 years. Fracture or operation ≤12 months, malignant tumor, ovariectomy, and drugs such as cortisone, strontium, fluorides, bisphosphonates, SERMs, estrogens, and steroids were exclusion criteria. The lowest T-score at the spine, femoral neck, or total hip was decisive. The indication for therapy was determined by evaluating age, BMD, and other risk factors. Using the WHO criteria 22.3% (n=21) had normal BMD, 52.1% (n=49) had OP, and 25.6% (n=24) had OST. According to "Dachverband Osteologie" (DVO) guidelines, 28 women (29.8%) of the whole group needed therapy. Of the 28 women receiving therapy, 9 had OP and 19 had OST. Therapy was indicated in 18.4% for OP and 79.2% for OST. A preventive measurement of BMD with DXA provides a benefit for postmenopausal women. Combinatory assessment and consideration of other risk factors allows identification of women who might benefit from early treatment.

  4. Olmesartan vs ramipril in the treatment of hypertension and associated clinical conditions in the elderly: a reanalysis of two large double-blind, randomized studies at the light of the most recent blood pressure targets recommended by guidelines

    Science.gov (United States)

    Omboni, Stefano; Malacco, Ettore; Mallion, Jean-Michel; Volpe, Massimo

    2015-01-01

    In this paper, we present the results of a reanalysis of the data of two large randomized, double-blind, parallel group studies with a similar design, comparing the efficacy of an angiotensin-receptor blocker (olmesartan medoxomil) with that of an angiotensin-converting enzyme inhibitor (ramipril), by applying two different blood pressure targets recently recommended by hypertension guidelines for all patients, irrespective of the presence of diabetes (hypertensive patients (hypertension type, diabetes status or other concomitant clinical conditions, or cardiovascular risk factors. In most cases, olmesartan provided better blood pressure control than ramipril. Olmesartan was significantly more effective than ramipril in male patients, in younger patients (aged 65–69 years), in those with metabolic syndrome, obesity, dyslipidemia, preserved renal function, diastolic ± systolic hypertension, and, in general, in patients with a high or very high cardiovascular risk. Interestingly, patients previously untreated or treated with two or more antihypertensive drugs showed a significantly larger response with olmesartan than with ramipril. Thus, our results confirm the good efficacy of olmesartan in elderly hypertensives even when new blood pressure targets for antihypertensive treatment are considered. Such results may be relevant for the clinical practice, providing some hint on the possible different response of elderly hypertensive patients to two different drugs acting on the renin–angiotensin system, when patients are targeted according to the blood pressure levels recommended by recent hypertension guidelines. PMID:26491273

  5. The new hypertension guidelines.

    Science.gov (United States)

    Stern, Ralph H

    2013-10-01

    The Canadian Hypertension Education Program (CHEP) has published guidelines annually since 2000. The CHEP guidelines are a model of concise, comprehensive, up-to-date, evidence-rated guidelines for physicians who diagnose and treat hypertension. The guidelines address measurement of blood pressure and the definition of hypertension, secondary hypertension evaluation and treatment, and blood pressure targets and medication choices in patients with and without compelling indications. This review describes CHEP's process for developing guidelines and provides an overview of the 2013 recommendations. ©2013 Wiley Periodicals, Inc.

  6. 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.

  7. Dietary Guidelines for Chinese Residents (2016): comments and comparisons.

    Science.gov (United States)

    Wang, Shan-Shan; Lay, Sovichea; Yu, Hai-Ning; Shen, Sheng-Rong

    2016-09-01

    A high quality diet is believed to play a functional role in promoting the healthy growth of mankind and preventing many kinds of chronic degenerative diseases, including cancer, cardiovascular disease, diabetes, and obesity. Adherence to a high quality diet has been strongly associated with a lower risk of mortality. To help promote healthy lifestyles and physical strength, the Chinese government has produced a new revised version of the Dietary Guidelines for Chinese Residents (2016) and the Chinese Food Pagoda, as guidance for dietary intake among its population. Similarly, the Japanese government has produced the Japanese Food Guide Spinning Top Model, and the US government has recently published revised dietary recommendations in its 2015-2020 eighth edition of Dietary Guidelines for Americans. The evidence from all respective cohort studies involved in producing these guidelines shows a reduced risk of many chronic diseases and mortality if the guidelines are followed. All scientific findings support encouraging the general population to consume a broad variety of food on the basis of nutrient and food intakes in order to prevent deficiency diseases and a surplus of energy and nutrients, and recommend daily physical activity for health promotion.

  8. Best practice guidelines in the psychosocial management of HPV-related head and neck cancer: recommendations from the European Head and Neck Cancer Society's Make Sense Campaign.

    Science.gov (United States)

    Reich, M; Licitra, L; Vermorken, J B; Bernier, J; Parmar, S; Golusinski, W; Castellsagué, X; Leemans, C R

    2016-10-01

    Over the past three decades, oral human papillomavirus (HPV) has been associated with an increase in the incidence of oropharyngeal squamous cell carcinoma (OPSCC) in several countries. Specialist oncologists in head and neck cancer are observing a wider range of demographics, sexual behaviours, and survival outcomes with their patients. Additionally, there are fewer smokers, consumers of alcohol, or people of lower socioeconomic status than in previous decades. In order to support patients, the European Head and Neck Society's Make Sense Campaign aims to promote best practice in the management of head and neck cancer through the delivery of counselling, psychological assessment, support with the patient experience following HPV-related cancer diagnosis, sexual impact (in terms of communication, behaviour and prevention), facilitating access to educational resources about HPV in head and neck squamous cell carcinoma and OPSCC, and early referral if necessary. New concerns about psychosocial distress and unmet psychosocial needs following diagnosis, therefore, exist throughout the disease and treatment periods. Oncologists treating patients with HPV-related head and neck cancer must integrate new parameters focused on infection risk transmission and sexual topics. The development and dissemination of best practice guidelines through The European Head and Neck Cancer Society Make Sense Campaign will help healthcare professionals to be more confident and resourceful in supporting patients with HPV-related head and neck cancer. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  9. Guidelines for pre-clinical assessment of the acetylcholine receptor-specific passive transfer myasthenia gravis model - recommendations for methods and experimental designs

    Science.gov (United States)

    Kusner, Linda L.; Losen, Mario; Vincent, Angela; Lindstrom, Jon; Tzartos, Socrates; Lazaridis, Konstantinos; Martinez-Martinez, Pilar

    2015-01-01

    Antibodies against the muscle acetylcholine receptor (AChR) are the most common cause of myasthenia gravis (MG). Passive transfer of AChR antibodies from MG patients into animals reproduces key features of human disease, including antigenic modulation of the AChR, complement-mediated damage of the neuromuscular junction, and muscle weakness. Similarly, AChR antibodies generated by active immunization in experimental autoimmune MG models can subsequently be passively transferred to other animals and induce weakness. The passive transfer model is useful to test therapeutic strategies aimed at the effector mechanism of the autoantibodies. Here we summarize published and unpublished experience using the AChR passive transfer MG model in mice, rats and rhesus monkeys, and give recommendations for the design of preclinical studies in order to facilitate translation of positive and negative results to improve MG therapies. PMID:25743217

  10. [Technical recommendations and best practice guidelines for May-Grünwald-Giemsa staining: literature review and insights from the quality assurance].

    Science.gov (United States)

    Piaton, Eric; Fabre, Monique; Goubin-Versini, Isabelle; Bretz-Grenier, Marie-Françoise; Courtade-Saïdi, Monique; Vincent, Serge; Belleannée, Geneviève; Thivolet, Françoise; Boutonnat, Jean; Debaque, Hervé; Fleury-Feith, Jocelyne; Vielh, Philippe; Cochand-Priollet, Béatrix; Egelé, Caroline; Bellocq, Jean-Pierre; Michiels, Jean-François

    2015-08-01

    May-Grünwald-Giemsa (MGG) stain is a Romanowsky-type, polychromatic stain as those of Giemsa, Leishman and Wright. Apart being the reference method of haematology, it has become a routine stain of diagnostic cytopathology for the study of air-dried preparations (lymph node imprints, centrifuged body fluids and fine needle aspirations). In the context of their actions of promoting the principles of quality assurance in cytopathology, the French Association for Quality Assurance in Anatomic and Cytologic Pathology (AFAQAP) and the French Society of Clinical Cytology (SFCC) conducted a proficiency test on MGG stain in 2013. Results from the test, together with the review of literature data allow pre-analytical and analytical steps of MGG stain to be updated. Recommendations include rapid air-drying of cell preparations/imprints, fixation using either methanol or May-Grünwald alone for 3-10minutes, two-step staining: 50% May-Grünwald in buffer pH 6.8 v/v for 3-5minutes, followed by 10% buffered Giemsa solution for 10-30minutes, and running water for 1-3minutes. Quality evaluation must be performed on red blood cells (RBCs) and leukocytes, not on tumour cells. Under correct pH conditions, RBCs must appear pink-orange (acidophilic) or buff-coloured, neither green nor blue. Leukocyte cytoplasm must be almost transparent, with clearly delineated granules. However, staining may vary somewhat and testing is recommended for automated methods (slide stainers) which remain the standard for reproducibility. Though MGG stain remains the reference stain, Diff-Quik(®) stain can be used for the rapid evaluation of cell samples. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Desert dust contribution to PM10 loads in Italy: Methods and recommendations addressing the relevant European Commission Guidelines in support to the Air Quality Directive 2008/50

    Science.gov (United States)

    Barnaba, Francesca; Bolignano, Andrea; Di Liberto, Luca; Morelli, Matteo; Lucarelli, Franco; Nava, Silvia; Perrino, Cinzia; Canepari, Silvia; Basart, Sara; Costabile, Francesca; Dionisi, Davide; Ciampichetti, Spartaco; Sozzi, Roberto; Gobbi, Gian Paolo

    2017-07-01

    In 2011 the European Commission (EC) released specific 'Guidelines' describing the methods to quantify and subtract the contribution of natural sources from the PM10 values regulated by the European Air Quality Directive (2008/50/EC). This work investigates the applicability to Italy of the EC-Methodology suggested for desert-dust, describes main limitations encountered and proposes specific modifications embedded within a 'revised-Methodology' to extend/improve its use. The revised-Methodology capabilities are evaluated using original, chemically-resolved mineral-dust mass concentration measurements, showing better performances in predicting timing and absolute values of the desert-dust contribution to the daily-PM10 with respect to the current EC-approach. The revised-Methodology is then translated into an automatic (user-independent) tool tailored to the expected final-users. This tool is applied over Central Italy across a 3-year long period (2012-2014), and over the whole Italian country for a calendar year (2012). The derived results confirm and extend to Italian regions never addressed before some previously observed features of the desert-dust impact over the country, such as a clear latitudinal dependence of the desert-dust impact on the yearly average PM10 (from more than 5 μg/m3 to less than 0.5 μg/m3, going from south to north Italy). The modifications introduced within the revised-Methodology also suggest a non-negligible role of desert-dust resuspension in areas characterized by both high traffic levels and soil sealing (urban areas and along the major Italian routes). In the Rome area, such an effect is found to add a contribution of about 2 μg/m3 (i.e., of 20%) to the mean desert-dust load per dust day (about 10 μg/m3). At the national level, this effect contributes increasing the total number of desert-dust-driven exceedances of the PM10 daily limit value even in the northern regions, where the desert-dust impact on the PM10 yearly average is

  12. Nutrient-gene interaction: metabolic genotype-phenotype relationship.

    Science.gov (United States)

    Go, Vay Liang W; Nguyen, Christine T H; Harris, Diane M; Lee, Wai-Nang Paul

    2005-12-01

    The U.S. Department of Health and Human Services (DHHS)/USDA Dietary Guidelines for Americans is a science and population evidence-based guide on diet and physical activity, providing advice and recommendations to promote a healthier lifestyle and reduce the risk of chronic diseases, including cancer. These recommendations are supported by the comprehensive evidence-based review on diet and cancer prevention conducted by the American Institute for Cancer Research, National Cancer Institute, World Health Organization/International Agency for Research on Cancer, and others. However, influencing dietary effects are the individual genetic predispositions that are the basis for considerable interindividual variations in cancer risk within the population and in nutrient homeostasis, which is maintained by genomic-nutrient and metabolic-phenotype interactions. Although genetics is an important component, it accounts for only a portion of this variation. An individual's overall phenotype, including health status, is achieved and maintained by the sum of metabolic activities functioning under differing circumstances within the life cycle and the complex interactions among genotype, metabolic phenotype, and the environment. In this postgenomic era, high-throughput groups of technologies in genomics, proteomics, and metabolomics measure and analyze DNA sequences, RNA transcripts, proteins, and nutrient-metabolic fluxes in a single experiment. These advances have transformed biomarker studies on nutrient-gene interactions from a reductionist concept into a holistic practice in which many regulated genes involved in metabolism, along with its metabolic phenotypes, can be measured through functional genomics and metabolic profiling. The overall integration of data and information from the building blocks of metabolism-based nutrient-gene interaction can lead to future individualized dietary recommendations to diminish cancer risk.

  13. Costs and cost-efficacy analysis of the 2017 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

    Science.gov (United States)

    Rivero, Antonio; Pérez-Molina, José Antonio; Blasco, Antonio Javier; Arribas, José Ramón; Asensi, Víctor; Crespo, Manuel; Domingo, Pere; Iribarren, José Antonio; Lázaro, Pablo; López-Aldeguer, José; Lozano, Fernando; Martínez, Esteban; Moreno, Santiago; Palacios, Rosario; Pineda, Juan Antonio; Pulido, Federico; Rubio, Rafael; Santos, Jesús; de la Torre, Javier; Tuset, Montserrat; Gatell, Josep M

    2017-05-19

    GESIDA and the Spanish National AIDS Plan panel of experts have recommended preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral therapy (ART) as initial therapy in HIV-infected patients for 2017. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR. Economic assessment of costs and efficiency (cost-efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, resistance studies and HLA B*5701 screening. The setting was Spain and the costs correspond to those of 2017. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. In the base case scenario, the cost of initiating treatment ranged from 6882 euro for TFV/FTC/RPV (AR) to 10,904 euros for TFV/FTC+RAL (PR). The efficacy varied from 0.82 for TFV/FTC+DRV/p (AR) to 0.92 for TAF/FTC/EVG/COBI (PR). The efficiency, in terms of cost-efficacy, ranged from 7923 to 12,765 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TFV/FTC+RAL (PR), respectively. Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TFV/FTC/RPV (AR) and TAF/FTC/EVG/COBI (PR). Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  14. Olmesartan vs ramipril in the treatment of hypertension and associated clinical conditions in the elderly: a reanalysis of two large double blind, randomized studies at the light of the most recent blood pressure targets recommended by guidelines

    Directory of Open Access Journals (Sweden)

    Omboni S

    2015-10-01

    Full Text Available Stefano Omboni,1 Ettore Malacco,2 Jean-Michel Mallion,3 Massimo Volpe4,5 1Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Varese, Italy; 2Department of Internal Medicine, Ospedale L Sacco, University of Milan, Milan, Italy; 3Cardiology and Arterial Hypertension, CHU de Grenoble, Grenoble, France; 4Division of Cardiology, II Faculty of Medicine, University of Rome “La Sapienza”, Sant’Andrea Hospital, Rome, Italy; 5IRCCS Neuromed, Pozzilli, Isernia, Italy Abstract: In this paper, we present the results of a reanalysis of the data of two large randomized, double-blind, parallel group studies with a similar design, comparing the efficacy of an angiotensin-receptor blocker (olmesartan medoxomil with that of an angiotensin-converting enzyme inhibitor (ramipril, by applying two different blood pressure targets recently recommended by hypertension guidelines for all patients, irrespective of the presence of diabetes (<140/90 mmHg, and for elderly hypertensive patients (<150/90 mmHg. The efficacy of olmesartan was not negatively affected by age, sex, hypertension type, diabetes status or other concomitant clinical conditions, or cardiovascular risk factors. In most cases, olmesartan provided better blood pressure control than ramipril. Olmesartan was significantly more effective than ramipril in male patients, in younger patients (aged 65–69 years, in those with metabolic syndrome, obesity, dyslipidemia, preserved renal function, diastolic ± systolic hypertension, and, in general, in patients with a high or very high cardiovascular risk. Interestingly, patients previously untreated or treated with two or more antihypertensive drugs showed a significantly larger response with olmesartan than with ramipril. Thus, our results confirm the good efficacy of olmesartan in elderly hypertensives even when new blood pressure targets for antihypertensive treatment are considered. Such results may be relevant for the clinical

  15. Adherence to recommendations on lipid-based nutrient supplement and iron and folic acid tablet consumption among pregnant and lactating women participating in a community health programme in northwest Bangladesh.

    Science.gov (United States)

    Harding, Kassandra L; Matias, Susana L; Mridha, Malay K; Moniruzzaman, Md; Vosti, Stephen A; Hussain, Sohrab; Dewey, Kathryn G; Stewart, Christine P

    2017-01-01

    Limited knowledge exists on sustained adherence to small-quantity lipid-based nutrient supplements for pregnant and lactating women (LNS-PL) and how this compares with that of other prenatal supplements. To address these gaps, a random subsample of women (n = 360) during pregnancy, early (6- to 12-week post-partum) and late (12- to 24-week post-partum) lactation, from an ongoing effectiveness trial in Bangladesh, was selected for in-home interviews about LNS-PL or iron/folic acid (IFA) use and preferences. Prevalence of high adherence (≥70% of the recommendation) based on self-reported supplement consumption was 67%, 68% and 81% among LNS-PL recipients during pregnancy, early and late lactation, and was 87% and 71% among IFA recipients during pregnancy and early lactation, respectively (P = 0.044). Programmatic factors (e.g. distribution and visits by programme staff) were consistently statistically significantly associated with reported high adherence. Among LNS-PL recipients, high overall supplement acceptability score [odds ratio (OR): 8.62; 95% confidence interval (CI) 3.53, 20.83] and use of reminder techniques (OR: 4.41; 95%CI 1.65, 11.76) were positively associated, and reported vomiting at enrollment was negatively associated (OR: 0.34; 95%CI 0.14, 0.80), with reported high adherence. Selected women (n = 16) and key informants (n = 18) participated in in-depth interviews about perceptions and acceptability of LNS-PL. Women perceived benefits of taking LNS-PL, but some faced barriers to consumption including aversion to odour and taste during pregnancy, forgetfulness and disruptions in supply. To achieve high adherence, results from this study suggest that maternal supplementation programmes should focus on programmatic barriers and consider incorporating reminder techniques. Organoleptic acceptability of LNS-PL, particularly during pregnancy, may also need to be addressed. © 2016 John Wiley & Sons Ltd.

  16. Energy and Nutrient Intakes from Processed Foods Differ by Sex, Income Status, and Race/Ethnicity of US Adults.

    Science.gov (United States)

    Eicher-Miller, Heather A; Fulgoni, Victor L; Keast, Debra R

    2015-06-01

    The 2010 Dietary Guidelines for Americans (DGA) recommends nutrients to increase and to decrease for US adults. The contributions processed foods make to the US intake of nutrients to increase and decrease may vary by the level of processing and by population subgroup. The hypotheses that the intakes of nutrients to increase or decrease, as specified by the DGA, are contributed exclusively from certain processed food categories and consumed differentially by population subgroups by sex, poverty-income ratio (ratio of household income to poverty threshold), and race/ethnicity was tested along with the hypothesis that specific processed food categories are responsible for nutrient intake differences between the population subgroups. The 24-hour dietary recall data from the cross-sectional 2003-2008 National Health and Nutrition Examination Survey was used to determine population subgroup energy and nutrient intake differences among processed food categories defined by the International Food Information Council Foundation Continuum of Processed Foods. Fifteen thousand fifty-three US adults aged ≥19 years. The mean daily intake of energy and nutrients from processed food categories reported by population subgroups were compared using regression analysis to determine covariate-adjusted least square means. Processed food categories that contributed to energy and nutrient intake differences within subgroups did not uniformly or exclusively contribute nutrients to increase or decrease per DGA recommendations. The between-group differences in mean daily intake of both nutrients to increase and decrease contributed by the various processed food categories were diverse and were not contributed exclusively from specific processed food categories. Recommendations for a diet adhering to the DGA should continue to focus on the energy and nutrient content, frequency of consumption, and serving size of individual foods rather than the level of processing. Copyright © 2015

  17. Modelling the likely impact of healthy eating guidelines on agriculture in England and Wales

    OpenAIRE

    Arnoult, Matthieu H.; Jones, Philip J.; Tranter, Richard B.; Tiffin, J. Richard; Traill, W. Bruce

    2008-01-01

    Household food consumption data is used to estimate likely changes in diet under healthy eating guidelines, and the consequences this would have on the agricultural sector in England and Wales. The first step entails imposing nutrient restrictions on food consumption following dietary recommendations. The resulting diet is then used as a proxy for demand in agricultural commodities, to test the impact of such a scenario on agricultural land use and production. Results of the diet optimisation...

  18. Total, Added, and Free Sugars: Are Restrictive Guidelines Science-Based or Achievable?

    OpenAIRE

    Jennifer Erickson; Joanne Slavin

    2015-01-01

    Sugar consumption, especially added sugars, is under attack. Various government and health authorities have suggested new sugar recommendations and guidelines as low as 5% of total calories from free sugars. Definitions for total sugars, free sugars, and added sugars are not standardized, nor are there accepted nutrient databases for this information. Our objective was to measure total sugars and added sugars in sample meal plans created by the United States Department of Agriculture (USDA) a...

  19. ESPEN Guidelines on Enteral Nutrition: Geriatrics.

    Science.gov (United States)

    Volkert, D; Berner, Y N; Berry, E; Cederholm, T; Coti Bertrand, P; Milne, A; Palmblad, J; Schneider, St; Sobotka, L; Stanga, Z; Lenzen-Grossimlinghaus, R; Krys, U; Pirlich, M; Herbst, B; Schütz, T; Schröer, W; Weinrebe, W; Ockenga, J; Lochs, H

    2006-04-01

    Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.

  20. Nutrient management of blueberry – Assessing plant nutrient needs and designing good fertilizer programs

    Science.gov (United States)

    In this article and presentation, we will address recommended soil nutrient levels for making pre-planting decisions, starting rates of key nutrients to apply, how to assess plant nutrient status to modify fertilizer programs, timing and source of fertilizer to apply, and fertigation. Key questions ...

  1. AJOL Recommended Peer-Reviewer Guidelines

    African Journals Online (AJOL)

    Peer review is an essential part of formal scholarly communication, and lies at the heart of the scientific method. Peer review assists the editor in making editorial decisions and through the editorial communications with the author may also assist the author in improving the paper. Peer Reviewers need to recognize the ...

  2. Comparison of the nutrient-based standards for school lunches among South Korea, Japan, and Taiwan.

    Science.gov (United States)

    Kim, Meeyoung; Abe, Satoko; Zhang, Chengyu; Kim, Soyoung; Choi, Jiyu; Hernandez, Emely; Nozue, Miho; Yoon, Jihyun

    2017-01-01

    Nutritional standards are important guidelines for providing students with nutritionally-balanced school meals. This study compared nutrient-based school lunch standards regulated by South Korea, Japan, and Taiwan. The data were collected from relevant literature and websites of each country during September 2014. The number of classification groups of target students was 8, 5, and 5 for South Korea, Japan, and Taiwan, respectively. Gender was considered across all age groups in South Korea but only for high school students in Taiwan. Gender was not considered in Japan. Along with energy, the number of nutrients included in the standards for South Korea, Japan and Taiwan was 9, 12, and 4, respectively. The standards for all three countries included protein and fat among macronutrients. The standards for South Korea and Japan included vitamin A, B-1, B-2, and C, while the standards for Taiwan did not include any vitamins. Calcium was the only mineral commonly included in the three standards. The proportions of recommended daily intakes as reference values for each nutrient differed among the countries. Japan differentiated the proportions among 33%, 40%, or 50%, reflecting the target students' intake status of the respective nutrients. Taiwan differentiated either two-fifths or one-third of the recommended daily intakes. South Korea applied the proportion of recommended daily intake as one-third for all selected nutrients. This study could be valuable information for countries in developing nutrient-based standards for school lunches and for South Korea, Japan, and Taiwan in the process of reforming nutrient-based standards.

  3. Bone nutrients for vegetarians.

    Science.gov (United States)

    Mangels, Ann Reed

    2014-07-01

    The process of bone mineralization and resorption is complex and is affected by numerous factors, including dietary constituents. Although some dietary factors involved in bone health, such as calcium and vitamin D, are typically associated with dairy products, plant-based sources of these nutrients also supply other key nutrients involved in bone maintenance. Some research suggests that vegetarian diets, especially vegan diets, are associated with lower bone mineral density (BMD), but this does not appear to be clinically significant. Vegan diets are not associated with an increased fracture risk if calcium intake is adequate. Dietary factors in plant-based diets that support the development and maintenance of bone mass include calcium, vitamin D, protein, potassium, and soy isoflavones. Other factors present in plant-based diets such as oxalic acid and phytic acid can potentially interfere with absorption and retention of calcium and thereby have a negative effect on BMD. Impaired vitamin B-12 status also negatively affects BMD. The role of protein in calcium balance is multifaceted. Overall, calcium and protein intakes in accord with Dietary Reference Intakes are recommended for vegetarians, including vegans. Fortified foods are often helpful in meeting recommendations for calcium and vitamin D. Plant-based diets can provide adequate amounts of key nutrients for bone health. © 2014 American Society for Nutrition.

  4. Greenhouse Gas Emissions and the Australian Diet—Comparing Dietary Recommendations with Average Intakes

    Directory of Open Access Journals (Sweden)

    Gilly A. Hendrie

    2014-01-01

    Full Text Available Nutrition guidelines now consider the environmental impact of food choices as well as maintaining health. In Australia there is insufficient data quantifying the environmental impact of diets, limiting our ability to make evidence-based recommendations. This paper used an environmentally extended input-output model of the economy to estimate greenhouse gas emissions (GHGe for different food sectors. These data were augmented with food intake estimates from the 1995 Australian National Nutrition Survey. The GHGe of the average Australian diet was 14.5 kg carbon dioxide equivalents (CO2e per person per day. The recommended dietary patterns in the Australian Dietary Guidelines are nutrient rich and have the lowest GHGe (~25% lower than the average diet. Food groups that made the greatest contribution to diet-related GHGe were red meat (8.0 kg CO2e per person per day and energy-dense, nutrient poor “non-core” foods (3.9 kg CO2e. Non-core foods accounted for 27% of the diet-related emissions. A reduction in non-core foods and consuming the recommended serves of core foods are strategies which may achieve benefits for population health and the environment. These data will enable comparisons between changes in dietary intake and GHGe over time, and provide a reference point for diets which meet population nutrient requirements and have the lowest GHGe.

  5. 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...

  6. Guidelines on oncologic imaging

    International Nuclear Information System (INIS)

    1989-01-01

    The present issue of European Journal of Radiology is devoted to guidelines on oncologic imaging. 9 experts on imaging in suspected or evident oncologic disease have compiled a broad survey on strategies as well as techniques on oncologic imaging. The group gives advice for detecting tumours at specific tumour sites and use modern literature to emphasize their recommendations. All recommendations are short, comprehensive and authoritative. (orig./MG)

  7. ASSET guidelines

    International Nuclear Information System (INIS)

    1990-11-01

    The IAEA Assessment of Safety Significant Events Team (ASSET) Service provides advice and assistance to Member States to enhance the overall level of plant safety while dealing with the policy of prevention of incidents at nuclear power plants. The ASSET programme, initiated in 1986, is not restricted to any particular group of Member States, whether developing or industrialized, but is available to all countries with nuclear power plants in operation or approaching commercial operation. The IAEA Safety Series publications form common basis for the ASSET reviews, including the Nuclear Safety Standards (NUSS) and the Basic Safety Principles (Recommendations of Safety Series No. 75-INSAG-3). The ASSET Guidelines provide overall guidance for the experts to ensure the consistency and comprehensiveness of their review of incident investigations. Additional guidance and reference material is provided by the IAEA to complement the expertise of the ASSET members. ASSET reviews accept different approaches that contribute to ensuring an effective prevention of incidents at plants. Suggestions are offered to enhance plant safety performance. Commendable good practices are identified and generic lessons are communicated to other plants, where relevant, for long term improvement

  8. Nutrient Management in Recirculating Hydroponic Culture

    Science.gov (United States)

    Bugbee, Bruce

    2004-01-01

    There is an increasing need to recirculate and reuse nutrient solutions in order to reduce environmental and economic costs. However, one of the weakest points in hydroponics is the lack of information on managing the nutrient solution. Many growers and research scientists dump out nutrient solutions and refill at weekly intervals. Other authors have recommended measuring the concentrations of individual nutrients in solution as a key to nutrient control and maintenance. Dumping and replacing solution is unnecessary. Monitoring ions in solution is not always necessary; in fact the rapid depletion of some nutrients often causes people to add toxic amounts of nutrients to the solution. Monitoring ions in solution is interesting, but it is not the key to effective maintenance.

  9. 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.

    2017-01-01

    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. PMID:27434803

  10. EAACI Guidelines on Allergen Immunotherapy

    DEFF Research Database (Denmark)

    Halken, Susanne; Larenas-Linnemann, Desiree; Roberts, Graham

    2017-01-01

    ) has developed a clinical practice guideline to provide evidence-based recommendations for AIT for prevention of i) development of allergic comorbidities in those with established allergic diseases, ii) development of first allergic condition and iii) allergic sensitization. This guideline has been...

  11. Impact of typical rather than nutrient-dense food choices in the US Department of Agriculture Food Patterns.

    Science.gov (United States)

    Britten, Patricia; Cleveland, Linda E; Koegel, Kristin L; Kuczynski, Kevin J; Nickols-Richardson, Sharon M

    2012-10-01

    The US Department of Agriculture (USDA) Food Patterns, released as part of the 2010 Dietary Guidelines for Americans, are designed to meet nutrient needs without exceeding energy requirements. They identify amounts to consume from each food group and recommend that nutrient-dense forms-lean or low-fat, without added sugars or salt-be consumed. Americans fall short of most food group intake targets and do not consume foods in nutrient-dense forms. Intake of calories from solid fats and added sugars exceed maximum limits by large margins. Our aim was to determine the potential effect on meeting USDA Food Pattern nutrient adequacy and moderation goals if Americans consumed the recommended quantities from each food group, but did not implement the advice to select nutrient-dense forms of food and instead made more typical food choices. Food-pattern modeling analysis using the USDA Food Patterns, which are structured to allow modifications in one or more aspects of the patterns, was used. Nutrient profiles for each food group were modified by replacing each nutrient-dense representative food with a similar but typical choice. Typical nutrient profiles were used to determine the energy and nutrient content of the food patterns. Moderation goals are not met when amounts of food in the USDA Food Patterns are followed and typical rather than nutrient-dense food choices are made. Energy, total fat, saturated fat, and sodium exceed limits in all patterns, often by substantial margins. With typical choices, calories were 15% to 30% (ie, 350 to 450 kcal) above the target calorie level for each pattern. Adequacy goals were not substantially affected by the use of typical food choices. If consumers consume the recommended quantities from each food group and subgroup, but fail to choose foods in low-fat, no-added-sugars, and low-sodium forms, they will not meet the USDA Food Patterns moderation goals or the 2010 Dietary Guidelines for Americans. Copyright © 2012 Academy of

  12. Eating disorders guidelines from NICE.

    Science.gov (United States)

    Wilson, G Terence; Shafran, Roz

    January, 2004, marked the publication of NICE guidelines for the treatment of eating disorders, a series of recommendations from a multidisciplinary, comprehensive, and rigorous process. The recommendations are assigned a grade from A (strong empirical support from well-conducted randomised trials) to C (expert opinion without strong empirical data). Over 100 recommendations were made, most of which were given a C grade. No specific recommendations were made for anorexia nervosa. Cognitive behavioural therapy for bulimia nervosa was assigned grade A because of the evidence showing that it is superior to other psychological and drug treatments. Antidepressants for bulimia nervosa were given grade B. No specific recommendations were made for atypical eating disorders except for binge-eating disorder (cognitive behavioural therapy was recommended [A]). The methodological rigour of the NICE guidelines is in contrast with the current Practice Guideline for Eating Disorders (PGED) of the American Psychiatric Association. PGED does not detail criteria for evaluating supporting research. Instead of making clear recommendations, PGED is uncritically inclusive and emphasises subjective judgment of individual clinicians. The NICE guidelines balance recommending specific treatments against the importance of clinical judgment when guideline recommendations are not readily applicable. Evidence-based guidelines are limited by the quality of the available research and its clinical relevance. The NICE guidelines underscore the absence of sufficient evidence for guidance in several important areas, such as atypical eating disorders (eating disorders not otherwise specified) which are the most common. Research on the treatment of these atypical eating disorders is needed. Evidence-based psychological treatments are not routinely implemented in general practice. Dissemination of these demonstrably effective treatments poses a challenge, and learning how to implement evidence

  13. CONCEPTS IN HUMAN NUTRITION AND ANIMAL FEEDING New Reference Values for nutrient intake in Germany, Austria and Switzerland (DACH-reference values

    Directory of Open Access Journals (Sweden)

    Wolfram Günther

    2001-01-01

    Full Text Available In accordance to their very good collaboration through decades especially at the “3 Countries Meetings” the Nutrition Societies of Germany, Austria and Switzerland (D, A, CH decided to prepare new Reference Values for nutrient intake as a joint edition in the year 2000. The Reference Values consist of two parts: Part 1, Nutritive aspects of nutrients. Part 2, Preventive aspect of nutrient and food components. The Reference Values presented should protect almost all individuals of the respective group against potential damage to health from their diet and provide a basis for full functional capacity. In detail recommendations, estimates or guideline values are presented for the different nutrients. Total fat should not exceed 30% of energy, saturated fatty acids should not provide more than 10% of energy and polyunsaturated fatty acids 7% of energy with n-6 and n-3 fatty acids in a ratio of 5:1. Preventive aspect concern the prophylaxis of nutrition-related diseases.

  14. Nutrients and neurodevelopment: lipids.

    Science.gov (United States)

    González, Horacio F; Visentin, Silvana

    2016-10-01

    Nutrients, lipids in particular, make up the central nervous system structure and play major functional roles: they stimulate development, migration, and nerve cell differentiation. They are part of gray matter, white matter, nerve nuclei, and synaptogenesis. Breast milk contains lipids which are crucial for infant brain development. The lipid profile of breast milk was used as a guideline for the development of breast milk substitutes. However, to date, no substitute has matched it. Complementary feeding should include docosahexaenoic acid, arachidonic acid, other polyunsaturated fatty acids, saturated fatty acids, and complex lipids found in milk fat. The lipid composition of breast milk depends on maternal intake and nutritional status during pregnancy and breast-feeding. It has a great impact on development. Our goal is to review scientific literature regarding the role of lipids on infant brain development and the importance of breast milk lipid composition, maternal diet, and complementary feeding. Sociedad Argentina de Pediatría.

  15. Adherence to cancer treatment guidelines: influence of general and cancer-specific guideline characteristics.

    NARCIS (Netherlands)

    Heins, M.J.; Jong, J.D. de; Spronk, I.; Ho, V.K.; Brink, M.; Korevaar, J.C.

    2017-01-01

    Background: Guideline adherence remains a challenge in clinical practice, despite guidelines’ ascribed potential to improve patient outcomes. We studied the level of adherence to recommendations from Dutch national cancer treatment guidelines, and the influence of general and

  16. Nutrition issues in Codex: health claims, nutrient reference values and WTO agreements: a conference report.

    Science.gov (United States)

    Aggett, Peter J; Hathcock, John; Jukes, David; Richardson, David P; Calder, Philip C; Bischoff-Ferrari, Heike; Nicklas, Theresa; Mühlebach, Stefan; Kwon, Oran; Lewis, Janine; Lugard, Maurits J F; Prock, Peter

    2012-03-01

    Codex documents may be used as educational and consensus materials for member governments. Also, the WTO SPS Agreement recognizes Codex as the presumptive international authority on food issues. Nutrient bioavailability is a critical factor in determining the ability of nutrients to provide beneficial effects. Bioavailability also influences the quantitative dietary requirements that are the basis of nutrient intake recommendations and NRVs. Codex, EFSA and some national regulatory authorities have established guidelines or regulations that will permit several types of health claims. The scientific basis for claims has been established by the US FDA and EFSA, but not yet by Codex. Evidence-based nutrition differs from evidence-based medicine, but the differences are only recently gaining recognition. Health claims on foods may provide useful information to consumers, but many will interpret the information to mean that they can rely upon the food or nutrient to eliminate a disease risk. NRVs are designed to provide a quantitative basis for comparing the nutritive values of foods, helping to illustrate how specific foods fit into the overall diet. The INL-98 and the mean of adult male and female values provide NRVs that are sufficient when used as targets for individual intakes by most adults. WTO recognizes Codex as the primary international authority on food issues. Current regulatory schemes based on recommended dietary allowances are trade restrictive. A substantial number of decisions by the EFSA could lead to violation of WTO agreements.

  17. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

    NARCIS (Netherlands)

    Rosen, Rachel; Vandenplas, Yvan; Singendonk, Maartje; Michael, Cabana; Carlo, Di Lorenzo; Gottrand, Frederic; Sandeep, Gupta; Miranda, Langendam; Annamaria, Staiano; Nikhil, Thapar; Tipnis, Neelesh; Tabbers, Merit

    2018-01-01

    This document serves as an update of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) 2009 clinical guidelines for the diagnosis and management of

  18. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition

    NARCIS (Netherlands)

    Rosen, Rachel; Vandenplas, Yvan; Singendonk, Maartje; Cabana, Michael; DiLorenzo, Carlo; Gottrand, Frederic; Gupta, Sandeep; Langendam, Miranda; Staiano, Annamaria; Thapar, Nikhil; Tipnis, Neelesh; Tabbers, Merit

    2018-01-01

    This document serves as an update of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) 2009 clinical guidelines for the diagnosis and management of

  19. Recommendations for gonadotoxicity surveillance in male childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium

    NARCIS (Netherlands)

    Skinner, R.; Mulder, R.L.; Kremer, L.C.; Hudson, M.M.; Constine, L.S.; Bardi, E.; Boekhout, A.; Borgmann-Staudt, A.; Brown, M.C.; Cohn, R.; Dirksen, U.; Giwercman, A.; Ishiguro, H.; Jahnukainen, K.; Kenney, L.B.; Loonen, J.J.; Meacham, L.; Neggers, S.; Nussey, S.; Petersen, C.; Shnorhavorian, M.; Heuvel-Eibrink, M.M. van den; Santen, H.M. van; Wallace, W.H.; Green, D.M.

    2017-01-01

    Treatment with chemotherapy, radiotherapy, or surgery that involves reproductive organs can cause impaired spermatogenesis, testosterone deficiency, and physical sexual dysfunction in male pubertal, adolescent, and young adult cancer survivors. Guidelines for surveillance and management of potential

  20. Recommendations for gonadotoxicity surveillance in male childhood, adolescent, and young adult cancer survivors : a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium

    NARCIS (Netherlands)

    Skinner, Roderick; Mulder, Renee L.; Kremer, Leontien C.; Hudson, Melissa M.; Constine, Louis S.; Bardi, Edit; Boekhout, Annelies; Borgmann-Staudt, Anja; Brown, Morven C.; Cohn, Richard; Dirksen, Uta; Giwercman, Alexsander; Ishiguro, Hiroyuki; Jahnukainen, Kirsi; Kenney, Lisa B.; Loonen, Jacqueline J.; Meacham, Lilian; Neggers, Sebastian; Nussey, Stephen; Petersen, Cecilia; Shnorhavorian, Margarett; van den Heuvel-Eibrink, Marry M.; van Santen, Hanneke M.; Wallace, William H B; Green, Daniel M.

    2017-01-01

    Treatment with chemotherapy, radiotherapy, or surgery that involves reproductive organs can cause impaired spermatogenesis, testosterone deficiency, and physical sexual dysfunction in male pubertal, adolescent, and young adult cancer survivors. Guidelines for surveillance and management of potential

  1. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: Executive Summary of recommendations

    DEFF Research Database (Denmark)

    Gharib, H; Papini, E; Paschke, R

    2010-01-01

    American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules are systematically developed statements to assist health care professionals in medical...

  2. Guidelines and checklists for short-term missions in global pediatric surgery: Recommendations from the American Academy of Pediatrics Delivery of Surgical Care Global Health Subcommittee, American Pediatric Surgical Association Global Pediatric Surgery Committee, Society for Pediatric Anesthesia Committee on International Education and Service, and American Pediatric Surgical Nurses Association, Inc. Global Health Special Interest Group.

    Science.gov (United States)

    Butler, Marilyn; Drum, Elizabeth; Evans, Faye M; Fitzgerald, Tamara; Fraser, Jason; Holterman, Ai-Xuan; Jen, Howard; Kynes, J Matthew; Kreiss, Jenny; McClain, Craig D; Newton, Mark; Nwomeh, Benedict; O'Neill, James; Ozgediz, Doruk; Politis, George; Rice, Henry; Rothstein, David; Sanchez, Julie; Singleton, Mark; Yudkowitz, Francine S

    2017-11-15

    Pediatric surgeons, anesthesia providers, and nurses from North America and other high-income countries (HICs) are increasingly engaged in resource-limited areas, with short-term missions (STMs) as the most common form of involvement. However, consensus recommendations currently do not exist for STMs in pediatric general surgery and associated perioperative care. The American Academy of Pediatrics (AAP) Delivery of Surgical Care Subcommittee and American Pediatric Surgical Association (APSA) Global Pediatric Surgery Committee, with the American Pediatric Surgical Nurses Association, Inc. (APSNA) Global Health Special Interest Group, and the Society for Pediatric Anesthesia (SPA) Committee on International Education and Service generated consensus recommendations for STMs based on extensive experience with STMs. Three distinct, but related areas were identified: 1) Broad goals of surgical partnerships between HICs- and low and middle-income countries (LMICs). A previous set of guidelines published by the Global Paediatric Surgery Network Collaborative (GPSN), was endorsed by all groups; 2) Guidelines for the conduct of STMs were developed, including planning, in-country perioperative patient care, post-trip follow-up, and sustainability; 3) travel and safety considerations critical to STM success were enumerated. A diverse group of stakeholders developed these guidelines for STMs in LMICs. These guidelines may be a useful tool to ensure safe, responsible, and ethical STMs given increasing engagement of HIC providers in this work. 5. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. 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

  4. Recommender systems

    CERN Document Server

    Kembellec, Gérald; Saleh, Imad

    2014-01-01

    Acclaimed by various content platforms (books, music, movies) and auction sites online, recommendation systems are key elements of digital strategies. If development was originally intended for the performance of information systems, the issues are now massively moved on logical optimization of the customer relationship, with the main objective to maximize potential sales. On the transdisciplinary approach, engines and recommender systems brings together contributions linking information science and communications, marketing, sociology, mathematics and computing. It deals with the understan

  5. The role of yogurt in improving the quality of the American diet and meeting dietary guidelines.

    Science.gov (United States)

    Webb, Densie; Donovan, Sharon M; Meydani, Simin Nikbin

    2014-03-01

    The Dietary Guidelines for Americans (DGA) recommend three daily servings of low- or nonfat dairy products, yet two-thirds of individuals in the United States do not meet that goal. Including low- or nonfat yogurt as part of an overall healthful diet can be a positive step toward meeting the DGA recommendations. Yogurt naturally contains calcium and potassium, and some products are fortified with vitamin D. All of these nutrients were identified in the DGA as "nutrients of concern," because typical intake falls far short of recommended intakes. Yogurt can also be an excellent source of high-quality protein, which promotes satiety, helps in maintaining a healthy body weight, and aids muscle and bone growth. In addition, yogurt is low in sodium and contributes 1.0% or less of added sugars to the diets of most individuals in the United States; however, 90% of children and adults consume less than 8 ounces (1 cup) of yogurt per week. Thus, consuming 1 serving of yogurt per day would help to meet the DGA-recommended dairy servings and would provide nutrients of concern. © 2014 International Life Sciences Institute.

  6. Guideline implementation: local anesthesia.

    Science.gov (United States)

    Fencl, Jennifer L

    2015-06-01

    It is not uncommon in perioperative settings for patients to receive local anesthesia for a variety of procedures. It is imperative for patient safety that the perioperative RN has a comprehensive understanding of best practices associated with the use of local anesthesia. The updated AORN "Guideline for care of the patient receiving local anesthesia" provides guidance on perioperative nursing assessments and interventions to safely care for patients receiving local anesthesia. This article focuses on key points of the guideline to help perioperative personnel become knowledgeable regarding best practice as they care for this patient population. The key points address patient assessment, the importance of having an overall understanding of the local agent being used, recommended monitoring requirements, and potential adverse events, including life-threatening events. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  7. The role of traditional foods in food-based dietary guidelines - A South African case study on maas (cultured milk).

    Science.gov (United States)

    Du Plooy, Z; Schönfeldt, H C; Hall, N

    2018-01-01

    With the revision of the South African food-based dietary guidelines (FBDGs) a new guideline specifically recommending the daily consumption of dairy products including maas (cultured milk) was introduced. This paper aims to evaluate the relevance of including maas as a traditional food product in the FBDGs. It was found that maas is a culturally relevant and traditional food product in South Africa. The nutrient profile of maas has changed notably over time since the first nutrient analysis was performed in 1995. The health benefits of maas, together with its popularity and its cultural relevance as part of the South African diet, make maas a suitable traditional food product to be included in the South African FBDGs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. ASVCP guidelines: Allowable total error hematology.

    Science.gov (United States)

    Nabity, Mary B; Harr, Kendal E; Camus, Melinda S; Flatland, Bente; Vap, Linda M

    2018-02-11

    The purpose of this document is to provide total allowable error (TE a ) recommendations for commonly analyzed hematology measurands for veterinary personnel. These guidelines define relevant terminology and highlight considerations specific to hematology measurands. They also provide reasons and guidelines for using TE a in instrument performance evaluation, including recommendations for when the total observed error exceeds the recommended TE a . Biological variation-based quality specifications are briefly discussed. The appendix describes the derivation of the hematology TE a recommendations and provides resources for external quality assurance/proficiency testing programs and a worksheet for implementation of the guidelines. © 2018 American Society for Veterinary Clinical Pathology.

  9. Guidelines for emergency laparoscopy

    Directory of Open Access Journals (Sweden)

    Sauerland Stefan

    2006-10-01

    Full Text Available Abstract Acute abdominal pain is a leading symptom in many surgical emergency patients. Laparoscopy allows for accurate diagnosis and immediate therapy of many intraabdominal pathologies. The guidelines of the EAES (European Association for Endoscopic Surgery provides scientifically founded recommendations about the role of laparoscopy in the different situations. Generally, laparoscopy is well suited for the therapy of the majority of diseases that cause acute abdominal pain.

  10. Adherence to nutrition guidelines in patients with cardiovascular diseases (CVD) as a secondary prevention

    Science.gov (United States)

    Woźniak, Agnieszka; Krótki, Monika; Anyżewska, Anna; Górnicka, Magdalena; Wawrzyniak, Agata

    The appropriate nutrition is an important component of the secondary prevention of cardiovascular diseases (CVD) The aim of the study was to investigate if the patients with cardiovascular disease were informed of the role of appropriate nutrition in prevention or received nutrition guidelines and to assess the dietary intake compared to recommendations for patients with cardiovascular disease who received or not nutrition guidelines The study was conducted among patients with cardiovascular disease (n = 127) of cardiological hospital clinic, aged 62 ± 11. The questionnaire was used to obtain personal and anthropometric details, information if patients had received nutrition guidelines. The method of 3-day food records was used for dietary assessment 20% of subjects had not received nutrition guidelines and almost 40% of subjects did not recognize the nutrition effect on cardiovascular disease development. Compared to the diets of the subjects who had not received nutrition guidelines, the diets of those who had received them were of significantly lower intake of: energy from saturated fatty acids (15%, p = 0.006), cholesterol (21%, p = 0.012) and higher intake (14-26%) of potassium (p = 0,003), sodium (p = 0.013), phosphorus (p = 0.044), magnesium (p = 0.003), iron (p = 0.005), copper (p = 0.001), zinc (p = 0.046). Among the patients who had received nutrition guidelines, percentage of the subjects whose intake of nutrients was consistent with recommendations was higher Not all subjects had received nutrition guidelines. Diets of those who had received them were more balanced, but in neither group nutrition guidelines were complied with

  11. 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.

  12. Heterogeneity of Rabies Vaccination Recommendations across Asia

    Directory of Open Access Journals (Sweden)

    Philippe Buchy

    2017-07-01

    Full Text Available Asian countries bear the greatest burden of the disease, with a majority (59% of rabies-related deaths occurring in Asia. In order to promote best practices, we summarized national human vaccination guidelines across this region, to highlight differences and similarities and to discuss the aspects that would benefit from updates. National management guidelines for rabies were retrieved from various sources to extract information on rabies pre- and post-exposure prophylaxis (PrEP, and PEP, booster vaccination, and route of administration. Rabies guidelines recommendations for wound management and PrEP across Asia are broadly aligned to the World Health Organization (WHO guidelines. For PEP, the 5-dose Essen, and the 4-dose Zagreb are the regimens of choice for intramuscular (IM, and the Thai Red Cross regimen for intradermal (ID, administration. Several national guidelines have yet to endorse ID vaccine administration. Most guidelines recommend rabies immunoglobulin in category III exposures. Booster recommendations are not included in all guidelines, with limited clarity on booster requirement across the spectrum of risk of rabies exposure. In conclusion, national recommendations across Asian countries differ and while some guidelines are closely aligned to the WHO recommendations, resource-saving ID administration and use of rational abbreviated schedules have yet to be endorsed.

  13. Recommendations for breast cancer surveillance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group

    NARCIS (Netherlands)

    Mulder, Renée L.; Kremer, Leontien C. M.; Hudson, Melissa M.; Bhatia, Smita; Landier, Wendy; Levitt, Gill; Constine, Louis S.; Wallace, W. Hamish; van Leeuwen, Flora E.; Ronckers, Cécile M.; Henderson, Tara O.; Dwyer, Mary; Skinner, Roderick; Oeffinger, Kevin C.

    2013-01-01

    Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were given radiation to fields that include breast tissue (ie, chest radiation) have an increased risk of breast cancer. Clinical practice guidelines are essential to ensure that these individuals receive optimum care and

  14. Comparison of the nutrient content of children's menu items at US restaurant chains, 2010-2014.

    Science.gov (United States)

    Deierlein, Andrea L; Peat, Kay; Claudio, Luz

    2015-08-15

    To determine changes in the nutritional content of children's menu items at U.S. restaurant chains between 2010 and 2014. The sample consisted of 13 sit down and 16 fast-food restaurant chains ranked within the top 50 US chains in 2009. Nutritional information was accessed in June-July 2010 and 2014. Descriptive statistics were calculated for nutrient content of main dishes and side dishes, as well as for those items that were added, removed, or unchanged during the study period. Nutrient content of main dishes did not change significantly between 2010 and 2014. Approximately one-third of main dishes at fast-food restaurant chains and half of main dishes at sit down restaurant chains exceeded the 2010 Dietary Guidelines for Americans recommended levels for sodium, fat, and saturated fat in 2014. Improvements in nutrient content were observed for side dishes. At sit down restaurant chains, added side dishes contained over 50% less calories, fat, saturated fat, and sodium, and were more likely to contain fruits/vegetables compared to removed sides (p restaurant chains contained less saturated fat (p restaurant industry and policy makers to improve the nutritional content of children's menu items at restaurant chains to align with the Dietary Guidelines for Americans. Additional efforts are necessary to help parents and children make informed choices when ordering at restaurant chains.

  15. 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

  16. 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

  17. Interconnection Guidelines

    Science.gov (United States)

    The Interconnection Guidelines provide general guidance on the steps involved with connecting biogas recovery systems to the utility electrical power grid. Interconnection best practices including time and cost estimates are discussed.

  18. 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

  19. OSART guidelines

    International Nuclear Information System (INIS)

    1988-02-01

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

  20. Diagnosing foliar nutrient dynamics of Eucalyptus grandis in ...

    African Journals Online (AJOL)

    Fertilisation is one of the most cost-effective methods of increasing and maintaining the productivity of Eucalyptus grandis plantations in South Africa. This silvicultural practice can be optimised by using the foliar nutrient ratios measured in plants at maximum growth as a guideline for fertiliser application. The foliar nutrient ...

  1. OARSI Clinical Trials Recommendations

    DEFF Research Database (Denmark)

    Kraus, V B; Blanco, F J; Englund, M

    2015-01-01

    The objective of this work was to describe requirements for inclusion of soluble biomarkers in osteoarthritis (OA) clinical trials and progress toward OA-related biomarker qualification. The Guidelines for Biomarkers Working Group, representing experts in the field of OA biomarker research from...... both academia and industry, convened to discuss issues related to soluble biomarkers and to make recommendations for their use in OA clinical trials based on current knowledge and anticipated benefits. This document summarizes current guidance on use of biomarkers in OA clinical trials...... and their utility at five stages, including preclinical development and phase I to phase IV trials. As demonstrated by this summary, biomarkers can provide value at all stages of therapeutics development. When resources permit, we recommend collection of biospecimens in all OA clinical trials for a wide variety...

  2. Food and Nutrients Intake in the School Lunch Program among School Children in Shanghai, China

    Directory of Open Access Journals (Sweden)

    Zhenru Huang

    2017-06-01

    Full Text Available This study aimed to evaluate the intake of food and nutrients among primary, middle, and high schools students in Shanghai, and provide recommendations for possible amendments in new school lunch standards of Shanghai. Twenty schools were included in the school lunch menu survey. Of those, seven schools enrolled 5389 students and conducted physical measurement of plate waste and a questionnaire survey. The amount of food and nutrients was compared according to the new China National Dietary Guideline for School Children (2016 and Chinese Dietary Reference Intakes (2013. The provision of livestock and poultry meat in menus was almost 5–8 times the recommended amount. The amount of seafood was less than the recommended amount, and mostly came from half-processed food. The average percentage of energy from fat was more than 30% in students of all grades. The greatest amount of food wasted was vegetables with 53%, 42%, and 31%, respectively, among primary, middle and high school students. Intake of Vitamin A, Vitamin B2, calcium, and iron was about 50% of the recommended proportion. Only 24.0% students were satisfied with the taste of school lunches. Higher proportions of livestock and poultry meat and low intake of vegetables have become integral problems in school lunch programs. Additionally, more attention needs to be paid to the serving size in primary schools with five age groups.

  3. Food and Nutrients Intake in the School Lunch Program among School Children in Shanghai, China.

    Science.gov (United States)

    Huang, Zhenru; Gao, Runying; Bawuerjiang, Nadila; Zhang, Yali; Huang, Xiaoxu; Cai, Meiqin

    2017-06-07

    This study aimed to evaluate the intake of food and nutrients among primary, middle, and high schools students in Shanghai, and provide recommendations for possible amendments in new school lunch standards of Shanghai. Twenty schools were included in the school lunch menu survey. Of those, seven schools enrolled 5389 students and conducted physical measurement of plate waste and a questionnaire survey. The amount of food and nutrients was compared according to the new China National Dietary Guideline for School Children (2016) and Chinese Dietary Reference Intakes (2013). The provision of livestock and poultry meat in menus was almost 5-8 times the recommended amount. The amount of seafood was less than the recommended amount, and mostly came from half-processed food. The average percentage of energy from fat was more than 30% in students of all grades. The greatest amount of food wasted was vegetables with 53%, 42%, and 31%, respectively, among primary, middle and high school students. Intake of Vitamin A, Vitamin B₂, calcium, and iron was about 50% of the recommended proportion. Only 24.0% students were satisfied with the taste of school lunches. Higher proportions of livestock and poultry meat and low intake of vegetables have become integral problems in school lunch programs. Additionally, more attention needs to be paid to the serving size in primary schools with five age groups.

  4. Are BTS guidelines followed?

    Science.gov (United States)

    2002-03-01

    In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax. The study's aim was to determine the level of adherence to these guidelines at a London teaching hospital. A retrospective case note audit of 59 episodes was performed. In patients undergoing intervention, the initial procedure was simple aspiration in 32 (73 per cent) and chest tube insertion in 12 (27 per cent) cases, contrasting with the BTS recommendation that aspiration should be attempted first in all such patients. Simple aspiration was successful on 34 per cent of occasions. Successful aspiration was associated with a significantly shorter hospital stay (median 3, range 1-11 days) than either failed aspiration (7, 3-66 days) or chest tube insertion without aspiration (9, 3-16 days). Other areas where practice differed from the BTS guidelines were clamping of chest tubes and use of a pursestring suture for wound closure. A follow up questionnaire suggested a lack of familiarity with the guidelines. These findings indicate that current management of spontaneous pneumothorax deviates from the BTS guidelines in potentially important respects.

  5. Nutrient cycling strategies.

    NARCIS (Netherlands)

    Breemen, van N.

    1995-01-01

    This paper briefly reviews pathways by which plants can influence the nutrient cycle, and thereby the nutrient supply of themselves and of their competitors. Higher or lower internal nutrient use efficiency positively feeds back into the nutrient cycle, and helps to increase or decrease soil

  6. Review of nutrition guidelines relevant for adolescents in low- and middle-income countries.

    Science.gov (United States)

    Lassi, Zohra S; Mansoor, Tarab; Salam, Rehana A; Bhutta, Shereen Z; Das, Jai K; Bhutta, Zulfiqar A

    2017-04-01

    The economic and social well-being of any country will one day depend on its current adolescent population. To provide a good foundation for healthy adolescent development, healthy diet, along with physical activity and adequate nutrients, is necessary. Therefore, addressing the nutrition needs of adolescents could be an important step toward breaking the vicious cycle of intergenerational malnutrition, chronic diseases, and poverty. These problems could be addressed with timely recognition and appropriately delivered interventions. Our aim here is to review the existing guidelines on various aspects of nutrition interventions for adolescents and young women. We review all of the major existing guidelines on adolescent nutrition. We were able to find 18 guideline bodies that covered some form of nutritional advice in guidelines that targeted adolescents. Although the guidelines that focus specifically on this age group are limited in scope, we also extrapolated recommendations from guidelines focused on adults, women of reproductive age, and pregnant women, which were based on evidence that included populations of adolescent girls. We were able to extract and synthesize specific directives for nutrition in adolescents, macro- and micronutrient supplementation, exercise, obesity, and nutrition during preconception, pregnancy, and the postconception period. © 2017 New York Academy of Sciences.

  7. New Insulin Delivery Recommendations.

    Science.gov (United States)

    Frid, Anders H; Kreugel, Gillian; Grassi, Giorgio; Halimi, Serge; Hicks, Debbie; Hirsch, Laurence J; Smith, Mike J; Wellhoener, Regine; Bode, Bruce W; Hirsch, Irl B; Kalra, Sanjay; Ji, Linong; Strauss, Kenneth W

    2016-09-01

    Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015. Recommendations are organized around the themes of anatomy, physiology, pathology, psychology, and technology. Key among the recommendations are that the shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and, therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them; effective long-term therapy with insulin is critically dependent on addressing psychological hurdles upstream, even before insulin has been started; inappropriate disposal of used sharps poses a risk of infection with blood-borne pathogens; and mitigation is possible with proper training, effective disposal strategies, and the use of safety devices. Adherence to these new recommendations should lead to more effective therapies, improved outcomes, and lower costs for patients with diabetes. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  8. Total, Added, and Free Sugars: Are Restrictive Guidelines Science-Based or Achievable?

    Directory of Open Access Journals (Sweden)

    Jennifer Erickson

    2015-04-01

    Full Text Available Sugar consumption, especially added sugars, is under attack. Various government and health authorities have suggested new sugar recommendations and guidelines as low as 5% of total calories from free sugars. Definitions for total sugars, free sugars, and added sugars are not standardized, nor are there accepted nutrient databases for this information. Our objective was to measure total sugars and added sugars in sample meal plans created by the United States Department of Agriculture (USDA and the Academy of Nutrition and Dietetics (AND. Utilizing the Nutrition Data System for Research (NDSR nutritional database, results found that plans created by the USDA and AND averaged 5.1% and 3.1% calories from added sugar, 8.7% and 3.1% from free sugar, and 23.3% and 21.1% as total sugars respectively. Compliance with proposed added sugar recommendations would require strict dietary compliance and may not be sustainable for many Americans. Without an accepted definition and equation for calculating added sugar, added sugar recommendations are arbitrary and may reduce intakes of nutrient-rich, recommended foods, such as yogurt, whole grains, and tart fruits including cranberries, cherries, and grapefruit. Added sugars are one part of excess calorie intake; however, compliance with low added sugar recommendations may not be achievable for the general public.

  9. Total, added, and free sugars: are restrictive guidelines science-based or achievable?

    Science.gov (United States)

    Erickson, Jennifer; Slavin, Joanne

    2015-04-15

    Sugar consumption, especially added sugars, is under attack. Various government and health authorities have suggested new sugar recommendations and guidelines as low as 5% of total calories from free sugars. Definitions for total sugars, free sugars, and added sugars are not standardized, nor are there accepted nutrient databases for this information. Our objective was to measure total sugars and added sugars in sample meal plans created by the United States Department of Agriculture (USDA) and the Academy of Nutrition and Dietetics (AND). Utilizing the Nutrition Data System for Research (NDSR) nutritional database, results found that plans created by the USDA and AND averaged 5.1% and 3.1% calories from added sugar, 8.7% and 3.1% from free sugar, and 23.3% and 21.1% as total sugars respectively. Compliance with proposed added sugar recommendations would require strict dietary compliance and may not be sustainable for many Americans. Without an accepted definition and equation for calculating added sugar, added sugar recommendations are arbitrary and may reduce intakes of nutrient-rich, recommended foods, such as yogurt, whole grains, and tart fruits including cranberries, cherries, and grapefruit. Added sugars are one part of excess calorie intake; however, compliance with low added sugar recommendations may not be achievable for the general public.

  10. Appendix to dialysis centre guidelines: recommendations for the relationship between outpatient haemodialysis centres and reference hospitals. Opinions from the Outpatient Dialysis Group. Grupo de Trabajo de Hemodiálisis Extrahospitalaria.

    Science.gov (United States)

    Berdud, I; Arenas, M D; Bernat, A; Ramos, R; Blanco, A

    2011-01-01

    The different clinical guidelines backed by the Spanish Society of Nephrology (SEN) attempt to homogenise the monitoring of renal patients. However, this effort to homogenise treatment has been obstructed in the case of renal replacement therapy patients on haemodialysis due to, among other reasons, the existence of several different dialysis providers, with private centres located in many cities, each with their own reference hospitals and different criteria for treatment based on the existing outsourcing services agreements with the public health service, which also differ between regions. A good relationship between a private dialysis centre and its reference hospital would lead to equal treatment for all dialysis patients, at least at that particular town. The SEN, through the efforts of the Grupo de Trabajo de Hemodiálisis Extrahospitalaria (Outpatient Haemodialysis Group), has prioritised a close relationship and good communication between reference hospitals and dialysis centres in order to guarantee proper continuity of the health care given to these patients. Conditions for referring patients from one centre to another. A patient that starts a haemodialysis programme should be referred from a reference hospital with a definitive vascular access for optimising treatment, with a full report updated within 24-48 hours before the transferral, including essential information for providing proper nephrological treatment: primary pathology, recent viral serology (including hepatitis B and C virus [HBV and HCV] and human immunodeficiency virus [HIV]), parameters for anaemia and calcium-phosphorus metabolism, and ions, date of the first session of dialysis, and the number and dates of blood transfusions received. Furthermore, patients referred from the dialysis centre to the hospital, whether for programmed visits or emergency hospitalisation, should be accompanied by an updated report indicating the primary diagnoses, recent events, viral serology and laboratory

  11. Clinical practice guideline: tinnitus.

    Science.gov (United States)

    Tunkel, David E; Bauer, Carol A; Sun, Gordon H; Rosenfeld, Richard M; Chandrasekhar, Sujana S; Cunningham, Eugene R; Archer, Sanford M; Blakley, Brian W; Carter, John M; Granieri, Evelyn C; Henry, James A; Hollingsworth, Deena; Khan, Fawad A; Mitchell, Scott; Monfared, Ashkan; Newman, Craig W; Omole, Folashade S; Phillips, C Douglas; Robinson, Shannon K; Taw, Malcolm B; Tyler, Richard S; Waguespack, Richard; Whamond, Elizabeth J

    2014-10-01

    Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Despite the high prevalence of tinnitus and its potential significant effect on quality of life, there are no evidence-based, multidisciplinary clinical practice guidelines to assist clinicians with management. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient's quality of life. The target audience for the guideline is any clinician, including nonphysicians, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and bothersome. The purpose of this guideline is to provide evidence-based recommendations for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers. The development group made a strong recommendation that clinicians distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus. The development group made a strong recommendation against obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate tinnitus that does not localize to 1 ear, is nonpulsatile

  12. Misguided guidelines for managing labor.

    Science.gov (United States)

    Cohen, Wayne R; Friedman, Emanuel A

    2015-06-01

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

  13. Nutrient Distribution in a Fish Pond at Rwasave Fish Farming and ...

    African Journals Online (AJOL)

    This paper reports on the study nutrient distribution in the fish pond carried out at Rwasave at Fish Farming and Research Station in Butare, Rwanda. The purpose of the study ... It is recommended that proper nutrient control practices be adopted for avoiding excess nutrients and environmental pollution. Key words: Nutrient ...

  14. Updated, web-based nutrition management guideline for PKU: An evidence and consensus based approach.

    Science.gov (United States)

    Singh, Rani H; Cunningham, Amy C; Mofidi, Shideh; Douglas, Teresa D; Frazier, Dianne M; Hook, Debra Geary; Jeffers, Laura; McCune, Helen; Moseley, Kathryn D; Ogata, Beth; Pendyal, Surekha; Skrabal, Jill; Splett, Patricia L; Stembridge, Adrya; Wessel, Ann; Rohr, Frances

    2016-06-01

    In 2014, recommendations for the nutrition management of phenylalanine hydroxylase deficiency were published as a companion to the concurrently published American College of Medical Genetics and Genomics guideline for the medical treatment of phenylketonuria (PKU). These were developed primarily from a summary of findings from the PKU scientific review conference sponsored by the National Institutes of Health and Agency for Healthcare Research & Quality along with additional systematic literature review. Since that time, the Genetic Metabolic Dietitians International and the Southeast Regional Newborn Screening and Genetics Collaborative have partnered to create a web-based technology platform for the update and development of nutrition management guidelines for inherited metabolic disorders. The purpose of this PKU guideline is to establish harmonization in treatment and monitoring, to guide the integration of nutrition therapy in the medical management of PKU, and to improve outcomes (nutritional, cognitive, and developmental) for individuals with PKU in all life stages while reducing associated medical, educational, and social costs. Six research questions critical to PKU nutrition management were formulated to support guideline development: Review, critical appraisal, and abstraction of peer-reviewed studies and unpublished practice literature, along with expert Delphi survey feedback, nominal group process, and external review from metabolic physicians and dietitians were utilized for development of recommendations relevant to each question. Recommendations address nutrient intake, including updated protein requirements, optimal blood phenylalanine concentrations, nutrition interventions, monitoring parameters specific to life stages, adjunct therapies, and pregnancy and lactation. Recommendations were graded using a rigorous system derived from the Academy of Nutrition and Dietetics. These guidelines, updated utilizing a thorough and systematic approach to

  15. Processed Food Contributions to Energy and Nutrient Intake Differ among US Children by Race/Ethnicity.

    Science.gov (United States)

    Eicher-Miller, Heather A; Fulgoni, Victor L; Keast, Debra R

    2015-12-02

    This study determined and compared the mean daily intake of energy and nutrients from processed foods by level of processing (minimally processed; processed for preservation, nutrient enhancement, and freshness; mixtures of combined ingredients; ready-to-eat processed foods; and prepared foods/meals) among non-Hispanic white, non-Hispanic black, and Mexican American US children. Data from participants 2-18 years old (n = 10,298) of the nationally representative cross-sectional National Health and Nutrition Examination Survey 2003-2008 with a complete one day, 24-h dietary recall were used to determine mean intake of energy and nutrients recommended for increase and decrease, as per the 2010 Dietary Guidelines for Americans, among child race/ethnic groups by category of food processing. Regression analysis was used to estimate and compare covariate-adjusted (gender, age, and poverty-income-level) least square means (p processed foods. Approximately 66% to 84% of total daily energy, saturated fat, cholesterol, fiber, total sugar, added sugars, calcium, vitamin D, potassium, and sodium intake are contributed by one of the five categories of processed foods. Clinicians and policy should primarily advise consideration of the energy and nutrient composition of foods, rather than the processing level, when selecting a healthy diet for children.

  16. Processed Food Contributions to Energy and Nutrient Intake Differ among US Children by Race/Ethnicity

    Directory of Open Access Journals (Sweden)

    Heather A. Eicher-Miller

    2015-12-01

    Full Text Available This study determined and compared the mean daily intake of energy and nutrients from processed foods by level of processing (minimally processed; processed for preservation, nutrient enhancement, and freshness; mixtures of combined ingredients; ready-to-eat processed foods; and prepared foods/meals among non-Hispanic white, non-Hispanic black, and Mexican American US children. Data from participants 2–18 years old (n = 10,298 of the nationally representative cross-sectional National Health and Nutrition Examination Survey 2003–2008 with a complete one day, 24-h dietary recall were used to determine mean intake of energy and nutrients recommended for increase and decrease, as per the 2010 Dietary Guidelines for Americans, among child race/ethnic groups by category of food processing. Regression analysis was used to estimate and compare covariate-adjusted (gender, age, and poverty-income-level least square means (p < 0.05/3 race/ethnic groups. All children, regardless of race or ethnicity consumed processed foods. Approximately 66% to 84% of total daily energy, saturated fat, cholesterol, fiber, total sugar, added sugars, calcium, vitamin D, potassium, and sodium intake are contributed by one of the five categories of processed foods. Clinicians and policy should primarily advise consideration of the energy and nutrient composition of foods, rather than the processing level, when selecting a healthy diet for children.

  17. International recommendations

    International Nuclear Information System (INIS)

    Lindell, Bo

    1986-01-01

    Full text: This short presentation will indicate the general radiation protection background to protective measures against foodstuffs contaminated with radioactive substances. A number of international organizations are involved in various aspects of radiation protection, for example, the International Atomic Energy Agency (IAEA), the United Nations Food and Agriculture Organization (FAO), the United Nations Environment Programme (UNEP), and the World Health Organization (WHO). Two international organizations, however, provide the basic background. These are the International Commission on Radiological Protection (ICRP) and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). UNSCEAR provides the scientific information on radiation levels and effects. It consists of 21 member countries, with truly international coverage. It issues reports to the UN General Assembly, including comprehensive scientific annexes. Its latest comprehensive report was issued in 1982, the next is expected to be published in 1988. That report will include an assessment of the radiological consequences of the Chernobyl accident. The ICRP is a non-governmental organization. It has issued recommendations on radiation protection since 1928. The postulated biological basis for radiation protection recommendations involves two types of biological effects. The so-called non-stochastic effects, mainly due to cell death, appear only when the radiation doses exceed a certain threshold value. These effects, therefore, can only appear after high accidental exposures. After the Chernobyl accident, they only affected about 200 individuals involved in fire extinction and rescue work at the damaged nuclear power plant. Stochastic effects, with some simplification, may be seen as the result of initial changes in the genetic code of some surviving cells. If these cells are germ cells, this may lead to hereditary harm. If they are somatic cells, the result could be cancer

  18. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients.

    Science.gov (United States)

    Parrott, Julie; Frank, Laura; Rabena, Rebecca; Craggs-Dino, Lillian; Isom, Kellene A; Greiman, Laura

    2017-05-01

    Optimizing postoperative patient outcomes and nutritional status begins preoperatively. Patients should be educated before and after weight loss surgery (WLS) on the expected nutrient deficiencies associated with alterations in physiology. Although surgery can exacerbate preexisting nutrient deficiencies, preoperative screening for vitamin deficiencies has not been the norm in the majority of WLS practices. Screening is important because it is common for patients who present for WLS to have at least 1 vitamin or mineral deficiency preoperatively. The focus of this paper is to update the 2008 American Society for Metabolic and Bariatric Surgery Nutrition in Bariatric Surgery Guidelines with key micronutrient research in laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, biliopancreatic diversion, and biliopancreatic diversion/duodenal switch. Four questions regarding recommendations for preoperative and postoperative screening of nutrient deficiencies, preventative supplementation, and repletion of nutrient deficiencies in pre-WLS patients have been applied to specific micronutrients (vitamins B1 and B12; folate; iron; vitamins A, E, and K; calcium; vitamin D; copper; and zinc). Out of the 554 articles identified as meeting preliminary search criteria, 402 were reviewed in detail. There are 92 recommendations in this update, 79 new recommendations and an additional 13 that have not changed since 2008. Each recommendation has a corresponding graded level of evidence, from grade A through D. Data continue to suggest that the prevalence of micronutrient deficiencies is increasing, while monitoring of patients at follow-up is decreasing. This document should be viewed as a guideline for a reasonable approach to patient nutritional care based on the most recent research, scientific evidence, resources, and information available. It is the responsibility of the registered dietitian nutritionist and WLS program to determine

  19. Tumor markers: applications and recommendations. New IZOTOPE products

    International Nuclear Information System (INIS)

    Gyenes, Ana Rosa

    2016-01-01

    At work aspects are discussed: Tumor markers; New products IZOTOP; Measuring principle of IRMA kits for tumor markers; Guidelines and Recommendations for the use of tumor markers. pre-analytical, post-analytical and Quality control recommendations are given

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

    African Journals Online (AJOL)

    : Physicians in this hospital fairly complied with the stated guidelines, but do not appear to have recommended lifestyle modifications to their hypertensive patients. Keywords: Adherence, Guidelines, Hypertension, Management. Tropical ...

  1. Compliance with national nutrition recommendations among breast cancer survivors in "stepping stone".

    Science.gov (United States)

    Dennis Parker, Elizabeth A; Sheppard, Vanessa B; Adams-Campbell, Lucile

    2014-03-01

    Compared with White breast cancer survivors, African American survivors are more likely to be overweight and obese. Differences in weight status may be attributed to differences in dietary intake; however, there is limited research pertaining to the dietary habits of African American breast cancer survivors. We compared baseline dietary intakes of 31 overweight and obese African American breast cancer survivors enrolled in a healthy lifestyle intervention to national dietary guidelines and also examined beverage intake habits. Dietary intake was assessed using the National Cancer Institute's Diet History Questionnaire and beverage intake was assessed using 3-day food intake records. Overall, the majority of survivors consumed the recommended daily servings of fruits and vegetables (71.0%) and red meat (83.9%); however, survivors exceeded national recommendations for energy intake from fat (64.5%), saturated fat (87.1%), and added sugars (77.4%). Few women met the guidelines for whole grain and fiber intake (6.5% and 35.5%, respectively). Additionally, survivors consumed ~10% of total energy intake from beverages alone and drank only ~3.5 cups of water daily. Current dietary guidelines for cancer survivors recommend consuming >5 servings per day of fruits and vegetables and broad guidelines regarding limiting discretionary fat and added sugars but do not specify beverage intake recommendations. Future dietary interventions in African American breast cancer survivors should focus on reducing intake from dietary fat and added sugar, as well as increasing whole grain consumption as a means for increasing daily fiber intake. Furthermore, substituting caloric beverages with water or noncaloric beverages may be a strategy to decrease caloric intake in African American breast cancer survivors. Nutrition information targeting these nutrients could be administered during treatments or doctor's visits as a means to prevent weight gain that often occurs following diagnosis.

  2. Vitamin D Sufficiency of Canadian Children Did Not Improve Following the 2010 Revision of the Dietary Guidelines That Recommend Higher Intake of Vitamin D: An Analysis of the Canadian Health Measures Survey

    Directory of Open Access Journals (Sweden)

    Lalani L. Munasinghe

    2017-08-01

    Full Text Available In 2010, the dietary guidelines for vitamin D for Canadians and Americans aged 1–70 years were revised upward. It is unknown whether the vitamin D status of Canadian children improved after 2010. We compared the prevalence of vitamin D sufficiency (25-hydroxy vitamin D (25(OHD concentration of ≥50 nmol/L, 25(OHD concentration and the frequency of consuming vitamin D-rich foods among children aged 6–18 years-old using data from the nationally representative 2007/2009 and 2012/2013 Canadian Health Measures Surveys. Associations of sociodemographic, anthropometric, seasonal, and regional variables with achieving vitamin D sufficiency, 25(OHD concentration, and consumption of vitamin D-rich foods were assessed using multiple logistic and linear regression models. 79% and 68% of children in 2007/2009 and 2012/2013 respectively, were vitamin D sufficient. The main dietary source of vitamin D was milk. Between 2007/2009 and 2012/2013, the frequency of milk and fish consumption declined, but egg and red meat consumption was unchanged. Age, income, weight status, season and ethnicity were associated with 25(OHD concentration and vitamin D sufficiency. Vitamin D status declined after the upward revision of dietary guidelines for vitamin D, consequently, dietary intake was inadequate to meet sufficiency. Public health initiatives to promote vitamin D-rich foods and supplementation for Canadian children are needed.

  3. [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.

  4. Primary care guidelines

    DEFF Research Database (Denmark)

    Ijäs, Jarja; Alanen, Seija; Kaila, Minna

    2009-01-01

    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......-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...... that no agreements on recording target blood pressure in patient records existed. A similar discrepancy was seen in recording cardiovascular risk (64% vs. 44%, p executives agreed best on the calibration of sphygmomanometers and the provision of weight-control group counselling. CONCLUSIONS...

  5. Dietary guidelines to nourish humanity and the planet in the twenty-first century. A blueprint from Brazil.

    Science.gov (United States)

    Monteiro, Carlos Augusto; Cannon, Geoffrey; Moubarac, Jean-Claude; Martins, Ana Paula Bortoletto; Martins, Carla Adriano; Garzillo, Josefa; Canella, Daniela Silva; Baraldi, Larissa Galastri; Barciotte, Maluh; Louzada, Maria Laura da Costa; Levy, Renata Bertazzi; Claro, Rafael Moreira; Jaime, Patrícia Constante

    2015-09-01

    To present and discuss the dietary guidelines issued by the Brazilian government in 2014. The present paper describes the aims of the guidelines, their shaping principles and the approach used in the development of recommendations. The main recommendations are outlined, their significance for the cultural, socio-economic and environmental aspects of sustainability is discussed, and their application to other countries is considered. Brazil in the twenty-first century. All people in Brazil, now and in future. The food- and meal-based Brazilian Dietary Guidelines address dietary patterns as a whole and so are different from nutrient-based guidelines, even those with some recommendations on specific foods or food groups. The guidelines are based on explicit principles. They take mental and emotional well-being into account, as well as physical health and disease prevention. They identify diet as having cultural, socio-economic and environmental as well as biological and behavioural dimensions. They emphasize the benefits of dietary patterns based on a variety of natural or minimally processed foods, mostly plants, and freshly prepared meals eaten in company, for health, well-being and all relevant aspects of sustainability, as well as the multiple negative effects of ready-to-consume ultra-processed food and drink products. The guidelines' recommendations are designed to be sustainable personally, culturally, socially, economically and environmentally, and thus fit to face this century. They are for foods, meals and dietary patterns of types that are already established in Brazil, which can be adapted to suit the climate, terrain and customs of all countries.

  6. The nutrient density approach to healthy eating: challenges and opportunities.

    Science.gov (United States)

    Nicklas, Theresa A; Drewnowski, Adam; O'Neil, Carol E

    2014-12-01

    The term 'nutrient density' for foods/beverages has been used loosely to promote the Dietary Guidelines for Americans. The 2010 Dietary Guidelines for Americans defined 'all vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas (legumes), and nuts and seeds that are prepared without added solid fats, added sugars, and sodium' as nutrient dense. The 2010 Dietary Guidelines for Americans further states that nutrient-dense foods and beverages provide vitamins, minerals and other substances that may have positive health effects with relatively few (kilo)calories or kilojoules. Finally, the definition states nutrients and other beneficial substances have not been 'diluted' by the addition of energy from added solid fats, added sugars or by the solid fats naturally present in the food. However, the Dietary Guidelines Advisory Committee and other scientists have failed to clearly define 'nutrient density' or to provide criteria or indices that specify cut-offs for foods that are nutrient dense. Today, 'nutrient density' is a ubiquitous term used in the scientific literature, policy documents, marketing strategies and consumer messaging. However, the term remains ambiguous without a definitive or universal definition. Classifying or ranking foods according to their nutritional content is known as nutrient profiling. The goal of the present commentary is to address the research gaps that still exist before there can be a consensus on how best to define nutrient density, highlight the situation in the USA and relate this to wider, international efforts in nutrient profiling.

  7. Soluble organic nutrient fluxes

    Science.gov (United States)

    Robert G. Qualls; Bruce L. Haines; Wayne Swank

    2014-01-01

    Our objectives in this study were (i) compare fluxes of the dissolved organic nutrients dissolved organic carbon (DOC), DON, and dissolved organic phosphorus (DOP) in a clearcut area and an adjacent mature reference area. (ii) determine whether concentrations of dissolved organic nutrients or inorganic nutrients were greater in clearcut areas than in reference areas,...

  8. Atenção primária à saúde: diretrizes, desafios e recomendações. Revisão de bibliografia internacional Primary health care: guidelines, challenges and recommendations. A review of international literature

    Directory of Open Access Journals (Sweden)

    Luiz Gustavo Silva Souza

    2011-01-01

    Full Text Available Apresentamos uma revisão de bibliografia internacional que teve por objetivo identificar e analisar a diversidade de temas associados à Atenção Primária à Saúde, especialmente o cotidiano de trabalho de seus profissionais, suas diretrizes e seus desafios políticos e clínicos. Analisamos os resumos de 105 artigos publicados entre 1999 e 2009. Selecionamos, para análise, 34 artigos identificados de acordo com critérios específicos. Criamos categorias temáticas e comparamos os dados com certa literatura brasileira sobre o tema. Os artigos centram-se no profissional de medicina e enfatizam a noção de medicina baseada em evidências. Abordam principalmente a implementação de diretrizes na Atenção Primária e as relações entre profissionais e usuários. Admitem a complexidade da Atenção Primária e a importância de aproximação à realidade dos pacientes. Entretanto, não abordam a intersetorialidade, não questionam radicalmente o especialismo curativista e não mencionam a promoção de cidadania, autonomia e cogestão junto aos usuários. Falam da necessidade de abordar problemas "humanos" nos níveis de implementação de diretrizes, encontro clínico etc., mas se mostram distanciados das ciências humanas.We present a review of international literature, aiming at identifying and analyzing the diversity of themes associated to Primary Health Care. We focused on the characteristics of the work of health care personnel, its guidelines and its political and clinical challenges. We analyzed the abstracts of 105 articles published between 1999 and 2009. Then, we integrally read and analyzed 34 articles, creating thematic categories. We compared data to Brazilian literature on the subject. The articles focus on physician's work and emphasize the notion of evidence-based medicine. They mainly approach the implementation of guidelines to primary health care and the professional-patient relations. They acknowledge the complexity of

  9. Guideline-related barriers to optimal prescription of oral anticoagulants in primary care

    NARCIS (Netherlands)

    Beukenhorst, A. L.; Arts, D. L.; Lucassen, W.; Jager, K. J.; van der Veer, S. N.

    2016-01-01

    Guidelines provide recommendations for antithrombotic treatment to prevent stroke in people with atrial fibrillation, but oral anticoagulant prescriptions in Dutch primary care are often discordant with these recommendations. Suboptimal guideline features (i.e. format and content) have been

  10. Methodological guidelines

    International Nuclear Information System (INIS)

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

    1999-01-01

    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

  11. 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.

  12. ASCOT guidelines

    International Nuclear Information System (INIS)

    1994-05-01

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

  13. 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...... as diagnostic tools. Antidepressants, melatonin and cognitive behavioural therapy have no effect on tinnitus, whereas sound generators, hearing aids and tinnitus retraining therapy show some but limited improvement. National recommendations are required to ensure a homogenous and optimum offer for all patients....

  14. Medical Malpractice Implications of Clinical Practice Guidelines.

    Science.gov (United States)

    Ruhl, Douglas S; Siegal, Gil

    2017-08-01

    Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

  15. Curriculum Guidelines for Microscopic Anatomy.

    Science.gov (United States)

    Journal of Dental Education, 1993

    1993-01-01

    The American Association of Dental Schools' guidelines for curricula in microscopic anatomy offer an overview of the histology curriculum, note primary educational goals, outline specific content for general and oral histology, suggest prerequisites, and make recommendations for sequencing. Appropriate faculty and facilities are also suggested.…

  16. Measure Guideline: Internal Insulation of Masonry Walls

    Energy Technology Data Exchange (ETDEWEB)

    Straube, J. F.; Ueno, K.; Schumacher, C. J.

    2012-07-01

    This measure guideline provides recommendations for interior insulation assemblies that control interstitial condensation and durability risks; recommendations for acceptable thermal performance are also provided. An illustrated guide of high-risk exterior details (which concentrate bulk water), and recommended remediation details is provided. This is followed by a recommended methodology for risk assessment of a masonry interior insulation project: a series of steps are suggested to assess the risks associated with this retrofit, with greater certainty with added steps.

  17. Measure Guideline. Internal Insulation of Masonry Walls

    Energy Technology Data Exchange (ETDEWEB)

    Straube, J. F. [Building Science Corporation (BSC), Somerville, MA (United States); Ueno, K. [Building Science Corporation (BSC), Somerville, MA (United States); Schumacher, C. J. [Building Science Corporation (BSC), Somerville, MA (United States)

    2012-07-01

    This measure guideline provides recommendations for interior insulation assemblies that control interstitial condensation and durability risks; recommendations for acceptable thermal performance are also provided. An illustrated guide of high-risk exterior details (which concentrate bulk water), and recommended remediation details is provided. This is followed by a recommended methodology for risk assessment of a masonry interior insulation project: a series of steps are suggested to assess the risks associated with this retrofit, with greater certainty with added steps.

  18. Quality Control Guidelines for SAM Chemical Methods

    Science.gov (United States)

    Learn more about quality control guidelines and recommendations for the analysis of samples using the chemistry methods listed in EPA's Selected Analytical Methods for Environmental Remediation and Recovery (SAM).

  19. Quality Control Guidelines for SAM Pathogen Methods

    Science.gov (United States)

    Learn more about quality control guidelines and recommendations for the analysis of samples using the biotoxin methods listed in EPA's Selected Analytical Methods for Environmental Remediation and Recovery (SAM).

  20. Quality Control Guidelines for SAM Biotoxin Methods

    Science.gov (United States)

    Learn more about quality control guidelines and recommendations for the analysis of samples using the pathogen methods listed in EPA's Selected Analytical Methods for Environmental Remediation and Recovery (SAM).

  1. Quality Control Guidelines for SAM Radiochemical Methods

    Science.gov (United States)

    Learn more about quality control guidelines and recommendations for the analysis of samples using the radiochemistry methods listed in EPA's Selected Analytical Methods for Environmental Remediation and Recovery (SAM).

  2. The 2015 Dietary Guidelines Advisory Committee Scientific Report: Development and Major Conclusions.

    Science.gov (United States)

    Millen, Barbara E; Abrams, Steve; Adams-Campbell, Lucile; Anderson, Cheryl Am; Brenna, J Thomas; Campbell, Wayne W; Clinton, Steven; Hu, Frank; Nelson, Miriam; Neuhouser, Marian L; Perez-Escamilla, Rafael; Siega-Riz, Anna Maria; Story, Mary; Lichtenstein, Alice H

    2016-05-01

    The Dietary Guidelines for Americans (DGA) is published every 5 y jointly by the Department of Health and Human Services (HHS) and the USDA and provides a framework for US-based food and nutrition programs, health promotion and disease prevention initiatives, and research priorities. Summarized in this report are the methods, major conclusions, and recommendations of the Scientific Report of the 2015 US Dietary Guidelines Advisory Committee (DGAC). Early in the process, the DGAC developed a conceptual model and formulated questions to examine nutritional risk and determinants and impact of dietary patterns in relation to numerous health outcomes among individuals aged ≥2 y. As detailed in the report, an expansive, transparent, and comprehensive process was used to address each question, with multiple opportunities for public input included. Consensus was reached on all DGAC's findings, including each conclusion and recommendation, and the entire report. When research questions were answered by original systematic literature reviews and/or with existing, high-quality expert reports, the quality and strength of the evidence was formally graded. The report was organized around the following 5 themes: 1) food and nutrient intakes and health: current status and trends; 2) dietary patterns, foods and nutrients, and health outcomes; 3) diet and physical activity behavior change; 4) food and physical activity environments; and 5) food sustainability and food safety. The following 3 cross-cutting topics were addressed: 1) sodium, 2) saturated fat, and 3) added sugars. Physical activity recommendations from recent expert reports were endorsed. The overall quality of the American diet was assessed to identify overconsumed and underconsumed nutrients of public health concern. Common food characteristics of healthy dietary patterns were determined. Features of effective interventions to change individual and population diet and physical activity behaviors in clinical, public

  3. General Quality Control (QC) Guidelines for SAM Methods

    Science.gov (United States)

    Learn more about quality control guidelines and recommendations for the analysis of samples using the methods listed in EPA's Selected Analytical Methods for Environmental Remediation and Recovery (SAM).

  4. Design Guidelines for Wearable Pointing Devices

    OpenAIRE

    Zucco, Joanne E.; Thomas, Bruce H.

    2016-01-01

    This paper presents design guidelines and recommendations for developing cursor manipulation interaction devices to be employed in a wearable context. The work presented in this paper is the culmination three usability studies designed to understand commercially available pointing (cursor manipulation) devices suitable for use in a wearable context. The set of guidelines and recommendations presented are grounded on experimental and qualitative evidence derived from three usability studies ...

  5. State Emergency Department Opioid Guidelines: Current Status.

    Science.gov (United States)

    Broida, Robert I; Gronowski, Tanner; Kalnow, Andrew F; Little, Andrew G; Lloyd, Christopher M

    2017-04-01

    The purpose of this study was to evaluate and categorize current state-sponsored opioid guidelines for the practice of emergency medicine (EM). We conducted a comprehensive search of EM-specific opioid prescribing guidelines and/or policies in each state to determine current state involvement in EM opioid prescribing, as well as to evaluate some of the specifics of each guideline or policy. The search was conducted using an online query and a follow-up email request to each state chapter of ACEP. We found that 17 states had emergency department-specific guidelines. We further organized the guidelines into four categories: limiting prescriptions for opioids with 67 total recommendations; preventing/diverting abuse with 56 total recommendations; addiction-related guidelines with 29 total recommendations; and a community resources section with 24 total recommendations. Our results showed that current state guidelines focus on providers limiting opioid pain prescriptions and vetting patients for possible abuse/diversion. This study highlights the 17 states that have addressed opioid prescribing guidelines and categorizes their efforts to date. It is hoped that this study will provide the basis for similar efforts in other states.

  6. EAU Guidelines on Chronic Pelvic Pain

    NARCIS (Netherlands)

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

    Context: 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. Objective: To revise guidelines for the diagnosis,

  7. Finding Evidence for Updates in Medical Guidelines

    NARCIS (Netherlands)

    Reinders, Roelof; ten Teije, Annette; Huang, Zisheng

    2015-01-01

    Medical guidelines are documents that describe optimal treatment for patients by medical practitioners based on current medical research (evidence), in the form of step-by-step recommendations. Because the field of medical research is very large and always evolving, keeping these guidelines

  8. [School meals: state of the art and recommendations].

    Science.gov (United States)

    Aranceta Bartrina, J; Pérez Rodrigo, C; Dalmau Serra, J; Gil Hernández, A; Lama More, R; Martín Mateos, M A; Martínez Suárez, V; Pavón Belinchón, P; Suárez Cortina, L

    2008-07-01

    School meals contribute substantially to overall energy and nutrient intake adequacy of children, but also play an important role in the development of child food habits and the socialisation process. Evidence shows that school based environmental actions, which include changes in school meals and school food policies related to increased availability and access to healthy foods and drinks while in the school are effective to foster healthy eating practices among children. A growing number of children engage in school meals. Available information to date shows that the quality of the food on offer is not always consistent with dietary guidelines. Vegetables and fish are served less often than desirable and excess added fats are used in food preparations. Norms and regulations are very detailed regarding food safety issues and administrative management of the service, including subcontracting of catering providers and care staff. Nutrition and health promotion issues should also be included in regulations by means of nutrition recommendations for school meals along with information on food based dietary guidelines and portion sizes. School meals should be part of the educational project using a whole school approach.

  9. ASSET guidelines. Revised 1991 Edition

    International Nuclear Information System (INIS)

    1991-12-01

    The present publication is an updated version of the IAEA Assessment of Safety Significant Events Team (ASSET) Guidelines, IAEA-TECDOC-573, published in 1990. Sections 5 and 6 include revised definitions and investigation guidelines for identification of both direct and root causes. These revisions were recommended by a Consultants Meeting held in Vienna on 3-7 December 1990. This guidance is not intended to infringe an expert's prerogative to investigate additional items. Its main purpose is to provide a basic structure and ensure consistency in the assessments. Use of the ASSET guidelines should also facilitate comparison between the observations made in different nuclear power plants and harmonize the reporting of generic ASSET results. The guidelines should always be used with a critical attitude and a view to possible improvements

  10. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 4: Unmet Needs in the Treatment of Bipolar Disorder and Recommendations for Future Research.

    Science.gov (United States)

    Fountoulakis, Konstantinos N; Vieta, Eduard; Young, Allan; Yatham, Lakshmi; Grunze, Heinz; Blier, Pierre; Moeller, Hans Jurgen; Kasper, Siegfried

    2017-02-01

    The current fourth paper on the International College of Neuropsychopharmacology guidelines for the treatment of bipolar disorder reports on the unmet needs that became apparent after an extensive review of the literature and also serves as a conclusion to the project of the International College of Neuropsychopharmacology workgroup. The systematic review of the literature that was performed to develop the International College of Neuropsychopharmacology guidelines for bipolar disorder identified and classified a number of potential shortcomings. Problems identified concerned the reliability and validity of the diagnosis of bipolar disorder and especially of bipolar depression. This, in turn, has profound consequences for early detection and correct treatment of the disorder. Another area that needs improvement is the unsatisfactory efficacy and effectiveness of therapeutic options, especially in special populations such as those with mixed features and rapid cycling course. Gender issues and adherence problems constitute an additional challenge. The literature suggests that while treatment providers are concerned more with treatment-related issues, patients and their caregivers worry more about issues pertaining to the availability of services and care, quality of life, and various types of burden. The workgroup identified additional unmet needs related to the current standard of research in bipolar disorder. These include the fragmentation of bipolar disorder into phases that are handled as being almost absolutely independent from each other, and thus the development of an overall therapeutic strategy on the basis of the existing evidence is very difficult. Trials are not always designed in a way that outcomes cover the most important aspects of bipolar disorder, and often the reporting of the results is biased and unsatisfactory. The data on combination treatments and high dosages are sparse, whereas they are common in real world practice. The workgroup endorses

  11. [Threatened late miscarriage. French guidelines].

    Science.gov (United States)

    Carcopino, X; Barde, K; Petrovic, M; Beucher, G; Capmas, P; Huchon, C; Deffieux, X; d'Ercole, C; Bretelle, F

    2014-12-01

    To define guidelines for the management of women diagnosed with threatened late miscarriage (TLM). A systematic review of the literature was performed using Pubmed and the Cochrane library databases and the guidelines from main international societies. Management of women diagnosed with threatened LM requires a complete history-taking searching for a previous history of LM and/or of premature delivery (Grade B). Speculum examination is required to diagnose membrane prolapse (Grade B) and vaginal ultrasound scan is recommended to measure the cervical length (Grade B). Finally, initial management should allow to rule out chorioamniotitis (Grade B). Vaginal progesterone therapy (90-200mg daily) is recommended for women diagnosed with a sole shortened cervix (Mc Donald technique) associated with systematic tocolytic therapy (indometacine) and antibiotics are to be recommended in women diagnosed with TLM with dilated cervical os eventually associated with membrane prolapse (GradeC). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Review of trace mineral requirements for preterm infants: what are the current recommendations for clinical practice?

    Science.gov (United States)

    Finch, Carolyn Weiglein

    2015-02-01

    Inadequate nutrient stores at birth are an inevitable consequence of being born prematurely. Preterm infants also have high nutrient requirements, which increase with earlier gestational ages. As a result, early nutrition intervention is required to prevent further deficits that, if not corrected, can affect growth and long-term outcomes. Preterm infants often require several weeks of parenteral nutrition (PN) support, which includes trace mineral supplementation. Trace minerals are considered essential nutrients, unable to be synthesized in the human body. Deficiencies of trace minerals have been reported, yet evidence-based guidelines for assessment and supplementation have not been clearly defined. Food and Drug Administration-approved parenteral trace mineral intake guidelines are more than 30 years old. In an effort to more clearly define trace mineral supplementation and monitoring guidelines for preterm infants, a review of literature was performed with the purpose to (1) summarize trace mineral roles in preterm infants, (2) describe clinical signs of deficiency and toxicity, and (3) present intake recommendations and considerations for preterm infants based on current available literature. Review of literature was completed using PubMed and Cochrane databases to find relevant studies specific to trace mineral requirements for preterm infants, trace mineral supplementation of PN, human milk fortifiers, and preterm infant formulas. Review of literature supports that trace mineral depletion can lead to clinical compromise in preterm infants; therefore, suggesting that every effort be made to ensure adequate provision of trace minerals is given to preterm infants. Practical considerations for the clinical nutrition management of preterm infants were also identified in this review. © 2014 American Society for Parenteral and Enteral Nutrition.

  13. Projected prevalence of inadequate nutrient intakes in Europe

    NARCIS (Netherlands)

    Vinas, B.R.; Barba, L.R.; Ngo, J.; Gurinovic, M.; Novakovic, R.; Cavelaars, A.J.E.M.; Groot, de C.P.G.M.; Veer, van 't P.; Matthys, C.; Serra Majem, L.

    2011-01-01

    Background: The purpose of this study was to analyze the prevalence of nutrient intake inadequacy in Europe, applying the Nordic Nutritional Recommendations in the context of the EURRECA Network of Excellence. Methods: Nutrient data was obtained from the European Nutrition and Health Report II.

  14. Dental sealants guidelines development: 2002-2014.

    Science.gov (United States)

    Crall, James J; Donly, Kevin J

    2015-01-01

    The purpose of this paper was to review the chronology of dental sealant guideline developments and changes in recommendations regarding sealant usage by various state, national, and international organizations between 2002 and 2014. More specific objectives include: (1) review and summarize the findings of systematic evidence-based reviews and recommendations regarding the use of pit and fissure sealants published since the 2002 American Academy of Pediatric Dentistry Pediatric Restorative Dentistry Consensus Conference; (2) identify consistencies and changes in conclusions or recommendations regarding the use of pit and fissure sealants, and differences in the methods used to develop recommendations/guidelines over time; and (3) describe the purpose and scope of current efforts to update American Dental Association 2008 Evidence-based Clinical Recommendations for the Use of Pit and Fissure Sealants. A summary of recommendations based on experts' synthesis of published evidence and recommendations is included.

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

    Science.gov (United States)

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

    2007-01-01

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

  16. S1 guidelines: Lipedema.

    Science.gov (United States)

    Reich-Schupke, Stefanie; Schmeller, Wilfried; Brauer, Wolfgang Justus; Cornely, Manuel E; Faerber, Gabriele; Ludwig, Malte; Lulay, Gerd; Miller, Anya; Rapprich, Stefan; Richter, Dirk Frank; Schacht, Vivien; Schrader, Klaus; Stücker, Markus; Ure, Christian

    2017-07-01

    The present, revised guidelines on lipedema were developed under the auspices of and funded by the German Society of Phlebology (DGP). The recommendations are based on a systematic literature search and the consensus of eight medical societies and working groups. The guidelines contain recommendations with respect to diagnosis and management of lipedema. The diagnosis is established on the basis of medical history and clinical findings. Characteristically, there is a localized, symmetrical increase in subcutaneous adipose tissue in arms and legs that is in marked disproportion to the trunk. Other findings include edema, easy bruising, and increased tenderness. Further diagnostic tests are usually reserved for special cases that require additional workup. Lipedema is a chronic, progressive disorder marked by the individual variability and unpredictability of its clinical course. Treatment consists of four therapeutic mainstays that should be combined as necessary and address current clinical symptoms: complex physical therapy (manual lymphatic drainage, compression therapy, exercise therapy, and skin care), liposuction and plastic surgery, diet, and physical activity, as well as psychotherapy if necessary. Surgical procedures are indicated if - despite thorough conservative treatment - symptoms persist, or if there is progression of clinical findings and/or symptoms. If present, morbid obesity should be therapeutically addressed prior to liposuction. © 2017 The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

  17. Improving artificial breeding of cattle in Africa. Guidelines and recommendations. A manual prepared under the framework of an IAEA technical cooperation regional AFRA project on increasing and improving milk and meat production

    International Nuclear Information System (INIS)

    2005-04-01

    cattle farmers and to arrive at a consensus on what can be considered 'best practice' in the countries represented. It was concluded that: (a) methods of keeping records, their analysis and use for evaluating genetic merit and fertility of AI bulls require improvement in most AFRA Member States; (b) the technical aspects of providing N-PD and related services to farmers based on progesterone assay have been clarified in many Member States; (c) the modalities and logistics of practical application under the different conditions in countries need to be further developed; and (d) there is a clear need for guidelines that can be used for improvement and harmonization of currently used technical procedures for AI in the Member States. Participants of the meeting developed a framework for the guidelines, formulated the first draft of the manual and identified the additional work necessary for its completion. The manual was subsequently compiled and the second draft was circulated to all AFRA national project coordinators for comments and suggestions for improvement. It was finally discussed at a Project Review, Coordination and Planning Meeting held in Addis Ababa in March 2002 and further material incorporated as required. This manual combines the outputs from the three meetings referred to above, and is the result of collaboration between the contributors listed at the end of the publication

  18. Lime and fertilizer recommendation system for coconut trees

    Directory of Open Access Journals (Sweden)

    Gustavo Nogueira Guedes Pereira Rosa

    2011-02-01

    Full Text Available Fertilizer recommendation to most agricultural crops is based on response curves. Such curves are constructed from field experimental data, obtained for a particular condition and may not be reliable to be applied to other regions. The aim of this study was to develop a Lime and Fertilizer Recommendation System for Coconut Crop based on the nutritional balance. The System considers the expected productivity and plant nutrient use efficiency to estimate nutrient demand, and effective rooting layer, soil nutrient availability, as well as any other nutrient input to estimate the nutrient supply. Comparing the nutrient demand with the nutrient supply the System defines the nutrient balance. If the balance for a given nutrient is negative, lime and, or, fertilization is recommended. On the other hand, if the balance is positive, no lime or fertilizer is needed. For coconut trees, the fertilization regime is divided in three stages: fertilization at the planting spot, band fertilization and fertilization at the production phase. The data set for the development of the System for coconut trees was obtained from the literature. The recommendations generated by the System were compared to those derived from recommendation tables used for coconut crop in Brazil. The main differences between the two procedures were for the P rate applied in the planting hole, which was higher in the proposed System because the tables do not pay heed to the pit volume, whereas the N and K rates were lower. The crop demand for K is very high, and the rates recommended by the System are superior to the table recommendations for the formation and initial production stage. The fertilizer recommendations by the System are higher for the phase of coconut tree growth as compared to the production phase, because greater amount of biomass is produced in the first phase.

  19. The 2015 Dutch food-based dietary guidelines

    NARCIS (Netherlands)

    Kromhout, D.; Spaaij, C.J.K.; Goede, de J.; Weggemans, R.M.; Brug, Johannes; Geleijnse, Johanna M.; Goudoever, van Johannes B.; Hoes, Arno W.; Hopman, Maria T.E.; Iestra, Jolein A.; Mensink, Ronald P.; Pijl, Hanno; Romijn, Johannes A.; Schols, Annemie M.W.J.; Seidell, Jaap C.; Veer, van 't Pieter; Visser, Marjolein; Zwietering, Marcel H.

    2016-01-01

    The objective of this study was to derive food-based dietary guidelines for the Dutch population. The dietary guidelines are based on 29 systematic reviews of English language meta-analyses in PubMed summarizing randomized controlled trials and prospective cohort studies on nutrients, foods and

  20. The 2015 Dutch food-based dietary guidelines

    NARCIS (Netherlands)

    Kromhout, D; Spaaij, C J K; de Goede, J; Weggemans, R M; Iestra, JA; Hoes, Arno W.

    The objective of this study was to derive food-based dietary guidelines for the Dutch population. The dietary guidelines are based on 29 systematic reviews of English language meta-analyses in PubMed summarizing randomized controlled trials and prospective cohort studies on nutrients, foods and food

  1. Farmers' use of nutrient management: lessons from watershed case studies.

    Science.gov (United States)

    Osmond, Deanna L; Hoag, Dana L K; Luloff, Al E; Meals, Donald W; Neas, Kathy

    2015-03-01

    Nutrient enrichment of water resources has degraded coastal waters throughout the world, including in the United States (e.g., Chesapeake Bay, Gulf of Mexico, and Neuse Estuary). Agricultural nonpoint sources have significant impacts on water resources. As a result, nutrient management planning is the primary tool recommended to reduce nutrient losses from agricultural fields. Its effectiveness requires nutrient management plans be used by farmers. There is little literature describing nutrient management decision-making. Here, two case studies are described that address this gap: (i) a synthesis of the National Institute of Food and Agriculture, the Conservation Effects Assessment Project, and (ii) field surveys from three nutrient-impaired river basins/watersheds in North Carolina (Neuse, Tar-Pamlico, and Jordan Lake drainage areas). Results indicate farmers generally did not fully apply nutrient management plans or follow basic soil test recommendations even when they had them. Farmers were found to be hesitant to apply N at university-recommended rates because they did not trust the recommendations, viewed abundant N as insurance, or used recommendations made by fertilizer dealers. Exceptions were noted when watershed education, technical support, and funding resources focused on nutrient management that included easing management demands, actively and consistently working directly with a small group of farmers, and providing significant resource allocations to fund agency personnel and cost-share funds to farmers. Without better dialogue with farmers and meaningful investment in strategies that reward farmers for taking what they perceive as risks relative to nutrient reduction, little progress in true adoption of nutrient management will be made. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  2. Development of the SoFAS (solid fats and added sugars) concept: the 2010 Dietary Guidelines for Americans.

    Science.gov (United States)

    Nicklas, Theresa A; O'Neil, Carol E

    2015-05-01

    The diets of most US children and adults are poor, as reflected by low diet quality scores, when compared with the recommendations of the Dietary Guidelines for Americans (DGAs). Contributing to these low scores is that most Americans overconsume solid fats, which may contain saturated fatty acids and added sugars; although alcohol consumption was generally modest, it provided few nutrients. Thus, the 2005 DGAs generated a new recommendation: to reduce intakes of solid fats, alcohol, and added sugars (SoFAAS). What precipitated the emergence of the new SoFAAS terminology was the concept of discretionary calories (a "calorie" is defined as the amount of energy needed to increase the temperature of 1 kg of water by 1°C), which were defined as calories consumed after an individual had met his or her recommended nutrient intakes while consuming fewer calories than the daily recommendation. A limitation with this concept was that additional amounts of nutrient-dense foods consumed beyond the recommended amount were also considered discretionary calories. The rationale for this was that if nutrient-dense foods were consumed beyond recommended amounts, after total energy intake was met then this constituted excess energy intake. In the 2010 DGAs, the terminology was changed to solid fats and added sugars (SoFAS); thus, alcohol was excluded because it made a minor contribution to overall intake and did not apply to children. The SoFAS terminology also negated nutrient-dense foods that were consumed in amounts above the recommendations for the specific food groups in the food patterns. The ambiguous SoFAS terminology was later changed to "empty calories" to reflect only those calories from solid fats and added sugars (and alcohol if consumed beyond moderate amounts). The purpose of this review is to provide an historical perspective on how the dietary recommendations went from SoFAAS to SoFAS and how discretionary calories went to empty calories between the 2005 and 2010

  3. Vegetarian diet for children-practical guidelines

    Directory of Open Access Journals (Sweden)

    Rok Orel

    2014-03-01

    Full Text Available Paediatric profession recommends that infants, children and adolescents should have a balanced, mixed diet containing nutrients of plant and animal origin. Paediatricians are sometimes faced with children who are fed a vegetarian diet in which certain types of foods are excluded. The avoidance of all foods of animal origin (meat, fish, eggs, milk and honey in vegans, raw eaters and fruitarians poses a serious risk due to the lack of several nutrients: iron, zinc, calcium, iodine, vitamins B12, B2, A, D, n-3 fatty acids, particularly docosahexaenoic acid (DHA, C22: 6ω-3, proteins and energy. The article provides an overview of critical nutrients in the diet of vegetarians, the list of laboratory investigations that need to be carried out for determination of specific nutrient deficiencies, and practical recommendations for vegetarian diet in children.

  4. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency.

    Science.gov (United States)

    Płudowski, Paweł; Karczmarewicz, Elżbieta; Bayer, Milan; Carter, Graham; Chlebna-Sokół, Danuta; Czech-Kowalska, Justyna; Dębski, Romuald; Decsi, Tamas; Dobrzańska, Anna; Franek, Edward; Głuszko, Piotr; Grant, William B; Holick, Michael F; Yankovskaya, Liudmila; Konstantynowicz, Jerzy; Książyk, Janusz B; Księżopolska-Orłowska, Krystyna; Lewiński, Andrzej; Litwin, Mieczysław; Lohner, Szimonetta; Lorenc, Roman S; Lukaszkiewicz, Jacek; Marcinowska-Suchowierska, Ewa; Milewicz, Andrzej; Misiorowski, Waldemar; Nowicki, Michał; Povoroznyuk, Vladyslav; Rozentryt, Piotr; Rudenka, Ema; Shoenfeld, Yehuda; Socha, Piotr; Solnica, Bogdan; Szalecki, Mieczysław; Tałałaj, Marek; Varbiro, Szabolcs; Żmijewski, Michał A

    2013-01-01

    Adequate Vitamin D intake and its concentration in serum are important for bone health and calcium-phosphate metabolism as well as for optimal function of many organs and tissues. Documented trends in lifestyle, nutritional habits and physical activity appear to be associated with moderate or severe Vitamin D deficits resulting in health problems. Most epidemiological studies suggest that Vitamin D deficiency is prevalent among Central European populations. Concern about this problem led to the organising of a conference focused on overcoming Vitamin D deficiency. After reviewing the epidemiological evidence and relevant literature, a Polish multidisciplinary group formulated theses on recommendations for Vitamin D screening and supplementation in the general population. These theses were subsequently sent to Scientific Committee members of the 'Vitamin D - minimum, maximum, optimum' conference for evaluation based on a ten-point scale.With 550 international attendees, the meeting 'Vitamin D - minimum, maximum, optimum' was held on October 19-20, 2012 in Warsaw(Poland). Most recent scientific evidence of both skeletal and non-skeletal effects of Vitamin D as well as the results of panellists' voting were reviewed and discussed during eight plenary sessions and two workshops. Based on many polemical discussions, including post-conference networking, the key opinion leaders established ranges of serum 25-hydroxyVitamin D concentration indicating Vitamin D deficiency [consensus on supplementation guidance and population strategies for Vitamin D in Central Europe.

  5. Ready-to-eat cereal consumption and the School Breakfast Program: relationship to nutrient intake and weight.

    Science.gov (United States)

    Affenito, Sandra G; Thompson, Douglas; Dorazio, Ali; Albertson, Ann M; Loew, Amy; Holschuh, Norton M

    2013-01-01

    Children in the United States exhibit high rates of nutrient inadequacy and overweight/obesity; other international studies report similar associations. The School Breakfast Program (SBP) may help alleviate these conditions for youth in the United States. This research examined the association of ready-to-eat (RTE) breakfast cereal consumption with students' (SBP participants and nonparticipants) dietary nutrient intake and weight status. Data were from the third School Nutrition Dietary Assessment Study (SNDA-III), conducted in 2004-2005. Analyses included all 2298 SNDA-III participants (ages 5-18 years), who completed a dietary recall and whose parents completed an interview. Students were categorized as skipping versus eating breakfast; students eating breakfast were categorized by SBP participation (SBP participant vs nonparticipant) and breakfast type (with vs without RTE cereal). Analyses estimated the association of these categorizations with total daily nutrient intake and weight-related measures, after adjusting for covariates. RTE cereal breakfast consumers (regardless of SBP participation) had greater intake of vitamin A, iron, and whole grain, compared with noncereal breakfast eaters. Breakfast consumers (regardless of SBP participation and type) had greater intake of vitamins A and C, calcium, iron, dietary fiber, and whole grain, relative to breakfast skippers. The SBP increases opportunity for improved nutrient intake and healthier body weight through breakfast consumption, especially whole grain RTE cereals, as recommended by the Dietary Guidelines 2010. © 2013, American School Health Association.

  6. [Guidelines for the management of hypertension].

    Science.gov (United States)

    Prieto-Díaz, Miguel Ángel

    2014-09-01

    In the last year, several scientific societies have published guidelines for the management of arterial hypertension. In Spain, two clinical practice guidelines have had a strong impact and have been closely followed in the last few years: the first is the Guideline of the National Heart, Lung and Blood Institute, although their last report (JNC 7) was published in 2003; the second is the clinical practice guideline for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH), whose latest version was published in 2007, although an update was published in 2009. A new ESC/ESH document, published in 2013, adopts a mainly educational stance, closely rooted in clinical practice. Many of the recommendations maintain the same criteria as previous guidelines. However, the new publication shows greater rigor and contains major contributions such as specification of the level of evidence and grade of recommendation for each recommendation, which was lacking in the previous guidelines of these societies. The document is both practical and easy to consult, consisting of 17 tables, 5 figures and 18 blocks of recommendations. The JNC 8 report, however, has a single objective: to respond to three questions that are considered a priority and which refer exclusively to drug therapy. Nine recommendations are made relating to these three questions. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Rural y Generalista (SEMERGEN). All rights reserved.

  7. EAU Guidelines on benign prostatic hyperplasia (BPH)

    NARCIS (Netherlands)

    de la Rosette, J. J.; Alivizatos, G.; Madersbacher, S.; Perachino, M.; Thomas, D.; Desgrandchamps, F.; de Wildt, M.

    2001-01-01

    To establish guidelines for the diagnosis, treatment, and follow-up of BPH. A search of published work was conducted using Medline. In combination with expert opinions recommendations were made on the usefulness of tests for assessment and follow-up: mandatory, recommended, or optional. In addition,

  8. DACH-LIGA homocystein (german, austrian and swiss homocysteine society): consensus paper on the rational clinical use of homocysteine, folic acid and B-vitamins in cardiovascular and thrombotic diseases: guidelines and recommendations.

    Science.gov (United States)

    Stanger, Olaf; Herrmann, Wolfgang; Pietrzik, Klaus; Fowler, Brian; Geisel, Jürgen; Dierkes, Jutta; Weger, Martin

    2003-11-01

    activities, numerous agents, drugs, diseases, and lifestyle factors have an impact on homocysteine metabolism. Folic acid deficiency is considered the most common cause of hyperhomocysteinemia. An adequate intake of at least 400 microg of folate per day is difficult to maintain even with a balanced diet, and high-risk groups often find it impossible to meet these folate requirements. Based on the available evidence, there is an increasing call for the diagnosis and treatment of elevated homocysteine levels in high-risk individuals in general and patients with manifest vascular disease in particular. Subjects of both populations should first have a baseline homocysteine assay. Except where manifestations are already present, intervention, if any, should be guided by the severity of hyperhomocysteinemia. Consistent with other working parties and consensus groups, we recommend a target plasma homocysteine level of homocysteine concentrations may theoretically prevent up to 25% of cardiovascular events. Supplementation is inexpensive, potentially effective, and devoid of adverse effects and, therefore, has an exceptionally favorable benefit/risk ratio. The results of ongoing randomized controlled intervention trials must be available before screening for, and treatment of, hyperhomocysteinemia can be recommended for the apparently healthy general population.

  9. [Guidelines for the management of dyslipidemia].

    Science.gov (United States)

    Díaz Rodríguez, Ángel

    2014-09-01

    The AHA/ACC 2013 guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease (ASCVD) in adults contains major differences with the previous ESC/EAS 2011 guidelines and the remaining international guidelines, which has generated major controversies. The AHA/ACC document has developed a new model for estimating cardiovascular risk for primary prevention which is not comparable with the SCORE recommended in the European guidelines. This guideline does not establish a fixed target for low-density lipoprotein cholesterol (LDLc). Instead, it identifies 4 major statin benefit groups at risk for the development ASCVD, who should receive low-, moderate-, and high-intensity statin therapy to reduce LCLc. In contrast, the European guidelines maintain LDLc as the main treatment target and non-high-density lipoprotein cholesterol as a secondary treatment target. The document recommends calculating cardiovascular risk for the overall treatment of patients with dyslipidemia according to 4 risk levels (low, moderate, high, and very high), establishes LDLc treatment targets, and recommends a statin-based therapeutic strategy and other, lipid-lowering strategies, aimed at achieving these targets. The American guidelines cannot be extrapolated to the European population. Target-based treatment, as recommended in the EAS/ESC guidelines, is the best strategy for Europe. In Spain, the Primary Care Guidelines of the Spanish Society of Family and Community Medicine (semFYC) and the Spanish Society of Primary Care Physicians (SEMERGEN) are based on the European recommendations. Finally, the Spanish Society of Arteriosclerosis (SEA), SEMERGEN, semFYC and the Spanish Society of General Medicine (SEMG) are reaching a consensus on the approach and management of patients with atherogenic dyslipidemia in primary care. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Rural y Generalista (SEMERGEN). All rights reserved.

  10. Dietary sources of energy and nutrient intake among children and adolescents with chronic kidney disease.

    Science.gov (United States)

    Chen, Wen; Ducharme-Smith, Kirstie; Davis, Laura; Hui, Wun Fung; Warady, Bradley A; Furth, Susan L; Abraham, Alison G; Betoko, Aisha

    2017-07-01

    Our purpose was to identify the main food contributors to energy and nutrient intake in children with chronic kidney disease (CKD). In this cross-sectional study of dietary intake assessed using Food Frequency Questionnaires (FFQ) in the Chronic Kidney Disease in Children (CKiD) cohort study, we estimated energy and nutrient intake and identified the primary contributing foods within this population. Completed FFQs were available for 658 children. Of those, 69.9% were boys, median age 12 (interquartile range (IQR) 8-15 years). The average daily energy intake was 1968 kcal (IQR 1523-2574 kcal). Milk was the largest contributor to total energy, protein, potassium, and phosphorus intake. Fast foods were the largest contributors to fat and sodium intake, the second largest contributors to energy intake, and the third largest contributors to potassium and phosphorus intake. Fruit contributed 12.0%, 8.7%, and 6.7% to potassium intake for children aged 2-5, 6-13, and 14-18 years old, respectively. Children with CKD consumed more sodium, protein, and calories but less potassium than recommended by the National Kidney Foundation (NKF) guidelines for pediatric CKD. Energy, protein, and sodium intake is heavily driven by consumption of milk and fast foods. Limiting contribution of fast foods in patients with good appetite may be particularly important for maintaining recommended energy and sodium intake, as overconsumption can increase the risk of obesity and cardiovascular complications in that population.

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

    NARCIS (Netherlands)

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

    2018-01-01

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

  12. Diagnosing oceanic nutrient deficiency

    Science.gov (United States)

    Moore, C. Mark

    2016-11-01

    The supply of a range of nutrient elements to surface waters is an important driver of oceanic production and the subsequent linked cycling of the nutrients and carbon. Relative deficiencies of different nutrients with respect to biological requirements, within both surface and internal water masses, can be both a key indicator and driver of the potential for these nutrients to become limiting for the production of new organic material in the upper ocean. The availability of high-quality, full-depth and global-scale datasets on the concentrations of a wide range of both macro- and micro-nutrients produced through the international GEOTRACES programme provides the potential for estimation of multi-element deficiencies at unprecedented scales. Resultant coherent large-scale patterns in diagnosed deficiency can be linked to the interacting physical-chemical-biological processes which drive upper ocean nutrient biogeochemistry. Calculations of ranked deficiencies across multiple elements further highlight important remaining uncertainties in the stoichiometric plasticity of nutrient ratios within oceanic microbial systems and caveats with regards to linkages to upper ocean nutrient limitation. This article is part of the themed issue 'Biological and climatic impacts of ocean trace element chemistry'.

  13. Adherence to HIV therapeutic drug monitoring guidelines in The Netherlands

    NARCIS (Netherlands)

    van Luin, Matthijs; Wit, Ferdinand W.; Smit, Colette; Rigter, Irma M.; Franssen, Eric J. F.; Richter, Clemens; Kroon, Frank; de Wolf, Frank; Burger, David M.

    2011-01-01

    Therapeutic drug monitoring (TDM) is recommended in several international HIV treatment guidelines. The adherence of clinicians to these recommendations is unknown. The authors evaluated the adherence to the Dutch TDM guideline of 2005. From the ATHENA cohort study, three scenarios were selected for

  14. 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.

  15. [Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise].

    Science.gov (United States)

    Morgano, Gian Paolo; Davoli, Marina; Moja, Lorenzo; Amato, Laura; Ferroni, Eliana; Tirani, Marcello

    2015-06-01

    Guideline developers worldwide are struggling with the lack of guidance for the practical steps in the guideline enterprise. Our objective was to systematically compile a comprehensive checklist of items linked to relevant resources and tools that guideline developers would consider for development and support of implementation. Data sources included manuals of international guideline developers, literature on guidelines for guidelines with a focus on international and national guideline agencies, professional societies, and recent systematic guidance articles. We reviewed these sources in duplicate, extracted items using a sensitive approach and developed overarching topics that are relevant to guidelines. In an iterative process, we reviewed items for duplication and omissions and involved experts in guideline development for revisions. We developed a checklist with 18 topics and 146 items and a webpage to facilitate its use by guideline developers (http://cebgrade.mcmaster.ca/guidecheck.html). The topics and items included cover all stages of the guideline enterprise, from planning to formulating recommendations, to dissemination and evaluation. The final itemized guideline development checklist (GDC) includes links to training material and resources for methodology. The GDC will serve as a resource for those involved in guideline development and we will use crowdsourcing to keep the checklist up to date and enhance it.

  16. National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis*

    Science.gov (United States)

    Ulrich, U.; Buchweitz, O.; Greb, R.; Keckstein, J.; von Leffern, I.; Oppelt, P.; Renner, S. P.; Sillem, M.; Stummvoll, W.; De Wilde, R.-L.; Schweppe, K.-W.

    2014-01-01

    In this guideline, recommendations and standards for optimum diagnosis and treatment of endometriosis are presented. They are based on the analysis of the available scientific evidence as published in prospective randomized and retrospective studies as well as in systematic reviews. The guideline working group consisted of experts from Austria, Germany, Switzerland, and the Czech Republic. PMID:26157194

  17. Essential Nutrients, Feed Classification and Nutrient Content of Feeds

    OpenAIRE

    Hall, John Burton, 1960-; Seay, William W.; Baker, Scott M., 1968-

    2005-01-01

    The cow-calf herd's primary source of nutrition is forages, but forages are variable in nutrient content. By knowing the nutrient content of their base forages, producers can then identify the deficient nutrients that need to be supplemented.

  18. Grain Productivity, Fertilizer Response and Nutrient Balance of Farming Systems in Tigray, Ethiopia

    NARCIS (Netherlands)

    Kraaijvanger, Richard; Veldkamp, Tom

    2015-01-01

    Application of nutrients is an important way to increase crop productivity. In our study area, Tigray, development agents recommend fertilizer application to boost productivity and counteract nutrient depletion. We analysed soil fertility from different perspectives, using responses and nutrient

  19. Index-TB Guidelines: Guidelines on extrapulmonary tuberculosis for India

    Science.gov (United States)

    Sharma, Surendra K.; Ryan, H.; Khaparde, Sunil; Sachdeva, K. S.; Singh, Achintya D.; Mohan, Alladi; Sarin, Rohit; Paramasivan, C N; Kumar, Prahlad; Nischal, Neeraj; Khatiwada, Saurav; Garner, Paul; Tharyan, Prathap

    2017-01-01

    Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i) use of Xpert MTB/RIF in diagnosis, (ii) use of adjunct corticosteroids in treatment, and (iii) duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research. PMID:28862176

  20. Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India

    Directory of Open Access Journals (Sweden)

    Surendra K Sharma

    2017-01-01

    Full Text Available Extrapulmonary tuberculosis (EPTB is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i use of Xpert MTB/RIF in diagnosis, (ii use of adjunct corticosteroids in treatment, and (iii duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.

  1. [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. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  2. Guideline Implementation: Surgical Smoke Safety.

    Science.gov (United States)

    Fencl, Jennifer L

    2017-05-01

    Research conducted during the past four decades has demonstrated that surgical smoke generated from the use of energy-generating devices in surgery contains toxic and biohazardous substances that present risks to perioperative team members and patients. Despite the increase in information available, however, perioperative personnel continue to demonstrate a lack of knowledge of these hazards and lack of compliance with recommendations for evacuating smoke during surgical procedures. The new AORN "Guideline for surgical smoke safety" provides guidance on surgical smoke management. This article focuses on key points of the guideline to help perioperative personnel promote smoke-free work environments; evacuate surgical smoke; and develop education programs and competency verification tools, policies and procedures, and quality improvement initiatives related to controlling surgical smoke. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  3. 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         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

  4. 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

  5. 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         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

  6. 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

  7. 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         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

  8. Association of usual intake of added sugars with nutrient adequacy

    Science.gov (United States)

    Recommendations for intakes of added sugars have varied considerably and the scientific basis supporting these recommendations has been inconsistent. The goal of this study was to examine the association of usual intake (UI) of added sugars and nutrient adequacy in those participating in NHANES 2009...

  9. Guidelines for vaccination of dogs and cats in Korea.

    Science.gov (United States)

    Song, Woo-Jin; Kim, Hyun-Tae; Yoo, Han-Sang; Youn, Hwa-Young

    2014-07-01

    This guideline contains the recommended vaccination schedules of dogs and cats from World Small Animal Veterinary Association (WSAVA) and American Animal Hospital Association (AAHA). In 2010, WSAVA published guidelines for the vaccination of dogs and cats. And, in 2011, AAHA also published guidelines for vaccination of dogs. In Korea, there is no published guideline for vaccination of dogs and cats yet. Therefore, the plane of vaccination also reports the present situation of vaccination schedule of dogs and cats in Korean animal hospitals.

  10. Nutrient mitigation in a temporary river basin.

    Science.gov (United States)

    Tzoraki, Ourania; Nikolaidis, Nikolaos P; Cooper, David; Kassotaki, Elissavet

    2014-04-01

    We estimate the nutrient budget in a temporary Mediterranean river basin. We use field monitoring and modelling tools to estimate nutrient sources and transfer in both high and low flow conditions. Inverse modelling by the help of PHREEQC model validated the hypothesis of a losing stream during the dry period. Soil and Water Assessment Tool model captured the water quality of the basin. The 'total daily maximum load' approach is used to estimate the nutrient flux status by flow class, indicating that almost 60% of the river network fails to meet nitrogen criteria and 50% phosphate criteria. We recommend that existing well-documented remediation measures such as reforestation of the riparian area or composting of food process biosolids should be implemented to achieve load reduction in close conjunction with social needs.

  11. The Universal Recommender

    OpenAIRE

    Kunegis, Jérôme; Said, Alan; Umbrath, Winfried

    2009-01-01

    We describe the Universal Recommender, a recommender system for semantic datasets that generalizes domain-specific recommenders such as content-based, collaborative, social, bibliographic, lexicographic, hybrid and other recommenders. In contrast to existing recommender systems, the Universal Recommender applies to any dataset that allows a semantic representation. We describe the scalable three-stage architecture of the Universal Recommender and its application to Internet Protocol Televisio...

  12. Reporting of financial conflicts of interest in clinical practice guidelines: a case study analysis of guidelines from the Canadian Medical Association Infobase.

    Science.gov (United States)

    Shnier, Adrienne; Lexchin, Joel; Romero, Mirna; Brown, Kevin

    2016-08-15

    Clinical practice guidelines are widely distributed by medical associations and relied upon by physicians for the best available clinical evidence. International findings report that financial conflicts of interest (FCOI) with drug companies may influence drug recommendations and are common among guideline authors. There is no comparable study on exclusively Canadian guidelines; therefore, we provide a case study of authors' FCOI declarations in guidelines from the Canadian Medical Association (CMA) Infobase. We also assess the financial relationships between guideline-affiliated organizations and drug companies. Using a population approach, we extracted first-line drug recommendations and authors' FCOI disclosures in guidelines from the CMA Infobase. We contacted the corresponding authors on guidelines when FCOI disclosures were missing for some or all authors. We also extracted guideline-affiliated organizations and searched each of their websites to determine if they had financial relationships with drug companies. We analyzed 350 authors from 28 guidelines. Authors were named on one, two, or three guidelines, yielding 400 FCOI statements. In 75.0 % of guidelines at least one author, and in 21.4 % of guidelines all authors, disclosed FCOI with drug companies. In 54.0 % of guidelines at least one author, and in 28.6 % of guidelines over half of the authors, disclosed FCOI with manufacturers of drugs that they recommended. Twenty of 48 authors on multiple guidelines reported different FCOI in their disclosures. Eight guidelines identified affiliated organizations with financial relationships with manufacturers of drugs recommended in those guidelines. This is the first study to systematically describe FCOI disclosures by authors of Canadian guidelines and financial relationships between guideline-affiliated organizations and pharmaceutical companies. These financial relationships are common. Because authoritative value is assigned to guidelines distributed by

  13. Nutrient Content Claims

    Science.gov (United States)

    ... 8, 2014 Articles from Diabetes Forecast® magazine: wcie-nutrition, . In this section Food What Can I Eat Food Tips Eating Out Quick Meal Ideas Cutting Back on Sodium Nutrient Content Claims Snacks Taking ...

  14. No. 354-Canadian HIV Pregnancy Planning Guidelines.

    Science.gov (United States)

    Loutfy, Mona; Kennedy, V Logan; Poliquin, Vanessa; Dzineku, Frederick; Dean, Nicola L; Margolese, Shari; Symington, Alison; Money, Deborah M; Hamilton, Scot; Conway, Tracey; Khan, Sarah; Yudin, Mark H

    2018-01-01

    The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist Canadians affected by HIV with their fertility, preconception, and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible and take into account diverse and intersecting local/population needs based on the social determinants of health. EVIDENCE: Literature searches were conducted by a librarian using the Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases for published articles in English and French related to HIV and pregnancy and HIV and pregnancy planning for each section of the guidelines. The full search strategy is available upon request. The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines. Guideline implementation should assist the practitioner in developing an evidence-based approach for the prevention of unplanned pregnancy, preconception, fertility, and pregnancy planning counselling in the context of HIV infection. These guidelines have been reviewed and approved by the Infectious Disease Committee and the Executive and Council of the SOGC. Canadian Institutes of Health Research Grant Planning and Dissemination grant (Funding Reference # 137186), which funded a Development Team meeting in 2016. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

  15. Nutrient intake and use of dietary supplements among US adults with disabilities.

    Science.gov (United States)

    An, Ruopeng; Chiu, Chung-Yi; Andrade, Flavia

    2015-04-01

    Physical, mental, social, and financial hurdles in adults with disabilities may limit their access to adequate nutrition. To examine the impact of dietary supplement use on daily total nutrient intake levels among US adults 20 years and older with disabilities. Study sample came from 2007-2008 and 2009-2010 waves of the National Health and Nutrition Examination Survey, a nationally representative repeated cross-sectional survey. Disability was classified into 5 categories using standardized indices. Nutrient intakes from foods and dietary supplements were calculated from 2 nonconsecutive 24-hour dietary recalls. Two-sample proportion tests and multiple logistic regressions were used to examine the adherence rates to the recommended daily nutrient intake levels between dietary supplement users and nonusers in each disability category. The association between sociodemographic characteristics and dietary supplement use was assessed using multiple logistic regressions, accounting for complex survey design. A substantial proportion of the US adult population with disabilities failed to meet dietary guidelines, with insufficient intakes of multiple nutrients. Over half of the US adults with disabilities used dietary supplements. Dietary supplement use was associated with higher adherence rates for vitamin A, vitamin B1, vitamin B2, vitamin B6, vitamin B12, vitamin C, vitamin D, vitamin E, calcium, copper, iron, magnesium, and zinc intake among adults with disabilities. Women, non-Hispanic Whites, older age, higher education, and higher household income were found to predict dietary supplement use. Proper use of dietary supplements under the guidance of health care providers may improve the nutritional status among adults with disabilities. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Recommendations for quality improvement in genetic testing for cystic fibrosis European Concerted Action on Cystic Fibrosis

    NARCIS (Netherlands)

    Dequeker, E; Cuppens, H; Dodge, J; Estivill, [No Value; Goossens, M; Pignatti, PF; Scheffer, H; Schwartz, M; Schwarz, M; Tummler, B; Cassiman, JJ

    These recommendations for quality improvement of cystic fibrosis genetic diagnostic testing provide general guidelines for the molecular genetic testing of cystic fibrosis in patients/individuals. General strategies for testing as well as guidelines for laboratory procedures, internal and external

  17. Guidelines for accident prevention and emergency preparedness

    Energy Technology Data Exchange (ETDEWEB)

    Fthenakis, V.M.; Morris, S.C.; Moskowitz, P.D.

    1993-05-01

    This report reviews recent developments in the guidelines on chemical accident prevention, risk assessment, and management of chemical emergencies, principally in the United States and Europe, and discusses aspects of their application to developing countries. Such guidelines are either in the form of laws or regulations promulgated by governments, or of recommendations from international, professional, or non governmental organizations. In many cases, these guidelines specify lists of materials of concern and methods for evaluating safe usage of these materials and recommend areas of responsibility for different organizations; procedures to be included in planning, evaluation, and response; and appropriate levels of training for different classes of workers. Guidelines frequently address the right of communities to be informed of potential hazards and address ways for them to participate in planning and decision making.

  18. IMIA Educational Recommendations and Nursing Informatics

    NARCIS (Netherlands)

    Mantas, John; Hasman, Arie

    2017-01-01

    The updated version of the IMIA educational recommendations has given an adequate guidelines platform for developing educational programs in Biomedical and Health Informatics at all levels of education, vocational training, and distance learning. This chapter will provide a brief introduction of the

  19. A new independent authority is needed to issue National Health Care guidelines.

    Science.gov (United States)

    Keyhani, Salomeh; Kim, Azalea; Mann, Micah; Korenstein, Deborah

    2011-02-01

    Health experts emphasize that getting doctors to follow clinical guidelines can save both lives and money. Less attention has been paid to how the guidelines are developed and the variability in the recommendations they include. We examined the quality and content of screening guidelines as a proxy for guidelines in general and found that the source of the guidelines affects their quality. Guidelines with inconsistent recommendations are unlikely to serve patients or physicians well. The creation of an independent organization that would work with multiple stakeholders to develop guidelines holds the potential to improve their quality.

  20. Overview of guidelines on breast screening

    DEFF Research Database (Denmark)

    Juhl Jørgensen, Karsten; Kalager, Mette; Barratt, Alexandra

    2017-01-01

    Updated guidelines on breast cancer screening have been published by several major organisations over the past five years. Recommendations vary regarding both age range, screening interval, and even on whether breast screening should be offered at all. The variation between recommendations reflects......, or they may not be followed as recommended. Further, results of trials performed decades ago may no longer be applicable. For observational studies, the framework for inclusion in guidelines is not similarly well-developed and there are methodological concerns specific to screening interventions......, such as small effects in absolute terms. There is a need for agreement on a hierarchy of observational study designs to quantify the major benefit and harm of cancer screening. This review provides a summary of recent guidelines on breast cancer screening and their major strengths and weaknesses, as well...

  1. Evaluation of a nutrient-rich food index score in the Netherlands

    NARCIS (Netherlands)

    Sluik, D.; Streppel, M.T.; Lee, van L.; Geelen, A.; Feskens, E.J.M.

    2015-01-01

    Nutrient-rich food (NRF) index scores are dietary quality indices based on nutrient density. We studied the design aspects involved in the development and validation of NRF index scores, using the Dutch consumption data and guidelines as an example. We evaluated fifteen NRF index scores against the

  2. Nutrient Load of the Sakumo Lagoon at the Sakumo Ramsar Site in ...

    African Journals Online (AJOL)

    Environmental Protection Agency (EPA)-Ghana permissible guideline values for effluents discharged into water bodies and values from similar studies on the lagoon in 1995 and 2003. Observations showed that, of all the nutrients studied, phosphates were the highest in the Sakumo lagoon. The decreasing order of nutrient ...

  3. Guidelines and recommendations on yeast cell death nomenclature

    NARCIS (Netherlands)

    Carmona-Gutierrez, Didac; Bauer, Maria Anna; Zimmermann, Andreas; Aguilera, Andrés; Austriaco, Nicanor; Ayscough, Kathryn; Balzan, Rena; Bar-Nun, Shoshana; Barrientos, Antonio; Belenky, Peter; Blondel, Marc; Braun, Ralf J; Breitenbach, Michael; Burhans, William C; Büttner, Sabrina; Cavalieri, Duccio; Chang, Michael; Cooper, Katrina F; Côrte-Real, Manuela; Costa, Vítor; Cullin, Christophe; Dawes, Ian; Dengjel, Jörn; Dickman, Martin B; Eisenberg, Tobias; Fahrenkrog, Birthe; Fasel, Nicolas; Fröhlich, Kai-Uwe; Gargouri, Ali; Giannattasio, Sergio; Goffrini, Paola; Gourlay, Campbell W; Grant, Chris M; Greenwood, Michael T; Guaragnella, Nicoletta; Heger, Thomas; Heinisch, Jürgen; Herker, Eva; Herrmann, Johannes M; Hofer, Sebastian; Jiménez-Ruiz, Antonio; Jungwirth, Helmut; Kainz, Katharina; Kontoyiannis, Dimitrios P; Ludovico, Paula; Manon, Stéphen; Martegani, Enzo; Mazzoni, Cristina; Megeney, Lynn A; Meisinger, Chris; Nielsen, Jens; Nyström, Thomas; Osiewacz, Heinz D; Outeiro, Tiago F; Park, Hay-Oak; Pendl, Tobias; Petranovic, Dina; Picot, Stephane; Polčic, Peter; Powers, Ted; Ramsdale, Mark; Rinnerthaler, Mark; Rockenfeller, Patrick; Ruckenstuhl, Christoph; Schaffrath, Raffael; Segovia, Maria; Severin, Fedor F; Sharon, Amir; Sigrist, Stephan J; Sommer-Ruck, Cornelia; Sousa, Maria João; Thevelein, Johan M; Thevissen, Karin; Titorenko, Vladimir; Toledano, Michel B; Tuite, Mick; Vögtle, F-Nora; Westermann, Benedikt; Winderickx, Joris; Wissing, Silke; Wölfl, Stefan; Zhang, Zhaojie J; Zhao, Richard Y; Zhou, Bing; Galluzzi, Lorenzo; Kroemer, Guido; Madeo, Frank

    2018-01-01

    Elucidating the biology of yeast in its full complexity has major implications for science, medicine and industry. One of the most critical processes determining yeast life and physiology is cel-lular demise. However, the investigation of yeast cell death is a relatively young field, and a widely

  4. Recommended Guidelines for NERC CIP Compliance for Synchrophasor Systems

    Energy Technology Data Exchange (ETDEWEB)

    Mix, Scott R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Kirkham, Harold [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Silverstein, Alison [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2017-11-14

    Compliance with the NERC requirements for Critical Infrastructure Protection (CIP) for synchrophasor systems in the Version 5 paradigm seems to be a matter of some uncertainty for those in the synchrophasor user community. This report aims to provide clarification and guidance in the form of case studies based on methods seen in the industry

  5. Older driver highway design handbook : recommendations and guidelines

    Science.gov (United States)

    2000-01-01

    This report contains highway design informaiton that will help accomodate the needs and capability of older road users. Specifically, it contains the recommendaitons section of a larger report titled: Older Driver Highway Design Handbook (FHWA-RD-97-...

  6. Recommendations for the Development of Regulatory Guidelines for ...

    African Journals Online (AJOL)

    The regulation and registration of traditional medicines (TM) continues to present challenges to many countries regardless of the fact that an increased number of the population utilises TM for their health care needs. There have been improvements in the legal and policy framework of South Africa based on the WHO ...

  7. Communication satellites: Guidelines for a strategic plan

    Science.gov (United States)

    1987-01-01

    To maintain and augment the leadership that the United States has enjoyed and to ensure that the nation is investing sufficiently and wisely to this purpose, a strategic plan for satellite communications research and development was prepared by NASA. Guidelines and recommendations for a NASA plan to support this objective and for the conduct of communication satellite research and development program over the next 25 years were generated. The guidelines are briefly summarized.

  8. Current micronutrient recommendations in Europe: towards understanding their differences and similarities

    NARCIS (Netherlands)

    Doets, E.L.; Wit, de L.S.; Dhonukshe-Rutten, R.A.M.; Cavelaars, A.J.E.M.; Raats, M.M.; Timotijevic, L.; Brzozowska, A.; Wijnhoven, T.M.A.; Pavlovic, M.; Holm Totland, T.; Andersen, L.F.; Ruprich, J.; Pijls, L.T.J.; Ashwell, M.; Lambert, J.P.; Veer, van 't P.; Groot, de C.P.G.M.

    2008-01-01

    Background Nowadays most countries in Europe have established their own nutrient recommendations to assess the adequacy of dietary intakes and to plan desirable dietary intakes. As yet there is no standard approach for deriving nutrient recommendations, they may vary from country to country. This

  9. Nutrient synchrony in preruminant calves

    NARCIS (Netherlands)

    Borne, van den J.J.G.C.

    2006-01-01

    In animal nutrition, the nutrient composition of the daily feed supply is composed to match the nutrient requirements for the desired performance. The time of nutrient availability within a day is usually considered not to affect the fate of nutrients. The aim of this thesis was to evaluate effects

  10. 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.

  11. Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice.

    Science.gov (United States)

    Gagliardi, Anna R; Brouwers, Melissa C

    2012-07-23

    Guidelines are important tools that inform healthcare delivery based on best available research evidence. Guideline use is in part based on quality of the guidelines, which includes advice for implementation and has been shown to vary. Others hypothesized this is due to limited instructions in guideline development manuals. The purpose of this study was to examine manual instructions for implementation advice. We used a directed and summative content analysis approach based on an established framework of guideline implementability. Six manuals identified by another research group were examined to enumerate implementability domains and elements. Manuals were similar in content but lacked sufficient detail in particular domains. Most frequently this was Accomodation, which includes information that would help guideline users anticipate and/or overcome organizational and system level barriers. In more than one manual, information was also lacking for Communicability, information that would educate patients or facilitate their involvement in shared decision making, and Applicability, or clinical parameters to help clinicians tailor recommendations for individual patients. Most manuals that direct guideline development lack complete information about incorporating implementation advice. These findings can be used by those who developed the manuals to consider expanding their content in these domains. It can also be used by guideline developers as they plan the content and implementation of their guidelines so that the two are integrated. New approaches for guideline development and implementation may need to be developed. Use of guidelines might be improved if they included implementation advice, but this must be evaluated through ongoing research.

  12. Integrated Urban Nutrient Management

    Science.gov (United States)

    Nhapi, I.; Veenstra, S.; Siebel, M. A.; Gijzen, H. J.

    Most cities, especially from the developing countries, are facing serious problems with the management of nutrients, necessitating an urgent review of current waste management systems. Whilst highly efficient technologies are available, the inclusion of these in a well-thought out and systematic approach is necessary to contain the nutrient influxes and outfluxes from towns. Five intervention measures are proposed in this paper. The first is to manage the use and generation of nutrients by drastically minimising water consumption and employing other cleaner production approaches. The second deals with the optimal reuse of nutrients and water at the smallest possible level, like at the household and on-plot level. The second option is to covert the waste into something useful for reuse, and, where not possible, to something which is envi- ronmentally neutral. This involves treatment, but applying technologies that makes the best use of side products via reuse. Where the first three options will have failed, two least preferred options could be used. Waste can be dispersed or diluted to enhance self-purification capacities of downstream water bodies. The last option is to store the wastewater for some parts of the year when there is water shortage to allow for polishing during the standing period. The success of urban nutrient planning requires an integrated approach, proving specific solutions to specific situations. This, in turn, requires appropriate institutional responses.

  13. An exploration of how guideline developer capacity and guideline implementability influence implementation and adoption: study protocol

    Directory of Open Access Journals (Sweden)

    Lemieux-Charles Louise

    2009-07-01

    Full Text Available Abstract Background Practice guidelines can improve health care delivery and outcomes but several issues challenge guideline adoption, including their intrinsic attributes, and whether and how they are implemented. It appears that guideline format may influence accessibility and ease of use, which may overcome attitudinal barriers of guideline adoption, and appear to be important to all stakeholders. Guideline content may facilitate various forms of decision making about guideline adoption relevant to different stakeholders. Knowledge and attitudes about, and incentives and capacity for implementation on the part of guideline sponsors may influence whether and how they develop guidelines containing these features, and undertake implementation. Examination of these issues may yield opportunities to improve guideline adoption. Methods The attributes hypothesized to facilitate adoption will be expanded by thematic analysis, and quantitative and qualitative summary of the content of international guidelines for two primary care (diabetes, hypertension and institutional care (chronic ulcer, chronic heart failure topics. Factors that influence whether and how guidelines are implemented will be explored by qualitative analysis of interviews with individuals affiliated with guideline sponsoring agencies. Discussion Previous research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes, but this produced little insight on how the products themselves, or their implementation, could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization, such as recall, attitude toward, confidence in, and adoption intention. If successful, then long-term objective

  14. User systems guidelines for software projects

    Energy Technology Data Exchange (ETDEWEB)

    Abrahamson, L. (ed.)

    1986-04-01

    This manual presents guidelines for software standards which were developed so that software project-development teams and management involved in approving the software could have a generalized view of all phases in the software production procedure and the steps involved in completing each phase. Guidelines are presented for six phases of software development: project definition, building a user interface, designing software, writing code, testing code, and preparing software documentation. The discussions for each phase include examples illustrating the recommended guidelines. 45 refs. (DWL)

  15. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary.

    Science.gov (United States)

    Bhattacharyya, Neil; Gubbels, Samuel P; Schwartz, Seth R; Edlow, Jonathan A; El-Kashlan, Hussam; Fife, Terry; Holmberg, Janene M; Mahoney, Kathryn; Hollingsworth, Deena B; Roberts, Richard; Seidman, Michael D; Prasaad Steiner, Robert W; Tsai Do, Betty; Voelker, Courtney C J; Waguespack, Richard W; Corrigan, Maureen D

    2017-03-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the "Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed emphasize diagnostic accuracy and efficiency, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing, and increasing the appropriate therapeutic repositioning maneuvers. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.

  16. Cancer Prevention Recommendations: Impact of Adherence.

    Science.gov (United States)

    Maresso, Karen Colbert; Hawk, Ernest

    2016-08-01

    To review the relationship between adherence to cancer prevention guidelines published by the American Cancer Society and the World Cancer Research Fund/American Institute for Cancer Research and reductions in cancer incidence, cancer mortality, cardiovascular mortality, and overall mortality. Current cancer prevention guidelines published by the American Cancer Society and the American Institute for Cancer Research, journal articles published between 2004 and 2016, and internet resources. Evidence from a number of large observational studies indicates that following current cancer prevention recommendations in a comprehensive manner results in significant reductions in both cancer risk and cancer mortality, as well as in cardiovascular mortality and overall mortality. Nurses can take the lead in familiarizing patients and families with established cancer prevention recommendations and resources that may assist patients in implementing them comprehensively in their daily lives, as well as in discussing the substantial health benefits of adhering to the recommendations. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. The subtropical nutrient spiral

    Science.gov (United States)

    Jenkins, William J.; Doney, Scott C.

    2003-12-01

    We present an extended series of observations and more comprehensive analysis of a tracer-based measure of new production in the Sargasso Sea near Bermuda using the 3He flux gauge technique. The estimated annually averaged nitrate flux of 0.84 ± 0.26 mol m-2 yr-1 constitutes only that nitrate physically transported to the euphotic zone, not nitrogen from biological sources (e.g., nitrogen fixation or zooplankton migration). We show that the flux estimate is quantitatively consistent with other observations, including decade timescale evolution of the 3H + 3He inventory in the main thermocline and export production estimates. However, we argue that the flux cannot be supplied in the long term by local diapycnal or isopycnal processes. These considerations lead us to propose a three-dimensional pathway whereby nutrients remineralized within the main thermocline are returned to the seasonally accessible layers within the subtropical gyre. We describe this mechanism, which we call "the nutrient spiral," as a sequence of steps where (1) nutrient-rich thermocline waters are entrained into the Gulf Stream, (2) enhanced diapycnal mixing moves nutrients upward onto lighter densities, (3) detrainment and enhanced isopycnal mixing injects these waters into the seasonally accessible layer of the gyre recirculation region, and (4) the nutrients become available to biota via eddy heaving and wintertime convection. The spiral is closed when nutrients are utilized, exported, and then remineralized within the thermocline. We present evidence regarding the characteristics of the spiral and discuss some implications of its operation within the biogeochemical cycle of the subtropical ocean.

  18. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of adult isthmic spondylolisthesis.

    Science.gov (United States)

    Kreiner, D Scott; Baisden, Jamie; Mazanec, Daniel J; Patel, Rakesh D; Bess, Robert S; Burton, Douglas; Chutkan, Norman B; Cohen, Bernard A; Crawford, Charles H; Ghiselli, Gary; Hanna, Amgad S; Hwang, Steven W; Kilincer, Cumhur; Myers, Mark E; Park, Paul; Rosolowski, Karie A; Sharma, Anil K; Taleghani, Christopher K; Trammell, Terry R; Vo, Andrew N; Williams, Keith D

    2016-12-01

    The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adult Isthmic Spondylolisthesis features evidence-based recommendations for diagnosing and treating adult patients with isthmic spondylolisthesis. The guideline is intended to reflect contemporary treatment concepts for symptomatic isthmic spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of June 2013. NASS' guideline on this topic is the only guideline on adult isthmic spondylolisthesis accepted in the Agency for Healthcare Research and Quality's National Guideline Clearinghouse. The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with isthmic spondylolisthesis. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. This is a guideline summary review. This guideline is the product of the Adult Isthmic Spondylolisthesis Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questionsto address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when

  19. 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. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. Nutrient allocation among stem, leaf and inflorescence of jatropha plants

    Directory of Open Access Journals (Sweden)

    Rosiane L. S. de Lima

    2015-08-01

    Full Text Available ABSTRACTInformation on the partitioning of nutrients among various organs in jatropha plants, as a complementary tool for the recommendation of fertilization, is still not available. This study aimed to evaluate the contents of macro and micronutrients in stems, leaves and inflorescences of jatropha branches at the beginning of flowering. At the beginning of flowering, adult jatropha plants were sampled and divided into five compartments: inflorescences, leaves from vegetative branches, leaves from flowering branches, stems from vegetative branches and stems from flowering branches. Jatropha inflorescences are a drain of nutrients. Leaves are important sources of nutrients demanded by the inflorescences at the beginning of flowering. The higher allocation of nutrients in the inflorescences suggests the need for preventive/corrective fertilizations, which must be performed at least 30 days before flowering, providing plants with nutrients in adequate amounts for a good yield.

  1. SARIS Guidelines. 2014 Ed

    International Nuclear Information System (INIS)

    2014-01-01

    The IAEA fundamental safety principles provide the basis for IAEA safety standards and IAEA related programmes. IAEA safety standards reflect an international consensus on what constitutes a high level of safety for protecting people and the environment, and therefore represent what all regulators should achieve. These standards, in particular IAEA Safety Standards Series No. GSR Part 1, Governmental, Legal and Regulatory Framework for Safety, provide the basics for establishing, maintaining and continuously improving the governmental, legal and regulatory framework for safety. Additional IAEA requirements and guidance, such as the IAEA Safety Standards Series No. GSR Part 3 (Interim), Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, and IAEA Safety Standards Series No. GS-R-3, The Management System for Facilities and Activities, are also used to establish and develop the national infrastructure for safety and for establishing and implementing a management system. Assessment of the regulatory framework for safety with respect to the IAEA safety standards can be made either through an external review or through internal self-assessment. Self-assessment offers a mechanism by which an organization can assess its performance against established standards and models and thereby identify areas for improvement. The IAEA has developed a methodology and tool for Self-assessment of the Regulatory Infrastructure for Safety (SARIS), to assist States in undertaking self-assessment of their national safety framework in accordance with the requirements and recommendations of the IAEA safety standards, and to develop an action plan for improvement. The IAEA self-assessment methodology and the associated tools are fully compatible with the IAEA safety standards and are also used in the preparation for regulatory review missions, such as the Integrated Regulatory Review Service and advisory missions. These guidelines have been developed to

  2. A Review Of Nutritional Guidelines And Menu Compositions For School Feeding Programs In 12 Countries.

    Directory of Open Access Journals (Sweden)

    Ruzky eAliyar

    2015-08-01

    Full Text Available Study objectives: To analyze the nutritional guidelines and menu compositions of school meal provision in various different countries.Background: School feeding is the provision of food on-site or to take home, which aims to increase school enrolment, attendance and retention, and exist as a social safety net for households with very low income. Home-grown school feeding (HGSF, additionally, aims to stimulate local economies by providing a source of income for local smallholder farmers. Methods: Literature searches using the Ovid MEDLINE databases, gathered information from in-country stakeholders, and accessed the programme websites of various countries. Nutrient composition of these menus was calculated from nutritional guidelines and menu compositions using a nutrition linear programming tool (NUTVAL.Country comparisons: School feeding aims differ between countries of each income group. The implementation, delivery of service and nutritional content of foods also differ considerably between countries and income groups. In high-income countries, guidelines and standards have been recommended in an attempt to combat rising levels of overweight and obesity, and to model healthier lifestyle habits. In low-income countries there is a gap in terms of guidance on nutrition standards and menu composition.Conclusions: Provision of evidence-based guidance on nutrition standards to middle and low income countries who have recently established or are planning to establish school feeding has the potential to greatly enhance and improve the quality of service and improve the life of millions of children worldwide.

  3. Barriers to implementing the clinical guideline on borderline personality disorder in the Netherlands

    NARCIS (Netherlands)

    Hermens, M.L.M.; van Splunteren, P.T.; van den Bosch, A.; Verheul, R.

    2011-01-01

    Objective: This study determined the gap between actual care and optimal care (recommended in the clinical guideline) for patients with borderline personality disorder in the Netherlands. Factors that affected guideline implementation were identified. Methods: Ten specialized mental health

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

    Science.gov (United States)

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

    2018-01-01

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

  5. [Summary of the practice guideline 'Thyroid disorders' (first revision) from the Dutch College of General Practitioners

    NARCIS (Netherlands)

    Lieshout, J. van; Wessels, P.; Rijswijk, E. van; Boer, A.M; Wiersma, A.; Goudswaard, A.N.

    2007-01-01

    --The practice guideline 'Thyroid disorders' developed by the Dutch College of General Practitioners replaces the practice guideline 'Functional thyroid disorders' from 1996. Recommendations for palpable thyroid disorders have been added. --Hypothyroidism can often be treated by the general

  6. 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).

  7. NCCN Guidelines® Insights Bladder Cancer, Version 2.2016 Featured Updates to the NCCN Guidelines

    Science.gov (United States)

    Clark, Peter E.; Spiess, Philippe E.; Agarwal, Neeraj; Bangs, Rick; Boorjian, Stephen A.; Buyyounouski, Mark K.; Efstathiou, Jason A.; Flaig, Thomas W.; Friedlander, Terence; Greenberg, Richard E.; Guru, Khurshid A.; Hahn, Noah; Herr, Harry W.; Hoimes, Christopher; Inman, Brant A.; Kader, A. Karim; Kibel, Adam S.; Kuzel, Timothy M.; Lele, Subodh M.; Meeks, Joshua J.; Michalski, Jeff; Montgomery, Jeffrey S.; Pagliaro, Lance C.; Pal, Sumanta K.; Patterson, Anthony; Petrylak, Daniel; Plimack, Elizabeth R.; Pohar, Kamal S.; Porter, Michael P.; Sexton, Wade J.; Siefker-Radtke, Arlene O.; Sonpavde, Guru; Tward, Jonathan; Wile, Geoffrey; Dwyer, Mary A.; Smith, Courtney

    2017-01-01

    These NCCN Guidelines Insights discuss the major recent updates to the NCCN Guidelines for Bladder Cancer based on the review of the evidence in conjunction with the expert opinion of the panel. Recent updates include (1) refining the recommendation of intravesical bacillus Calmette-Guérin, (2) strengthening the recommendations for perioperative systemic chemotherapy, and (3) incorporating immunotherapy into second-line therapy for locally advanced or metastatic disease. These NCCN Guidelines Insights further discuss factors that affect integration of these recommendations into clinical practice. PMID:27697976

  8. New guidelines for the diagnosis of fibromyalgia.

    Science.gov (United States)

    Heymann, Roberto E; Paiva, Eduardo S; Martinez, José Eduardo; Helfenstein, Milton; Rezende, Marcelo C; Provenza, Jose Roberto; Ranzolin, Aline; Assis, Marcos Renato de; Feldman, Daniel P; Ribeiro, Luiz Severiano; Souza, Eduardo J R

    2017-01-01

    To establish guidelines based on scientific evidence for the diagnosis of fibromyalgia. Evidence collection was performed based on 9 questions regarding the diagnosis of fibromyalgia, structured using the Patient, Intervention or Indicator, Comparison and Outcome (P.I.C.O.), with searches in the main, primary databases of scientific information. After defining the potential studies to support the recommendations, they were graded according to evidence and degree of recommendation. Copyright © 2017. Published by Elsevier Editora Ltda.

  9. Ethics in Psychiatric Research: Issues and Recommendations.

    Science.gov (United States)

    Jain, Shobhit; Kuppili, Pooja Patnaik; Pattanayak, Raman Deep; Sagar, Rajesh

    2017-01-01

    Psychiatric research has increased remarkably over recent decades to help in understanding the current trends and better therapeutic options for illness. On the other hand, there is also a trend toward higher rates of retraction of published papers in the recent years. Ethics is required to maintain and increase the overall quality and morality of research. Psychiatric research faces several unique ethical challenges. Ethical guidelines are very important tool of research which safeguards participants; however, there is a dearth of such guidelines in India. The present paper aims to review available ethical issues and guidelines pertaining to psychiatric research. A search was conducted on Pubmed using search terms (e.g., "ethics," "psychiatry," "research"). Relevant studies were selected for the review after manual screening of title/abstract. Additional sources were referred to using cross references and Google Scholar. Psychiatric research has several important ethical issues which are different from other medical disciplines. These issues are related to informed consent, confidentiality, conflict of interest, therapeutic misconception, placebo related, vulnerability, exploitation, operational challenges, among others. The current paper has made several recommendations to deal with ethical challenges commonly faced in psychiatric research. The ethical guidelines are utmost needed for Indian psychiatric research. Specific guidelines are lacking pertaining to psychiatric research. The issues and recommendations merit a further discussion and consideration.

  10. Megafauna moves nutrients uphill.

    Science.gov (United States)

    Gross, Michael

    2016-01-11

    Large animals have a disproportionate capacity to transport nutrients along gradients and against water flow directions, making them more available to ecosystems and ultimately saving them from disappearing in sea floor sediments. Megafauna extinctions have reduced this capacity dramatically, while humans and their livestock aren’t stepping in to restore this important ecosystem service.

  11. Obstetric Thromboprophylaxis: The Swedish Guidelines

    Directory of Open Access Journals (Sweden)

    Pelle G. Lindqvist

    2011-01-01

    Full Text Available Obstetric thromboprophylaxis is difficult. Since 10 years Swedish obstetricians have used a combined risk estimation model and recommendations concerning to whom, at what dose, when, and for how long thromboprophylaxis is to be administrated based on a weighted risk score. In this paper we describe the background and validation of the Swedish guidelines for obstetric thromboprophylaxis in women with moderate-high risk of VTE, that is, at similar or higher risk as the antepartum risk among women with history of thrombosis. The risk score is based on major risk factors (i.e., 5-fold increased risk of thromboembolism. We present data on the efficacy of the model, the cost-effectiveness, and the lifestyle advice that is given. We believe that the Swedish guidelines for obstetric thromboprophylaxis aid clinicians in providing women at increased risk of VTE with effective and appropriate thromboprophylaxis, thus avoiding both over- and under-treatment.

  12. Use of sediment quality guidelines

    Science.gov (United States)

    Wenning, R. J.; Batley, G. E.; Ingersoll, Christopher G.; Moore, David W.

    2005-01-01

    Are sediment quality guidelines (SQGs) adequately able to predict the presence or absence of chronic toxicity to sediment-dwelling organisms in field-collected sediments? Can SQGs predict effects resulting from the bioaccumulation of sediment-associated contaminants? Do SQGs define cause-and-effect relationships? Can they predict effects on organisms exposed in the field on the basis of amphipod mortality measured in the laboratory?These and other questions brought together 55 scientists from 8 countries for a Pellston Workshop convened by the Society of Environmental Toxicology and Chemistry (SETAC) in Fairmont, Montana, USA. In this book, these experts in ecology, ecotoxicology, engineering, environmental regulation, and risk assessment examine the scientific underpinnings of sediment quality guidelines and provide recommendations on the appropriate use of SQGs in the assessment and management of contaminated sediments.

  13. European guidelines for workplace drug testing in urine.

    Science.gov (United States)

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

    2017-06-01

    These European Guidelines for Workplace Drug Testing in Urine have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The first version of these urine guidelines was published in 2002. Since then, the guidelines have been followed by many laboratories in different European countries and their role has been essential particularly in countries lacking legislation for workplace drug testing. In 2014, the EWDTS started a guidelines updating project and published a new version of the urine guidelines in 2015. Here we represent this updated version of the urine guidelines. 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. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  14. Actinic Keratosis Clinical Practice Guidelines: An Appraisal of Quality

    Directory of Open Access Journals (Sweden)

    Joslyn S. Kirby

    2015-01-01

    Full Text Available Actinic keratosis (AK is a common precancerous skin lesion and many AK management guidelines exist, but there has been limited investigation into the quality of these documents. The objective of this study was to assess the strengths and weaknesses of guidelines that address AK management. A systematic search for guidelines with recommendations for AK was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE II was used to appraise the quality of guidelines. Multiple raters independently reviewed each of the guidelines and applied the AGREE II tool and scores were calculated. Overall, 2,307 citations were identified and 7 fulfilled the study criteria. The Cancer Council of Australia/Australian Cancer Network guideline had the highest mean scores and was the only guideline to include a systematic review, include an evidence rating for recommendations, and report conflicts of interest and funding sources. High-quality, effective guidelines are evidence-based with recommendations that are concise and organized, so practical application is facilitated. Features such as concise tables, pictorial diagrams, and explicit links to evidence are helpful. However, the rigor and validity of some guidelines were weak. So, it is important for providers to be aware of the features that contribute to a high-quality, practical document.

  15. Canadian guidelines for acute bacterial rhinosinusitis

    Science.gov (United States)

    Kaplan, Alan

    2014-01-01

    Objective To provide a clinical summary of the Canadian clinical practice guidelines for acute bacterial rhinosinusitis (ABRS) that includes relevant considerations for family physicians. Quality of evidence Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology—Head and Neck Surgery, Canadian Association of Emergency Physicians, and the Family Physicians Airways Group of Canada). Main message Diagnosis of ABRS is based on the presence of specific symptoms and their duration; imaging or culture are not needed in uncomplicated cases. Treatment is dependent on symptom severity, with intranasal corticosteroids (INCSs) recommended as monotherapy for mild and moderate cases, although the benefit might be modest. Use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours, and for initial treatment of patients with severe symptoms. Antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunct therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist. The guidelines address situations unique to the Canadian health care environment, including actions to take during prolonged wait periods for specialist referral or imaging. Conclusion The Canadian guidelines provide up-to-date recommendations for diagnosis and treatment of ABRS that reflect an evolving understanding of the disease. In addition, the guidelines offer useful tools to help

  16. Antibiotic prophylaxis is not indicated prior to dental procedures for prevention of periprosthetic joint infections : A systematic review and new guidelines from the Dutch Orthopaedic and Dental Societies

    NARCIS (Netherlands)

    Rademacher, W.M.H.; Walenkamp, G.H.I.M.; Moojen, D.J.F.; Hendriks, J.G.E.; Goedendorp, T.A.; Rozema, F.R.

    2017-01-01

    Background and purpose — To minimize the risk of hematogenous periprosthetic joint infection (HPJI), international and Dutch guidelines recommended antibiotic prophylaxis prior to dental procedures. Unclear definitions and contradictory recommendations in these guidelines have led to unnecessary

  17. 2011 Nutritional Assessment Guidelines : information

    Directory of Open Access Journals (Sweden)

    Lisa Freeman

    2011-05-01

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

  18. Physical Activity Guidelines

    Science.gov (United States)

    ... use this site. health.gov Physical Activity Guidelines Physical Activity Physical activity is key to improving the health of the Nation. Based on the latest science, the Physical Activity Guidelines for Americans is an essential resource ...

  19. Differences in nutrient composition and choice of side dishes between red meat and fish dinners in Norwegian adults

    Directory of Open Access Journals (Sweden)

    Jannicke Borch Myhre

    2016-01-01

    Full Text Available Background: Food-based dietary guidelines often recommend increased consumption of fish and reduced intake of red and processed meat. However, little is known about how changing the main protein source from red meat to fish may influence the choice of side dishes. Objective: To investigate whether side dish choices differed between red meat and fish dinners. Moreover, to compare intakes of macronutrients and selected micronutrients in red meat and fish dinners and to see whether whole-day intakes of these nutrients differed between days with red meat dinners and days with fish dinners. Design: Data were collected in a cross-sectional nationwide Norwegian dietary survey using two non-consecutive telephone-administered 24-h recalls. The recalls were conducted approximately 4 weeks apart. In total, 2,277 dinners from 1,517 participants aged 18–70 were included in the analyses. Results: Fish dinners were more likely to include potatoes and carrots than red meat dinners, whereas red meat dinners more often contained bread, tomato sauce, and cheese. Red meat dinners contained more energy and iron; had higher percentages of energy (E% from fat, saturated fat, and monounsaturated fat; and a lower E% from protein and polyunsaturated fat than fish dinners. Fish dinners contained more vitamin D, β-carotene, and folate than red meat dinners. Similar differences were found when comparing whole-day intakes of the same nutrients on days with red meat versus fish dinners. Conclusion: Fish dinners were accompanied by different side dishes than red meat dinners. With regard to nutrient content, fish dinners generally had a healthier profile than red meat dinners. However, iron intake was higher for red meat dinners. Information about associated foods will be useful both for developing public health guidelines and when studying associations between dietary factors and health outcomes.

  20. Guideline level-3 PSA

    International Nuclear Information System (INIS)

    Roelofsen, P.M.; Van der Steen, J.

    1993-09-01

    For several applications of radioactive materials calculations must be executed to determine the radiation risk for the population. A guideline for the risk calculation method of two main sources: nuclear power plants, and other intended and unintended activities with radioactive materials, is given. The standards, recommendations and regulations in this report concern mainly the analysis of the radiological (external) consequences of nuclear power plant accidents, classified as level-3 PSA (Probabilistic Safety Analysis). Level-3 PSA falls within the scales 5-7 of the International Nuclear Event Scale (INES). The standards, etc., focus on the risks for groups of people and the so-called maximum individual risk. In chapter two the standards and regulations are formulated for each part of level-3 PSA: the source term spectrum, atmospheric distribution and deposition, exposure to radiation doses and calculation of radiation doses, dose-response relationships, measures to reduce the effect of radiation doses, design basis accidents, and finally uncertainty analysis. In chapter four, modelled descriptions are given of the standards and regulations, which could or should be used in a calculation program in case of level-3 PSA. In chapter three the practical execution of a probabilistic consequences analysis, the collection of input data and the presentation of the results are dealt with. 2 figs., 14 tabs., 64 refs

  1. EAACI Guidelines on Allergen Immunotherapy

    DEFF Research Database (Denmark)

    Sturm, Gunter J; Varga, Eva-Maria; Roberts, Graham

    2018-01-01

    immunotherapy, has been informed by a formal systematic review and meta-analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom allergic children...... practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence-based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence. This article...

  2. Japanese Guideline for Childhood Asthma

    Directory of Open Access Journals (Sweden)

    Toshiyuki Nishimuta

    2011-01-01

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

  3. Translating international HIV treatment guidelines into local priorities in Indonesia

    NARCIS (Netherlands)

    N. Tromp; Prawiranegara, R. (Rozar); Siregar, A. (Adiatma); R. Wisaksana (Rudi); Pinxten, L. (Lucas); Pinxten, J. (Juul); Lesmana Putra, A. (Arry); Kurnia Sunjaya, D. (Deni); Jansen, M. (Maarten); J.A.C. Hontelez (Jan); Maurits, S. (Scott); Maharani, F. (Febrina); Bijlmakers, L. (Leon); R. Baltussen (R.)

    2018-01-01

    textabstractObjective: International guidelines recommend countries to expand antiretroviral therapy (ART) to all HIV-infected individuals and establish local-level priorities in relation to other treatment, prevention and mitigation interventions through fair processes. However, no practical

  4. [Revised guideline 'Diabetic retinopathy: screening, diagnosis and treatment'

    NARCIS (Netherlands)

    Polak, B.C.P.; Hartstra, W.W.; Ringens, P.J.; Scholten, R.J.

    2008-01-01

    The revised evidence-based guideline 'Diabetic retinopathy: screening, diagnosis and treatment' contains important recommendations concerning screening, diagnosis and treatment of diabetic retinopathy. Regular screening and the treatment of risk factors, such as hyperglycemia, hypertension,

  5. Highlights of the 2017 European AIDS Clinical Society (EACS) Guidelines for the treatment of adult HIV-positive persons version 9.0

    DEFF Research Database (Denmark)

    Ryom, L; Boesecke, C; Bracchi, M

    2018-01-01

    BACKGROUND: The European AIDS Clinical Society (EACS) Guidelines have since 2005 provided multidisciplinary recommendations for the care of HIV-positive persons in geographically diverse areas. GUIDELINE HIGHLIGHTS: Major revisions have been made in all sections of the 2017 Guidelines: antiretrov......BACKGROUND: The European AIDS Clinical Society (EACS) Guidelines have since 2005 provided multidisciplinary recommendations for the care of HIV-positive persons in geographically diverse areas. GUIDELINE HIGHLIGHTS: Major revisions have been made in all sections of the 2017 Guidelines...

  6. Late gestational nutrient restriction

    DEFF Research Database (Denmark)

    Tygesen, Malin Plumhoff; Nielsen, Mette Olaf; Nørgaard, Peder

    2008-01-01

    We investigated the effect of 50% nutrient restriction during the last 6 weeks of gestation on twin-pregnant ewes' plasma glucose, non-esterified fatty acid, ß-hydroxybutyrate, insulin, IGF-1 and leptin concentrations and the effects on lamb birth weight and ewes' lactation performance. Plasma...... metabolite and hormone concentrations in restricted ewes suggest that maternal tissues were being mobilised. Despite the ewes' adaptations their lambs weighed significantly less at birth. Furthermore, colostrum and milk yields were markedly reduced up until the latest measurement at 3 weeks post partum...... despite adlibitum access to feed. Reduced milk yields coincided with reduced plasma IGF-1 concentration pre partum in nutrient restricted ewes indicating, that mammary gland development may have been compromised. The present data suggest that leptin is not involved in the regulation of early lactation...

  7. Nutrients in the nexus

    Science.gov (United States)

    Davidson, Eric A.; Niphong, Rachel; Ferguson, Richard B.; Palm, Cheryl; Osmond, Deanna L.; Baron, Jill S.

    2016-01-01

    Synthetic nitrogen (N) fertilizer has enabled modern agriculture to greatly improve human nutrition during the twentieth century, but it has also created unintended human health and environmental pollution challenges for the twenty-first century. Averaged globally, about half of the fertilizer-N applied to farms is removed with the crops, while the other half remains in the soil or is lost from farmers’ fields, resulting in water and air pollution. As human population continues to grow and food security improves in the developing world, the dual development goals of producing more nutritious food with low pollution will require both technological and socio-economic innovations in agriculture. Two case studies presented here, one in sub-Saharan Africa and the other in Midwestern United States, demonstrate how management of nutrients, water, and energy is inextricably linked in both small-scale and large-scale food production, and that science-based solutions to improve the efficiency of nutrient use can optimize food production while minimizing pollution. To achieve the needed large increases in nutrient use efficiency, however, technological developments must be accompanied by policies that recognize the complex economic and social factors affecting farmer decision-making and national policy priorities. Farmers need access to affordable nutrient supplies and support information, and the costs of improving efficiencies and avoiding pollution may need to be shared by society through innovative policies. Success will require interdisciplinary partnerships across public and private sectors, including farmers, private sector crop advisors, commodity supply chains, government agencies, university research and extension, and consumers.

  8. Improved and more effective algorithms to screen for nutrient deficiencies after bariatric surgery.

    Science.gov (United States)

    Bazuin, I; Pouwels, S; Houterman, S; Nienhuijs, S W; Smulders, J F; Boer, A K

    2017-02-01

    Most bariatric guidelines recommend frequent lab monitoring of patients to detect nutrient and vitamin deficiencies as early as possible. The aim of this study was to optimize the cost effectiveness of the nutrient panel, by developing an algorithm, which detects nutrient deficiencies at lower costs. In this retrospective study, 2055 patients who had undergone Laparoscopic Roux-Y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG) surgery at Catharina Hospital Eindhoven between January 2009 and December 2013 were included. Perioperative biochemical measurements (7 days before and 127 days after surgery) and measurements >549 days before surgery were excluded. For analysis, the most recent preoperative and postoperative measurements were selected for each biochemical parameter separately. First, the amount of moderate and severe deficiencies were calculated. Second, we investigated whether each variable (vitamins A, B 1 , B 6 , B 12 , D, folate, ferritin, zinc and magnesium) could predict the presence of deficiency. In total, 561 (LRYGB) and 831 (LSG) patients had at least preoperative and postoperative values of vitamin A, B 1 , B 6 , B 12 , D, folate, ferritin, zinc or magnesium. The algorithm reduces vitamin D, B 12 , B 6 , B 1 and ferritin examinations by 15, 11, 28, 28 and 38%, respectively, without missing clinically relevant deficiencies. The corresponding potential cost savings was 14%. This study identified substantial cost savings in laboratory test for both LRYGB and LSG procedures. The potential cost reduction of 14% might even be increased to 42% when less frequent moderate deficiencies are not screened anymore, whereas >99.0 of moderate deficiencies will be detected.

  9. European guideline for the diagnosis and treatment of insomnia

    OpenAIRE

    Riemann, Dieter; Baglioni, Chiara; Bassetti, Claudio; Bjorvatn, Bjorn; Groselj, Leja Dolenc; Ellis, Jason G.; Espie, Colin A.; Garcia-Borreguero, Diego; Gjerstad, Michaela; Goncalves, Marta; Hertenstein, Elisabeth; Jansson-Frojmark, Markus; Jennum, Poul J.; Leger, Damien; Nissen, Christoph

    2017-01-01

    Abstract: This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes ad...

  10. Trends in nutrients

    Science.gov (United States)

    Heathwaite, A.L.; Johnes, P.J.; Peters, N.E.

    1996-01-01

    The roles of nitrogen (N) and phosphorus (P) as key nutrients determining the trophic status of water bodies are examined, and evidence reviewed for trends in concentrations of N and P species which occur in freshwaters, primarily in northern temperate environments. Data are reported for water bodies undergoing eutrophication and acidification, especially water bodies receiving increased nitrogen inputs through the atmospheric deposition of nitrogen oxides (NOx). Nutrient loading on groundwaters and surface freshwaters is assessed with respect to causes and rates of (change, relative rates of change for N and P, and implications of change for the future management of lakes, rivers and groundwaters. In particular, the nature and emphasis of studies for N species and P fractions in lakes versus rivers and groundwaters are contrasted. This review paper primarily focuses on results from North America and Europe, particularly for the UK where a wide range of data sets exists. Few nutrient loading data have been published on water bodies in less developed countries; however, some of the available data are presented to provide a global perspective. In general, N and P concentrations have increased dramatically (>20 times background concentrations) in many areas and causes vary considerably, ranging from urbanization to changes in agricultural practices.

  11. Guideline for stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbaek; Lorentzen, Kristian; Clausen, Niels

    2014-01-01

    Stress ulcer prophylaxis (SUP) is commonly used in the intensive care unit (ICU), and is recommended in the Surviving Sepsis Campaign guidelines 2012. The present guideline from the Danish Society of Intensive Care Medicine and the Danish Society of Anesthesiology and Intensive Care Medicine sums...

  12. Variation in guideline adherence in intrauterine insemination care.

    NARCIS (Netherlands)

    Haagen, E.C.; Nelen, W.L.D.M.; Grol, R.P.T.M.; Braat, D.D.M.; Hermens, R.P.M.G.; Kremer, J.A.M.

    2010-01-01

    Health-care delivery according to clinical practice guidelines is thought to be critical in achieving optimal outcomes. This study aimed to assess the extent to which practice performance in intrauterine insemination (IUI) care is consistent with guideline recommendations and to evaluate the

  13. The Practice Guidelines for Primary Care of Acute Abdomen 2015.

    Science.gov (United States)

    Mayumi, Toshihiko; Yoshida, Masahiro; Tazuma, Susumu; Furukawa, Akira; Nishii, Osamu; Shigematsu, Kunihiro; Azuhata, Takeo; Itakura, Atsuo; Kamei, Seiji; Kondo, Hiroshi; Maeda, Shigenobu; Mihara, Hiroshi; Mizooka, Masafumi; Nishidate, Toshihiko; Obara, Hideaki; Sato, Norio; Takayama, Yuichi; Tsujikawa, Tomoyuki; Fujii, Tomoyuki; Miyata, Tetsuro; Maruyama, Izumi; Honda, Hiroshi; Hirata, Koichi

    2016-01-01

    Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine in collaboration with four other medical societies launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines [all clinical questions (CQs) and recommendations are shown in supplementary information]. A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on 9 subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.

  14. Introductory to the ESPEN guidelines on enteral nutrition

    DEFF Research Database (Denmark)

    Lochs, H.; Allison, S.P.; Meier, R.

    2006-01-01

    The ESPEN guidelines on enteral nutrition are the first evidence-based European recommendations for enteral nutrition. They were established by European experts for a variety of disease groups. During guideline development it became evident that terms and definitions in clinical nutrition have been...

  15. Adolescent Pregnancy Guidelines.

    Science.gov (United States)

    Fleming, Nathalie; O'Driscoll, Teresa; Becker, Gisela; Spitzer, Rachel F

    2015-08-01

    and postpartum, and more frequently if deemed necessary, is one option for such screening. (II-2A) 10. Pregnant adolescents should have a nutritional assessment, vitamins and food supplementation if needed, and access to a strategy to reduce anemia and low birth weight and to optimize weight gain in pregnancy. (II-2A) 11. Conflicting evidence supports and refutes differences in gestational hypertension in the adolescent population; therefore, the care usual for adult populations is supported for pregnant adolescents at this time. (II-2A) 12. Practitioners should consult gestational diabetes mellitus (GDM) guidelines. In theory, testing all patients is appropriate, although rates of GDM are generally lower in adolescent populations. Practitioners should be aware, however, that certain ethnic groups including Aboriginal populations are at high risk of GDM. (II-2A) 13. An ultrasound anatomical assessment at 16 to 20 weeks is recommended because of increased rates of congenital anomalies in this population. (II-2A) 14. As in other populations at risk of intrauterine growth restriction (IUGR) and low birth weight, an ultrasound to assess fetal well-being and estimated fetal weight at 32 to 34 weeks gestational age is suggested to screen for IUGR. (III-A) 15. Visits in the second or third trimester should be more frequent to address the increased risk of preterm labour and preterm birth and to assess fetal well-being. All caregivers should be aware of the signs and symptoms of preterm labour and should educate their patients to recognize them. (III-A) 16. It should be recognized that adolescents have improved vaginal delivery rates and a concomitantly lower Caesarean section rate than their adult counterparts. (II-2A) As with antenatal care, peripartum care in hospital should be multidisciplinary, involving social care, support for breastfeeding and lactation, and the involvement of children's aid services when warranted. (III-B) 17. Postpartum care should include a focus

  16. Trust for intelligent recommendation

    CERN Document Server

    Bhuiyan, Touhid

    2013-01-01

    Recommender systems are one of the recent inventions to deal with the ever-growing information overload in relation to the selection of goods and services in a global economy. Collaborative Filtering (CF) is one of the most popular techniques in recommender systems. The CF recommends items to a target user based on the preferences of a set of similar users known as the neighbors, generated from a database made up of the preferences of past users. In the absence of these ratings, trust between the users could be used to choose the neighbor for recommendation making. Better recommendations can b

  17. Korean clinical practice guideline for benign prostatic hyperplasia

    Science.gov (United States)

    Yeo, Jeong Kyun; Choi, Hun; Bae, Jae Hyun; Kim, Jae Heon; Yang, Seong Ok; Oh, Chul Young; Cho, Young Sam; Kim, Kyoung Woo

    2016-01-01

    In 2014, the Korean Urological Association organized the Benign Prostatic Hyperplasia Guideline Developing Committee composed of experts in the field of benign prostatic hyperplasia (BPH) with the participation of the Korean Academy of Family Medicine and the Korean Continence Society to develop a Korean clinical practice guideline for BPH. The purpose of this clinical practice guideline is to provide current and comprehensive recommendations for the evaluation and treatment of BPH. The committee developed the guideline mainly by adapting existing guidelines and partially by using the de novo method. A comprehensive literature review was carried out primarily from 2009 to 2013 by using medical search engines including data from Korea. Based on the published evidence, recommendations were synthesized, and the level of evidence of the recommendations was determined by using methods adapted from the 2011 Oxford Centre for Evidence-Based Medicine. Meta-analysis was done for one key question and four recommendations. A draft guideline was reviewed by expert peer reviewers and discussed at an expert consensus meeting until final agreement was achieved. This evidence-based guideline for BPH provides recommendations to primary practitioners and urologists for the diagnosis and treatment of BPH in men older than 40 years. PMID:26966724

  18. Nutrient deficiencies prior to bariatric surgery.

    Science.gov (United States)

    Roust, Lori R; DiBaise, John K

    2017-03-01

    The purpose of this review is to provide an update of recent additions to our understanding of the prevalence of nutrient deficiencies and the potential role of preoperative weight loss in contributing to these deficiencies in obese individuals planning to undergo bariatric surgery. Recent reports that have included bariatric surgery candidates from sites around the world have shown consistent deficiencies in a variety of nutrients. Although protein-energy malnutrition is uncommon preoperatively, micronutrient deficiencies occur commonly with multiple deficiencies often present in the same individual. No difference in the prevalence of deficiency between men and women is apparent, and a standard profile of susceptibility to deficiency has not been identified. In the only studies that have evaluated dietary intake of total energy, macronutrients and micronutrients preoperatively, despite an excess of calories ingested, micronutrient intake tends to be lower than recommended. A high prevalence of micronutrient deficiencies, especially vitamin D, folate, B12 and iron, is present in obese individuals being considered for bariatric surgery. Despite high-caloric intake, the deficiencies present appear to be related to the poor quality of the diet and low micronutrient intake. These findings strengthen prior recommendations of routine preoperative nutritional screening. Because a standard profile of susceptibility to deficiency has not been identified, extensive nutritional screening, including micronutrient testing, should be considered in all patients in the preoperative setting. Finally, we recommend early supplementation of vitamins and minerals based on laboratory assessment and incorporation of a program to optimize eating behaviors prior to surgery.

  19. World Health Organization guideline development: an evaluation.

    Directory of Open Access Journals (Sweden)

    David Sinclair

    Full Text Available BACKGROUND: Research in 2007 showed that World Health Organization (WHO recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization's own "Guidelines for Guidelines". In response, the WHO established a "Guidelines Review Committee" (GRC to implement and oversee internationally recognized standards. We examined the impact of these changes on WHO guideline documents and explored senior staff's perceptions of the new procedures. METHODS AND FINDINGS: We used the AGREE II guideline appraisal tool to appraise ten GRC-approved guidelines from nine WHO departments, and ten pre-GRC guidelines matched by department and topic. We interviewed 20 senior staff across 16 departments and analyzed the transcripts using the framework approach. Average AGREE II scores for GRC-approved guidelines were higher across all six AGREE domains compared with pre-GRC guidelines. The biggest changes were noted for "Rigour of Development" (up 37.6%, from 30.7% to 68.3% and "Editorial Independence" (up 52.7%, from 20.9% to 73.6%. Four main themes emerged from the interviews: (1 high standards were widely recognized as essential for WHO credibility, particularly with regard to conflicts of interest; (2 views were mixed on whether WHO needed a single quality assurance mechanism, with some departments purposefully bypassing the procedures; (3 staff expressed some uncertainties in applying the GRADE approach, with departmental staff concentrating on technicalities while the GRC remained concerned the underlying principles were not fully institutionalized; (4 the capacity to implement the new standards varied widely, with many departments looking to an overstretched GRC for technical support. CONCLUSIONS: Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance

  20. Cancer screening recommendations: an international comparison of high income countries.

    Science.gov (United States)

    Ebell, Mark H; Thai, Thuy Nhu; Royalty, Kyle J

    2018-01-01

    Recommendations regarding cancer screening vary from country to country, and may also vary within countries depending on the organization making the recommendations. The goal of this study was to summarize the cancer screening recommendations from the 21 countries with the highest per capita spending on healthcare. Cancer screening guidelines were identified for each country based on a review of the medical literature, internet searches, and contact with key informants in most countries. The highest level recommendation was identified for each country, in the order of national recommendation, cancer society recommendation, or medical specialty society recommendation. Breast cancer screening recommendations were generally consistent across countries, most commonly recommending mammography biennially from ages 50 to 69 or 70 years. In the USA, specialty societies generally offered more intensive screening recommendations. All countries also recommend cervical cancer screening, although there is some heterogeneity regarding the test (cytology or HPV or both) and the age of initiation and screening interval. Most countries recommend colorectal cancer screening using fecal immunochemical (FIT) testing, while only seven countries recommend general or selective screening for prostate cancer, and a similar number explicitly recommend against screening for prostate cancer. Screening for lung and skin cancer is only recommended by a few countries. Greater per capita healthcare expenditures are not associated with greater screening intensity, with the possible exception of prostate cancer. Guidelines for cancer screening differ between countries, with areas of commonality but also clear differences. Recommendations have important commonalities for well-established cancer screening programs such as breast and cervical cancer, with greater variation between countries regarding prostate, colorectal, lung, and skin cancer screening. Ideally, recommendations should be made by a

  1. Nutrient Status of Adults with Cystic Fibrosis

    Science.gov (United States)

    GORDON, CATHERINE M.; ANDERSON, ELLEN J.; HERLYN, KAREN; HUBBARD, JANE L.; PIZZO, ANGELA; GELBARD, RONDI; LAPEY, ALLEN; MERKEL, PETER A.

    2011-01-01

    Nutrition is thought to influence disease status in patients with cystic fibrosis (CF). This cross-sectional study sought to evaluate nutrient intake and anthropometric data from 64 adult outpatients with cystic fibrosis. Nutrient intake from food and supplements was compared with the Dietary Reference Intakes for 16 nutrients and outcomes influenced by nutritional status. Attention was given to vitamin D and calcium given potential skeletal implications due to cystic fibrosis. Measurements included weight, height, body composition, pulmonary function, and serum metabolic parameters. Participants were interviewed about dietary intake, supplement use, pulmonary function, sunlight exposure, and pain. The participants’ mean body mass index (±standard deviation) was 21.8±4.9 and pulmonary function tests were normal. Seventy-eight percent used pancreatic enzyme replacement for malabsorption. Vitamin D deficiency [25-hydroxyvitamin D (25OHD)<37.5 nmol/L] was common: 25 (39%) were deficient despite adequate vitamin D intake. Lipid profiles were normal in the majority, even though total and saturated fat consumption represented 33.0% and 16.8% of energy intake, respectively. Reported protein intake represented 16.9% of total energy intake (range 10%–25%). For several nutrients, including vitamin D and calcium, intake from food and supplements in many participants exceeded recommended Tolerable Upper Intake Levels. Among adults with cystic fibrosis, vitamin D deficiency was common despite reported adequate intake, and lipid profiles were normal despite a relatively high fat intake. Mean protein consumption was adequate, but the range of intake was concerning, as both inadequate or excessive intake may have deleterious skeletal effects. These findings call into question the applicability of established nutrient thresholds for patients with cystic fibrosis. PMID:18060897

  2. WHO Environmental noise guidelines for the European Region - What is new? 1. Policy context and methodology used for guideline development

    NARCIS (Netherlands)

    Heroux, M.E.; Babisch, W.; Belojevic, G.; Brink, M.; Janssen, S.; Lercher, P.; Paviotti, M.; Pershagen, G.; Persson Waye, K.; Preis, A.; Stansfeld, S.; Verbeek, J.

    2016-01-01

    WHO Regional Office for Europe is currently coordinating the systematic review of all pertinent literature in order to provide recommendations for the protection of public health as part of the upcoming WHO Environmental Noise Guidelines for the European Region (the Guidelines). The entire process

  3. Guideline-related barriers to optimal prescription of oral anticoagulants in primary care.

    Science.gov (United States)

    Beukenhorst, A L; Arts, D L; Lucassen, W; Jager, K J; van der Veer, S N

    2016-05-01

    Guidelines provide recommendations for antithrombotic treatment to prevent stroke in people with atrial fibrillation, but oral anticoagulant prescriptions in Dutch primary care are often discordant with these recommendations. Suboptimal guideline features (i.e. format and content) have been suggested as a potential explanatory factor for this type of discordance. Therefore, we systematically appraised features of the Dutch general practitioners' (NHG) atrial fibrillation guideline to identify guidelinerelated barriers that may hamper its use in practice. We appraised the guideline's methodological rigour and transparency using the Appraisal of Guidelines, Research and Evaluation (AGREE) II tool. Additionally, we used the Guideline Implementability Appraisal (GLIA) tool to assess the key recommendations on oral anticoagulant prescription. The editorial independence of the guideline group scored highly (88%); scores for other aspects of the guideline's methodological quality were acceptable, ranging from 53% for stakeholder involvement to 67% for clarity of presentation. At the recommendation level, the main implementation obstacles were lack of explicit statements on the quality of underlying evidence, lack of clarity around the strength of recommendations, and the use of ambiguous terms which may hamper operationalisation in electronic systems. Based on our findings we suggest extending stakeholder involvement in the guideline development process, standardising the layout and language of key recommendations, providing monitoring criteria, and preparing electronic implementation parallel with guideline development. We expect this to contribute to optimising the NHG atrial fibrillation guideline, facilitating its implementation in practice, and ultimately to improving antithrombotic treatment and stroke prevention in people with atrial fibrillation.

  4. Nutrient balances in the forest energy cycle

    International Nuclear Information System (INIS)

    Olsson, Bengt

    2006-02-01

    or wood in fuel mixture). Losses of P at harvesting, fuel storage or transportation, and contamination (soil) or additions of lime are possible causes. To a less extent, also K losses seem to occur in the process. On average, the recommended highest dose of ash to forest (3000 kg d.w./ha) over-compensate for alkalinity but under-compensate for K and P. There is thus a risk that standard values of ash doses will not result in the target compensation, in particular if the aim is to compensate for specific elements. The nutrient compensation needs can be defined to two levels (compensate for slash, or for slash and stem harvesting, respectively), and to four aims: (1) improve forest tree nutrient status and growth, (2) increase base saturation of forest soils and increase soil nutrient pools, (3) increase alkalinity in run-off water to counteract acidification of surface waters, and (4) as a complement to nitrogen fertilisation. Increasing the alkalinity of soils and soil water is the aim that can be most easily reached by ash application, due to the relatively high Ca and Mg contents in ashes. Compensation of ash for K losses is complicated by the high mobility of K ion in ecosystems and because its high solubility even in stabilised ashes. K in logging residues and ashes tend to be leached out and lost. Management for maintaining high availability of K in forest ecosystems should include several aspects, in particular the de sign of clear-fellings, timing of ash recycling and handling of slash and ashes. Compensation for P by application of stabilised wood-ashes is normally in efficient in the short time perspective, due to low P content in ashes and the bonding of P into poorly soluble apatite. However, in the long run P in ashes may improve forest P nutrition. New research is needed to estimate P-fluxes associated with harvesting, storage and transport of forest biomass in realistic situations, and to evaluate if P availability will be deteriorated in the long run

  5. CLINICAL RECOMMENDATIONS FOR DIAGNOSING SEPSIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    R. F. Tepaev

    2015-01-01

    Full Text Available Sepsis is one of the leading causes of child lethality. Timely diagnostics is the most important condition for treating sepsis successfully. This study contains analysis of recommendations on diagnosing the syndrome of systemic inflammatory response, sepsis, severe sepsis and septic shock of the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012,published in 2013. The modern perceptions of systemic inflammation during sepsis and sterile inflammation are highlighted.

  6. CLINICAL RECOMMENDATIONS FOR DIAGNOSING SEPSIS IN CHILDREN

    OpenAIRE

    R. F. Tepaev

    2015-01-01

    Sepsis is one of the leading causes of child lethality. Timely diagnostics is the most important condition for treating sepsis successfully. This study contains analysis of recommendations on diagnosing the syndrome of systemic inflammatory response, sepsis, severe sepsis and septic shock of the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012,published in 2013. The modern perceptions of systemic inflammation during sepsis and sterile ...

  7. IDSA releases updated coccidioidomycosis guidelines

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-09-01

    Full Text Available No abstract available. Article truncated at 150 words. The Infectious Diseases Society of America (IDSA has released updated Guidelines for the Treatment of Coccidioidomycosis, also known as cocci or Valley Fever (1. Coccidioidomycosis is a fungal infection endemic to the southwestern United States and a common cause of pneumonia and pulmonary nodules in this area. However, the infection can disseminate systemically especially in immunocompromised hosts and certain ethnic populations resulting in a variety of pulmonary and extrapulmonary complications. In addition to recommendations for these complications, the new guidelines address management of special at-risk populations, preemptive management strategies in at-risk populations and after unintentional laboratory exposure. The guidelines also suggest shorter courses of antibiotics for hospitalized patients and more ambulatory treatment for most individuals who have contracted Valley Fever. The panel was led by John N. Galgiani, MD, director of the Valley Fever Center for Excellence at the University of Arizona Health Sciences. Galgiani led a panel of 16 ...

  8. Conflicts of interest among authors of clinical practice guidelines for glycemic control in type 2 diabetes mellitus.

    Science.gov (United States)

    Norris, Susan L; Holmer, Haley K; Ogden, Lauren A; Burda, Brittany U; Fu, Rongwei

    2013-01-01

    Conflict of interest (COI) is an important potential source of bias in the development of clinical practice guidelines (CPGs). To examine rates of disclosure of COI, including financial interests in companies that manufacture drugs that are recommended in CPGs on glycemic control in type 2 diabetes mellitus, and to explore the relationship between recommendations for specific drugs in a guideline and author COI. We identified a cohort of relevant guidelines from the National Guideline Clearinghouse (NGC) and abstracted COI disclosures from all guideline authors for this observational, cross-sectional study. We determined which hypoglycemic drugs were recommended in each guideline, and explored the relationship between specific disclosures and whether a drug was recommended. Among 13 included guidelines, the percentage of authors with one or more financial disclosures varied from 0 to 94% (mean 44.2%), and was particularly high for two US-based guidelines (91% and 94%). Three guidelines disclosed no author financial COI. The percentage of authors with disclosures of financial interests in manufacturers of recommended drugs was also high (mean 30%). On average, 56% of manufacturers of patented drugs recommended in each guideline had one or more authors with a financial interest in their company. We did not find a significant relationship between financial interests and whether a drug was recommended in our sample; US-based guidelines were more likely to make recommendations for a specific drug compared to non-US based guidelines. Authors of this cohort of guidelines have financial interests directly related to the drugs that they are recommending. Although we did not find an association between author COI and drugs recommended in these guidelines and we cannot draw conclusions about the validity of the recommendations, the credibility of many of these guidelines is in doubt.

  9. Magnetic resonance imaging safety guidelines

    International Nuclear Information System (INIS)

    Feast, R.; Hurrell, M.; Tremewan, R.

    1996-01-01

    These guidelines are based on the findings and recommendations of the International Commission on Non-Ionizing Radiation Protection, the National Radiological Protection Board (UK), the National Health and Medical Research Council (Australia), the US Food and Drug Administration, the International Electrotechnical Commission and the Society for Magnetic Resonance Imaging. They indicate circumstances under which examinations may proceed with no special precautions, and those where a nmore careful evaluation may be necessary. They do not displace the need to maintain a current knowledge of the relevant medical literature. The guidelines have been endorsed by the Australasian College of Physical Scientists and Engineers in Medicine (NZ Branch), the NZ Institute of Medical Radiation Technologists and the Royal Australasian College of Radiologists (NZ Branch) as being supportive of good practice in MRI. They are based on information available at the time of publication. MRI imaging is an evolving technique, and it is recognised that future research and experience may require modifications to these recommendations. In recognition of this fact, they will ceaseto be valid on 31 December 2001. It is intended that they should be reviewed and modified where necessary before that date. (author). 9 refs., 2 tabs

  10. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition.

    Science.gov (United States)

    Mehta, Nilesh M; Skillman, Heather E; Irving, Sharon Y; Coss-Bu, Jorge A; Vermilyea, Sarah; Farrington, Elizabeth Anne; McKeever, Liam; Hall, Amber M; Goday, Praveen S; Braunschweig, Carol

    2017-07-01

    This document represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition and the Society of Critical Care Medicine, to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric (> 1 mo and clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1,661 citations. In total, the search for clinical trials yielded 1,107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer one of the eight preidentified question groups for this guideline. We used the Grading of Recommendations, Assessment, Development and Evaluation criteria to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutritional assessment, particularly the detection of malnourished patients who are most vulnerable and therefore potentially may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery is an area of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric

  11. Evidence in dentistry guidelines

    Directory of Open Access Journals (Sweden)

    Cristiane Rufino Macedo

    Full Text Available CONTEXT AND OBJECTIVE: Guidelines are suggestions for clinical practice based on the best available scientific evidence. Nevertheless, in drafting such guidelines, existing systematic reviews are often ignored and are replaced by general consensuses. This ends up compromising the quality of the instructions through bias. Our objective was to investigate whether Cochrane systematic reviews were present among the bibliographic references of prevention and treatment guidelines for dentistry that have been published in databases. DESIGN AND SETTING: This retrospective, observational study was conducted at the Brazilian Cochrane Center. METHODS: The databases were searched for guidelines. Any guidelines obtained were then checked to find whether Cochrane systematic reviews were present in the bibliographic references of the guidelines. In their absence, we checked whether such reviews had not been included because no reviews existed yet, or because such reviews had not been consulted despite already existing. RESULTS: 223 studies were initially selected; of these, 77 were excluded. Of the 146 guidelines included, 46 could have made reference to existing systematic reviews, but only 13 studies did so. Among these 13 studies, eight were systematic reviews following Cochrane methodology. Thirty-three guidelines had not been drafted using published systematic reviews as references, and 100 guidelines had been unable to use Cochrane references because no reviews existed yet. CONCLUSION: It is necessary to increase awareness of the importance of using systematic reviews in drafting dentistry guidelines. Likewise, it is necessary to develop systematic reviews that answer questions on the various topics that remain unanswered.

  12. Served versus actual nutrient intake of hospitalised patients with ...

    African Journals Online (AJOL)

    Objectives: To assess whether actual nutrient intake of hospitalised patients with tuberculosis differed from that served by the hospital and from that required according to current recommendations. Design: Descriptive, cross-sectional study. Setting: Brooklyn Chest Hospital in Brooklyn, Cape Town, Western Cape, South ...

  13. Assessment of the Nutrient Contents of Finished Broiler Starter and ...

    African Journals Online (AJOL)

    The study was conducted to assess and compare the proximate composition and amino acid profile of six (6) finished broiler starter and finisher diets with recommendations of National Research Council (NRC) nutrient requirements table for the different physiological age growth stage. Four samples of each feed type were ...

  14. OARSI Clinical Trials Recommendations

    DEFF Research Database (Denmark)

    McAlindon, T. E.; Driban, J. B.; Henrotin, Y.

    2015-01-01

    The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct......, and reporting of clinical trials for knee OA we initially drafted recommendations through an iterative process. Members of the working group included representatives from industry and academia. After the working group members reviewed a final draft, they scored the appropriateness for recommendations. After...... and index knee, describing interventions, patient-reported and physical performance measures, structural outcome measures, biochemical biomarkers, and reporting recommendations. In summary, the working group identified 25 recommendations that represent the current best practices regarding clinical trials...

  15. Nutrient density in complementary feeding of infants and toddlers.

    Science.gov (United States)

    Solomons, N W; Vossenaar, M

    2013-05-01

    The paradigm of the first 1000 days of life, the period from conception to the second birthday, has been advanced as a critical window of opportunity to save a life and a child's future. Infancy and toddler life, through the first 24 months after birth, is a unique period during which human milk is recommended as either the exclusive source of nutrition (6 months) or a variable component thereof. After the maternal delivery of milk is accounted for, the remainder of the energy and nutrients needs come from complementary foods. There is an intrinsic gap left by the maternal milk supply in volume and micronutrient content in relation to expanding infant and toddler needs. The nutrient density approach provides us with a mathematical framework to manage the closing of the nutrient gap. The intrinsic nutrient content of the unprocessed foods appropriate for young children is limited. The most problematic nutrients are calcium, iron and zinc. Some manner to enhance the nutrient density of the complementary foods is an incontestable necessity. The nutrient density consideration, which identifies for us the nature of the problem, offers a tool for the titrating of the fortification to an adequate--but safe--addition.

  16. Trust and Recommendations

    Science.gov (United States)

    Victor, Patricia; de Cock, Martine; Cornelis, Chris

    Recommendation technologies and trust metrics constitute the two pillars of trust-enhanced recommender systems. We discuss and illustrate the basic trust concepts such as trust and distrust modeling, propagation and aggregation. These concepts are needed to fully grasp the rationale behind the trust-enhanced recommender techniques that are discussed in the central part of the chapter, which focuses on the application of trust metrics and their operators in recommender systems. We explain the benefits of using trust in recommender algorithms and give an overview of state-of-the-art approaches for trust-enhanced recommender systems. Furthermore, we explain the details of three well-known trust-based systems and provide a comparative analysis of their performance. We conclude with a discussion of some recent developments and open challenges, such as visualizing trust relationships in a recommender system, alleviating the cold start problem in a trust network of a recommender system, studying the effect of involving distrust in the recommendation process, and investigating the potential of other types of social relationships.

  17. evaluation of nutrients status of soils under rice cultivation in cross ...

    African Journals Online (AJOL)

    deficient nutrient elements are recommended. KEYWORDS: Evaluation, Nutrient status, Soils, Cross River. INTRODUCTION. Rice is one food crop that has solved or nearly solved the food problem of many densely populated countries like India, Japan, Taiwan and South Korea. Nigeria having serious food security problem ...

  18. Design guidelines for wearable pointing devices

    Directory of Open Access