Safety of Nonoperative Management After Acute Diverticulitis

Science.gov (United States)

Amoza Pais, Sonia; Batlle Marin, Xavi; Oronoz Martinez, Begoña; Balen Ribera, Enrique; Yarnoz Irazabal, Concepción

2014-01-01

Purpose The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery. Methods We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode. Results Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated

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

Science.gov (United States)

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

2012-11-01

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

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

Science.gov (United States)

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

2012-11-01

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

Nonoperative management of penetrating kidney injuries: a prospective audit.

Science.gov (United States)

Moolman, C; Navsaria, P H; Lazarus, J; Pontin, A; Nicol, A J

2012-07-01

The role of nonoperative management for penetrating kidney injuries is unknown. Therefore, we review the management and outcome of penetrating kidney injuries at a center with a high incidence of penetrating trauma. Data from all patients presenting with hematuria and/or kidney injury discovered on imaging or at surgery admitted to the trauma center at Groote Schuur Hospital in Cape Town, South Africa during a 19-month period (January 2007 to July 2008) were prospectively collected and reviewed. These data were analyzed for demographics, injury mechanism, perioperative management, nephrectomy rate and nonoperative success. Patients presenting with hematuria and with an acute abdomen underwent a single shot excretory urogram. Those presenting with hematuria without an indication for laparotomy underwent computerized tomography with contrast material. A total of 92 patients presented with hematuria following penetrating abdominal trauma. There were 75 (80.4%) proven renal injuries. Of the patients 84 were men and the median age was 26 years (range 14 to 51). There were 50 stab wounds and 42 gunshot renal injuries. Imaging modalities included computerized tomography in 60 cases and single shot excretory urography in 18. There were 9 patients brought directly to the operating room without further imaging. A total of 47 patients with 49 proven renal injuries were treated nonoperatively. In this group 4 patients presented with delayed hematuria, of whom 1 had a normal angiogram and 3 underwent successful angioembolization of arteriovenous fistula (2) and false aneurysm (1). All nonoperatively managed renal injuries were successfully treated without surgery. There were 18 nephrectomies performed for uncontrollable bleeding (11), hilar injuries (2) and shattered kidney (3). Post-nephrectomy complications included 1 infected renal bed hematoma requiring percutaneous drainage. Of the injuries found at laparotomy 12 were not explored, 2 were drained and 5 were treated with

Factors for failure of nonoperative management of blunt ...

African Journals Online (AJOL)

Factors for failure of nonoperative management of blunt hepatosplenic trauma in children. ... Annals of Pediatric Surgery ... However, other than hemodynamic instability, the other factors mentioned above deserve further evaluation to ...

Criteria for nonoperative management of blunt splenic trauma

Directory of Open Access Journals (Sweden)

Sarmast Shoushtary MH

2009-02-01

Full Text Available "nBackground: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and diagnostic criteria for selection of patients for surgery. "nMethods: One hundred and one patients with blunt splenic injury entered in our prospective observational and cross sectional study. Patients with unstable hemodyna-mics and obvious abdominal symptoms underwent emergency splenectomy was performed. In stable patients, abdominal and pelvic CT scan with IV contrast was performed. Patients with stable hemodynamics who lack obvious abdominal symptoms, admitted in ICU ward. Patients' demographics, blood pressure changes, hemoglobin concertration, severity of trauma with injury severity score (ISS scoring system, CT scan findings, amount of blood transfusion; Hospitalization time and mechanism of injury were recorded. "nResults: From 101 patients, 61(60.3% underwent early laparotomy. 40 patients were planned for conservative management. In 30 patients (29.7% nonoperative management was successful. In 10 patients (9.9% This management failed and they underwent surgery. Hypotension, hemoglobin concentration dropping more than one episode and blood transfusion requirement more than one time, increased the risk of operation. Higher ISS number and ISS≥16 had a direct relation with operative management. In patients who underwent early laparotomy CT grade of injury was higher. CT findings correlated well with laparotomy findings. "nConclusion: Nonoperative management was successful in 75% of selected patients. With correct selection of patients and concerning to homodynamic status, hemoglobin concentration changes and injury severity score in conjunction with CT findings, we can use this management in greater number of patients.

Severe hepatic trauma: nonoperative management, definitive repair, or damage control surgery?

Science.gov (United States)

Leppäniemi, Ari K; Mentula, Panu J; Streng, Mari H; Koivikko, Mika P; Handolin, Lauri E

2011-12-01

Management of severe liver injuries has evolved to include the options for nonoperative management and damage control surgery. The present study analyzes the criteria for choosing between nonoperative management and early surgery, and definitive repair versus damage control strategy during early surgery. In a retrospective analysis of 144 patients with severe (AAST grade III-V) liver injuries (94% blunt trauma), early laparotomy was performed in 50 patients. Initial management was nonoperative in 94 blunt trauma patients with 8 failures. Uni- and multivariate analyses were used to calculate predictor odds ratios (OR) with 95% confidence intervals (CI). Factors associated with early laparotomy in blunt trauma included shock on admission, associated grade IV-V splenic injury, grade IV-V head injury, and grade V liver injury. Only shock was an independent predictor (OR, 26.1; 95% CI, 8.9-77.1; P < 0.001). The presence of a grade IV-V splenic injury predicted damage control strategy (OR infinite; P = 0.021). Failed nonoperative management was associated with grade IV-V splenic injury (OR, 14.00; 95% CI, 1.67-117.55), and shock (OR, 6.82; 95% CI, 1.49-31.29). The hospital mortality rate was 15%; 8 of 21 deaths were liver-related. Shock (OR, 9.3; 95% CI, 2.4-35.8; P = 0.001) and severe head injury (OR, 9.25; 95% CI, 3.0-28.9; P = 0.000) were independent predictors for mortality. In patients with severe liver injury, associated severe splenic injury favors early laparotomy and damage control strategy. Patients who arrive in shock or have an associated severe splenic injury should not be managed nonoperatively. In addition to severe head injury, uncontrollable bleeding from the liver injury is still a major cause of early death.

Non-operative management of abdominal gunshot injuries: Is it safe in all cases?

Science.gov (United States)

İflazoğlu, Nidal; Üreyen, Orhan; Öner, Osman Zekai; Meral, Ulvi Mehmet; Yülüklü, Murat

2018-01-01

In line with advances in diagnostic methods and expectation of a decrease in the number of negative laparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used over the last three decades. We aim to detect the possibility of treatment without surgery and present our experience in selected cases referred from Syria to a hospital at the Turkish-Syrian border. Between February 2012 and June 2014, patients admitted with abdominal gunshot wounds were analyzed. Computed tomography was performed for all patients on admission. Patients who were hemodynamically stable and did not have symptoms of peritonitis at the time of presentation were included in the study. The primary outcome parameters were mortality and morbidity. Successful selective non-operative management (Group 1) and unsuccessful selective non-operative management (Group 2) groups were compared in terms of complications, blood transfusion, injury site, injury severity score (ISS), and hospital stay. Of 158 truncal injury patients, 18 were considered feasible for selective non-operative management. Of these, 14 (78%) patients were treated without surgery. Other Four patients were operated upon progressively increasing abdominal pain and tenderness during follow-up. On diagnostic exploration, all of these cases had intestinal perforations. No mortality was observed in selective non-operative management. There was no statistically significant difference between Group 1 and Group 2, in terms of length of hospital stay (96 and 127 h, respectively). Also, there was no difference between groups in terms of blood transfusion necessity, injury site, complication rate, and injury severity score (p>0.05). Decision making on patient selection for selective non-operative management is critical to ensure favorable outcomes. It is not possible to predict the success of selective non-operative management in advance. Cautious clinical examination and close monitoring of these

Factors predicting the outcome of non-operative management of ...

African Journals Online (AJOL)

A.M. Maarouf

Predictors of non-operative management failure of high-grade blunt renal trauma. 45 and computed .... perform univariate and multivariate analyses of the risk factors. The .... possible. At our institutions, renal trauma management decisions were based on the ... gency nephrectomy and thus limits the possibility of preserving.

Nonoperative management of pancreatic injuries in pediatric patients

International Nuclear Information System (INIS)

Cigdem, M.K.; Senturk, S.; Onen, A.; Siga, M.; Akay, H.; Otcu, S.

2011-01-01

Nonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients. Between 2003 and 2009, 31 patients, 28 male and 3 female, with pancreatic injury due to blunt abdominal trauma were treated in our clinic. All patients were evaluated by ultrasonography, computed tomography (CT), and evaluation of serum amylase levels. Patients with ongoing hemodynamic instability after resuscitation or signs of bowel perforation underwent immediate laparotomy, and the remaining patients were conservatively treated. Conservative treatment consisted of nasogastric tube replacement, total parenteral nutrition, monitoring of amylase levels, and serial clinical examination. The most common mechanism of injury was a fall (35.4%). Ten patients (32.2%) had associated extraabdominal injuries, and 18 patients (58.1%) had associated abdominal injuries. The spleen was the most common site of intra-abdominal injury that was associated with pancreatic trauma. Initial amylase levels were normal in 5 patients, whose CT scans revealed pancreatic injury. Twenty-five patients (80.6%) were conservatively treated. Six patients (19.4%) required surgical intervention because of a hollow viscus or diaphragmatic injury and hemodynamic instability. A pseudocyst developed in 11 of the 25 patients who were nonoperatively treated; 6 patients required intervention for the pseudocyst (percutaneous drainage and cystogastrostomy). No patient succumbed to injury. The majority of the pancreatic injuries in pediatric patients can be successfully treated conservatively, unless there is hemodynamic instability and a hollow viscus injury. The most common complication is a pseudocyst. (author)

The cost-effectiveness of nonoperative management versus laparoscopic appendectomy for the treatment of acute, uncomplicated appendicitis in children.

Science.gov (United States)

Wu, James X; Sacks, Greg D; Dawes, Aaron J; DeUgarte, Daniel; Lee, Steven L

2017-07-01

Several studies have demonstrated the safety and short-term success of nonoperative management in children with acute, uncomplicated appendicitis. Nonoperative management spares the patients and their family the upfront cost and discomfort of surgery, but also risks recurrent appendicitis. Using decision-tree software, we evaluated the cost-effectiveness of nonoperative management versus routine laparoscopic appendectomy. Model variables were abstracted from a review of the literature, Healthcare Cost and Utilization Project, and Medicare Physician Fee schedule. Model uncertainty was assessed using both one-way and probabilistic sensitivity analyses. We used a $100,000 per quality adjusted life year (QALY) threshold for cost-effectiveness. Operative management cost $11,119 and yielded 23.56 quality-adjusted life months (QALMs). Nonoperative management cost $2277 less than operative management, but yielded 0.03 fewer QALMs. The incremental cost-to-effectiveness ratio of routine laparoscopic appendectomy was $910,800 per QALY gained. This greatly exceeds the $100,000/QALY threshold and was not cost-effective. One-way sensitivity analysis found that operative management would become cost-effective if the 1-year recurrence rate of acute appendicitis exceeded 39.8%. Probabilistic sensitivity analysis indicated that nonoperative management was cost-effective in 92% of simulations. Based on our model, nonoperative management is more cost-effective than routine laparoscopic appendectomy for children with acute, uncomplicated appendicitis. Cost-Effectiveness Study: Level II. Published by Elsevier Inc.

Early Uncomplicated Appendicitis-Who Can We Treat Nonoperatively?

Science.gov (United States)

Horattas, Mark C; Horattas, Ileana K; Vasiliou, Elya M

2018-02-01

This study evaluated nonoperative treatment for mild appendicitis and reviewed selection criteria to be used in introducing this option into clinical practice. A retrospective review of 73 consecutive cases of appendicitis treated by a single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm proposed in this manuscript were considered for nonoperative management. An additional 17 patients with mild appendicitis were offered and successfully treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73 patients, 37 had moderate to severe appendicitis and directly underwent appendectomy. The remaining patients were diagnosed with mild appendicitis and considered eligible for nonoperative management. Of these, 14 patients were offered nonoperative therapy. Thirteen responded successfully; one patient responded partially, but later opted for surgery. In 2014, this scoring system and preliminary results were shared with the other surgeons in our department. Nonoperative management was then selectively adopted by a few of the surgeons from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being offered and successfully managed nonoperatively. Patients with mild or early appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS scoring system may provide a helpful mnemonic for successfully selecting patients for this option.

Patient Outcomes in the Operative and Nonoperative Management of High-Grade Spondylolisthesis in Children

DEFF Research Database (Denmark)

Lundine, K. M.; Lewis, S. J.; Al-Aubaidi, Zaid

2014-01-01

Background:The optimal management of high-grade spondylolisthesis in the growing child is controversial. Some authors have advocated for surgery in all cases regardless of symptoms. Surgical intervention results in a >10% risk of complications with increased risk of neurological injury associated...... with slip reduction maneuvers. There is a paucity of literature regarding nonoperative management in this setting. This study sought to obtain outcome measures in pediatric patients with high-grade spondylolisthesis managed either operatively or nonoperatively.Methods:Database review was performed...

Nonoperative management for major blunt hepatic trauma. A case report.

Science.gov (United States)

Mingoli, Andrea; Saracino, Andrea; Brachini, Gioia; Mariotta, Giovanni; Migliori, Emanuele; Silvestri, Vania

2015-03-16

Over the past 20 years the management of blunt liver trauma has evolved from a primary operative approach to a nonoperative one, for both low and high grade injuries, only on the basis of hemodynamic stability. However, in spite of a high success rate of non operative management, it is frequently observed, also in our country, an old fashioned way to approach these patients, based on habit more than observation and evidence based medicine. We present a case of successful nonoperative treatment of a grade IV blunt liver trauma (lacero-contusive injury of V, VI and VII segments) in a 34-year-old woman. Nowadays more than 85% of liver injuries are managed without operative intervention, irrespective of the injury grade. Success rate of the conservative approach ranges from 82% to 100% and almost all complications (14% in high grade injuries) can be managed with interventional radiology procedures, still avoiding major surgery. Today, in the absence of other abdominal injuries requiring surgical exploration, hemodynamic instability from ongoing hemorrhage after primary evaluation and resuscitative treatment, is the only indication to an operative management of traumatic liver injuries.

Non-Operative Management of Isolated Pneumoperitoneum Due to Severe Blunt Abdominal Trauma

Directory of Open Access Journals (Sweden)

Murat Kilic

2016-02-01

Full Text Available Nonoperative management of blunt abdominal trauma is the treatment of choice for hemodynamically stable patients. The results of nonoperative management are more successful in isolated solid organ injuries such as the liver and spleen than hollow viscus injury. In this approach, both the clinical course of the patient and the computed tomography findings play an important role. Isolated pneumoperitoneum in blunt abdominal trauma may be a surgical challenge for clinicians because it is usually a significant radiological sign for hallow viscus perforations. Here, we report a case of isolated pneumoperitoneum detected on computed tomography and managed non-surgically, in a young man suffered from a severe blunt abdominal trauma. Our aim is to attract the attention of surgeons to the management problems of the presence of pneumoperitoneum in the absence of other radiological findings in blunt abdominal trauma.

Is non-operative management still justified in the treatment of ...

African Journals Online (AJOL)

Abstract. Background: Adhesive small bowel obstruction (ASBO) is a feared complication after abdominal operations in both children and adults. The optimal ... Followup data were available for 29 patients. Demographic ... required surgery. Key words: Adhesive small bowel obstruction, children, non-operative management ...

Non-operative management (NOM) of blunt hepatic trauma: 80 cases.

Science.gov (United States)

Özoğul, Bünyami; Kısaoğlu, Abdullah; Aydınlı, Bülent; Öztürk, Gürkan; Bayramoğlu, Atıf; Sarıtemur, Murat; Aköz, Ayhan; Bulut, Özgür Hakan; Atamanalp, Sabri Selçuk

2014-03-01

Liver is the most frequently injured organ upon abdominal trauma. We present a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and/or surgical intervention. A total of 80 patients with blunt liver injury who were hospitalized to the general surgery clinic or other clinics due to the concomitant injuries were followed non-operatively. The normally distributed numeric variables were evaluated by Student's t-test or one way analysis of variance, while non-normally distributed variables were analyzed by Mann-Whitney U-test or Kruskal-Wallis variance analysis. Chi-square test was also employed for the comparison of categorical variables. Statistical significance was assumed for phepatic trauma seems to be the gold standard.

Evaluation of a protocol for the non-operative management of perforated peptic ulcer.

Science.gov (United States)

Marshall, C; Ramaswamy, P; Bergin, F G; Rosenberg, I L; Leaper, D J

1999-01-01

The non-operative management of perforated peptic ulcer has previously been shown to be both safe and effective although it remains controversial. A protocol for non-operative management was set up in this hospital in 1989. Adherence to the guidelines in the protocol has been audited over a 6-year period with a review of outcome. The case-notes of patients with a diagnosis of perforated peptic ulcer were reviewed. Twelve guidelines from the protocol were selected for evaluation of compliance to the protocol. Forty-nine patients underwent non-operative treatment initially. Eight patients failed to respond and underwent operation. Complications included abscess formation (seven patients), renal failure (one), gastric ileus (one), chest infection (two), and cardiac failure and stroke (one). Four deaths occurred in this group. Adherence to certain protocol guidelines was poor, notably those concerning prevention of thromboembolism, use of antibiotics, use of contrast examination to confirm the diagnosis and referral for follow-up endoscopy. Two gastric cancers were detected on subsequent endoscopy. This experience demonstrates that non-operative treatment can be used successfully in a general hospital. Adherence to protocol guidelines was found to be variable and the protocol has therefore been simplified. This study highlights the need for an accurate diagnosis and the importance of follow-up endoscopy.

Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country?

Directory of Open Access Journals (Sweden)

Osifo Osarumwense

2010-01-01

Full Text Available Background: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country. Patients and Methods: This is a retrospective analysis of records of children who were managed with adhesive intestinal obstruction at the University of Benin Teaching Hospital between January 2002 and December 2008. Results: Adhesive intestinal obstruction accounted for 21 (8.8% of 238 children managed with intestinal obstruction. They were aged between 7 weeks and 16 years (mean 3 ± 6.4 years, comprising 13 males and eight females (ratio 1.6:1. Prior laparotomy for gangrenous/perforated intussusception (seven, 33.3%, perforated appendix (five, 23.8%, perforated volvulus (three, 14.3%, penetrating abdominal trauma (two, 9.5% and perforated typhoid (two, 9.5% were major aetiologies. Adhesive obstruction occurred between 6 weeks and 7 years after the index laparotomies. All the 21 children had initial nonoperative management without success, owing to lack of total parenteral nutrition and monitoring facilities. Outcomes of open adhesiolysis performed between 26 and 48 h in six (28.6% children due to poor response to nonoperative management, 11-13 days in 12 (57.1% who responded minimally and 2-5 weeks in three (14.3% who had relapse of symptoms were encouraging. Exploration of the 21 adhesive obstructions confirmed small bowel obstruction due to solitary bands (two, 9.5%, multiple bands/adhesions (13, 61.9% and encasement, including one bowel gangrene (six, 28.6%. Postoperatively, the only child who had recurrence during 1-6 years of follow-up did well after a repeat adhesiolysis. Conclusion: Nonoperative management was unsuccessful in this setting. Open adhesiolysis may be adopted in children to prevent avoidable morbidities and

Non-operative management of right side thoracoabdominal penetrating injuries--the value of testing chest tube effluent for bile.

Science.gov (United States)

De Rezende Neto, João Baptista; Guimarães, Tiago Nunes; Madureira, João Lopo; Drumond, Domingos André Fernandes; Leal, Juliana Campos; Rocha, Aroldo; Oliveira, Rodrigo Guimarães; Rizoli, Sandro B

2009-05-01

While mandatory surgery for all thoracoabdominal penetrating injuries is advocated by some, the high rate of unnecessary operations challenges this approach. However, the consequences of intrathoracic bile remains poorly investigated. We sought to evaluate the outcome of patients who underwent non-operative management of right side thoracoabdominal (RST) penetrating trauma, and the levels of bilirubin obtained from those patients' chest tube effluent. We managed non-operatively all stable patients with a single RST penetrating injury. Chest tube effluent samples were obtained six times within (4-8 h; 12-16 h; 20-24 h; 28-32 h; 36-40 h; 48 h and 72 h) of admission for bilirubin measurement and blood for complete blood count, bilirubin, alanine (ALT) and aspartate aminotransferases (AST) assays. For comparison we studied patients with single left thoracic penetrating injury. Forty-two patients with RST injuries were included. All had liver and lung injuries confirmed by CT scans. Only one patient failed non-operative management. Chest tube bilirubin peaked at 48 h post-trauma (mean 3.3+/-4.1 mg/dL) and was always higher than both serum bilirubin (pchest tube effluent from control group (27 patients with left side thoracic trauma). Serum ALT and AST were higher in RST injury patients (ptrauma appears to be safe. Bile originating from the liver injury reaches the right thoracic cavity but does not reflect the severity of that injury. The highest concentration was found in the patient failing non-operative management. The presence of intrathoracic bile in selected patients who sustain RST penetrating trauma, with liver injury, does not preclude non-operative management. Our study suggests that monitoring chest tube effluent bilirubin may provide helpful information when managing a patient non-operatively.

Trauma surgery in the era of nonoperative management: the Dutch model

NARCIS (Netherlands)

Goslings, J. Carel; Ponsen, Kees Jan; Luitse, Jan S. K.; Jurkovich, Gregory J.

2006-01-01

BACKGROUND: Falling operative experience and diminished job satisfaction of trauma surgeons appears to be in part the result of nonoperative management of many blunt injuries. In The Netherlands, the responsibility of trauma surgeons includes the operative treatment of most pelvic and extremity

Nonoperative care for hip fracture in the elderly: the influence of race, income, and comorbidities.

Science.gov (United States)

Neuman, Mark D; Fleisher, Lee A; Even-Shoshan, Orit; Mi, Lanyu; Silber, Jeffrey H

2010-04-01

Hip fracture occurs in 340,000 older adults each year. Operative repair is the standard of care, maximizing the chances of functional recovery. Not receiving operative care may condemn patients to a lifetime of pain and potential immobility. To measure the incidence of nonoperative treatment for first-time hip fracture in a population-based cohort and to measure the odds of nonoperative treatment of hip fracture among patients of differing race and income. Retrospective cohort study of 165,861 Medicare beneficiaries admitted for hip fracture between March 31, 2002 and December 31, 2006 to hospitals in New York, Illinois, and Texas. Odds of nonoperative management of hip fracture, adjusted for fracture characteristics, comorbidities, source of admission, age, sex, race, income, and individual hospital effects. Nonoperative management occurred in 6.2% of patients (N = 10,283). After adjustment, black patients had a 79% increase in the odds of nonoperative management as compared with whites (OR 1.79, 95% CI 1.64-1.95). Low income itself was not associated with a change in the odds of nonoperative care. Among patients not receiving operative repair, blacks demonstrated lower mortality than whites at 7 days (7.96% vs. 20.17%, P < 0.0001) and 30 days (24.14% vs. 38.22%, P < 0.0001). Black race predicts an increased odds of nonoperative care for hip fracture. Among patients receiving nonoperative care, black patients demonstrated increased survival compared with whites. These results are consistent with differential selection of operative candidates by patient race.

Nonoperative modalities to treat symptomatic cervical spondylosis.

LENUS (Irish Health Repository)

Hirpara, Kieran Michael

2012-01-01

Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means. A review of the literature supporting various modalities of conservative management is presented, and it is concluded that although effective, nonoperative treatment is labour intensive, requiring regular review and careful selection of medications and physical therapy on a case by case basis.

Nonoperative management for perforated peptic ulcer: Who can benefit?

OpenAIRE

Cao, Feng; Li, Jia; Li, Ang; Fang, Yu; Ya-jun Wang, Ya-jun Wang; Li, Fei

2017-01-01

Background: Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought to predict who can benefit from it. Methods: A clinicoradiological protocol for the assessment of patients presenting with PPU was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would identify patients who can be successfully treated with ...

A novel nonoperative approach to abdominal compartment syndrome after abdominal wall reconstruction.

Science.gov (United States)

Hasan, Zeenat R; Sorensen, G Brent

2013-01-01

Intraabdominal hypertension and abdominal compartment syndrome have been increasingly recognized as significant causes of morbidity and mortality in both medical and surgical patients. The gold standard remains surgical intervention; however, nonoperative approaches have been investigated less. Here, we describe the successful treatment of a severe acute case by intubation, nasogastric decompression, and paralysis--a novel approach not previously described in the literature. After the patient underwent laparoscopic bilateral component separation and repair of a large recurrent ventral hernia with a 20 30-cm Strattice mesh (LifeCell Corp, Branchburg, NJ), acute renal failure developed within 12 hours postoperatively, and was associated with oliguria, hyperkalemia, and elevated peak airway and bladder pressures. The patient was treated nonoperatively with intubation, nasogastric tube decompression, and paralysis with a vecuronium drip. Rapid reversal was seen, avoiding further surgery. Within 2 hours after intubation and paralysis, our patient's urine output improved dramatically with an initial diuresis of approximately 1 L, his bladder pressures decreased, and within 12 hours his creatinine level had normalized. Although surgical intervention has traditionally been thought of as the most effective--and thus the gold standard--for abdominal compartment syndrome, this preliminary experience demonstrates nonoperative management as highly efficacious, with the added benefit of decreased morbidity. Therefore, nonoperative management could be considered first-line therapy, with laparotomy reserved for refractory cases only. This suggests a more complex pathology than the traditional teaching of congestion and edema alone.

Non-operative management of blunt hepatic trauma: Does angioembolization have a major impact?

Science.gov (United States)

Bertens, K A; Vogt, K N; Hernandez-Alejandro, R; Gray, D K

2015-02-01

A paradigm shift toward non-operative management (NOM) of blunt hepatic trauma has occurred. With advances in percutaneous interventions, even severe liver injuries are being managed non-operatively. However, although overall mortality is decreased with NOM, liver-related morbidity remains high. This study was undertaken to explore the morbidity and mortality of blunt hepatic trauma in the era of angioembolization (AE). A retrospective cohort of trauma patients with blunt hepatic injury who were assessed at our centre between 1999 and 2011 were identified. Logistic regression was undertaken to identify factors increasing the likelihood of operative management (OM) and mortality. We identified 396 patients with a mean ISS of 33 (± 14). Sixty-two (18%) patients had severe liver injuries (≥ AAST grade IV). OM occurred in 109 (27%) patients. Logistic regression revealed high ISS (OR 1.07; 95% CI 1.05-1.10), and lower systolic blood pressure on arrival (OR 0.98; 95% CI 0.97-0.99) to be associated with OM. The overall mortality was 17%. Older patients (OR 1.05; 95% CI 1.03-1.07), those with high ISS (OR 1.11; 95% CI 1.08-1.14) and those requiring OM (OR 2.89; 95% CI 1.47-5.69) were more likely to die. Liver-related morbidities occurred in equal frequency in the OM (23%) and AE (29%) groups (p = 0.32). Only 3% of those with NOM experienced morbidity. The majority of patients with blunt hepatic trauma can be successfully managed non-operatively. Morbidity associated with NOM was low. Patients requiring AE had morbidity similar to OM.

Is non-operative management still justified in the treatment of adhesive small bowel obstruction in children?

Science.gov (United States)

Nasir, Abdulrasheed A; Abdur-Rahman, Lukman O; Bamigbola, Kayode T; Oyinloye, Adewale O; Abdulraheem, Nurudeen T; Adeniran, James O

2013-01-01

Adhesive small bowel obstruction (ASBO) is a feared complication after abdominal operations in both children and adults. The optimal management of ASBO in the pediatric population is debated. The aim of the present study was to examine the safety and effectiveness of non-operative management in ASBO. A retrospective review of 33 patients who were admitted for ASBO over a 5-year period was carried out. Follow-up data were available for 29 patients. Demographic, clinical, and operative details and outcomes were collected for these patients. Data analysis was done with SPSS version 15.0. P ≤ 0.05 was regarded as significant. Out of 618 abdominal surgeries within the 5-year period, 34 admissions were recorded from 29 patients at the follow-up period of 1-28 months. There were 19 boys (65.5%). The median age of patients was 4.5 years. Typhoid intestinal perforation (n = 7), intussusception (n = 6), intestinal malrotation (n = 5), and appendicitis (n = 4) were the major indications for a prior abdominal surgery leading to ASBO. Twenty-five patients (73.5%) developed SBO due to adhesions within the first year of the primary procedure. Of the 34 patients admitted with ASBO, 18 (53%) underwent operative intervention and 16 (47%) were successfully managed non-operatively. There were no differences in sex (P = 0.24), initial procedure (P = 0.12), age, duration of symptoms, and time to re-admission between the patients who responded to non-operative management and those who underwent operative intervention. However, the length of hospital stay was significantly shorter in the non-operative group (P operative management is still a safe and preferred approach in selected patients with ASBO. However, 53% eventually required surgery.

Success of nonoperative management of adductor longus tendon ruptures in National Football League athletes.

Science.gov (United States)

Schlegel, Theodore F; Bushnell, Brandon D; Godfrey, Jenna; Boublik, Martin

2009-07-01

Acute complete ruptures of the proximal adductor longus tendon are rare but challenging injuries to treat. The limited literature supports operative treatment, but data from management of chronic groin pain in athletes indicate that anatomical attachment of the tendon to the pubis may not be required for high-level function. Nonoperative management of complete adductor rupture can provide equal results to surgical repair in terms of return to play in the National Football League. Case series; Level of evidence, 4. Using the National Football League Injury Surveillance System, adductor tendon ruptures documented by magnetic resonance imaging were identified in 19 National Football League players from 1992 to 2004. The team physician for each respective player completed a survey with information about history, physical examination, magnetic resonance imaging findings, treatment, and outcomes. Statistics were analyzed with a Student unpaired t test. Fourteen players were treated nonoperatively, and 5 players were treated with surgical repair using suture anchors. In both groups, all players eventually returned to play in the National Football League. Mean time for return to play was 6.1 +/- 3.1 weeks (range, 3-12 weeks) for the nonoperative group and 12.0 +/- 2.5 weeks (range, 10-16 weeks) for the operative group (P = .001). One player in the operative group suffered the complication of a draining wound and heterotopic ossification. Players represented a variety of positions, and 12 of 19 (63%) had experienced prior symptoms or events. Nonoperative treatment of proximal adductor tendon rupture results in a statistically significantly faster return to play than does operative treatment in athletes competing in the National Football League and avoids the risks associated with surgery while providing an equal likelihood of return to play at the professional level.

Delayed splenic vascular injury after nonoperative management of blunt splenic trauma.

Science.gov (United States)

Furlan, Alessandro; Tublin, Mitchell E; Rees, Mitchell A; Nicholas, Dederia H; Sperry, Jason L; Alarcon, Louis H

2017-05-01

Delayed splenic vascular injury (DSVI) is traditionally considered a rare, often clinically occult, harbinger of splenic rupture in patients with splenic trauma that are managed conservatively. The purpose of our study was to assess the incidence of DSVI and associated features in patients admitted with blunt splenic trauma and managed nonoperatively. A retrospective analysis was conducted over a 4-y time. Patients admitted with blunt splenic trauma, managed no-operatively and with a follow-up contrast-enhanced computed tomography (CT) scan study during admission were included. The CT scans were reviewed for American Association for the Surgery of Trauma splenic injury score, amount of hemoperitoneum, and presence of DSVI. Logistic regression models were used to investigate the risk factors associated with DSVI. A total of 100 patients (60 men and 40 women) constituted the study group. Follow-up CT scan demonstrated a 23% incidence of DSVI. Splenic artery angiography validated DSVI in 15% of the total patient population. Most DSVIs were detected only on arterial phase CT scan imaging. The American Association for the Surgery of Trauma splenic injury score (odds ratio = 1.73; P = 0.045) and the amount of hemoperitoneum (odds ratio = 1.90; P = 0.023) on admission CT scan were associated with the development of DSVI on follow-up CT scan. DSVI on follow-up CT scan imaging of patients managed nonoperatively after splenic injury is common and associated with splenic injury score assessed on admission CT scan. Copyright © 2016 Elsevier Inc. All rights reserved.

The long-term functional outcome of type II odontoid fractures managed non-operatively.

LENUS (Irish Health Repository)

Butler, J S

2010-10-01

Odontoid fractures currently account for 9-15% of all adult cervical spine fractures, with type II fractures accounting for the majority of these injuries. Despite recent advances in internal fixation techniques, the management of type II fractures still remains controversial with advocates still supporting non-rigid immobilization as the definitive treatment of these injuries. At the NSIU, over an 11-year period between 1 July 1996 and 30 June 2006, 66 patients (n = 66) were treated by external immobilization for type II odontoid fractures. The medical records, radiographs and CT scans of all patients identified were reviewed. Clinical follow-up evaluation was performed using the Cervical Spine Outcomes Questionnaire (CSOQ). The objectives of this study were to evaluate the long-term functional outcome of patients suffering isolated type II odontoid fractures managed non-operatively and to correlate patient age and device type with clinical and functional outcome. Of the 66 patients, there were 42 males and 24 females (M:F = 1.75:1) managed non-operatively for type II odontoid fractures. The mean follow-up time was 66 months. Advancing age was highly correlated with poorer long-term functional outcomes when assessing neck pain (r = 0.19, P = 0.1219), shoulder and arm pain (r = 0.41, P = 0.0007), physical symptoms (r = 0.25, P = 0.472), functional disability (r = 0.24, P = 0.0476) and psychological distress (r = 0.41, P = 0.0007). Patients >65 years displayed a higher rate of pseudoarthrosis (21.43 vs. 1.92%) and established non-union (7.14 vs. 0%) than patients <65 years. The non-operative management of type II odontoid fractures is an effective and satisfactory method of treating type II odontoid fractures, particularly those of a stable nature. However, patients of advancing age have been demonstrated to have significantly poorer functional outcomes in the long term. This may be linked to higher rates of non-union.

"Stiction Syndrome": Non-Operative Management of Patients With Difficult AMS 700 Series Inflation.

Science.gov (United States)

Kavoussi, Nicholas L; Viers, Boyd R; VanDyke, Maia E; Pagliara, Travis J; Morey, Allen F

2017-09-01

Static friction (stiction) is a mechanical phenomenon in which a state of increased resistance exists across a control valve mechanism. To present a strategy for non-operative management of inflatable penile prosthesis (IPP) cases with pump malfunction from pump valve stiction. All patients had American Medical Systems (AMS; Minnetonka, MN, USA) 700 series Momentary Squeeze IPPs with transient pump malfunction owing to pump valve stiction after extended periods of device inactivity. Our evolving non-operative management experience with the "forced deflation" maneuver is described. This technique has successfully prevented the need for surgical pump replacement. Of patients with IPP who were instructed to inflate and deflate daily to prevent stiction recurrence, none have re-presented with difficult inflation. Of 306 patients receiving the AMS 700 series IPP at our institution from 2007 through 2015, 6 (1.9%) presented with difficulty activating the Momentary Squeeze pump (from 2011 through 2015). Four additional patients were referred from outside institutions with the same complaint. All patients (10 of 10, 100%) presented after a prolonged period of inactivity (minimum = 6 weeks) during which the IPP was not cycled and remained stagnant. Although the initial four patients (40%) underwent surgical exploration with pump mobilization and replacement, the six most recent patients (60%) were successfully instructed in the forced deflation maneuver in the office, which enabled the device to cycle normally thereafter. Device inactivity, for as little as 6 weeks, can predispose to Momentary Squeeze pump valve malfunction; and a regimen of daily IPP cycling could prevent stiction-related malfunction. Our findings should encourage practitioners to attempt conservative management of patients with "stiction syndrome" whenever possible, thereby avoiding unnecessary surgery. Kavoussi NL, Viers BR, VanDyke ME, et al. "Stiction Syndrome": Non-Operative Management of Patients

Natural history of nonoperative management for grade 4 and 5 liver and spleen injuries in children.

Science.gov (United States)

Yang, Jeannie C; Sharp, Susan W; Ostlie, Daniel J; Holcomb, George W; St Peter, Shawn D

2008-12-01

Nonoperative management is standard treatment of blunt liver or spleen injuries. However, there are few reports outlining the natural history and outcomes of severe blunt hepatic and splenic trauma. Therefore, we reviewed our experience with nonoperative management of grade 4 or 5 liver and spleen injuries. A retrospective analysis was performed on patients with grade 4 or 5 (high-grade) blunt liver and/or spleen injuries from April 1997 to July 2007 at our children's hospital. Demographics, hospital course data, and follow-up data were analyzed. There were 74 high-grade injuries in 72 patients. There were 30 high-grade liver and 44 high-grade spleen injuries. Two patients had both a liver and splenic injury. High-grade liver injuries had a significantly longer length of intensive care and hospital stay compared to high-grade spleen injuries. There were also a significantly higher number of transfusions, radiographs, and total charges in the high-grade liver injuries when compared to the high-grade splenic injuries. The only mortality from solid organ injury was a grade 4 liver injury with portal vein disruption. In contrast, there was only one complication from a high-grade splenic injury-a pleural effusion treated with thoracentesis. There were 5 patients with complications from their liver injury requiring 18 therapeutic procedures. Three patients (10%) with liver injury required readmission as follows: one 5 times, one 3 times, and another one time. Patients with high-grade liver injuries have a longer recovery, more complications, and greater use of resources than in patients with similar injuries to the spleen.

Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: A systematic review

NARCIS (Netherlands)

Olthof, Dominique C.; Joosse, Pieter; van der Vlies, Cornelis H.; de Haan, Rob J.; Goslings, J. Carel

2013-01-01

BACKGROUND: Contradictory findings are reported in the literature concerning prognostic factors for failure of nonoperative management (NOM) in the treatment of adults with blunt splenic injury. The objective of this systematic review was to identify prognostic factors for failure of NOM, with or

Non-operative management for penetrating splenic trauma : how far can we go to save splenic function?

NARCIS (Netherlands)

Spijkerman, Roy; Teuben, Michel Paul Johan; Hoosain, Fatima; Taylor, Liezel Phyllis; Hardcastle, Timothy Craig; Blokhuis, Taco Johan; Warren, Brian Leigh; Leenen, Luke Petrus Hendrikus

2017-01-01

BACKGROUND: Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim

Nonoperative options for management of residual stones after cholecystostomy in high-risk patients

Science.gov (United States)

Reed, David M.; Daye, S. S.; Lincer, R. M.

1993-05-01

Cholecystostomy is frequently performed to obtain control of sepsis in high risk patients with acute cholecystitis. Retained stones in the gallbladder may cause future clinical problems. We present two patients with cholecystostomy tubes managed non-operatively. A review of other reported methods for stone extraction or destruction is also presented. Knowledge of safe and effective techniques for removal of these stones, using minimally invasive techniques is useful to the general surgeon.

Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

NARCIS (Netherlands)

van der Vlies, C. H.; Hoekstra, J.; Ponsen, K. J.; Reekers, J. A.; van Delden, O. M.; Goslings, J. C.

2012-01-01

Introduction Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to

Anterolateral ankle impingement in adolescents: outcomes of nonoperative and operative treatment.

Science.gov (United States)

Edmonds, Eric W; Chambers, Reid; Kaufman, Elizabeth; Chambers, Henry G

2010-03-01

Ankle sprains in adolescents usually resolve with conservative management but a few patients may develop ankle impingement syndrome. There have been adult studies addressing surgical treatment of this pathology, but our study evaluated the surgical management of anterolateral ankle impingement in adolescents by comparing their outcomes after nonoperative treatment and subsequent surgical intervention. Thirteen patients (children and adolescents) diagnosed with ankle impingement by history, physical examination, and magnetic resonance imaging during a 9-year period at our institution underwent eventual arthroscopic debridement. A retrospective chart review of these patients was performed and they were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) functional rating scale on 3 separate occasions: (1) initial presentation, (2) termination of nonoperative management, and (3) final postoperative follow-up visit. Thirteen adolescents (11 girls and 2 boys; 14 ankles) with a mean age of 15.6 (11.9-18.3) years met the inclusion criteria; of these, all had arthroscopic surgery. Mean duration of reported symptoms was 9.6 (4-15) months and mean duration of nonoperative management (physical therapy, activity modifications) was 6.9 (2-12) months. The mean AOFAS rating (out of 100 total) at initial presentation was 68.4 (40-84) and after nonoperative management was no better with a mean of 68.2 (63-76). The mean AOFAS rating at final follow-up was 90.6 (52-100), which was statistically significant (Pankle impingement in the adolescent population.

Computed tomography and nonoperative treatment for blunt abdominal trauma

International Nuclear Information System (INIS)

Watanabe, Shinsuke; Ishi, Takashi; Kamachi, Masahiro; Takahashi, Toshio.

1990-01-01

Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries. (author)

Computed tomography and nonoperative treatment for blunt abdominal trauma

Energy Technology Data Exchange (ETDEWEB)

Watanabe, Shinsuke; Ishi, Takashi; Kamachi, Masahiro [Saiseikai Shiga Hospital, Shiga (Japan); Takahashi, Toshio

1990-01-01

Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries. (author).

Nonoperative treatment of adult splenic trauma: Role of CT

International Nuclear Information System (INIS)

Raptopoulos, V.; Fink, M.; Resciniti, A.; Davidoff, A.; Silva, W.E.

1987-01-01

Of 27 adult patients with known splenic injuries admitted to a regional referral trauma center and who were initially treated nonoperatively, ten (37%) ultimately required splenectomy. A CT scoring system was developed based on the degree of splenic parenchymal injury and the presence of fluid in the perisplenic region, the upper abdomen, and the pelvis. Adult patients who were successfully treated nonoperatively had a significantly (P=.011) lower total CT score than did patients who required delayed celiotomy. No patient older than 17 years with a total CT score less than 2.5 required delayed operative intervention. CT can be used to select a subset of adults with splenic trauma who are excellent candidates for a trail of nonoperative management

Nonoperative management in children with early acute appendicitis: A systematic review.

Science.gov (United States)

Xu, Jane; Adams, Susan; Liu, Yingrui Cyril; Karpelowsky, Jonathan

2017-09-01

Appendectomy has remained the gold standard treatment of acute appendicitis for more than 100years. Nonoperative management (NOM) has been shown to be a valid treatment alternative for acute uncomplicated appendicitis in adults. A systematic review of available evidence comparing operative management (OM) and NOM in children with acute uncomplicated appendicitis was performed. Systematic searches of MedLine, Embase, and a clinical trial register (https://clinicaltrials.gov/) were performed in March 2016. Only articles that studied NOM for uncomplicated appendicitis in children were included. Data generation was performed independently by two authors, and quality was assessed using the rating schema by the Oxford Centre for Evidence-Based Medicine. 15 articles were selected: four retrospective analyses, four prospective cohort studies, four prospective nonrandomized comparative trials and one randomized controlled trial (RCT). Initial success of the NOM groups (a cure within two weeks of intervention) ranged from 58 to 100%, with 0.1-31.8% recurrence at one year. Although present literature is scarce, publications support the feasibility of further studies investigating NOM of acute uncomplicated appendicitis in children. Higher quality prospective RCTs with larger sample sizes and robust randomization methods, studying the noninferiority of NOM with antibiotics compared with OM are required to establish its utility. This manuscript is a systematic review and thus assigned the lowest evidence used from the manuscripts analyzed which is a Level IV. Copyright © 2017. Published by Elsevier Inc.

An assessment of the quality indicators of operative and non-operative times in a public university hospital.

Science.gov (United States)

Costa, Altair da Silva; Leão, Luiz Eduardo Villaça; Novais, Maykon Anderson Pires de; Zucchi, Paola

2015-01-01

To assess the operative time indicators in a public university hospital. A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6 ± 110 and 129.8 ± 97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8 ± 113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3 ± 17.3 minutes. The time to set the next patient in operating room was 119.8 ± 79.6 minutes. Our total non-operative time was 155 minutes. Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

MRI evaluation of anterior knee pain: predicting response to nonoperative treatment

International Nuclear Information System (INIS)

Wittstein, Jocelyn R.; Garrett, William E.; O'Brien, Seth D.; Vinson, Emily N.

2009-01-01

Tibial tubercle lateral deviation and patellofemoral chondromalacia are associated with anterior knee pain (AKP). We hypothesized that increased tibial tubercle lateral deviation and patellofemoral chondromalacia on magnetic resonance imaging correlates with the presence of AKP and with failure of nonoperative management. In this retrospective comparative study, a blinded musculoskeletal radiologist measured tibial tubercle lateral deviation relative to the trochlear groove in 15 controls, 15 physical therapy responders with AKP, and 15 physical therapy nonresponders with AKP. Patellar and trochlear cartilage was assessed for signal abnormality, irregularity, and defects. The mean tibial tubercle lateral deviation in controls, physical therapy responders, and physical therapy nonresponders were 9.32 ± 0.68, 13.01 ± 0.82, and 16.07 ± 1.16 mm, respectively (data are mean ± standard deviation). The correlation coefficients for tubercle deviation, chondromalacia patellae, and trochlear chondromalacia were 0.51 (P < 0.01), 0.44 (P < 0.01), and 0.28 (P < 0.05), respectively. On analysis of variance, tubercle deviation and chondromalacia patellae contributed significantly to prediction of AKP and response to physical therapy. The presence of chondromalacia patellae and a tubercle deviation greater than 14.6 mm is 100% specific and 67% sensitive with a positive predictive value of 100% and negative predictive value of 75% for failure of nonoperative management. Subjects with AKP have more laterally positioned tibial tubercles and are more likely to have patellar chondromalacia. Patients with AKP, chondromalacia patellae, and a tubercle deviation greater than 14.6 mm are unlikely to respond to nonoperative treatment. Knowledge of tibial tubercle lateralization and presence of chondromalacia patellae may assist clinicians in determining patient prognosis and selecting treatment options. (orig.)

MRI evaluation of anterior knee pain: predicting response to nonoperative treatment

Energy Technology Data Exchange (ETDEWEB)

Wittstein, Jocelyn R.; Garrett, William E. [Duke University Medical Center, Division of Orthopaedic Surgery, Durham, NC (United States); O' Brien, Seth D. [Brooke Army Medical Center, Department of Radiology, San Antonio, TX (United States); Vinson, Emily N. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)

2009-09-15

Tibial tubercle lateral deviation and patellofemoral chondromalacia are associated with anterior knee pain (AKP). We hypothesized that increased tibial tubercle lateral deviation and patellofemoral chondromalacia on magnetic resonance imaging correlates with the presence of AKP and with failure of nonoperative management. In this retrospective comparative study, a blinded musculoskeletal radiologist measured tibial tubercle lateral deviation relative to the trochlear groove in 15 controls, 15 physical therapy responders with AKP, and 15 physical therapy nonresponders with AKP. Patellar and trochlear cartilage was assessed for signal abnormality, irregularity, and defects. The mean tibial tubercle lateral deviation in controls, physical therapy responders, and physical therapy nonresponders were 9.32 {+-} 0.68, 13.01 {+-} 0.82, and 16.07 {+-} 1.16 mm, respectively (data are mean {+-} standard deviation). The correlation coefficients for tubercle deviation, chondromalacia patellae, and trochlear chondromalacia were 0.51 (P < 0.01), 0.44 (P < 0.01), and 0.28 (P < 0.05), respectively. On analysis of variance, tubercle deviation and chondromalacia patellae contributed significantly to prediction of AKP and response to physical therapy. The presence of chondromalacia patellae and a tubercle deviation greater than 14.6 mm is 100% specific and 67% sensitive with a positive predictive value of 100% and negative predictive value of 75% for failure of nonoperative management. Subjects with AKP have more laterally positioned tibial tubercles and are more likely to have patellar chondromalacia. Patients with AKP, chondromalacia patellae, and a tubercle deviation greater than 14.6 mm are unlikely to respond to nonoperative treatment. Knowledge of tibial tubercle lateralization and presence of chondromalacia patellae may assist clinicians in determining patient prognosis and selecting treatment options. (orig.)

Use of computed tomographic scanning and embolization to improve the nonoperative management of splenic trauma: critically appraised topic

International Nuclear Information System (INIS)

Elliott, J.E.; Millward, S.F.; Kribs, S.W.

2003-01-01

A patient with a grade 3 splenic laceration, who was stable and being treated with nonoperative management (NOM) underwent contrast-enhancement abdominal computed tomography (CT) 3 days after the injury. The scan showed a 2-cm well-defined hyperdense contrast collection within the splenic laceration. (author)

Use of computed tomographic scanning and embolization to improve the nonoperative management of splenic trauma: critically appraised topic

Energy Technology Data Exchange (ETDEWEB)

Elliott, J.E.; Millward, S.F.; Kribs, S.W. [Univ. of Western Ontario, London Health Services Centre, London, Ontario (Canada)

2003-06-01

A patient with a grade 3 splenic laceration, who was stable and being treated with nonoperative management (NOM) underwent contrast-enhancement abdominal computed tomography (CT) 3 days after the injury. The scan showed a 2-cm well-defined hyperdense contrast collection within the splenic laceration. (author)

CT grading systems as a predictor of successful nonoperative treatment of splenic trauma

International Nuclear Information System (INIS)

Umlas, S.L.; Cronan, J.J.

1990-01-01

PURPOSE: Selective nonoperative management of splenic trauma yields benefits with regard to preservation of the body's defense systems. This paper evaluates the capability of CT grading systems to predict successful non- operative management of splenic trauma in children and adults. Fifty-six patients with documented splenic injury were assessed with CT following standard trauma protocols. Each of these CT scans were graded according to the three recently proposed splenic trauma systems. The charts of these patients were then reviewed, and correlations between the CT grade and the clinical outcome were determined for each of these three grading systems

Critical review on non-operative management of adolescent idiopathic scoliosis.

Science.gov (United States)

Wong, M S; Liu, W C

2003-12-01

There are a number of different non-operative interventions which aim to control moderate adolescent idiopathic scoliosis (AIS) from progression. Clinicians may find difficulties in the selection of appropriate interventions for AIS. A comprehensive literature review was carried out to study all contemporary non-operative interventions, it was noted that rigid spinal orthoses apparently give more curve control; however, it would compromise the patient's quality of life via those inevitable factors--physical constraint, poor acceptance and psychological disturbance. There is a trend to develop more effective, acceptable and user-friendly interventions. Under such an aspiration, the theories and clinical evidence of different interventions should be developed along the clinical pathway of early intervention with reliable indicators/predictors, patient's active participation, dynamic control mechanism, holistic psychological and psychosocial considerations, and effective and long-lasting outcome.

Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial.

Science.gov (United States)

Sanders, David W; Tieszer, Christina; Corbett, Bradley

2012-03-01

To compare clinical and functional outcomes after operative and nonoperative treatment of undisplaced, unstable, isolated fibula fractures. Randomized multicenter clinical trial. Six level 1 trauma centers. Eighty-one patients with undisplaced, unstable, isolated fibula fractures as confirmed by an external rotation stress examination demonstrating an increase in medial clear space to 5 mm or greater were followed for 12 months after treatment. Forty-one patients were treated operatively by open reduction and internal fixation of the fibula. Forty patients underwent nonoperative treatment, which included the use of a short leg cast or brace and protected weight bearing for 6 weeks. Functional outcomes determined using the Olerud-Molander Ankle Score and the Short Form 36. Radiographic outcomes included measurement of union and displacement at each visit. There were no statistically significant differences in functional outcome scores or pace of recovery between the operative and nonoperative groups at any time interval (β = -0.28, 3.49; P = 0.936). Complications in the nonoperative group included 8 patients with a medial clear space ≥5 mm and 8 patients with delayed union or nonunion. In the operative group, 5 patients had a surgical site infection and 5 patients required hardware removal. Patients managed operatively had equivalent functional outcomes compared with nonoperative treatment; however, the risk of displacement and problems with union was substantially lower in patients managed with surgery.

Blunt trauma pancreatic duct injury managed by non-operative technique, a case study and literature review

Directory of Open Access Journals (Sweden)

A. Zala

2015-02-01

Full Text Available We describe the case of a 15 year old boy who presented with generalised abdominal pain following a seemingly minor collision at weekend soccer. Investigation revealed a grade IV pancreatic injury that was subsequently managed with pancreatic stent insertion by endoscopic retrograde cholangiopancreatography (ERCP and total parenteral nutrition (TPN prior to recommencing low fat diet 10 days post-injury. Keywords: Trauma, Blunt injury, Pancreas, Non-operative

Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Mingoli A

2017-08-01

Full Text Available Andrea Mingoli,1,2 Marco La Torre,1,2 Emanuele Migliori,1,2 Bruno Cirillo,1,2 Martina Zambon,1,2 Paolo Sapienza,1,2 Gioia Brachini1,2 1Emergency Department, 2Department of Surgery P Valdoni, Policlinico Umberto I, Sapienza University, Rome, Italy Introduction: Preservation of kidney and renal function is the goal of nonoperative management (NOM of renal trauma (RT. The advantages of NOM for minor blunt RT have already been clearly described, but its value for major blunt and penetrating RT is still under debate. We present a systematic review and meta-analysis on NOM for RT, which was compared with the operative management (OM with respect to mortality, morbidity, and length of hospital stay (LOS. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed for this study. A systematic search was performed on Embase, Medline, Cochrane, and PubMed for studies published up to December 2015, without language restrictions, which compared NOM versus OM for renal injuries. Results: Twenty nonrandomized retrospective cohort studies comprising 13,824 patients with blunt (2,998 or penetrating (10,826 RT were identified. When all RT were considered (American Association for the Surgery of Trauma grades 1–5, NOM was associated with lower mortality and morbidity rates compared to OM (8.3% vs 17.1%, odds ratio [OR] 0.471; 95% confidence interval [CI] 0.404–0.548; P<0.001 and 2% vs 53.3%, OR 0.0484; 95% CI 0.0279–0.0839, P<0.001. Likewise, NOM represented the gold standard treatment resulting in a lower mortality rate compared to OM even when only high-grade RT was considered (9.1% vs 17.9%, OR 0.332; 95% CI 0.155–0.708; P=0.004, be they blunt (4.1% vs 8.1%, OR 0.275; 95% CI 0.0957–0.788; P=0.016 or penetrating (9.1% vs 18.1%, OR 0.468; 95% CI 0.398–0.0552; P<0.001. Conclusion: Our meta-analysis demonstrated that NOM for RT is the treatment of choice not only for AAST grades 1 and 2, but also for higher

Non-operative diagnosis - effect on repeat-operation rates in the UK breast screening programme

International Nuclear Information System (INIS)

Wallis, M.G.; Cheung, S.; Kearins, O.; Lawrence, G.M.

2009-01-01

Non-operative diagnosis rates in the UK breast screening programme have improved dramatically from 48.8% in 1994/95 (only nine units achieved the then minimum standard of 70%) to 94% in 2005/06 (only seven units failed to achieve the target of 90%). Preoperative and operative history of all 120,550 women diagnosed with screen-detected breast cancer in the UK between April 1994 and March 2006 was derived from different national databases. In 2005/06, 2,790 (17.8%) of the 15,688 women having surgery needed two or more operations. In 2001/02 (non-operative diagnosis rate 87%), the re-operation rate was 23.8% (2,377 of 9,969). Extrapolation backwards to 1994/95 (non-operative diagnosis rate 48.8%) suggests a re-operation rate of 62%. Analysis over the 4 years from April 2002 (n=34,198) demonstrates that 4,089 (12%) women with a correct non-operative diagnosis of invasive disease required additional surgery compared to 1,166 (48%) of women who were under-staged (diagnosed as non-invasive based on core biopsy, but actually suffering from invasive disease). Failure to achieve a non-operative diagnosis of invasive disease (n=1,542) or non-invasive disease (n=2,247) resulted in re-operation rates of 65 and 43% respectively. Given the impact of not having a diagnosis pre-operatively, or of under-staging invasive carcinoma, it seems timely to introduce more sophisticated standards. (orig.)

Pancreatic injury in children: good outcome of nonoperative treatment.

NARCIS (Netherlands)

Blaauw, I. de; Winkelhorst, J.T.; Rieu, P.N.M.A.; Staak, F.H.J.M. van der; Wijnen, M.H.W.A.; Severijnen, R.S.V.M.; Vugt, A.B. van; Wijnen, R.M.H.

2008-01-01

PURPOSE: Treatment of blunt injury of the pancreas in children remains controversial. Some prefer nonoperative treatment, whereas others prefer operative management in selected cases. This report reviews the treatment of patients with blunt pancreatic trauma admitted to a level I pediatric trauma

Wandering spleen associated with omphalocele in a neonate: An unusual case with non-operative management

Directory of Open Access Journals (Sweden)

Daisuke Masui

2017-09-01

Full Text Available Wandering spleen with a history of omphalocele is extremely rare. We encountered a male baby with wandering spleen associated with omphalocele. This case of wandering spleen in a neonate was diagnosed by ultrasound and computed tomography scans after surgery for omphalocele. Our case was able to be managed non-operatively due to the lack of any findings suggesting torsion of the spleen and its asymptomatic status. We herein report the clinical presentation as well as the treatment options regarding wandering spleen associated with omphalocele.

Non-operative management of blunt abdominal trauma: positive predictors

Directory of Open Access Journals (Sweden)

A. A. Pankratov

2017-01-01

Full Text Available Background: Over the last years a non-operative management (NOM of blunt  abdominal  trauma has been included into the standard treatment guidelines  in leading  trauma  centers  all over the world.  The  success  of NOM is based  on  careful patient  selection. Nevertheless, the selection  criteria have not been clearly determined up to now.Aim: To identify predictors of successful NOM and to  create  a diagnostic  and  treatment algorithm for its implementation.Materials and methods: 209 patients  with abdominal  trauma  who underwent  laparoscopy  or NOM from January 2006 to September 2015 were included  in the  study. The hemoperitoneum volume  and  organ  injury rate evaluated   by  using  ultrasonography  and  computed  tomography scan, as well as hemoglobin level, blood  pressure,  and  peripheral  pulse  were analyzed. We performed  comparative  analysis of prognostic  values of various selection  criteria for NOM, such as: 1 Huang and McKenney ultrasound scoring systems for hemoperitoneum quantification; 2 hemodynamic parameters; 3 hemoglobin levels;  4 various combinations  of the  above mentioned factors; 5 Sonographic  Scoring for Operating  Room Triage in Trauma (SSORTT scoring system.Results: Positive prognostic  values of parameters included into the study varied from 88 to 91.7% when used separately or in combination with other scored factors. Furthermore, there was no  significant  difference  between positive  predictive value  of all combinations of factors  and McKenney ultrasound hemoperitoneum scoring system used alone.Conclusion: The proposed predictors  as  well as  diagnostic  and  treatment algorithm are easy-to-use  and available in clinical practice.

Acute high-grade acromioclavicular joint injuries: quality of life comparison between patients managed operatively with a hook plate versus patients managed non-operatively.

Science.gov (United States)

Natera Cisneros, Luis Gerardo; Sarasquete Reiriz, Juan

2017-04-01

Surgical indication for acromioclavicular joint (ACJ) injuries still represents a reason for shoulder and trauma debate. In high-grade injuries, surgery is advocated because some of the non-operatively managed patients may have persistent shoulder pain that could make them unable to return to their previous activity. It has been shown that many of the patients with high-grade ACJ injuries that are managed non-operatively involve the development of scapular dyskinesis, situation that may result in loss of strength and weakness. On the other side, it has been widely reported that the period while the hook plate is present involves functional limitations and pain. The purpose of this study was to compare the quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III-V), managed operatively with a hook plate versus the QoL of patients managed non-operatively, 24 months or more after shoulder injury. Patients with acute high-grade ACJ injuries managed operatively (hook plate) or non-operatively, between 2008 and 2012 were included. The QoL was evaluated by means of the Health Survey questionnaire (SF36), the Visual Analogue Scale (VAS) for pain, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the Global Satisfaction (scale from 0 to 10) assessed at the last follow-up visit. The presence of scapular dyskinesis was assessed. Comparison between groups was made. Thirty-two patients were included: 11 hook plate-group (PLATE group) (5 Rockwood III and 6 V) and 21 conservative-group (CONS group) (4 Rockwood III and 17 V). The mean age was 41 [19-55] years old for the PLATE group and 38 [19-55] for the CONS group (p = 0.513). The mean follow-up was 32.50 ± 11.64 months for the PLATE group and 34.77 ± 21.98 months for the CONS group (p = 0.762). The mean results of the questionnaires assessed at the last follow-up visit were: (1) physical SF36 score (PLATE group 53.70 ± 4.33 and CONS group

Patient profiling can identify patients with adult spinal deformity (ASD) at risk for conversion from nonoperative to surgical treatment: initial steps to reduce ineffective ASD management.

Science.gov (United States)

Passias, Peter G; Jalai, Cyrus M; Line, Breton G; Poorman, Gregory W; Scheer, Justin K; Smith, Justin S; Shaffrey, Christopher I; Burton, Douglas C; Fu, Kai-Ming G; Klineberg, Eric O; Hart, Robert A; Schwab, Frank; Lafage, Virginie; Bess, Shay

2018-02-01

Non-operative management is a common initial treatment for patients with adult spinal deformity (ASD) despite reported superiority of surgery with regard to outcomes. Ineffective medical care is a large source of resource drain on the health system. Characterization of patients with ASD likely to elect for operative treatment from non-operative management may allow for more efficient patient counseling and cost savings. This study aimed to identify deformity and disability characteristics of patients with ASD who ultimately convert to operative treatment compared with those who remain non-operative and those who initially choose surgery. A retrospective review was carried out. A total of 510 patients with ASD (189 non-operative, 321 operative) with minimum 2-year follow-up comprised the patient sample. Oswestry Disability Index (ODI), Short-Form 36 Health Assessment (SF-36), Scoliosis Research Society questionnaire (SRS-22r), and spinopelvic radiographic alignment were the outcome measures. Demographic, radiographic, and patient-reported outcome measures (PROMs) from a cohort of patients with ASD prospectively enrolled into a multicenter database were evaluated. Patients were divided into three treatment cohorts: Non-operative (NON=initial non-operative treatment and remained non-operative), Operative (OP=initial operative treatment), and Crossover (CROSS=initial non-operative treatment with subsequent conversion to operative treatment). NON and OP groups were propensity score-matched (PSM) to CROSS for baseline demographics (age, body mass index, Charlson Comorbidity Index). Time to crossover was divided into early (1 year). Outcome measures were compared across and within treatment groups at four time points (baseline, 6 weeks, 1 year, and 2 years). Following PSM, 118 patients were included (NON=39, OP=38, CROSS=41). Crossover rate was 21.7% (41/189). Mean time to crossover was 394 days. All groups had similar baseline sagittal alignment, but CROSS had larger

Turning whine into wine: the fiscal impact of comprehensive documentation and billing for nonoperative pediatric surgical services.

Science.gov (United States)

Gollin, Gerald; Moores, Donald

2006-06-01

Some pediatric surgeons rarely document nonoperative services, believing that the reimbursement provided for such care is negligible. We evaluated the impact of comprehensive documentation and billing for nonoperative, pediatric surgical care. All bills submitted for inpatient, nonoperative care for 1 year were reviewed. Total receipts for documented admissions, consultations, critical care, and daily care were determined. The Evaluation and Management code billed for each service was recorded, and the total and average payments attributable to each Evaluation and Management code were calculated. Fifty-six percent of services were covered by Medicaid and 26% by a commercial insurer. There were 607 billed admission history and physical exams for which reimbursement totaled 43,493 dollars. Critical care services were provided to 49 patients and yielded 8964 dollars in payments. Six hundred thirty-nine inpatient consultations were performed with a reimbursement of 42,830 dollars. Daily care services were billed 1044 times and produced 71,579 dollars in payments. Overall reimbursement for documented, nonoperative services was 166,866 dollars. This represented 16.2% of total, noncontracted income for the practice. Despite a payer mix heavily weighted toward Medicaid, comprehensive documentation and billing for nonoperative services increased total, noncontracted reimbursement by almost 20% over what it would have been had only operative services been billed. The yield from properly documented, nonoperative care can be substantial.

Non-operative management of isolated liver trauma.

Science.gov (United States)

Li, Min; Yu, Wen-Kui; Wang, Xin-Bo; Ji, Wu; Li, Jie-Shou; Li, Ning

2014-10-01

Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma. Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2% (70/72). The success rates of NOM in the patients with grade I-III, IV and V liver trauma were 100%, 94.4% and 83.3%. The complication rates were 10.0% and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived. NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.

Outcomes and indications for intervention in non-operative management of paediatric liver trauma: A 5 year retrospective study

International Nuclear Information System (INIS)

Inchingolo, R.; Ljutikov, A.; Deganello, A.; Kane, P.; Karani, J.

2014-01-01

Aim: To determine the applicability of accurate computed tomography (CT) evaluation and embolization as non-operative management for liver trauma in a paediatric population. Material and methods: A retrospective observational study of 37 children (mean age 10.5 years) with hepatic trauma (28 blunt, 9 penetrating) admitted to a trauma referral centre over a 5 year period. All patients were evaluated with CT and scored with an Association for the Surgery of Trauma score. Inpatient information was reviewed for demographics, associated injuries, modes of management, efficacy and complications of management, and outcome. Statistical analysis was performed. Results: There were seven contusions, two grade I, two grade II, nine grade III, and 17 grade IV liver lacerations. Only two patients (grade IV, penetrating) underwent surgery for the management of bowel perforation. All children had non-surgical treatment of their liver trauma: three cases (grade IV) had primary angiography due to CT evidence of active bleeding and embolization was performed in two of these. Seven patients (two grade III, five grade IV) had angiography during the follow-up for evidence of a complicating pseudoaneurysm and embolization was performed in six of them. Embolization was successful in all the children; one minor complication occurred (cholecystitis). Endoscopic retrograde cholangiopancreatography (ERCP) plus stenting was performed in two cases for a bile leak. All 37 children had a positive outcome. Conclusion: The present study demonstrates that non-operative management of hepatic trauma is applicable to children and may have a higher success rate than in adults

Results of non-operative management of splenic trauma and its complications in children

Directory of Open Access Journals (Sweden)

Ndour Oumar

2014-01-01

Full Text Available Introduction: Non-operative management (NOM of splenic trauma in children is currently the treatment of choice. Purpose: We report a series of 83 cases in order to compare our results with literature data. Patients and Methods: For this, we conducted a retrospective study of 13 years and collected 83 cases of children with splenic trauma contusion, managed at Lapeyronie Montpellier Hospital in Visceral Pediatric Surgery Department. The studied parameters were age, sex, circumstances, the blood pressure (BP, hematology, imaging, associated injuries, transfusion requirements, treatment, duration of hospital stay, physical activity restriction and evolution. Results: NOM was successful in 98.7% of cases. We noted 4 complications including 3 pseudo aneurysms (PSA of splenic artery and 1 pseudocyst spleen with a good prognosis. There was no mortality in our series. Conclusion: NOM is the treatment of choice for splenic trauma in children with a success rate of over 90%. Complications are rare and are dominated by the PSA of splenic artery.

Outcome of non-operative management of femoral shaft fractures in children

Directory of Open Access Journals (Sweden)

Akinyoola A

2011-01-01

Full Text Available Background: Femoral shaft fractures are common injuries in childhood. There is paucity of information on their presentation and outcome of the available treatment methods in the African population. This study evaluated the outcome of non-operative methods of treatment of femoral shaft fractures in our centre. Patients and Methods: A retrospective review of the database of children aged 14 years and below with femoral shaft fractures treated non-operatively over a 10-year period. Results: A total of 134 patients with 138 fractures met the study criteria. This consisted of 71 boys (mean age = 6.1 years ± SD and 63 girls (mean age = 6.5 years ± SD. Pedestrian vehicular accident was the most common cause of femoral shaft fractures in the study population. The midshaft was the most common site of fractures. There were associated injuries to other parts of the body (especially head injury in 34.3% of the patients. The commonest mode of treatment was skin traction only (87.7%. The mean time to fracture union was 4.9 weeks ± SD (range = 3-15 weeks. The mean length of hospitalisation was 6.7 weeks ± SD (range = 5 days-11 weeks. There was a fairly strong positive correlation between the length of hospitalisation and the presence of associated injuries, especially head injury, upper limb fractures and bilaterality of the fractures. The mean total cost of treatment was #7685 (Naira or $51.2 (range = $14.2-$190. At the last follow up, 97.8% of the fractures united without significant angulation or shortening. Conclusion: The outcome of non-operative treatment of femoral shaft fractures in our setting is comparable to the results of other workers. Methods of treatment that shorten the length of hospitalisation without unduly increasing cost should be encouraged.

The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review

NARCIS (Netherlands)

van der Vlies, Cornelis H.; Saltzherr, Teun P.; Wilde, Jim C. H.; van Delden, Otto M.; de Haan, Rob J.; Goslings, J. Carel

2010-01-01

Purpose: Nonoperative management (NOM) is the treatment of choice for hemodymically stable pediatric patients with spleen or liver trauma. The aim of this study was to assess the failure rate of NOM in children with blunt liver and/or splenic injury when a contrast blush is present on a computed

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

Directory of Open Access Journals (Sweden)

Vince W Lands

2016-01-01

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

Non-operative anti-caries agents and dental caries increment among adults at high caries risk: a retrospective cohort study

OpenAIRE

Chaffee, Benjamin W.; Cheng, Jing; Featherstone, John DB

2015-01-01

Background Consensus guidelines support non-operative preventives for dental caries management; yet, their use in practice is far from universal. The purpose of this study was to evaluate the effectiveness of non-operative anti-caries agents in caries prevention among high caries risk adults at a university clinic where risk-based caries management is emphasized. Methods This retrospective observational study drew data from the electronic patient records of non-edentulous adult patients deeme...

Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

International Nuclear Information System (INIS)

Vlies, C. H. van der; Hoekstra, J.; Ponsen, K. J.; Reekers, J. A.; Delden, O. M. van; Goslings, J. C.

2012-01-01

Introduction: Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to assess the results of NOM in a relatively low-volume Dutch level 1 trauma center. Methods: An analysis of a prospective trauma registry was performed for a 6-year period before (period 1) and after the introduction and implementation of splenic artery embolization (SAE) (period 2). Primary outcome was the failure rate of initial treatment. Results: A total of 151 patients were reviewed. An increased use of SAE and a reduction of splenic operations during the second period was observed. Compared with period 1, the failure rate after observation in period 2 decreased from 25% to 10%. The failure rate after SAE in period 2 was 18%. The splenic salvage rate (SSR) after observation increased from 79% in the first period to 100% in the second period. During the second period, all patients with failure after observation were successfully treated with SAE. The SSR after SAE in periods 1 and 2 was respectively 100% and 86%. Conclusions: SAE of patients with blunt splenic injuries is associated with a reduction in splenic operations. The failure and splenic salvage rates in this current study were comparable with the results from large-volume studies of level 1 trauma centers. Nonoperative management also is feasible in a relatively low-volume level 1 trauma center outside the United States.

Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis.

Science.gov (United States)

Gorter, Ramon R; The, Sarah-May M L; Gorter-Stam, Marguerite A W; Eker, Hasan H; Bakx, Roel; van der Lee, Johanna H; Heij, Hugo A

2017-08-01

To compare the risk of complications between initial nonoperative treatment and appendectomy of uncomplicated (simple) appendicitis in children. Systematic literature search. Eligible for inclusion were both and randomized controlled trials and cohort studies including children in which the outcome of nonoperative treatment of uncomplicated appendicitis was reported with a minimum follow-up period of one year. Two authors extracted data independently and assessed quality. Primary outcome parameter was the percentage of children experiencing complications. Secondary outcomes were early failures, recurrent appendicitis and appendectomies, for all indications and on request. Five of the 2051 articles screened were eligible for inclusion, including 147 children (nonoperative treatment) and 173 children (appendectomy) with one year follow-up. Percentage of children experiencing complications ranged from 0 to 13% versus 0-17% for nonoperative and appendectomy, respectively. Nonoperative treatment avoided an appendectomy in 62-81% of the children after one year follow-up. The evidence base for initial nonoperative treatment of acute uncomplicated appendicitis in children is by far insufficient. It suggests that the percentage of patients experiencing complications in the initial nonoperative treatment group is comparable to the appendectomy group, and it may avoid an appendectomy in the large majority of children after one year follow-up. Systematic review. 1. Copyright © 2017 Elsevier Inc. All rights reserved.

The emerging trend of non-operative treatment in paediatric type I open forearm fractures.

Science.gov (United States)

Zhang, H; Fanelli, M; Adams, C; Graham, J; Seeley, M

2017-08-01

Open fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures. An Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed. The search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9). The five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan.

Science.gov (United States)

Shamim, Muhammad Shahzad; Ali, Syed Faizan; Enam, Syed Ather

2011-01-01

Surgical stabilization of injured spine in patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view. A detailed analysis of patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All patients presenting within 14 days of injury were divided in two groups, those who underwent stabilization procedures and those who were managed non-operatively. The two groups were compared with the endpoints being time to rehabilitation, length of hospital stay, 30 day morbidity/mortality, cost of treatment, and status at follow up. Fifty-four patients fulfilled the inclusion criteria and half of these were operated. On comparing endpoints, patients in the operative group took longer time to rehabilitation (P-value = 0.002); had longer hospital stay (P-value = 0.006) which included longer length of stay in special care unit (P-value = 0.002) as well as intensive care unit (P-value = 0.004); and were associated with more complications, especially those related to infections (P-value = 0.002). The mean cost of treatment was also significantly higher in the operative group (USD 6,500) as compared to non-operative group (USD 1490) (P-value managed non-operatively with a provision of surgery only if their rehabilitation is impeded due to pain or deformity.

Factors associated with failure of nonoperative treatment in lateral epicondylitis.

Science.gov (United States)

Knutsen, Elisa J; Calfee, Ryan P; Chen, Raymond E; Goldfarb, Charles A; Park, Kevin W; Osei, Daniel A

2015-09-01

Lateral epicondylitis is a common cause of elbow pain that is treated with a variety of nonoperative measures and often improves with time. Minimal research is available on patients in whom these nonoperative treatments fail. To identify baseline patient and disease factors associated with the failure of nonoperative treatment of lateral epicondylitis, defined as surgery after a period of nonoperative treatment. Case control study; Level of evidence, 3. A total of 580 patients treated for lateral epicondylitis at a tertiary center between 2007 and 2012 were analyzed. Disease-specific and patient demographic characteristics were compared between patient groups (nonoperative vs surgical treatment). A multivariable logistic regression model was created based on preliminary univariate testing to determine which characteristics were associated with failure of nonoperative treatment. Of the 580 patients, 92 (16%) underwent surgical treatment at a mean of 6 months (range, 0-31 months) from their initial visit. Univariate analysis demonstrated a potential association (P 12 months (OR, 2.5) remained significant independent predictors of surgical treatment. This study identifies risk factors for surgical treatment for lateral epicondylitis. While these findings do not provide information regarding causal factors associated with surgery, these patient and disease-specific considerations may be helpful when counseling patients regarding treatment options and the likelihood of the success of continued nonoperative treatment. © 2015 The Author(s).

Non-operative management of blunt splenic injuries in a paediatric population: a 12-year experience.

Science.gov (United States)

Kirkegård, Jakob; Avlund, Tue Højslev; Amanavicius, Nerijus; Mortensen, Frank Viborg; Kissmeyer-Nielsen, Peter

2015-02-01

Non-operative management (NOM) is now the primary treatment for blunt splenic injuries in children. Only one study has examined the use of NOM in a Scandinavian population. Thus, the purpose of this study is to report our experience in treating children with blunt splenic injuries with NOM at a Danish university hospital. We conducted a retrospective observational study of 34 consecutive children (aged 16 years or less) admitted to our level 1-trauma centre with blunt splenic injury in the 12-year period from 1 January 2001 to 31 December 2012. Data on patients and procedures were obtained by review of all medical records and re-evaluation of all initial computed tomographies (CT). We included 34 children with a median age of 10.5 years (67.6% males) in this study. All patients were scheduled for NOM, and two (5.9%) patients underwent splenic artery embolisation (SAE). Two (5.9%) patients later needed surgical intervention. The NOM success rate was 88% (95% confidence interval (CI): 73-97%) without SAE and 94% (95% CI: 80-99%) with SAE. We found no difference in the American Association for the Surgery of Trauma grade when comparing the initial CT evaluation (mean 2.59 ± 1.1) with the CT re-evaluation (mean 2.71 ± 0.94); p = 0.226. We demonstrated a high degree of success and safety of non-operative treatment in children with blunt splenic injury in a Scandinavian setting. Our results are comparable to international findings.

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Science.gov (United States)

Frandon, Julien; Rodiere, Mathieu; Arvieux, Catherine; Vendrell, Anne; Boussat, Bastien; Sengel, Christian; Broux, Christophe; Bricault, Ivan; Ferretti, Gilbert; Thony, Frédéric

2015-01-01

We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury.

Nonoperative management of blunt splenic injury in adults: there is (still) a long way to go. The results of the Bologna-Maggiore Hospital trauma center experience and development of a clinical algorithm.

Science.gov (United States)

Tugnoli, Gregorio; Bianchi, Elisa; Biscardi, Andrea; Coniglio, Carlo; Isceri, Salvatore; Simonetti, Luigi; Gordini, Giovanni; Di Saverio, Salomone

2015-10-01

Non-operative management (NOM) of hemodynamically stable patients with blunt splenic injury (BSI) is the standard of care, although it is associated with a potential risk of failure. Hemodynamically unstable patients should always undergo immediate surgery and avoid unnecessary CT scans. Angioembolization might help to increase the NOM rates, as well as NOM success rates. The aim of this study was to review and critically analyze the data from BSI cases managed at the Maggiore Hospital Trauma Center during the past 5 years, with a focus on NOM, its success rates and outcomes. A further aim was to develop a proposed clinical practical algorithm for the management of BSI derived from Clinical Audit experience. During the period between January 1, 2009 and December 31, 2013 we managed 293 patients with splenic lesions at the Trauma Center of Maggiore Hospital of Bologna. The data analyzed included the demographics, clinical parameters and characteristics, diagnostic and therapeutic data, as well as the outcomes and follow-up data. A retrospective evaluation of the clinical outcomes through a clinical audit has been used to design a practical clinical algorithm. During the five-year period, 293 patients with BSI were admitted, 77 of whom underwent immediate surgical management. The majority (216) of the patients was initially managed non-operatively and 207 of these patients experienced a successful NOM, with an overall rate of successful NOM of 70 % among all BSI cases. The success rate of NOM was 95.8 % in this series. All patients presenting with stable hemodynamics underwent an immediate CT-scan; angiography with embolization was performed in 54 cases for active contrast extravasation or in cases with grade V lesions even in absence of active bleeding. Proximal embolization was preferentially used for high-grade injuries. After a critical review of the cases treated during the past 5 years during a monthly clinical audit meeting, a clinical algorithm has been

Limitations of nonoperative management of type IIIb blunt hepatic injuries in hemodynamically stable patients after fluid resuscitation

International Nuclear Information System (INIS)

Sekine, Kazuhiko; Kitano, Mitsuhide; Shimizu, Masayuki; Matsumoto, Shokei; Yoshii, Hiroshi; Yamazaki, Motoyasu; Aikawa, Naoki

2007-01-01

Nonoperative management (NOM) of hepatic injuries caused by blunt trauma in hemodynamically stable patients is widely accepted, but the feasibility of NOM for severe hepatic injuries has not been fully evaluated. Among all patients with blunt severe hepatic injury (type IIIb) admitted to Saiseikai Kanagawa-ken Hospital and Keio University Hospital from 1988 to 2004, those who had been hemodynamically stable after fluid resuscitation at the emergency department were initially managed nonoperatively. We reviewed demographic, physiological, and laboratory data; computed tomography (CT) findings; 80-day cumulative laparotomy rate; and complications. The anatomical severity of the hepatic injuries was evaluated based on the CT findings, such as hepatic vein injuries and area lacerated according to the Couinaud liver segment. In patients who underwent surgery after admission, the surgical indications and operative findings were reviewed. Overall, 34 consecutive patients were enrolled in this study. Five patients underwent surgery, and all of their surgical indications were attributable to liver-related complications after injury. The indication for surgery was hemodynamic instability in 3 patients with hepatic vein injures in the early phase (<15 hours after estrogen receptor (ER) arrival) and intra-abdominal septic complications in 2 patients in the late phase (hospital days 14 and 64). The cumulative 80-day laparotomy rate in the early phase was significantly higher (p<0.0001) in the patients suspected of having hepatic vein injury, and in the late phase it was higher (p=0.002) in those with injuries in 4 or more segments of hepatic injuries. For the successful NOM of blunt hepatic injury type IIIb in patients who are hemodynamically stable after fluid resuscitation, a strong suspicion of concurrent hepatic vein injury is critical in the early phase, and laceration in 4 or more segments should be noted in the late phase. (author)

Ten-year experience of splenic trauma in New Zealand: the rise of non-operative management.

Science.gov (United States)

Alamri, Yassar; Moon, Dana; Yen, Damien Ah; Wakeman, Chris; Eglinton, Tim; Frizelle, Frank

2017-10-06

The aim of this study was to describe the demographics, mechanisms of injury, management and outcomes in patients who suffered splenic trauma in Christchurch, New Zealand. A retrospective study included all splenic injury patients admitted to Christchurch Public Hospital between January 2005 and August 2015. A total of 238 patients were included, with a median age of 26 years (4-88.7). Of these, 235 patients had blunt injuries. Eighty-nine had high-grade injuries. Yearly admissions of splenic trauma patients have gradually increased. A total of 173 (72.7%) patients were managed with observation; 28 patients (11.8%) had radiological intervention and 37 patients (15.5%) had splenectomy. Patients who died were significantly more likely to be older (median, 46.5 vs 25.2 years, p=0.04) and to have been admitted to ICU (100% vs 32%, p=Splenic injuries have shown a steady increase in the last decade. Splenectomy rates have decreased in favour of non-operative techniques. Radiological intervention with splenic artery embolisation was successful in all selected patients with high-grade injuries.

Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment

Directory of Open Access Journals (Sweden)

Ioannis Polyzois

2016-04-01

Full Text Available Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA, the effects of delaying surgery and the optimal method of immobilisation. Extensive literature review was performed looking for previous publication addressing 4 points. i Natural history of primary shoulder dislocation ii Effect of surgical intervention on natural history iii Risk of long term osteoarthritis with and without surgical intervention iv Immobilisation techniques post reduction. Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces. Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.

Nonoperative Management, Rehabilitation, and Functional and Clinical Progression of Osteitis Pubis/Pubic Bone Stress in Professional Soccer Players: A Case Series.

Science.gov (United States)

McAleer, Stephen S; Lippie, Ed; Norman, Darcy; Riepenhof, Helge

2017-09-01

Study Design Case series. Background Pubic bone stress (PBS) is a common acute or chronic response of the pelvis in sports where sprinting, kicking, twisting, and cutting are the dominant movements. There are few nonoperative rehabilitation strategies for the condition reported in the literature, and the outcome of conservative treatment has not been documented. Case Description Five professional and academy soccer players complaining of pubic symphysis pain, confirmed as PBS on magnetic resonance imaging and objective assessment, were treated with a nonoperative rehabilitation program that featured functional and clinical objective markers as progression criteria. Interventions in the acute phase included pharmacological and physical therapeutic modalities to reduce pain initially. Rehabilitation management focused on improving range of motion at the hips and thorax, adductor strengthening, trunk and lumbopelvic stability, gym-based strength training, and field-based rehabilitation and conditioning. Clinical follow-up was performed at least 8 months following return to play. Outcomes All players demonstrated reduced or resolved pain, increased adductor squeeze strength, and return to pain-free training and match play. Return-to-training time averaged 40.6 days (range, 30-60 days) and return to play averaged 49.4 days (range, 38-72 days) within the 5 players. At final follow-up (mean, 29.6 months; range, 16-33 months), there had been no recurrences. Discussion This report of 5 cases suggests that a nonoperative protocol, using clinical and functional progression criteria, may be successful in rehabilitating athletes with PBS for return to sport within 11 weeks. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2017;47(9):683-690. Epub 3 Aug 2017. doi:10.2519/jospt.2017.7314.

Evidence-Based Management and Controversies in Blunt Splenic Trauma

NARCIS (Netherlands)

Olthof, D. C.; van der Vlies, C. H.; Goslings, J. C.

2017-01-01

The study aims to describe the evidence-based management and controversies in blunt splenic trauma. A shift from operative management to non-operative management (NOM) has occurred over the past decades where NOM has now become the standard of care in haemodynamically stable patients with blunt

[Non-operative treatment for severe forms of infantile idiopathic scoliosis].

Science.gov (United States)

Trobisch, P D; Samdani, A; O'Neil, C; Betz, R; Cahill, P

2012-02-01

Infantile idiopathic scoliosis (IIS) is a rare orthopaedic condition. Braces and casts are popular options in the treatment of IIS but there is a paucity of studies commenting on the outcome of non-operative treatment. The purpose of this study was to analyse failure and success after non-operative treatment for severe forms of IIS. We retrospectively reviewed the data of all children who had been treated for IIS between 2003 and 2009 at a single institution. After calculating the failure and success rates, we additionally performed a risk factor analysis for patients who failed non-operative treatment. Chi (2) and T tests were used for statistical analysis with significance set at p failure (55 versus 42) while neither age, gender, nor RVAD seem to influence the outcome. In children who were considered as successfully treated, the Cobb angle decreased from 42 to 18 degrees. Non-operative treatment for IIS is successful in 3 out of 4 patients. © Georg Thieme Verlag KG Stuttgart · New York.

Nonoperative Management and Novel Imaging for Posterior Circumflex Humeral Artery Injury in Volleyball.

Science.gov (United States)

van de Pol, Daan; Planken, R Nils; Terpstra, Aart; Pannekoek-Hekman, Marja; Kuijer, P Paul F M; Maas, Mario

We report on a 34-yr-old male elite volleyball player with symptomatic emboli in the spiking hand from a partially thrombosed aneurysm of the posterior circumflex humeral artery (PCHA) in his dominant shoulder. At initial diagnosis and follow-up, a combination of time-resolved and high-resolution steady state contrast-enhanced magnetic resonance angiography (CE-MRA) enabled detailed visualization of: (1) emboli that were not detectable by vascular ultrasound; and (2) the PCHA aneurysm, including compression during abduction and external rotation (ABER provocation). At 15-month follow-up, including forced cessation of volleyball activities over the preceding 9 months, the PCHA aneurysm remained unchanged. Central filling defects in the palmar arch and digital arteries resolved over time and affected arterial vessel segments showed postthrombotic changes. Digital blood pressure values improved substantially and almost normalized during follow-up. In conclusion, this case report is the first to show promising results of nonoperative management for a vascular shoulder overuse injury in a professional volleyball player as an alternative to invasive therapeutic options.

Blunt hepatic trauma: comparison between surgical and nonoperative treatment.

Science.gov (United States)

Zago, Thiago Messias; Pereira, Bruno Monteiro; Calderan, Thiago Rodrigues Araujo; Hirano, Elcio Shiyoiti; Rizoli, Sandro; Fraga, Gustavo Pereira

2012-01-01

To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.

Operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults

DEFF Research Database (Denmark)

Rehn, Carl-Henrik; Kirkegaard, Martin; Viberg, Bjarke

2013-01-01

Intervention studies of clavicle fracture treatment are numerous, but only a few high quality studies prospectively compare operative and nonoperative treatment. The objective of this study was to review evidence from randomized controlled trials on operative versus nonoperative treatment of disp...

Successful return to sports in athletes following non-operative management of acute isolated posterior cruciate ligament injuries: medium-term follow-up.

Science.gov (United States)

Agolley, D; Gabr, A; Benjamin-Laing, H; Haddad, F S

2017-06-01

The aim of this study was to report the outcome of the non-operative treatment of high-grade posterior cruciate ligament (PCL) injuries, particularly Hughston grade III injuries, which have not previously been described. This was a prospective study involving 46 consecutive patients who were athletes with MRI-confirmed isolated PCL injuries presenting within four weeks of injury. All had Hughston grade II (25 athletes) or III (21 athletes) injuries. Our non-operative treatment regimen involved initial bracing, followed by an individualised rehabilitation programme determined by the symptoms and physical signs. The patients were reviewed until they had returned to sports-specific training, and were reviewed again at a mean of 5.2 years (3 to 9). The mean time to return to sports-specific training was 10.6 weeks and the mean time to return to full competitive sport was 16.4 weeks (10 to 40). A total of 42 patients (91.3%) were playing at the same or higher level of sport two years after the injury, with a mean Tegner activity score of 9 (5 to 10). At five years, 32 patients (69.5%) were playing at the same or higher level of sport, and 38 patients (82.6%) were playing at a competitive level, with a mean Tegner activity score of 9 (5 to 10). Medium-term review of a series of athletes suggests that commencing the non-operative management of isolated, Hughston grade II and III PCL injuries within four weeks of injury gives excellent functional outcomes with a high proportion returning to the same or higher level of sport. Cite this article: Bone Joint J 2017;99-B:774-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage.

LENUS (Irish Health Repository)

Sultan, Sherif

2008-01-01

Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD +\\/- 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] +\\/- 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD +\\/- 33.7, 95% confidence interval [CI] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm\\/s (95% CI 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE +\\/- 11.1) for SCBD, compared with 69.2% in the control group (SE +\\/- 12.8%) (p = .4, hazards ratio = 0.58, 95% CI 0.15-2.32). The mean total cost of primary amputation per patient is euro29,815 ($44,000) in comparison with euro13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.

Is non-operative management safe and effective for all splenic blunt trauma? A systematic review.

Science.gov (United States)

Cirocchi, Roberto; Boselli, Carlo; Corsi, Alessia; Farinella, Eriberto; Listorti, Chiara; Trastulli, Stefano; Renzi, Claudio; Desiderio, Jacopo; Santoro, Alberto; Cagini, Lucio; Parisi, Amilcare; Redler, Adriano; Noya, Giuseppe; Fingerhut, Abe

2013-09-03

The goal of non-operative management (NOM) for blunt splenic trauma (BST) is to preserve the spleen. The advantages of NOM for minor splenic trauma have been extensively reported, whereas its value for the more severe splenic injuries is still debated. The aim of this systematic review was to evaluate the available published evidence on NOM in patients with splenic trauma and to compare it with the operative management (OM) in terms of mortality, morbidity and duration of hospital stay. For this systematic review we followed the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" statement. A systematic search was performed on PubMed for studies published from January 2000 to December 2011, without language restrictions, which compared NOM vs. OM for splenic trauma injuries and which at least 10 patients with BST. We identified 21 non randomized studies: 1 Clinical Controlled Trial and 20 retrospective cohort studies analyzing a total of 16,940 patients with BST. NOM represents the gold standard treatment for minor splenic trauma and is associated with decreased mortality in severe splenic trauma (4.78% vs. 13.5% in NOM and OM, respectively), according to the literature. Of note, in BST treated operatively, concurrent injuries accounted for the higher mortality. In addition, it was not possible to determine post-treatment morbidity in major splenic trauma. The definition of hemodynamic stability varied greatly in the literature depending on the surgeon and the trauma team, representing a further bias. Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison. NOM of BST, preserving the spleen, is the treatment of choice for the American Association for the Surgery of Trauma grades I and II

A pair-matched comparison of return to pivoting sports at 1 year in ACL-injured patients after a nonoperative versus operative treatment course

Science.gov (United States)

Grindem, Hege; Eitzen, Ingrid; Moksnes, Håvard; Snyder-Mackler, Lynn; Risberg, May Arna

2013-01-01

Background The wish to return to level I pivoting sports is a major indication of ACL-reconstruction. Patients usually return to pivoting sports between 6 months and 1 year postoperatively, but no matched study has so far examined 1-year return to sport rates in nonoperatively and operatively treated ACL-injured patients. Hypothesis ACL-injured patients following a nonoperative treatment course, including recommendation of activity modification, will have lower return to pivoting sport rates than operatively treated patients 1 year after baseline testing/surgery, when matched by preinjury sports activity, age and sex. Study Design Pair-matched cohort study Methods Sixty-nine nonoperatively treated ACL-injured patients were pair-matched with 69 operatively treated patients (n=138), based on specific preinjury sport, age and sex. Nonoperatively treated patients were recommended not to return to level I sports. Patients were defined as nonoperatively or operatively treated according to their status at follow-up. The baseline and follow-up testing included registration of sports participation, KT-1000 measurements, 4 hop tests, and patient-reported outcome measures. McNemar’s test and paired t-tests or Wilcoxon’s test were used to compare outcomes of nonoperatively and operatively treated patients. Results No significant baseline differences were found. At 12.9±1.2 months (mean ± standard deviation) after baseline testing (nonoperative) and 12.7±1.2 months after surgery (operative), there was no significant difference in overall return to sport rates (nonoperative: 68.1 %, operative: 68.1 %, p=1.000), or in return to level I sport rates (nonoperative: 54.8 %, operative: 61.9 %, p=0.664). Nonoperatively treated patients who participated in level I sports prior to injury had a significantly lower return to sport rate (54.8 %) than nonoperatively treated patients who participated in level II sports (88.9 %, p=0.003). The nonoperatively treated patients had

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Science.gov (United States)

Frandon, Julien; Rodiere, Mathieu; Arvieux, Catherine; Vendrell, Anne; Boussat, Bastien; Sengel, Christian; Broux, Christophe; Bricault, Ivan; Ferretti, Gilbert; Thony, Frédéric

2015-01-01

PURPOSE We aimed to compare clinical outcomes and early adverse events of operative management (OM), nonoperative management (NOM), and NOM with splenic artery embolization (SAE) in blunt splenic injury (BSI) and identify the prognostic factors. METHODS Medical records of 136 consecutive patients with BSI admitted to a trauma center from 2005 to 2010 were retrospectively reviewed. Patients were separated into three groups: OM, NOM, and SAE. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. RESULTS The total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural drainage, acute renal failures, and pancreatitis in OM and more pseudocysts in SAE. Six prognostic factors were statistically significant for one or more adverse events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. CONCLUSION Patients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury. PMID:26081719

A Cohort Study of the Natural History of Odontoid Pseudoarthrosis Managed Nonoperatively in Elderly Patients.

Science.gov (United States)

Hong, Jennifer; Zaman, Rifat; Coy, Shannon; Pastel, David; Simmons, Nathan; Ball, Perry; Mirza, Sohail; Abdu, William; Pearson, Adam; Lollis, S Scott

2018-06-01

Although the primary goal of treatment of type II odontoid fracture is bony union, some advocate continued nonsurgical management of minimally symptomatic older patients who have fibrous union or minimal fracture motion. The risk of this strategy is unknown. We reviewed our long-term outcomes after dens nonunion to define the natural history of Type II odontoid fractures in elderly patients managed nonoperatively. A retrospective chart review of 50 consecutive adults aged 65 or older with Type II odontoid fracture initially managed nonsurgically from 1998 to 2012 at a single tertiary care institution was conducted. Particular attention was paid to patients who had orthosis removal despite absent bony fusion. Patients were contacted prospectively by telephone and followed until death, surgical intervention, or last known contact. Fifty patients initially were managed nonsurgically; of these, 21 (42.0%) proceeded to bony fusion, 3 (6%) underwent delayed surgery for persistent instability, and 26 (52%) had orthosis removal despite the lack of solid arthrodesis on imaging. The last group had a median follow-up of 25 months (range 4-158 months), with 20 of 26 (76.9%) followed until death. Of these patients, 1 patient developed progressive quadriplegia and dysphagia 11 months after initial injury. Compared with patients with spontaneous union, patients with nonunion had shorter life expectancy, despite no significant differences between the groups with respect to age, sex, injury mechanism, radiographic variables, or follow-up duration. Orthosis removal despite fracture nonunion may be reasonable in elderly patients with Type II dens fractures. Copyright © 2018 Elsevier Inc. All rights reserved.

Non-operative Management of Gallbladder Perforation After Blunt ...

African Journals Online (AJOL)

management of isolated traumatic gallbladder perforation in a patient that was ... A transthoracic echocardiogram 2 days later revealed a right ventricular .... EPUB is an open e-book standard recommended by The International Digital Publishing Forum which is designed for reflowable content i.e. the text display can be ...

Management of adult blunt hepatic trauma.

Science.gov (United States)

Kozar, Rosemary A; McNutt, Michelle K

2010-12-01

To review the nonoperative and operative management of blunt hepatic injury in the adult trauma population. Although liver injury scale does not predict need for surgical intervention, a high-grade complex liver injury should alert the physician to a patient at increased risk of hepatic complications following nonoperative management. Blunt hepatic injury remains a frequent intraabdominal injury in the adult trauma population. The management of blunt hepatic injury has undergone a major paradigm shift from mandatory operative exploration to nonoperative management. Hemodynamic instability with a positive focused abdominal sonography for trauma and peritonitis are indications for emergent operative intervention. Although surgical intervention for blunt hepatic trauma is not as common as in years past, it is imperative that the current trauma surgeon be familiar with the surgical skill set to manage complex hepatic injuries. This study represents a review of both nonoperative and operative management of blunt hepatic injury.

Outcomes of nonoperatively treated displaced scapular body fractures.

Science.gov (United States)

Dimitroulias, Apostolos; Molinero, Kenneth G; Krenk, Daniel E; Muffly, Matthew T; Altman, Daniel T; Altman, Gregory T

2011-05-01

Displaced scapular body fractures most commonly are treated conservatively. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the DASH (Disability of Arm, Shoulder and Hand) score; (2) the radiographic outcome was assessed by the change of the glenopolar angle (GPA); and (3) associated scapular and extrascapular injuries that may affect outcome were identified. Forty-nine consecutive patients were treated with early passive and active ROM exercises for a displaced scapular body fracture. We followed 32 of these patients (65.3%) for a minimum of 6 months (mean, 15 months; range, 6-33 months). Mean age of the patients was 46.9 years (range, 21-84 years) and the mean Injury Severity Score (ISS) was 21.5 (range, 5-50). Subjective functional results (DASH score) and radiographic assessment (fracture union, glenopolar angle) were measured. All fractures healed uneventfully. The mean change of glenopolar angle was 9° (range, 0°-20°). The mean change of the DASH score was 10.2, which is a change with minimal clinical importance. There was a correlation between the change in this score with the ISS and presence of rib fractures. Satisfactory outcomes are reported with nonoperative treatment of displaced scapular body fractures. We have shown that the severity of ISS and the presence of rib fractures adversely affect the clinical outcome.

Non-operative anti-caries agents and dental caries increment among adults at high caries risk: a retrospective cohort study.

Science.gov (United States)

Chaffee, Benjamin W; Cheng, Jing; Featherstone, John D B

2015-09-24

Consensus guidelines support non-operative preventives for dental caries management; yet, their use in practice is far from universal. The purpose of this study was to evaluate the effectiveness of non-operative anti-caries agents in caries prevention among high caries risk adults at a university clinic where risk-based caries management is emphasized. This retrospective observational study drew data from the electronic patient records of non-edentulous adult patients deemed to be at high risk for dental caries during baseline oral evaluations that were completed between July 1, 2007 and December 31, 2012 at a dental university in the United States. We calculated and compared adjusted mean estimates for the number of new decayed or restored teeth (DFT increment) from baseline to the next completed oral evaluation (N = 2,724 patients with follow-up) across three categories of delivery of non-operative anti-caries agents (e.g., high-concentration fluoride toothpaste, chlorhexidine rinse, xylitol products): never, at a single appointment, or at ≥2 appointments ≥4 weeks apart. Estimates were adjusted for patient and provider characteristics, baseline dental status, losses-to-follow-up, and follow-up time. Approximately half the patients did not receive any form of non-operative anti-caries agent. Most that received anti-caries agents were given more than one type of product in combination. One-time delivery of anti-caries agents was associated with a similar DFT increment as receiving no such therapy (difference in increment: -0.04; 95% CI: -0.28, 0.21). However, repeated, spaced delivery of anti-caries agents was associated with approximately one decayed or restored tooth prevented over 18 months for every three patients treated (difference in increment: -0.35; 95% CI: -0.65, -0.08). These results lend evidence that repeatedly receiving anti-caries agents can reduce tooth decay among high-risk patients engaged in regular dental care.

Initial non-operative management of uncomplicated appendicitis in children: a protocol for a multicentre randomised controlled trial (APAC trial)

NARCIS (Netherlands)

Knaapen, Max; van der Lee, Johanna H.; Bakx, Roel; The, Sarah-May L.; van Heurn, Ernst W. E.; Heij, Hugo A.; Gorter, Ramon R.; Rippen, H.; Bet, P. M.; Kazemier, G.; Kneepkens, C. M. F.; Wijnen, R.; Offringa, M.; Ahmadi, N.; Bonjer, H. J.; van Rijn, R. R.; Benninga, M. A.; Bemelman, W. A.; Hilarius, D. L.; van Veen, S. A. J. M.; Go, P. M. N. Y. H.; Cense, H. A.; de Vries, A.; Straatman, J.; in ’t Hof, K. H.; van Beek, E. J. A. H.; Bender, M. H. M.; van den Hill, L. C. L.; Bolhuis, H. W.; Treskes, K.; Bijlsma, T. S.; Geubbels, N.; de Blaauw, I.; Botden, S. M. B. I.; Leijdekkers, V. J.; Boonstra, M. C.; Rongen, L. H.; Boerma, E. J. G.; Luyer, M. D. P.; Vugts, G.; Copper, T.; Garssen, F. P.; Hulsker, C.; Visschers, R. G. J.

2017-01-01

Introduction Based on epidemiological, immunological and pathology data, the idea that appendicitis is not necessarily a progressive disease is gaining ground. Two types are distinguished: simple and complicated appendicitis. Non-operative treatment (NOT) of children with simple appendicitis has

Management of liver trauma.

LENUS (Irish Health Repository)

Badger, S A

2012-02-01

BACKGROUND: Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems. METHODS: A literature review was undertaken to determine the current consensus on investigation and management strategies. RESULTS: The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing. CONCLUSIONS: Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome.

MANAGEMENT OF SPLENIC INJURY AFTER BLUNT INJURY TO ABDOMEN

Directory of Open Access Journals (Sweden)

J. Bharath Prakash Reddy

2016-07-01

Full Text Available BACKGROUND The spleen is an important organ in the body’s immune system. It is the most frequently injured organ in blunt abdominal trauma. 1 Over the past several decades, diagnosis and management of splenic trauma has been evolved. The conservative, operative approach has been challenged by several reports of successful non-operative management aided by the power of modern diagnostic imaging. The aim of our prospective study was to compare non-operative management with surgery for cases of splenic injury. METHODS We conducted a prospective study of patients admitted with blunt splenic injury to our regional hospital over a three-year period (2012-2015. Haemodynamic status upon admission, FAST examination, computed tomography 2 grade of splenic tear, presence and severity of associated injuries have been taken into account to determine the treatment of choice. Therapeutic options were classified into non-operative and splenectomy. RESULTS Over a 3-year period, 24 patients were admitted with blunt splenic injury. Sixteen patients were managed operatively and eight patients non-operatively. 3,4 Non-operative management failed in one patient due to continued bleeding. The majority of grades I, II, and III splenic injuries were managed non-operatively and grades IV and V were managed operatively. Blood transfusion requirement was significantly higher among the operative group, but the operative group had a significantly longer hospital stay. Among those managed non-operatively (median age 24.5 years, a number of patients were followed up with CT scans with significant radiation exposure and unknown longterm consequences. CONCLUSION In our experience, NOM is the treatment of choice for grade I, II and III blunt splenic injuries. Splenectomy was the chosen technique in patients who met exclusion criteria for NOM, as well as for patients with grade IV and V injury.

Trends in pediatric spleen management: Do hospital type and ownership still matter?

Science.gov (United States)

Liu, Shaoming; Bowman, Stephen M; Smith, Tyler C; Sharar, Sam R

2015-05-01

Nonoperative management of traumatic blunt splenic injury is preferred over splenectomy because of improved outcomes and reduced complications. However, variability in treatment is previously reported with respect to hospital profit types and ownership. Our study objectives were to investigate the past decade's trends in pediatric splenic injury management and to determine whether previously reported disparities by hospital type have changed. We analyzed data from the Kid's Inpatient Database from Healthcare Cost and Utility Project for Years 2000, 2003, 2006, and 2009. Multivariable logistic regression was used to investigate the likelihood of receiving splenectomy in different hospital profit and ownership types. Patients 18 years and younger admitted with blunt splenic injury (DRG International Classification of Diseases-9th Rev.-Clinical Modification code 865) were included. Treatment was dichotomized into nonoperative management, defined as initial attempt at nonoperative management, and operative management, defined as splenectomy within 1 day of admission. Of 17,044 patient records, 11,893 participants were studied. Not-for-profit hospitals demonstrated a higher rate of nonoperative management than for-profit hospitals in 2000 (83.8% vs. 71.0 %). Both not-for-profit and for-profit hospitals increased the use of nonoperative management, with a narrower disparity observed by 2009 (87.5% vs. 84.6%). The use of splenectomy was reduced significantly between 2000 and 2003 (odds ratio, 0.66; weighted 95% confidence interval, 0.54-0.81). The rate of nonoperative management in children's hospitals remained very high across the study period (98.6% in 2009) and continued to be the benchmark for pediatric spleen injury management. Improvement was observed in nonoperative management rates for pediatric spleen injuries in both not-for-profit and for-profit hospitals. However, general hospitals still fail to reach the target of 90% nonoperative management. Further

Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation

Science.gov (United States)

Joukainen, Antti; Kröger, Heikki; Niemitukia, Lea; Mäkelä, E. Antero; Väätäinen, Urho

2014-01-01

Background: The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved. Purpose: To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed. Results: Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in

Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients.

Science.gov (United States)

Trust, Marc D; Teixeira, Pedro G; Brown, Lawrence H; Ali, Sadia; Coopwood, Ben; Aydelotte, Jayson D; Brown, Carlos V R

2018-01-01

Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age < 65) and geriatric (age ≥ 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs. 4%, p < 0.0001). On logistic regression analysis, Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778; confidence interval, 1.769-4.363; p < 0.0001). There was no difference in mortality in geriatric patients who had successful vs. failed NOM (11% vs. 15%; p = 0.22). Independent risk factors for mortality in geriatric patients included admission hypotension, Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429; confidence interval, 0.776-2.625; p = 0.25). Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. Therapeutic, level IV.

Second date appendectomy: Operating for failure of nonoperative treatment in perforated appendicitis.

Science.gov (United States)

Lotti, Marco

2017-06-01

Nonoperative treatment of acute appendicitis is embraced by many surgical teams, driven by low to moderate quality randomized studies that support noninferiority of antibiotics versus appendectomy for treatment of acute uncomplicated appendicitis. Several flaws of these studies have emerged, especially in the recruitment strategy and in the diagnostic criteria that were used. The growing confidence given to antibiotics, together with the lack of reliable criteria to distinguish between uncomplicated and perforated appendicitis, exposes patients with perforated appendicitis to the likelihood to be treated with antibiotics instead of surgery. Among them, those patients who experience a temporary relief of symptoms due to antibiotics, followed by early recurrence of disease when antibiotics are discontinued, are likely to undergo appendectomy at their second date. Second date appendectomy, i.e. the removal of the appendix when acute inflammation relapses within the scar of a previously unhealed perforated appendicitis, is the unwanted child of the nonoperative treatment and a new challenge for both the surgeon and the patient. Between June and July 2016, two patients were readmitted and operated for failure of nonoperative treatment with antibiotics. A video is presented, which focuses on the different anatomic presentation and technical challenges between prompt and second date laparoscopic appendectomy. When proposing nonoperative treatment for acute appendicitis, surgeons should be aware and inform their patients that if the appendix is perforated and an incomplete healing and early recurrence occur, a second date appendectomy could be a more challenging operation compared to a prompt appendectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures.

Science.gov (United States)

Liu, W; Xiao, J; Ji, F; Xie, Y; Hao, Y

2015-04-01

The optimal treatment of midshaft clavicle fractures remains controversial. Nonunion is usually considered to be an uncommon complication following a nonoperatively treated clavicle fracture. Not every midshaft clavicular fractures shares the same risk of developing nonunion after nonoperative treatment. The present study was performed to identify the intrinsic and extrinsic independent factors that are independently predictive of nonunion in patients with midshaft clavicular fractures after nonoperative treatment. We performed a retrospective study of a series of 804 patients (391 men and 413 women with a median age of 51.3 years) with a radiographically confirmed midshaft clavicle fracture, which was treated nonoperatively. There were 96 patients who underwent nonunion. Putative intrinsic (patient-related) and extrinsic (injured-related) risk factors associated with nonunion were determined with the use of bivariate and multivariate statistical analyses. By bivariate analysis, the risk of nonunion was significantly increased by several intrinsic risk factors including age, sex, and smoking and extrinsic risk factors including displacement of the fracture and the presence of comminution (P<0.05 for all). On multivariate analysis, smoking (OR=4.16, 95% CI: 1.01-14.16), fracture displacement (OR=7.81, 95% CI: 2.27-25.38) and comminution of fracture (OR=3.86, 95% CI: 1.16-13.46) were identified as independent predictive factors. The risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures are multifactorial. Smoking, fracture displacement and comminution of fracture are independent predictors for an individual likelihood of nonunion. Further studies are still required to evaluate these factors in the future. Level III, case-control study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

Science.gov (United States)

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

2015-01-01

This case report illustrates and discusses the non-operative management of a complete anterior cruciate ligament (ACL) injury in an English Premier League football player, his return to play within 8 weeks and problem-free follow-up at 18 months post injury. When non-operative verses surgical ACL reconstruction is considered there are many fundamental gaps in our knowledge and currently, at elite level, there are no cases in cutting sports within the literature to guide these decisions. When the norm is for all professional footballers to be recommended surgery, it will be very challenging when circumstances and patient autonomy dictate a conservative approach, where prognosis, end points and risk are unclear and assumed to be high. This case challenges current dogma and provides a starting point for much needed debate about best practice, treatment options, research direction and not just at the elite level of sport. PMID:25917066

Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up.

Science.gov (United States)

Krych, Aaron J; Reardon, Patrick J; Johnson, Nick R; Mohan, Rohith; Peter, Logan; Levy, Bruce A; Stuart, Michael J

2017-02-01

Medial meniscus posterior root tears (MMPRTs) are a significant source of pain and dysfunction, but little is known about the natural history and outcome and for non-operative management of these lesions. The purpose of this study was to evaluate (1) the mid-term clinical and radiographic outcomes of non-operative treatment of MMPRTs and (2) risk factors for worse outcomes. A retrospective review was performed for patients with symptomatic, unrepaired MMPRTs and a minimum 2-year follow-up for IKDC and Tegner outcome scores. Baseline and final radiographs were reviewed and graded according to Kellgren-Lawrence scores. Baseline MRIs were reviewed for the presence of meniscal extrusion, subchondral oedema, and insufficiency fractures. Failure was defined as conversion to arthroplasty or severely abnormal patient subjective IKDC score. Fifty-two patients (21M:31F) with a mean age of 58 ± 10 years were diagnosed with symptomatic MMPRTs clinically and confirmed by MRI and followed for a mean of 62 ± 30 months. Sixteen patients (31 %) underwent total knee arthroplasty at a mean of 30 ± 32 months after diagnosis with higher Kellgren-Lawrence grades associated with increased rates of arthroplasty (p = 0.01). Mean IKDC scores for the remaining patients were 61.2 ± 21 with significantly lower scores in females compared to males (75 ± 12 vs. 49 ± 20; p = 0.03). Mean Kellgren-Lawrence grades and rates of arthritis progressed over time on radiographs (1.5 ± 0.7 vs. 2.4 ± 1.0; p meniscus posterior horn root tears is associated with poor clinical outcome, worsening arthritis, and a relatively high rate of arthroplasty at 5-year follow-up. Female gender was associated with lower subjective scores and higher rate of arthroplasty. The current study provides a natural history benchmark for clinical outcomes that can be expected in patients with medial meniscus posterior horn root tears undergoing non-operative treatment and helps in counselling

Nonoperative treatment of symptomatic spondylolysis.

Science.gov (United States)

Kurd, Mark F; Patel, Deepan; Norton, Robert; Picetti, George; Friel, Brian; Vaccaro, Alexander R

2007-12-01

Symptomatic spondylolysis resulting from a stress fracture of the pars interarticularis is a cause of low back pain in the juvenile and adolescent patient. Treatment is conservative in the majority of cases. To analyze the outcome of patients with symptomatic isthmic spondylolysis treated nonoperatively with a custom fit thoracolumbar orthosis and activity cessation for 3 months followed by an organized physical therapy program. Retrospective case series. Four hundred thirty-six juvenile and adolescent patients with spondylolysis. Pain improvement, hamstring flexibility, range of motion, resolution of back spasms, and return to previous activities. Retrospective review of 436 juvenile and adolescent patients with symptomatic spondylolysis confirmed by single-photon emission computed tomography or computed tomography. Clinical outcomes were assessed through patient history and physical examination. Ninety-five percent of patients achieved excellent results according to a modified Odom's Criteria. The remaining 5% of patients achieved good results as they required occasional nonsteroidal anti-inflammatory drugs to relieve pain. Back spasms were resolved and hamstring tightness and range of motion returned to normal in all patients. All patients returned to their preinjury activity level. No patients went on to surgery. Symptomatic juvenile and adolescent patients with an isthmus spondylolysis may be effectively managed with a custom fit thoracolumbar orthosis brace and activity cessation for approximately 3 months followed by an organized physical therapy program.

Penetrating abdominal injuries: management controversies

Science.gov (United States)

Butt, Muhammad U; Zacharias, Nikolaos; Velmahos, George C

2009-01-01

Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries. PMID:19374761

Penetrating abdominal injuries: management controversies

Directory of Open Access Journals (Sweden)

Velmahos George C

2009-04-01

Full Text Available Abstract Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries.

Management of spleen injuries in the adult trauma population: a ten-year experience.

Science.gov (United States)

Cadeddu, Margherita; Garnett, Anna; Al-Anezi, Khaled; Farrokhyar, Forough

2006-12-01

Increasing awareness of the postoperative risks associated with splenectomies has led physicians and surgeons to use an alternative nonoperative strategy in handling traumatic spleen injuries. Our primary objective was to compare clinical outcomes between operative and nonoperative managements in adult patients with blunt splenic injuries. The secondary objective was to assess the changes in the patterns of managing splenic injuries in the past 10 years. We performed a retrospective chart review on 266 adult patients with a spleen injury who were admitted to a tertiary trauma centre in Ontario between 1992 and 2001. We grouped and compared the patients according to the treatment received, either operative or nonoperative. Frequencies and confidence intervals are reported. Categorical variables were compared with chi-square or Fisher's exact tests. Continuous variables were reported as median and quartile (Q) and were compared with the nonparametric Mann-Whitney U test. Of 266 patients, 118 had surgery and 148 were managed nonoperatively. The mortality rate was similar between operative and nonoperative groups (9.3% v. 6.8%, p = 0.49), respectively. The rate of any complication was 47.9% for the operative group and 37.9% for the nonoperative group. The median length of stay in hospital was significantly higher in the operative group than in the nonoperative group (21.0 [Q 11.0-40.5] v. 14.0 [Q 7.0-31.5] d, p trauma has increased over time and has acceptable mortality and complication rates in selected patients. Additional prospective studies are needed to assess the feasibility and safety of nonoperative management in adult spleen injuries. Furthermore, the management of traumatic spleen injuries with respect to associated injuries, such as head injuries or intra-abdominal injuries, needs ongoing evaluation.

Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU).

Science.gov (United States)

Chertoff, Jason; Khullar, Vikas; Burke, Lucas

2015-01-01

The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. We present the case of a 63-year-old male who presented to our institution's emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. Due to the patient's hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Management of pediatric blunt splenic injury at a rural trauma center.

Science.gov (United States)

Bird, Julio J; Patel, Nirav Y; Mathiason, Michelle A; Schroeppel, Thomas J; D'huyvetter, Cecile J; Cogbill, Thomas H

2012-10-01

Patterns for nonoperative management of pediatric blunt splenic injuries (BSIs) vary significantly within and between institutions. The indications for repeated imaging, duration of activity restrictions, as well as the impact of volume and type of trauma center (pediatric vs. adult) on outcomes remain unclear. A retrospective review of all patients younger than 16 years with BSI managed at a rural American College of Surgeons-verified adult Level II trauma center from January 1995 to December 2008 was completed. Patients were identified from the trauma registry by DRG International Classification of Diseases-9th Rev. (865.00-865.09) and management codes (41.5, 41.43, and 41.95). Variables reviewed included demographics, mechanism of injury, Injury Severity Score, grade of splenic injury, degree of hemoperitoneum, presence of arterial phase contrast blush on computed tomography at admission, admission and nadir hemoglobin level, blood transfused, length of stay, disposition, outpatient clinical and radiographic follow-up, interval of return to unrestricted activity, and clinical outcomes. During the 13-year study period, 38 children with BSI were identified. Thirty-seven (97%) were successfully managed nonoperatively. Median grade of splenic injury was 3 (range, 1-5); 73% had moderate-to-large hemoperitoneum. Median Injury Severity Score was 10 (range, 4-34). Three patients with isolated contrast blush on initial computed tomography were successfully managed nonoperatively with no angiographic intervention. One patient failed nonoperative management and underwent successful splenorrhaphy. All patients were discharged home. Thirty-day mortality was zero. Median follow-up duration was 5.5 years, with no late complications identified. Of the patients successfully managed nonoperatively, 92% had their follow-up at our institution; 74% underwent subsequent imaging, and none resulted in intervention or alteration of management plan. Pediatric BSI can be managed in adult

The effects of various physical non-operative modalities on the pain in osteoarthritis of the knee.

Science.gov (United States)

Cherian, J J; Jauregui, J J; Leichliter, A K; Elmallah, R K; Bhave, A; Mont, M A

2016-01-01

The purpose of this study was to evaluate the effect of various non-operative modalities of treatment (transcutaneous electrical nerve stimulation (TENS); neuromuscular electrical stimulation (NMES); insoles and bracing) on the pain of osteoarthritis (OA) of the knee. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify the therapeutic options which are commonly adopted for the management of osteoarthritis (OA) of the knee. The outcome measurement tools used in the different studies were the visual analogue scale and The Western Ontario and McMaster Universities Arthritis Index pain index: all pain scores were converted to a 100-point scale. A total of 30 studies met our inclusion criteria: 13 on insoles, seven on TENS, six on NMES, and four on bracing. The standardised mean difference (SMD) in pain after treatment with TENS was 1.796, which represented a significant reduction in pain. The significant overall effect estimate for NMES on pain was similar to that of TENS, with a SMD of 1.924. The overall effect estimate of insoles on pain was a SMD of 0.992. The overall effect of bracing showed a significant reduction in pain of 1.34. Overall, all four non-operative modalities of treatment were found to have a significant effect on the reduction of pain in OA of the knee. This study shows that non-operative physical modalities of treatment are of benefit when treating OA of the knee. However, much of the literature reviewed evaluates studies with follow-up of less than six months: future work should aim to evaluate patients with longer follow-up. ©2016 The British Editorial Society of Bone & Joint Surgery.

Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

Science.gov (United States)

Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

2013-01-01

Introduction The economic burden associated with the treatment of low back pain (LBP) in the United States is significant. LBP caused by sacroiliac (SI) joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS) options may offer potential cost savings to Medicare. Methods An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars) were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG) payments of $46,700 (with major complications - DRG 459) and $27,800 (without major complications - DRG 460), weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were discounted by 3.0% per annum. Results The extrapolated lifetime cost of treating Medicare patients with MIS fusion was $48,185/patient compared to $51,543/patient for nonoperative care, resulting in a $660 million savings to Medicare (196,452 beneficiaries at $3,358 in savings/patient). Including those with ICD-9-CM code 721.3 (lumbosacral spondylosis) increased lifetime cost estimates (up to 478,764 beneficiaries at $8,692 in savings/patient). Conclusion Treating Medicare

IMPLEMENTING A RISK MANAGEMENT STANDARD

Directory of Open Access Journals (Sweden)

Constantin PREDA

2013-01-01

Full Text Available After risk management “conquered” more and more project managers’ minds and showed its benefits for business and programs, the need to have a global risk management standard has become a crucial issue in the world of risk management. But having a global risk management standard has been a big challenge, starting from the decision of developing the standard (March-June 2005, to the moment of publishing it, November 2009. So, developing the ISO 31000:2009 standard has been more or less like a bumpy ride. Apparently, the people involved in developing the global risk management standard understood from the very beginning that no challenges are too big, nor any tasks too small and that the task of having a new, comprehensive global risk management standard should be completed with excellence: defining the principles and the framework guiding the risk management process applicable for all type of organizations and for a wide range of activities. Coming up with a global standard should always be based on the real organizations’ needs and should fulfill real risk management requirements. The article is trying to present the pros and cons of risk management standard implementation, challenging the implementation process itself and the added value of implementing the standard due to the lack of implementation enablers, like risk culture, a real problem especially in an international environment.

Emergency strategies and trends in the management of liver trauma.

Science.gov (United States)

Jiang, Hongchi; Wang, Jizhou

2012-09-01

The liver is the most frequently injured organ during abdominal trauma. The management of hepatic trauma has undergone a paradigm shift over the past several decades, with mandatory operation giving way to nonoperative treatment. Better understanding of the mechanisms and grade of liver injury aids in the initial assessment and establishment of a management strategy. Hemodynamically unstable patients should undergo focused abdominal sonography for trauma, whereas stable patients may undergo computed tomography, the standard examination protocol. The grade of liver injury alone does not accurately predict the need for operation, and nonoperative management is rapidly becoming popular for high-grade injuries. Hemodynamic instability with positive focused abdominal sonography for trauma and peritonitis is an indicator of the need for emergent operative intervention. The damage control concept is appropriate for the treatment of major liver injuries and is associated with significant survival advantages compared with traditional prolonged surgical techniques. Although surgical intervention for hepatic trauma is not as common now as it was in the past, current trauma surgeons should be familiar with the emergency surgical skills necessary to manage complex hepatic injuries, such as packing, Pringle maneuver, selective vessel ligation, resectional debridement, and parenchymal sutures. The present review presents emergency strategies and trends in the management of liver trauma.

The dangerous gamble of heparinization within two weeks of nonoperative traumatic acute subdural hematoma in patients with increased stroke risk: a case series.

Science.gov (United States)

McClelland, S; Mackey, S J; Kim, S S

2014-01-01

In traumatic acute subdural hematoma (aSDH) management, systemic anticoagulation is contraindicated, particularly during the first 2 weeks. We present two cases of patients with nonoperative aSDH whose stroke risk led to heparinization within 2 weeks of the initial hemorrhage and examine their outcomes to illustrate the risks and benefits associated with systemic anticoagulation. Two elderly males, on warfarin at baseline who developed traumatic nonoperative aSDH were heparinized within 2 weeks of aSDH onset. One patient showed a decreased SDH volume on Day 19. The second patient developed sudden onset headache with fixed/dilated pupils on Day 5. In this patient, a CT scan of the brain revealed marked enlargement of the aSDH from 0.9 to 2.4 cm with midline shift of 1.5 cm, and uncal herniation that was incompatible with life. Heparinization within two weeks of aSDH may cause SDH enlargement resulting in rapidly fatal neurologic deterioration. Further study is needed to more definitively address this issue.

A review on the nonoperative removal of necrotic tissue from burn wounds

NARCIS (Netherlands)

Klasen, HJ

The study of nonoperative debridement of burns got underway during:thr Second World War. A large number of substances such as enzymes of plant origin, acids and proteolytic enzymes:of bacterial origin were examined since. The proteolytic enzymes derived from filtrates of C, histolyticum and B,

Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis.

Science.gov (United States)

Chen, Bing-Lin; Guo, Jia-Bao; Zhang, Hong-Wei; Zhang, Ya-Jun; Zhu, Yi; Zhang, Juan; Hu, Hao-Yu; Zheng, Yi-Li; Wang, Xue-Qiang

2018-02-01

To investigate the effects of surgical versus non-operative treatment on the physical function and safety of patients with lumbar disc herniation. PubMed, Cochrane Library, Embase, EBSCO, Web of Science, China National Knowledge Infrastructure and Chinese Biomedical Literature Database were searched from initiation to 15 May 2017. Randomized controlled trials that evaluated surgical versus non-operative treatment for patients with lumbar disc herniation were selected. The primary outcomes were pain and side-effects. Secondary outcomes were function and health-related quality of life. A random effects model was used to calculate the pooled mean difference with 95% confidence interval. A total of 19 articles that involved 2272 participants met the inclusion criteria. Compared with non-operative treatment, surgical treatment was more effective in lowering pain (short term: mean difference = -0.94, 95% confidence interval = -1.87 to -0.00; midterm: mean difference = -1.59, 95% confidence interval = -2.24 to -9.94), improving function (midterm: mean difference = -7.84, 95% confidence interval = -14.00 to -1.68; long term: mean difference = -12.21, 95% confidence interval = -23.90 to -0.52) and quality of life. The 36-item Short-Form Health Survey for physical functions (short term: mean difference = 6.25, 95% confidence interval = 0.43 to 12.08) and bodily pain (short term: mean difference = 5.42, 95% confidence interval = 0.40 to 10.45) was also utilized. No significant difference was observed in adverse events (mean difference = 0.82, 95% confidence interval = 0.28 to 2.38). Low-quality evidence suggested that surgical treatment is more effective than non-operative treatment in improving physical functions; no significant difference was observed in adverse events. No firm recommendation can be made due to instability of the summarized data.

Impact of concomitant trauma in the management of blunt splenic injuries.

Science.gov (United States)

Lo, Albert; Matheson, Anne-Marie; Adams, Dave

2004-09-10

Conservative management of isolated blunt splenic injuries has become widely accepted for haemodynamically stable patients, but may be untenable in those with multiple injuries. A retrospective review was performed to evaluate of our cumulative experience with non-operative management of splenic injuries, and to identify the risk factors for operative management. Eighty patients were identified. Demographics, mechanism of injury, injury severity score (ISS), clinical signs at presentation, utility of computed tomography scans and methods of treatment (operative management vs conservative management) were documented and statistically analysed to identify predictors for operative management. Initially, 45 patients (56%) were managed without operation, while 35 patients underwent urgent laparotomy - with 26 (74% in operative group) of these having splenectomy performed. Two patients (out of 45) failed conservative management and required delayed splenectomy, a 96% success rate for intended conservative management. Thus, overall rates of 54% non-operative management and 65% splenic conservation were achieved. The mean ISS of the operative management group (ISS=30) was higher than that of the non-operative treatment group (ISS=13, ptrauma. Risk factors for patients with blunt splenic injuries requiring operative management include ISS > or =16, hypotension, GCS trauma, there is an increasing trend towards operative management.

Progression of carpal tunnel syndrome according to electrodiagnostic testing in nonoperatively treated patients

NARCIS (Netherlands)

van Suchtelen, Mark; Becker, Stéphanie J. E.; Gruber, Jillian S.; Ring, David

2014-01-01

This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS) over time according to median nerve distal motor latency (DML) on two electrodiagnostic tests. This retrospective study analyzed sixty-two adult

INTEGRATIVE AUGMENTATION OF STANDARDIZED MANAGEMENT SYSTEMS

Directory of Open Access Journals (Sweden)

Stanislav Karapetrovic

2008-03-01

Full Text Available The development, features and integrating abilities of different international standards related to management systems are discussed. A group of such standards that augment the performance of quality management systems in organizations is specifically focused on. The concept, characteristics and an illustrative example of one augmenting standard, namely ISO 10001, are addressed. Integration of standardized augmenting systems, both by themselves and within the overall management system, is examined. It is argued that, in research and practice alike, integrative augmentation represents the future of standardized quality and other management systems.

Trauma surgeons practice what they preach: The NTDB story on solid organ injury management.

Science.gov (United States)

Hurtuk, Michael; Reed, R Lawrence; Esposito, Thomas J; Davis, Kimberly A; Luchette, Fred A

2006-08-01

Recent studies advocate a nonoperative approach for hepatic and splenic trauma. The purpose of this study was to determine whether the literature has impacted surgical practice and, if so, whether or not the overall mortality of these injuries had changed. The American College of Surgeons' National Trauma Data Bank (NTDB 4.0) was analyzed using trauma admission dates ranging from 1994 to 2003. All hepatic and splenic injuries were identified by ICD-9 codes. As renal trauma management has not changed during the study period, renal injuries were included as a control. Nonoperative management (NOM) rates and overall mortality were determined for each organ. Proportions were compared using chi analysis with significance set at p hepatic, 15,960 renal injuries. There was a significant (p hepatic and splenic trauma whereas renal NOM remained stable for the study period. Despite an increase in NOM for splenic and hepatic injuries, mortality has remained unchanged. This study demonstrates that the management of hepatic and splenic injuries has significantly changed in the past 10 years with no appreciable effect on mortality. NOM has become the standard of care for the management of hepatic and splenic trauma. The NTDB can be used to monitor changes in trauma care in response to new knowledge regarding improved outcomes.

Working out the standards for nuclear power aging management implementation (PLM Standards)

International Nuclear Information System (INIS)

Miyano, Hiroshi

2008-01-01

Background of preparation of standards, preparation of standards for development of nuclear power aging management technologies, revision of PLM (Product Lifecycle Management) standards, and problems of PLM standards are stated. The placement of social needs, scheme, the standards system, preparation of rules and standards, and practical use of them by road map are illustrated and explained. Relation between the safety regulations and examination standards, and development and preparation of standards system are outlined. The nuclear power plant aging management and the maintenance control are provided by many rules and standards. PLM standards defines the aging phenomena and extracts the measurements and reflects them on the usual maintenance flow under the long term maintenance program. New examination system constructs the usual maintenance and the maintenance based on the aging management and long term maintenance program. Outline and construction of PLM standards are explained with notes and additional books. (S.Y.)

The management of ankle fractures in patients with diabetes.

Science.gov (United States)

Wukich, Dane K; Kline, Alex J

2008-07-01

Patients with diabetes mellitus have higher complication rates following both open and closed management of ankle fractures. Diabetic patients with neuropathy or vasculopathy have higher complication rates than both diabetic patients without these comorbidities and nondiabetic patients. Unstable ankle fractures in diabetic patients without neuropathy or vasculopathy are best treated with open reduction and internal fixation with use of standard techniques. Patients with neuropathy or vasculopathy are at increased risk for both soft-tissue and osseous complications, including delayed union and nonunion. Careful soft-tissue management as well as stable, rigid internal fixation are crucial to obtaining a good outcome. Prolonged non-weight-bearing and subsequently protected weight-bearing are recommended following both operative and nonoperative management of ankle fractures in patients with diabetes.

Plantar Pressures After Nonoperative Treatment for Clubfoot: Intermediate Follow-up at Age 5 Years.

Science.gov (United States)

Jeans, Kelly A; Erdman, Ashley L; Karol, Lori A

2017-01-01

Worldwide, a nonoperative approach in the treatment of idiopathic clubfoot has been taken in an attempt to reduce the incidence of surgical outcomes. Although both the Ponseti casting (Ponseti) and the French physiotherapy (PT) methods have shown gait and pedobarograph differences at age 2 years, improved gait results have been reported by age 5 years. The purpose of this study was to assess plantar pressures in feet treated with the Ponseti versus the PT methods at this intermediate stage. Clubfoot patients treated nonoperatively (Ponseti or PT) underwent pedobarograph data collection at age 5 years. The foot was subdivided into the medial/lateral hindfoot, midfoot, and forefoot regions. Variables included Peak Pressure, Maximum Force, Contact Area%, Contact Time%, Pressure Time Integral, the hindfoot-forefoot angle, and displacement of the center of pressure (COP) line. Twenty controls were used for comparison. Pedobarograph data from 164 patients (238 feet; 122 Ponseti and 116 PT) showed no significant differences between the Ponseti and the PT feet, except the PT feet had a significantly less medial movement of the COP than the Ponseti feet (P=0.0379). Compared with controls, both groups had decreased plantar pressures in the hindfoot and first metatarsal regions, whereas the midfoot and lateral forefoot experienced significant increases compared with controls. This lateralization was also reflected in the hindfoot-forefoot angle and the COP. Feet that remain nonoperative and avoid surgical intervention are considered a good clinical result. However, pedobarograph results indicate mild residual deformity in these feet despite clinically successful outcomes. Level II-therapeutic.

Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

Science.gov (United States)

Ackerman, Stacey J; Polly, David W; Knight, Tyler; Holt, Tim; Cummings, John

2014-01-01

Introduction Low back pain is common and originates in the sacroiliac (SI) joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US). Methods A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3), an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date), and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars) were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592) per privately-insured patient (N=78,533). Among patients with lumbar spinal fusion (N=434), attributable 3-year mean costs were $91,720 (SD $75,502) per patient compared to $15,776 (SD $27,542) per patient among patients without lumbar spinal fusion (N=78,099). Overall, inpatient hospitalizations (19.4%), hospital outpatient visits and procedures (14.0%), and outpatient pain medications (9.6%) accounted for the largest proportion of costs. The estimated 3-year insurance payments attributable to SI joint disruption

Challenging a classic myth: pneumoperitoneum associated with acute diverticulitis is not an indication for open or laparoscopic emergency surgery in hemodynamically stable patients. A 10-year experience with a nonoperative treatment.

Science.gov (United States)

Costi, Renato; Cauchy, François; Le Bian, Alban; Honart, Jean-François; Creuze, Nicolas; Smadja, Claude

2012-07-01

In patients presenting with acute diverticulitis (AD) and signs of acute peritonitis, the presence of extradigestive air (EDA) on a computer tomography (CT) scan is often considered to indicate the need for emergency surgery. Although the traditional management of "perforated" AD is open sigmoidectomy, more recently, laparoscopic drainage/lavage (usually followed by delayed elective sigmoidectomy) has been reported. The aim of this retrospective study is to evaluate the results of nonoperative management of emergency patients presenting with AD and EDA. The outcomes of 39 consecutive hemodynamically stable patients (23 men, mean age = 54.7 years) who were admitted with AD and EDA and were managed nonoperatively (antibiotic and supportive treatment) at a tertiary-care university hospital between January 2001 and June 2010 were retrospectively collected and analyzed. These included morbidity (Clavien-Dindo) and treatment failure (need for emergency surgery or death). A univariate analysis of clinical, radiological, and laboratory criteria with respect to treatment failure was performed. Results of delayed elective laparoscopic sigmoidectomy were also analyzed. There was no mortality. Thirty-six of the 39 patients (92.3%) did not need surgery (7 patients required CT-guided abscess drainage). Mean hospital stay was 8.1 days. Duration of symptoms, previous antibiotic administration, severe sepsis, PCR level, WBC concentration, and the presence of abdominal collection were associated with treatment failure, whereas "distant" location of EDA and free abdominal fluid were not. Five patients had recurrence of AD and were treated medically. Seventeen patients (47.2%) underwent elective laparoscopic sigmoidectomy for which mean operative time was 246 min (range = 100-450) and the conversion rate was 11.8%. Mortality was nil and the morbidity rate was 41.2%. Mean postoperative stay was 7.1 days (range = 4-23). Nonoperative management is a viable option in most emergency

Integrated management system - management standards evolution and the IAEA new approach

International Nuclear Information System (INIS)

Oliveira, Dirceu Paulo de; Zouain, Desiree Moraes

2007-01-01

The management standards application began in military and nuclear areas towards the end of Second World War, when some westerns countries developed quality standards to improve their means to assess suppliers' conditions to assure their products conformance, which was increasingly complex and required a higher degree of reliability. Afterwards, the quality standards application was extended to the consumer market focused on consumers' requirements satisfaction. Coming along the society crescent concern about quality of life, other management standards were developed, such as those dealing with environmental and sustainable development, occupational health and safety, social accountability and so on. As a consequence, the management process became complex. The management system integrated form approach makes possible the compatibility of distinct and complementary interests from several functions and disciplines involved and supply the absence of the organizations' holistic approach. According to this integrated management approach, the Agency - 'International Atomic Energy Agency' (IAEA) - decided to review the structure of the 50-C-Q standard - 'Quality Assurance for Safety in Nuclear Power Plants and Other Nuclear Installations', from 1996, publishing in 2006 the new GS-R-3 standard - 'The Management System for Facilities and Activities - Safety Requirements'. This work presents a brief evolution of management standards and integrated management approach, showing the Agency's new vision concerning this issue with the GS-R-3 standard publication. (author)

Long-term functional outcome after type A3 spinal fractures : operative versus non-operative treatment

NARCIS (Netherlands)

Post, Richard B.; van der Sluis, Corry K.; Leferink, Vincent J. M.; ten Duis, Henk-Jan

The authors retrospectively studied, by questionnaires, the long-term (5 years) functional outcome after operative (posterior instrumentation : 38 cases) and non-operative treatment (25 cases) for type A3 spinal fractures (Comprehensive Classification) without neurological deficit. A possible bias

Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

Science.gov (United States)

Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J

2015-07-15

Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of $14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in $5900 and $800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a $100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle

Management system - correlation study between new IAEA standards and the market standards

Energy Technology Data Exchange (ETDEWEB)

Oliveira, Dirceu Paulo de [Centro Tecnologico da Marinha em Sao Paulo (CTMSP), Ipero, SP (Brazil)], e-mail: dirceupo@hotmail.com; Zouain, Desiree Moraes [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)], e-mail: dmzouain@ipen.br

2009-07-01

In order to answer the growing concern of society with respect of the aspects that affect the quality of life, international and national regulatory bodies have developed standards that enable organizations to establish management systems for quality, environment and sustainable development, health, safety and social responsibility, among other functions. Within this context it is necessary to structure an integrated management system that promotes interests compatibility of several distinct and complementary functions involved. Considering this vision of the management system integration, the International Atomic Energy Agency (IAEA) decided to review the structure of safety standards on Quality Assurance - code and guides 50-C/SGQ1/ 14:1996, publishing, in 2006, IAEA GS-R-3 and IAEA GS-G-3.1 standards, enlarging the management approach of the previous standards, including the possibility of integrating the functions foremost mentioned. This paper presents the results about a correlation study between IAEA management system standards - IAEA GS-R-3: 2006, IAEA GS-G-3.1: 2006 and IAEA DS349 rev. 2007, this latter still a draft standard, with those market management system standards on quality - ISO 9001:2008, environmental - ISO 14001:2004, and occupational health and safety - BS OHSAS 18001:2007, identifying gaps, redundancies and complementarities among their requirements and guidances. The purpose of the study is to provide subsidies that could contribute to the structuring of a management system to nuclear facilities that satisfies, in an integrated manner, the common and complementary requirements and guidances of IAEA and market standards. (author)

Management system - correlation study between new IAEA standards and the market standards

International Nuclear Information System (INIS)

Oliveira, Dirceu Paulo de; Zouain, Desiree Moraes

2009-01-01

In order to answer the growing concern of society with respect of the aspects that affect the quality of life, international and national regulatory bodies have developed standards that enable organizations to establish management systems for quality, environment and sustainable development, health, safety and social responsibility, among other functions. Within this context it is necessary to structure an integrated management system that promotes interests compatibility of several distinct and complementary functions involved. Considering this vision of the management system integration, the International Atomic Energy Agency (IAEA) decided to review the structure of safety standards on Quality Assurance - code and guides 50-C/SGQ1/ 14:1996, publishing, in 2006, IAEA GS-R-3 and IAEA GS-G-3.1 standards, enlarging the management approach of the previous standards, including the possibility of integrating the functions foremost mentioned. This paper presents the results about a correlation study between IAEA management system standards - IAEA GS-R-3: 2006, IAEA GS-G-3.1: 2006 and IAEA DS349 rev. 2007, this latter still a draft standard, with those market management system standards on quality - ISO 9001:2008, environmental - ISO 14001:2004, and occupational health and safety - BS OHSAS 18001:2007, identifying gaps, redundancies and complementarities among their requirements and guidances. The purpose of the study is to provide subsidies that could contribute to the structuring of a management system to nuclear facilities that satisfies, in an integrated manner, the common and complementary requirements and guidances of IAEA and market standards. (author)

48 CFR 970.3270 - Standard financial management clauses.

Science.gov (United States)

2010-10-01

... Standard financial management clauses. (a) The following DEAR and FAR clauses are standard financial... Accounting Standards. (b) The following DEAR clauses are standard financial management clauses. The... systems: (1) 970.5232-7, Financial management system. (2) 970.5232-8, Integrated accounting. (c) Any...

The standard for portfolio management

CERN Document Server

2017-01-01

The Standard for Portfolio Management – Fourth Edition has been updated to best reflect the current state of portfolio management. It describe the principles that drive accepted good portfolio management practices in today’s organizations. It also expands the description of portfolio management to reflect its relation to organizational project management and the organization.

Management plan for the Nuclear Standards Program

International Nuclear Information System (INIS)

1979-11-01

This Management Plan was prepared to describe the manner in which Oak Ridge National Laboratory will provide technical management of the Nuclear Standards Program. The organizational structure that has been established within ORNL for this function is the Nuclear Standards Management Center, which includes the Nuclear Standards Office (NSO) already in existence at ORNL. This plan is intended to support the policies and practices for the development and application of technical standards in ETN projects, programs, and technology developments as set forth in a standards policy memorandum from the DOE Program Director for Nuclear Energy

The role of kinesitherapy and electrotherapeutic procedures in non-operative management of patients with intermittent claudications.

Science.gov (United States)

Marković, Miroslav D; Marković, Danica M; Dragaš, Marko V; Končar, Igor B; Banzić, Igor L; Ille, Mihailo E; Davidović, Lazar B

2016-06-01

To examine the effects of physical therapy (kinesitherapy and electrotherapeutic procedures) on the course of peripheral arterial occlusive disease by monitoring the changes in values of claudication distance and ankle-brachial indexes. Prospective randomized study included 47 patients with peripheral arterial occlusive disease manifested by intermittent claudications associated with ankle-brachial indexes values ranging from 0.5 to 0.9. Patients from the first group (25 pts) were treated with medicamentous therapy, walking exercises beyond the pain threshold, dynamic low-burden kinesi exercises and electrotherapeutic ageneses (interference therapy, diadynamic therapy, and electromagnetic field), while the second group of patients (22 pts) was treated with "conventional" non-operative treatment - medicamentous therapy and walking exercises. The values of newly established absolute claudication distance and ankle-brachial indexes were measured. Significant increase of absolute claudication distance in both groups of patients was registered, independently of therapeutic protocol applied (p operative treatment of peripheral arterial occlusive disease patients, improving their functional ability and thus postponing surgical treatment. However, further investigations including larger number of patients are needed. © The Author(s) 2015.

Risk in Management Systems according to ISO standard

Directory of Open Access Journals (Sweden)

P. Królas

2010-07-01

Full Text Available The purpose of this article was to present selected management standards in context of risk management. It presents main ISOmanagement standards (ISO 9001, ISO 14001, OHSAS 18001, ISO 27001, BS 25999, ISO 31000 that apply to polish enterprises. In thefirst part of this article there are analyzed management standards regarding quality, environment, occupational health and safety,information security, as well as business continuity management and risk management. The second part of the article discusses the processof dealing with risk based on chosen management standard.

Study of International Standards of Risk Management

Directory of Open Access Journals (Sweden)

Dykan Volodymyr L.

2014-01-01

Full Text Available The goal of the article lies in the study of existing international standards of risk management, an important factor of improvement of risk management in domestic corporations and enterprises and development of recommendations on application of international standards in Ukraine, in particular, within the framework of building corporate systems of risk management. The conducted study shows that approaches on organisation of the process of risk management, used in standards of risk management, are of general character and differ with the degree of detailing. Their undoubted value in development of risk management in Ukraine is identification of a general direction of building corporate systems of risk management in practice. The said approaches at the national and corporate levels of standardisation in Ukraine within the framework of building corporate systems of risk management would allow improvement of risk management in corporations and enterprises. The prospect of further studies of domestic specialists in the field of risk management is development of the domestic standard of risk management with consideration of modern domestic specific features of development of risk management in Ukraine and leading foreign experience.

Performance standards of road safety management

Directory of Open Access Journals (Sweden)

Čabarkapa Milenko R.

2016-01-01

Full Text Available Road safety management controlling means the process of finding out the information whether the road safety is improving in a measure to achieve the objectives. The process of control consists of three basic elements: definition of performances and standards, measurement of current performances and comparison with the set standards, and improvement of current performances, if they deviate from the set standards. The performance standards of road safety management system are focused on a performances measurement, in terms of their design and characteristics, in order to support the performances improvement of road safety system and thus, ultimately, improve the road safety. Defining the performance standards of road safety management system, except that determines the design of the system for performances measurement, directly sets requirements whose fulfillment will produce a road safety improvement. The road safety management system, based on the performance standards of road safety, with a focus on results, will produce the continuous improvement of road safety, achieving the long-term 'vision zero', the philosophy of road safety, that human life and health take priority over mobility and other traffic objectives of the road traffic.

Nonoperative Treatment of Thoracic and Lumbar Spine Fractures : A Prospective Randomized Study of Different Treatment Options

NARCIS (Netherlands)

Stadhouder, Agnita; Buskens, Erik; Vergroesen, Diederik A.; Fidler, Malcolm W.; de Nies, Frank; Oner, F. C.

Objectives: To evaluate and compare nonoperative treatment methods for traumatic thoracic and lumbar compression fractures and burst fractures. Design: Prospective randomized controlled trial with long-term follow-up. Setting: Two general hospitals in the Netherlands. Patients/Participants: Patients

The role of splenic angioembolization as an adjunct to nonoperative management of blunt splenic injuries: A systematic review and meta-analysis.

Science.gov (United States)

Crichton, James Charles Ian; Naidoo, Kamil; Yet, Barbaros; Brundage, Susan I; Perkins, Zane

2017-11-01

Nonoperative management (NOM) of hemodynamically normal patients with blunt splenic injury (BSI) is the standard of care. Guidelines recommend additional splenic angioembolization (SAE) in patients with American Association for the Surgery of Trauma (AAST) Grade IV and Grade V BSI, but the role of SAE in Grade III injuries is unclear and controversial. The aim of this systematic review was to compare the safety and effectiveness of SAE as an adjunct to NOM versus NOM alone in adults with BSI. A systematic literature search (Medline, Embase, and CINAHL) was performed to identify original studies that compared outcomes in adult BSI patients treated with SAE or NOM alone. Primary outcome was failure of NOM. Secondary outcomes included morbidity, mortality, hospital length of stay, and transfusion requirements. Bayesian meta-analyses were used to calculate an absolute (risk difference) and relative (risk ratio [RR]) measure of treatment effect for each outcome. Twenty-three studies (6,684 patients) were included. For Grades I to V combined, there was no difference in NOM failure rate (SAE, 8.6% vs NOM, 7.7%; RR, 1.09 [0.80-1.51]; p = 0.28), mortality (SAE, 4.8% vs NOM, 5.8%; RR, 0.82 [0.45-1.31]; p = 0.81), hospital length of stay (11.3 vs 9.5 days; p = 0.06), or blood transfusion requirements (1.8 vs 1.7 units; p = 0.47) between patients treated with SAE and those treated with NOM alone. However, morbidity was significantly higher in patients treated with SAE (SAE, 38.1% vs NOM, 18.6%; RR, 1.83 [1.20-2.66]; p splenic injury, SAE significantly reduced the failure rate of NOM in patients with Grade IV and Grade V splenic injuries but had minimal effect in those with Grade I to Grade III injuries. Splenic angioembolization should be strongly considered as an adjunct to NOM in patients with AAST Grade IV and Grade V BSI but should not be routinely recommended in patients with AAST Grade I to Grade III injuries. Systematic review and meta-analysis, level III.

Selective angiographic embolization of blunt splenic traumatic injuries in adults decreases failure rate of nonoperative management.

Science.gov (United States)

Bhullar, Indermeet S; Frykberg, Eric R; Siragusa, Daniel; Chesire, David; Paul, Julia; Tepas, Joseph J; Kerwin, Andrew J

2012-05-01

To determine whether angioembolization (AE) in hemodynamically stable adult patients with blunt splenic trauma (BST) at high risk for failure of nonoperative management (NOM) (contrast blush [CB] on computed tomography, high-grade IV-V injuries, or decreasing hemoglobin) results in lower failure rates than reported. The records of patients with BST from July 2000 to December 2010 at a Level I trauma center were retrospectively reviewed using National Trauma Registry of the American College of Surgeons. Failure of NOM (FNOM) occurred if splenic surgery was required after attempted NOM. Logistic regression analysis was used to identify factors associated with FNOM. A total of 1,039 patients with BST were found. Pediatric patients (age <17 years), those who died in the emergency department, and those requiring immediate surgery for hemodynamic instability were excluded. Of the 539 (64% of all BST) hemodynamically stable patients who underwent NOM, 104 (19%) underwent AE and 435 (81%) were observed without AE (NO-AE). FNOM for the various groups were as follows: overall NOM (4%), NO-AE (4%), and AE (4%). There was no significant difference in FNOM for NO-AE versus AE for grades I to III: grade I (1% vs. 0%, p = 1), grade II (2% vs. 0%, p = 0.318), and grade III (5% vs. 0%, p = 0.562); however, a significant decrease in FNOM was noted with the addition of AE for grades IV to V: grade IV (23% vs. 3%, p = 0.04) and grade V (63% vs. 9%, p = 0.03). Statistically significant independent risk factors for FNOM were grade IV to V injuries and CB. Application of strictly defined selection criteria for NOM and AE in patients with BST resulted in one of the lowest overall FNOM rates (4%). Hemodynamically stable BST patients are candidates for NOM with selective AE for high-risk patients with grade IV to V injuries, CB on initial computed tomography, and/or decreasing hemoglobin levels. III, therapeutic study.

Developing and enforcing internal information systems standards: InduMaker’s Standards Management Process

Directory of Open Access Journals (Sweden)

Claudia Loebbecke

2016-01-01

Full Text Available It is widely agreed that standards provide numerous benefits when available and enforced. Company-internal Information Systems (IS management procedures and solutions, in the following coined IS ‘standards’, allow for harmonizing operations between company units, locations and even different service providers. However, many companies lack an organized process for defining and managing internal IS standards, which causes uncertainties and delays in decision making, planning, and design processes. In this case study of the globally operating InduMaker (anonymized company name, an established manufacturing supplier, we look into the company-internal management of IS standards. Theoretically grounded in the organizational and IS-focused literature on business process modelling and business process commoditization, we describe and investigate InduMaker’s newly developed Standard Management Process (SMP for defining and managing company-internal business and IS standards, with which the multinational pursues offering clear answers to business and IT departments about existing IS standards, their degree of obligation, applicability, and scope at any time.

Management of isolated splenic injuries after blunt trauma: an institution's experience over 6 years.

Science.gov (United States)

Tan, K K; Chiu, M T; Vijayan, A

2010-12-01

Forty-two patients with traumatic blunt splenic injuries were admitted over a six year period. Vehicular-related collisions and fall from height accounted for the injuries in 38 (90.5%) of them. Eleven (26.2%) underwent immediate surgery (7 splenectomy and 4 splenorrhaphy), while the remaining 31 patients were treated nonoperatively of which 3 underwent angio-embolisation. Twenty seven patients had either grade III or IV splenic injuries. Operative management was more likely in patients with lower haemoglobin or with more severe splenic injury. Nonoperative management can be adopted in patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances.

Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

Directory of Open Access Journals (Sweden)

Ackerman SJ

2013-11-01

Full Text Available Stacey J Ackerman1, David W Polly Jr2, Tyler Knight3, Karen Schneider4, Tim Holt5, John Cummings61Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Covance Market Access Services Inc, Sydney, NSW, Australia; 5Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USAIntroduction: The economic burden associated with the treatment of low back pain (LBP in the United States is significant. LBP caused by sacroiliac (SI joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS options may offer potential cost savings to Medicare.Methods: An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG payments of $46,700 (with major complications - DRG 459 and $27,800 (without major complications - DRG 460, weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were

Optimization and standardization of pavement management processes.

Science.gov (United States)

2004-08-01

This report addresses issues related to optimization and standardization of current pavement management processes in Kentucky. Historical pavement management records were analyzed, which indicates that standardization is necessary in future pavement ...

A Critical Review: Management and Surgical Options for Articular Defects in the Hip.

Science.gov (United States)

Makhni, Eric C; Stone, Austin V; Ukwuani, Gift C; Zuke, William; Garabekyan, Tigran; Mei-Dan, Omer; Nho, Shane J

2017-07-01

Patients with articular cartilage lesions of the hip may present with pain and symptoms that may be vague in nature and onset. Therefore, a thorough history and physical examination should be performed for every patient presenting with hip pain and/or disability. The management may be operative or nonoperative. Nonoperative management includes a trial of rest and/or activity modification, along with anti-inflammatory medications, physical therapy, and biologic injections. Operative treatment in the form of arthroscopic techniques continues to decrease morbidity and offer innovative solutions and new applications for microfracture, ACT, and AMIC. Copyright © 2017 Elsevier Inc. All rights reserved.

77 FR 33950 - Prudential Management and Operations Standards

Science.gov (United States)

2012-06-08

... FEDERAL HOUSING FINANCE AGENCY 12 CFR Part 1236 RIN 2590-AA13 Prudential Management and Operations... establish prudential standards (Standards) relating to the management and operations of the Federal National... establish other appropriate management and operations standards. 12 U.S.C. 4513b(a)(11). \\1\\ The authorizing...

Management of liver trauma

Directory of Open Access Journals (Sweden)

Hanan M Alghamdi

2017-01-01

Full Text Available In the last 30 years, the management of liver injury has evolved significantly. The advancement of imaging studies has played an important role in the conservative approach for management. A shift from operative to nonoperative management for most hemodynamically stable patients with hepatic injury has been prompted by speed and sensitivity of diagnostic imaging and by advances in critical care monitoring. In this review article, the up-to-date recommendation on the management approach of liver trauma will be discussed.

Non-operative treatment of a fracture to the coracoid process with acromioclavicular dislocation in an adolescent

Directory of Open Access Journals (Sweden)

Vera Pedersen

2014-08-01

Full Text Available Coracoid process fractures are rare and often associated with dislocations of the acromioclavicular (AC joint. There is little evidence about the treatment of these injuries in adolescents, but the few case reports published recommend surgery. We report a case of a dislocated epiphyseal fracture to the base of the coracoid process with AC joint dislocation in a 14-year-old ice-hockey player following direct impact to his left shoulder. Since magnetic resonance tomography revealed intact AC and coracoclavicular ligaments, we initiated non-operative treatment with immobilization and unloading of the shoulder by an abduction brace allowing limited rotation for 6 weeks. This treatment resulted in complete recovery after 8 weeks and return to full sports on first league level after 3 month. In conclusion, non-operative treatment of coracoid base fractures with concomitant AC-joint injury in the adolescent can result in excellent functional results and early recovery.

The standard for program management

CERN Document Server

2017-01-01

The Standard for Program Management – Fourth Edition differs from prior editions by focusing on the principles of good program management. Program activities have been realigned to program lifecycle phases rather than topics, and the first section was expanded to address the key roles of program manager, program sponsor and program management office. It has also been updated to better align with PMI’s Governance of Portfolios, Programs, and Projects: A Practice Guide.

Discussion on enterprise technical standard management work

International Nuclear Information System (INIS)

Li Xinyou

2010-01-01

The technical standard management is an important part of enterprise information work, also the basis of enterprise standardization work. Only by rational and orderly management, can it exert maximum effectiveness, provide reliable support for the production and business of enterprise. (author)

New standard environmental management

International Nuclear Information System (INIS)

Andriola, Luca; Luciani, Roberto

2006-01-01

The ISO 14001:2004 standard, like ISO 9001:2000 on quality management, transcends the preventive approach (based on a rigid and more or less adequate process-management model still mainly inspired by traditional production methods) and introduces in its stead a highly flexible approach applicable to any socio-economic activity. It is structured by processes rather than system elements, and is based on the quest for efficacy and ongoing improvement [it

Intra-abdominal solid organ injuries: an enhanced management algorithm.

Science.gov (United States)

Kokabi, Nima; Shuaib, Waqas; Xing, Minzhi; Harmouche, Elie; Wilson, Kenneth; Johnson, Jamlik-Omari; Khosa, Faisal

2014-11-01

The organ injury scale grading system proposed by the American Association for the Surgery of Trauma provides guidelines for operative versus nonoperative management in solid organ injuries; however, major shortcomings of the American Association for the Surgery of Trauma injury scale may become apparent with low-grade injuries, in which conservative management may fail. Nonoperative management of common intra-abdominal solid organ injuries relies increasingly on computed tomographic findings and other clinical factors, including patient age, presence of concurrent injuries, and serial clinical assessments. Familiarity with characteristic imaging features is essential for the prompt diagnosis and appropriate treatment of blunt abdominal trauma. In this pictorial essay, the spectrum of the American Association for the Surgery of Trauma organ injury scale grading system is illustrated, and a multidisciplinary management algorithm for common intra-abdominal solid organ injuries is proposed. Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.

Science.gov (United States)

Boorman, Richard S; More, Kristie D; Hollinshead, Robert M; Wiley, James P; Mohtadi, Nicholas G; Lo, Ian K Y; Brett, Kelly R

2018-03-01

The purpose of this study was to examine 5-year outcomes in a prospective cohort of patients previously enrolled in a nonoperative rotator cuff tear treatment program. Patients with chronic (>3 months), full-thickness rotator cuff tears (demonstrated on imaging) who were referred to 1 of 2 senior shoulder surgeons were enrolled in the study between October 2008 and September 2010. They participated in a comprehensive, nonoperative, home-based treatment program. After 3 months, the outcome in these patients was defined as "successful" or "failed." Patients in the successful group were essentially asymptomatic and did not require surgery. Patients in the failed group were symptomatic and consented to undergo surgical repair. All patients were followed up at 1 year, 2 years, and 5 or more years. At 5 or more years, all patients were contacted for follow-up; the response rate was 84%. Approximately 75% of patients remained successfully treated with nonoperative treatment at 5 years and reported a mean rotator cuff quality-of-life index score of 83 of 100 (SD, 16). Furthermore, between 2 and 5 years, only 3 patients who had previously been defined as having a successful outcome became more symptomatic and underwent surgical rotator cuff repair. Those in whom nonoperative treatment had failed and who underwent surgical repair had a mean rotator cuff quality-of-life index score of 89 (SD, 11) at 5-year follow-up. The operative and nonoperative groups at 5-year follow-up were not significantly different (P = .11). Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management

Science.gov (United States)

Panteliadis, Pavlos; Nagra, Navraj S.; Edwards, Kimberley L.; Behrbalk, Eyal; Boszczyk, Bronek

2016-01-01

Study Design  Narrative review. Objective  The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. Methods  The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term “spondylolysis AND athlete.” The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. Results  Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. Conclusion  There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis. PMID:27556003

76 FR 35791 - Prudential Management and Operations Standards

Science.gov (United States)

2011-06-20

... FEDERAL HOUSING FINANCE AGENCY 12 CFR Part 1236 RIN 2590-AA13 Prudential Management and Operations... (FHFA) to establish prudential standards relating to the management and operations of the Federal... to establish standards that address 10 separate areas relating to the management and operation of the...

7 CFR 3016.20 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Standards for financial management systems. 3016.20... Standards for financial management systems. (a) A State must expand and account for grant funds in... financial management systems of other grantees and subgrantees must meet the following standards: (1...

7 CFR 277.6 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Standards for financial management systems. 277.6... ADMINISTRATIVE COSTS OF STATE AGENCIES § 277.6 Standards for financial management systems. (a) General. This section prescribes standards for financial management systems in administering program funds by the State...

44 CFR 13.20 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Standards for financial... Standards for financial management systems. (a) A State must expand and account for grant funds in... financial management systems of other grantees and subgrantees must meet the following standards: (1...

Nonoperative dynamic treatment of acute achilles tendon rupture

DEFF Research Database (Denmark)

Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Bloch Lauridsen, Hanne

2014-01-01

BACKGROUND: Dynamic rehabilitation has been suggested to be an important part of nonoperative treatment of acute Achilles tendon rupture that results in functional outcome and rerupture rates comparable with those of operative treatment. However, the optimal role of weight-bearing during early re...... Score (ATRS) after one year. Secondary outcomes included heel-rise work, health-related quality of life, and the rerupture rate. Outcome assessors were blinded to the intervention. RESULTS: Thirty patients were randomized to each group; twenty-nine in the weight-bearing group and twenty......, the total heel-rise work performed by the injured limb relative to that by the uninjured limb was 53% in the weight-bearing group and 58% in the control group (p = 0.37). There were three reruptures in the weight-bearing group and two in the control group (p = 1.0). CONCLUSIONS: The ATRS and heel-rise work...

Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

Directory of Open Access Journals (Sweden)

Ackerman SJ

2014-02-01

Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Tim Holt,4 John Cummings5 1Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 5Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and originates in the sacroiliac (SI joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US. Methods: A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3, an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date, and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results: The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592 per privately-insured patient (N=78,533. Among patients with lumbar spinal fusion (N=434, attributable 3-year

Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

Science.gov (United States)

Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

2014-01-01

Introduction Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI) joint (15%–30% of cases) is commonly treated with nonoperative care, but new minimally invasive surgery (MIS) options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication) were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier’s Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results The cumulative 3-year (base-case analysis) and 5-year (sensitivity analysis) differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS) were $14,545 and $6,137 per patient, respectively (2012 US dollars). Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality was achieved in year 1. Conclusion Cost offsets from new interventions for chronic conditions such as MIS SI joint fusion accrue over time. Higher initial procedure costs for MIS were largely offset by decreased nonoperative care costs over a 5-year time horizon. Optimizing effective resource use in both nonoperative and operative patients will facilitate cost-effective health care delivery. The impact of SI joint disruption on direct and indirect costs to commercial insurers, health

29 CFR 97.20 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Standards for financial management systems. 97.20 Section 97... Standards for financial management systems. (a) A State must expand and account for grant funds in... financial management systems of other grantees and subgrantees must meet the following standards: (1...

Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials.

Science.gov (United States)

Coughlin, T A; Ng, J W G; Rollins, K E; Forward, D P; Ollivere, B J

2016-08-01

Flail chest from a blunt injury to the thorax is associated with significant morbidity and mortality. Its management globally is predominantly non-operative; however, there are an increasing number of centres which undertake surgical stabilisation. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management. A systematic search of the literature was carried out to identify randomised controlled trials (RCTs) which compared the clinical outcome of patients with a traumatic flail chest treated by surgical stabilisation of any kind with that of non-operative management. Of 1273 papers identified, three RCTs reported the results of 123 patients with a flail chest. Surgical stabilisation was associated with a two thirds reduction in the incidence of pneumonia when compared with non-operative management (risk ratio 0.36, 95% confidence interval (CI) 0.15 to 0.85, p = 0.02). The duration of mechanical ventilation (mean difference -6.30 days, 95% CI -12.16 to -0.43, p = 0.04) and length of stay in an intensive care unit (mean difference -6.46 days, 95% CI 9.73 to -3.19, p = 0.0001) were significantly shorter in the operative group, as was the overall length of stay in hospital (mean difference -11.39, 95% CI -12.39 to -10.38, p < 0.0001). Surgical stabilisation for a traumatic flail chest is associated with significant clinical benefits in this meta-analysis of three relatively small RCTs. Cite this article: Bone Joint J 2016;98-B:1119-25. ©2016 The British Editorial Society of Bone & Joint Surgery.

34 CFR 74.21 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Standards for financial management systems. 74.21... Requirements Financial and Program Management § 74.21 Standards for financial management systems. (a... practical. (b) Recipients' financial management systems shall provide for the following: (1) Accurate...

32 CFR 34.11 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Standards for financial management systems. 34... ORGANIZATIONS Post-award Requirements Financial and Program Management § 34.11 Standards for financial management systems. (a) Recipients shall be allowed and encouraged to use existing financial management...

22 CFR 145.21 - Standards for financial management systems.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Standards for financial management systems. 145... Financial and Program Management § 145.21 Standards for financial management systems. (a) The Department... whenever practical. (b) Recipients' financial management systems shall provide for the following. (1...

24 CFR 84.21 - Standards for financial management systems.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Standards for financial management... and Program Management § 84.21 Standards for financial management systems. (a) HUD shall require.... (b) Recipients' financial management systems shall provide for the following: (1) Accurate, current...

7 CFR 3019.21 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Standards for financial management systems. 3019.21... Requirements Financial and Program Management § 3019.21 Standards for financial management systems. (a) Federal... cost information whenever practical. (b) Recipients' financial management systems shall provide for the...

2 CFR 215.21 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... 2 Grants and Agreements 1 2010-01-01 2010-01-01 false Standards for financial management systems... Financial and Program Management § 215.21 Standards for financial management systems. (a) Federal awarding... information whenever practical. (b) Recipients' financial management systems shall provide for the following...

The Role of Diagnostic Algorithms in the Management of Blunt Splenic Injury

Directory of Open Access Journals (Sweden)

Liang-Yu Chen

2005-08-01

Conclusion: Diagnostic algorithms using sonograms for screening provide an initial means of selecting patients for NOM. Patients with higher grades of splenic injury can then be managed non-operatively.

40 CFR 30.21 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Standards for financial management... Program Management § 30.21 Standards for financial management systems. (a) EPA shall require recipients to...) Recipients' financial management systems shall provide for the following. (1) Accurate, current and complete...

32 CFR 32.21 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Standards for financial management systems. 32... Program Management § 32.21 Standards for financial management systems. (a) DoD Components shall require... unit cost information. (b) Recipients' financial management systems shall provide for the following. (1...

29 CFR 95.21 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Standards for financial management systems. 95.21 Section 95... Requirements Financial and Program Management § 95.21 Standards for financial management systems. (a... practical. (b) Recipients' financial management systems shall provide for the following: (1) Accurate...

45 CFR 74.21 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Standards for financial management systems. 74.21... Management § 74.21 Standards for financial management systems. (a) Recipients shall relate financial data to... cost information is usually not appropriate. (b) Recipients' financial management systems shall provide...

Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis

Science.gov (United States)

Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

2016-01-01

Abstract The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively. We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis. Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach. In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

Nonoperative Management of Splenic Injury in Combat: 2002-2012

Science.gov (United States)

2015-03-01

recognized as the defini- tive treatment for splenic injury when Dr. Johnston reported 150 splenectomies for trauma in 1908.4 However, in 1968, Upadhyaya...management safe and effective for all splenic blunt trauma ? A systematic review. Crit Care 2013; 17(5): R185. 6. Joint Theater Trauma System Clinical Practice...2014. 7. Zonies D, Eastridge B: Combat management of splenic injury: trends during a decade of conflict. J Trauma Acute Care Surg 2012; 73(2 Suppl 1

The pattern and management outcomes of splenic injuries in the ...

African Journals Online (AJOL)

Background: In the last decade or so, the management of splenic injuries has undergone a lot of debate and changes including refinement of the indications for non-operative management (NOM). The aims of this retrospective study are: to characterize the pattern of splenic injuries in the Abha region of Saudi Arabia; ...

20 CFR 435.21 - Standards for financial management systems.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Standards for financial management systems... ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Financial and Program Management § 435.21 Standards for financial management systems. (a) Introduction. SSA requires recipients to relate financial...

28 CFR 70.21 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Standards for financial management..., HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Financial and Program Management § 70.21 Standards for financial management systems. (a) Recipients must relate financial data to...

Progression of Carpal Tunnel Syndrome According to Electrodiagnostic Testing in Nonoperatively Treated Patients

Directory of Open Access Journals (Sweden)

Mark van Suchtelen

2014-09-01

Full Text Available Background:  This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS over time according to median nerve distal motor latency (DML on two electrodiagnostic tests.   Methods:  This retrospective study analyzed sixty-two adult nonoperatively treated patients who were diagnosed with CTS confirmed by a minimum of two electrodiagnostic tests at our institution between December 2006 and  tober 2012. A Wilcoxon signed-rank test was conducted to test the difference between electrodiagnostic measurements between the first and last test. Results: The mean time between the first and last electrodiagnostic test was 26±12 months (range, 12 to 55 months. The only electrodiagnostic measurement that increased significantly was the difference between median and ulnar DML on the same side (r=0.19, P =0.038. The time between the electrodiagnostic tests was significantly longer for patients with at least 10% worsening of the DML at the second test compared to cases of which the DML did not worsen or improve a minimum of 10% (P =0.015.  Conclusions: There is evidence that—on average—idiopathic median neuropathy at the carpal tunnel slowly progresses over time, and this can be measured with electrodiagnostics, but studies with a much longer interval between lectrodiagnostic tests may be needed to determine if it always progresses.

Non-operative management of blunt trauma in abdominal solid organ injuries: a prospective study to evaluate the success rate and predictive factors of failure.

Science.gov (United States)

Hashemzadeh, S H; Hashemzadeh, K H; Dehdilani, M; Rezaei, S

2010-06-01

Over the past several years, non-operative management (NOM) has increasingly been recommended for the care of selected blunt abdominal solid organ injuries. No prospective study has evaluated the rate of NOM of blunt abdominal trauma in the northwest of Iran. The objective of our study was to evaluate the success rate of this kind of management in patients who do not require emergency surgery. This prospective study was carried out in Imam Khomeini Hospital (as a referral center of trauma) at Tabriz University of Medical Sciences, Iran, between 20 March 2004 and 20 March 2007. All trauma patients who had suffered an injury to a solid abdominal organ (kidney, liver, or spleen) were selected for initial analysis, using the Student's t test or the c2 test. During the three years of the study, 98 patients (83 males and 15 females) with blunt trauma were selected to NOM for renal, hepatic and splenic injuries. Mean age was 26.1+/-17.7 years (range, 2 to 89) and mean injury severity score (ISS) was 14.5+/-7.4. The success rate of NOM was 93.8%. Fifty-one patients (43 males, 8 females; mean ISS, 14.2+/-5.8) underwent NOM of splenic trauma; 38 patients (33 males, 5 females; mean ISS, 12.9+/-8.2) hepatic trauma, and nine patients (7 males, 2 females; mean ISS, 22.2+/-7.6) renal trauma. Six patients underwent laparotomy due to the failure of NOM. The success rates of this treatment were 94.1%, 94.7% and 88.8% for the spleen, liver and kidney injuries, respectively. Age, female gender and ISS were significant predictors of the failure of NOM (Ptrauma. The study indicates that the rates of NOM vary in relation to the severity of the organ injury. This suggests trauma centers should use this approach.

A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability

DEFF Research Database (Denmark)

Eshoj, Henrik; Rasmussen, Sten; Frich, Lars Henrik

2017-01-01

BACKGROUND: Anterior shoulder dislocation is a common injury and may have considerable impact on shoulder-related quality of life (QoL). If not warranted for initial stabilising surgery, patients are mostly left with little to no post-traumatic rehabilitation. This may be due to lack of evidence......-based exercise programmes. In similar, high-impact injuries (e.g. anterior cruciate ligament tears in the knee) neuromuscular exercise has shown large success in improving physical function and QoL. Thus, the objective of this trial is to compare a nonoperative neuromuscular exercise shoulder programme...... dislocations due to at least one traumatic event will be randomised to 12 weeks of either a standardised, individualised or physiotherapist-supervised neuromuscular shoulder exercise programme or standard care (self-managed shoulder exercise programme). Patients will be stratified according to injury status...

49 CFR 19.21 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Standards for financial management systems. 19.21... ORGANIZATIONS Post-Award Requirements § 19.21 Standards for financial management systems. (a) Federal awarding... information whenever practical. (b) Recipients' financial management systems shall provide for the following...

43 CFR 12.921 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Standards for financial management systems... Organizations Post-Award Requirements § 12.921 Standards for financial management systems. (a) Federal awarding... information whenever practical. (b) Recipients' financial management systems shall provide for the following...

29 CFR 1470.20 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Standards for financial management systems. 1470.20 Section... Post-Award Requirements Financial Administration § 1470.20 Standards for financial management systems... the restrictions and prohibitions of applicable statutes. (b) The financial management systems of...

45 CFR 2543.21 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Standards for financial management systems. 2543... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Financial and Program Management § 2543.21 Standards for financial management systems. (a) Federal awarding agencies shall require recipients to relate...

15 CFR 14.21 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Standards for financial management...-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Financial and Program Management § 14.21 Standards for financial management systems. (a) The Grants Officer shall require recipients to relate...

38 CFR 49.21 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... Program Management § 49.21 Standards for financial management systems. (a) Federal awarding agencies shall... practical. (b) Recipients' financial management systems shall provide for the following. (1) Accurate... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Standards for financial...

22 CFR 518.21 - Standards for financial management systems.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Standards for financial management systems. 518... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 518.21 Standards for financial management systems. (a) Federal awarding agencies shall require recipients to relate financial data to...

36 CFR 1210.21 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... Program Management § 1210.21 Standards for financial management systems. (a) The NHPRC shall require.... (b) Recipients' financial management systems shall provide for the following. (1) Accurate, current... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Standards for financial...

45 CFR 2541.200 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Standards for financial management systems. 2541... STATE AND LOCAL GOVERNMENTS Post-Award Requirements § 2541.200 Standards for financial management... violation of the restrictions and prohibitions of applicable statutes. (b) The financial management systems...

Risk Management Standards: Towards a contemporary, organisation-wide management approach

OpenAIRE

Koutsoukis, Nikitas-Spiros

2010-01-01

Risk management has been progressively evolving into a systemic approach for organisational decision making in today’s dynamic economic environment of the global era. In this context, risk management is reaching beyond its traditional finance and insurance application context and is entering the sphere of generic, organisation-wide management approaches. In support of this argument we consider four generic risk management standards issued at the institutional, national or international level...

34 CFR 80.20 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Standards for financial management systems. 80.20... Financial Administration § 80.20 Standards for financial management systems. (a) A State must expand and... of applicable statutes. (b) The financial management systems of other grantees and subgrantees must...

20 CFR 437.20 - Standards for financial management systems.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Standards for financial management systems... Financial Administration § 437.20 Standards for financial management systems. (a) A State must expend and... of applicable statutes. (b) The financial management systems of other grantees and subgrantees must...

10 CFR 600.311 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Standards for financial management systems. 600.311... Requirements § 600.311 Standards for financial management systems. (a) Recipients are encouraged to use existing financial management systems to the extent that the systems comply with Generally Accepted...

22 CFR 226.21 - Standards for financial management systems.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Standards for financial management systems. 226... AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Financial and Program Management § 226.21 Standards for financial management systems. (a) Recipients shall relate financial data to...

45 CFR 1183.20 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Standards for financial management systems. 1183... Financial Administration § 1183.20 Standards for financial management systems. (a) A State must expand and... of applicable statutes. (b) The financial management systems of other grantees and subgrantees must...

14 CFR 1260.121 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Standards for financial management systems... Requirements § 1260.121 Standards for financial management systems. (a) Recipients shall relate financial data...) Recipients' financial management systems shall provide for the following. (1) Accurate, current and complete...

22 CFR 135.20 - Standards for financial management systems.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Standards for financial management systems. 135... Financial Administration § 135.20 Standards for financial management systems. (a) A State must expand and... of applicable statutes. (b) The financial management systems of other grantees and subgrantees must...

45 CFR 1174.20 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Standards for financial management systems. 1174... Financial Administration § 1174.20 Standards for financial management systems. (a) A State must expand and... of applicable statutes. (b) The financial management systems of other grantees and subgrantees must...

21 CFR 1403.20 - Standards for financial management systems.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Standards for financial management systems. 1403... Financial Administration § 1403.20 Standards for financial management systems. (a) A State must expend and... of applicable statutes. (b) The financial management systems of other grantees and subgrantees must...

40 CFR 35.6270 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Standards for financial management... § 35.6270 Standards for financial management systems. (a) Accounting system standards—(1) General. The... of the adequacy of the financial management system as described in 40 CFR 31.20(c). (2) Allowable...

45 CFR 1157.20 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Standards for financial management systems. 1157... Administration § 1157.20 Standards for financial management systems. (a) A State must expand and account for... statutes. (b) The financial management systems of other grantees and subgrantees must meet the following...

32 CFR 33.20 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Standards for financial management systems. 33... financial management systems. (a) A State must expand and account for grant funds in accordance with State... management systems of other grantees and subgrantees must meet the following standards: (1) Financial...

24 CFR 85.20 - Standards for financial management systems.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Standards for financial management... Administration § 85.20 Standards for financial management systems. (a) A State must expand and account for grant... statutes. (b) The financial management systems of other grantees and subgrantees must meet the following...

49 CFR 18.20 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Standards for financial management systems. 18.20... Administration § 18.20 Standards for financial management systems. (a) A State must expand and account for grant... statutes. (b) The financial management systems of other grantees and subgrantees must meet the following...

7 CFR 205.271 - Facility pest management practice standard.

Science.gov (United States)

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Facility pest management practice standard. 205.271... Requirements § 205.271 Facility pest management practice standard. (a) The producer or handler of an organic facility must use management practices to prevent pests, including but not limited to: (1) Removal of pest...

Managing the financial cost of exception to contracting standards

DEFF Research Database (Denmark)

Henschel, Rene Franz

2008-01-01

In managing financial cost of exception to contracting standards, the first step is to put up an intelligent contract standards exception monitoring system The next step is to maintain tailor-made, fair and transparent contracting standards The third step is to eliminate unnecessary information...... and repetitiveness in contracting standards The fourth step is to enable your organization and the customers or suppliers to handle the necessary exceptions themselves Finally you should consider the use of independent contracting standards and elimination of your own standards as a tool in managing the cost...

Safety standards of IAEA for management systems

International Nuclear Information System (INIS)

Vincze, P.

2005-01-01

IAEA has developed a new series of safety standards which are assigned for constitution of the conditions and which give the instruction for setting up the management systems that integrate the aims of safety, health, life environment and quality. The new standard shall replace IAEA 50-C-Q - Requirements for security of the quality for safety in nuclear power plants and other nuclear facilities as well as 14 related safety instructions mentioned in the Safety series No. 50-C/SG-Q (1996). When developing of this complex, integrated set of requirements for management systems, the IAEA requirements 50-C-Q (1996) were taken into consideration as well as the publications developed within the International organisation for standardization (ISO) ISO 9001:2000 and ISO14001: 1996. The experience of European Union member states during the development, implementation and improvement of the management systems were also taken into consideration

41 CFR 105-72.301 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Standards for financial... Management § 105-72.301 Standards for financial management systems. (a) Federal awarding agencies shall... practical. (b) Recipients' financial management systems shall provide for the following. (1) Accurate...

Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology

Directory of Open Access Journals (Sweden)

Ackerman SJ

2014-05-01

Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Karen Schneider,4 Tim Holt,5 John Cummings Jr6 1Covance Market Access Services Inc., San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc., Gaithersburg, MD, USA; 4Covance Market Access Services Inc., Sydney, Australia; 5Montgomery Spine Center, Orthopedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI joint (15%–30% of cases is commonly treated with nonoperative care, but new minimally invasive surgery (MIS options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods: An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier's Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results: The cumulative 3-year (base-case analysis and 5-year (sensitivity analysis differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS were $14,545 and $6,137 per patient, respectively (2012 US dollars. Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality

Development of the private practice management standards for psychology.

Science.gov (United States)

Mathews, Rebecca; Stokes, David; Littlefield, Lyn; Collins, Leah

2011-01-01

This paper describes the process of developing a set of private practice management standards to support Australian psychologists and promote high quality services to the public. A review of the literature was conducted to identify management standards relevant to psychology, which were further developed in consultation with a panel of experts in psychology or in the development of standards. Forty-three psychologists in independent private practice took part in either a survey (n=22) to provide feedback on the relevance of, and their compliance with, the identified standards, or a 6-month pilot study (n=21) in which a web-based self-assessment instrument evaluating the final set of standards and performance indicators was implemented in their practice to investigate self-reported change in management procedures. The pilot study demonstrated good outcomes for practitioners when evaluation of compliance to the standards was operationalized in a self-assessment format. Study results are based on a small sample size. Nevertheless, relevance and utility of the standards was found providing an initial version of management standards that have relevance to the practice of psychology in Australia, along with a system for evaluating psychological service provision to ensure best practice in service delivery. © 2010 National Association for Healthcare Quality.

Paediatric interventional radiology

African Journals Online (AJOL)

2016-06-29

Jun 29, 2016 ... Non-operative management is the standard of care in children with blunt solid ... treatment of choice in children with extensive deep venous ... thrombosis. An IVC .... children, a paediatric nurse comfortable with administering.

Evaluation and Management of Elbow Tendinopathy

Science.gov (United States)

Taylor, Samuel A.; Hannafin, Jo A.

2012-01-01

Context: Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations. Evidence Acquisitions: The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy. Results: Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments. Conclusions: Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury. PMID:23016111

Treatment of thoraco-lumbar curves in adolescent females affected by idiopathic scoliosis with a progressive action short brace (PASB: assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria

Directory of Open Access Journals (Sweden)

Perisano Carlo

2009-09-01

Full Text Available Abstract Background The effectiveness of conservative treatment of scoliosis is controversial. Some studies suggest that brace is effective in stopping curve progression, whilst others did not report such an effect. The purpose of the present study was to effectiveness of Progressive Action Short Brace (PASB in the correction of thoraco-lumbar curves, in agreement with the Scoliosis Research Society (SRS Committee on Bracing and Nonoperative Management Standardisation Criteria. Methods Fifty adolescent females (mean age 11.8 ± 0.5 years with thoraco-lumbar curve and a pre-treatment Risser score ranging from 0 to 2 have been enrolled. The minimum duration of follow-up was 24 months (mean: 55.4 ± 44.5 months. Antero-posterior radiographs were used to estimate the curve magnitude (CM and the torsion of the apical vertebra (TA at 5 time points: beginning of treatment (t1, one year after the beginning of treatment (t2, intermediate time between t1 and t4 (t3, end of weaning (t4, 2-year minimum follow-up from t4 (t5. Three situations were distinguished: curve correction, curve stabilisation and curve progression. The Kruskal Wallis and Spearman Rank Correlation tests have been used as statistical tests. Results CM mean value was 29,30 ± 5,16 SD at t1 and 14,67 ± 7,65 SD at t5. TA was 12.70 ± 6,14 SD at t1 and 8,95 ± 5,82 at t5. The variation between measures of Cobb and Perdriolle degrees at t1,2,3,4,5 and between CM t5-t1 and TA t5-t1 were significantly different. Curve correction was accomplished in 94% of patients, whereas a curve stabilisation was obtained in 6% of patients. Conclusion The PASB, due to its peculiar biomechanical action on vertebral modelling, is highly effective in correcting thoraco-lumbar curves.

24 CFR 902.43 - Management operations performance standards.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Management operations performance... URBAN DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM PHAS Indicator #3: Management Operations § 902.43 Management operations performance standards. (a) Management operations sub-indicators. The following sub...

Future directions in combined modality therapy for rectal cancer: reevaluating the role of total mesorectal excision after chemoradiotherapy

Directory of Open Access Journals (Sweden)

Solanki AA

2013-08-01

Full Text Available Abhishek A Solanki,1 Daniel T Chang,2 Stanley L Liauw11Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA; 2Department of Radiation Oncology, Stanford University, Stanford, CA, USAAbstract: Most patients who develop rectal cancer present with locoregionally advanced (T3 or node-positive disease. The standard management of locoregionally advanced rectal cancer is neoadjuvant concurrent chemoradiotherapy (nCRT, followed by radical resection (low-anterior resection or abdominoperineal resection with total mesorectal excision. Approximately 15% of patients can have a pathologic complete response (pCR at the time of surgery, indicating that some patients can have no detectable residual disease after nCRT. The actual benefit of surgery in this group of patients is unclear. It is possible that omission of surgery in these patients, termed selective nonoperative management, can limit the toxicities associated with standard, multimodal combined modality therapy without compromising disease control. In this review, we discuss the clinical experiences to date using selective nonoperative management and various attempts at escalation of nCRT to improve the number of patients who have a pCR. We also explore several clinical, laboratory, imaging, histopathologic, and genetic biomarkers that have been tested as tools to predict which patients are most likely to have a pCR after nCRT.Keywords: rectal cancer, chemoradiotherapy, total mesorectal excision, nonoperative management, organ preservation

Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries

NARCIS (Netherlands)

Mulders, M. A. M.; van Eerten, P. V.; Goslings, J. C.; Schep, N. W. L.

2017-01-01

Background: Although secondary displacement following closed reduction and plaster immobilisation is high, several guidelines still recommend non-operative treatment for displaced distal radius fractures with an adequate closed reduction. Purpose: The purpose of this study was to evaluate functional

ISO 9001:2000--setting the standard for quality management.

Science.gov (United States)

Edelstein, M E

2001-04-01

How will you approach the next quality management initiative? This article offers an introduction to the ISO 9001:2000 quality management system standards that can be applied to the HIM industry and how these standards can improve your department's policies and procedures.

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

Science.gov (United States)

van Delden, Otto M.; Punt, Bastiaan J.; Ponsen, Kees J.; Reekers, Jim A.; Goslings, J. Carel

2010-01-01

Introduction The spleen is the second most frequently injured organ following blunt abdominal trauma. Trends in management have changed over the years. Traditionally, laparotomy and splenectomy was the standard management. Presently, nonoperative management (NOM) of splenic injury is the most common management strategy in hemodynamically stable patients. Splenic injuries can be managed via simple observation (OBS) or with angiography and embolization (AE). Angio-embolization has shown to be a valuable alternative to observational management and has increased the success rate of nonoperative management in many series. Diagnostics Improved imaging techniques and advances in interventional radiology have led to a better selection of patients who are amenable to nonoperative management. Despite this, there is still a lot of debate about which patients are prone to NOM. Angiography and Embolization The optimal patient selection is still a matter of debate and the role of CT and angio-embolization has not yet fully evolved. We discuss the role of sonography and CT features, such as contrast extravasation, pseudoaneurysms, arteriovenous fistulas, or hemoperitoneum, to determine the optimal patient selection for angiography and embolization. We also review the efficiency, technical considerations (proximal or selective embolization), logistics, and complication rates of AE for blunt traumatic splenic injuries. PMID:20668852

Literature Review of the Role of Ultrasound, Computed Tomography, and Transcatheter Arterial Embolization for the Treatment of Traumatic Splenic Injuries

International Nuclear Information System (INIS)

Vlies, Cornelis H. van der; Delden, Otto M. van; Punt, Bastiaan J.; Ponsen, Kees J.; Reekers, Jim A.; Goslings, J. Carel

2010-01-01

IntroductionThe spleen is the second most frequently injured organ following blunt abdominal trauma. Trends in management have changed over the years. Traditionally, laparotomy and splenectomy was the standard management. Presently, nonoperative management (NOM) of splenic injury is the most common management strategy in hemodynamically stable patients. Splenic injuries can be managed via simple observation (OBS) or with angiography and embolization (AE). Angio-embolization has shown to be a valuable alternative to observational management and has increased the success rate of nonoperative management in many series.DiagnosticsImproved imaging techniques and advances in interventional radiology have led to a better selection of patients who are amenable to nonoperative management. Despite this, there is still a lot of debate about which patients are prone to NOM.Angiography and EmbolizationThe optimal patient selection is still a matter of debate and the role of CT and angio-embolization has not yet fully evolved. We discuss the role of sonography and CT features, such as contrast extravasation, pseudoaneurysms, arteriovenous fistulas, or hemoperitoneum, to determine the optimal patient selection for angiography and embolization. We also review the efficiency, technical considerations (proximal or selective embolization), logistics, and complication rates of AE for blunt traumatic splenic injuries.

7 CFR 3015.61 - Financial management standards.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Financial management standards. 3015.61 Section 3015.61 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Standards for Financial...

Long-term Outcomes of Operative and Nonoperative Treatment of Congenital Coxa Vara.

Science.gov (United States)

Roberts, David W; Saglam, Yavuz; De La Rocha, Adriana; Frasquillo, Brigid N; Tulchin-Francis, Kirsten; Kim, Harry K W

2018-04-01

Congenital coxa vara (CCV) is a rare hip condition with few long-term studies. The purpose of this study was to assess clinical, radiographic, and functional outcomes after operative and nonoperative treatment of CCV, assess reliability of radiographic parameters, and investigate risk factors for recurrence after surgery. Retrospective review was performed of all CCV patients treated at 1 institution from 1980 to 2010. In addition, patients were recalled for additional follow-up x-rays, modified Harris Hip Score (mHHS), and gait analysis. Radiographic measurements [neck-shaft angle (NSA), head-shaft angle (HSA), Hilgenreiner-epiphyseal angle (HEA), and femoral neck length (FNL)] were assessed for reliability using intraclass correlation coefficients. Multivariate analysis was performed to identify risk factors for recurrence after surgery. Forty-six hips in 32 patients were reviewed. Mean age at presentation was 5.4±4.9 years. Mean follow-up was 11.8±5.8 years. Valgus proximal femoral osteotomy was performed in 27 hips (20 patients). Initial deformity was greater in the operative group (NSA 90±17 degrees, HEA 68±19 degrees) versus nonoperative patients (NSA 122±19 degrees, HEA 34±14 degrees) (PNSA occurred in only 21%. In contrast, 56% of operative hips showed decreased FNL growth rates. Interobserver reliability was excellent for HEA (0.98), NSA (0.90), and FNL (0.89), and good for HSA (0.79). Repeat osteotomy was performed in 6 cases (22%). No significant predictors for recurrence were identified. At long-term follow-up for recalled patients, 72% had significantly abnormal gait, and 50% had fair-poor functional outcomes (mHHSNSA are the most reliable radiographic measurements of proximal femoral deformity in CCV. Recurrence is not uncommon, but no predictors were identified. Many patients have persistent gait abnormalities and functional impairment at long-term follow-up, regardless of prior treatment. Level III-retrospective cohort.

43 CFR 12.60 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Standards for financial management systems... AUDIT REQUIREMENTS AND COST PRINCIPLES FOR ASSISTANCE PROGRAMS Uniform Administrative Requirements for... Standards for financial management systems. (a) A State must expand and account for grant funds in...

10 CFR 603.620 - Financial management standards for nonprofit participants.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Financial management standards for nonprofit participants... Financial Matters § 603.620 Financial management standards for nonprofit participants. So as not to force... organization, expenditure-based TIA requirements for the financial management system of any nonprofit...

Prompt Referral in the Nonoperative Treatment of Obstetrical Brachial Plexus Injuries

Science.gov (United States)

Aubin-Lemay, Camille; Kvann, Julie Chakriya; Retrouvey, Helene; Aldekhayel, Salah; Zadeh, Teanoosh

2017-01-01

Background: Prompt physical and occupational therapy is crucial in managing nonsurgical candidates with obstetrical brachial plexus injuries (OBPI). The objective of our study was to identify newborns suffering from nonoperative OBPI in need of a “fast-track” evaluation by a multidisciplinary team. Methods: This is a retrospective review of patients with OBPI from June 1995 to June 2015. All nonsurgical candidates (Narakas class 1) were included in the study. The Gilbert score and the Medical Research Council grading system were used to measure shoulder and elbow function, respectively. The relationship between shoulder and elbow functional outcomes and time delay to consultation was studied using analysis of variance and Welch’s tests. Various subgroups were studied based on OBPI risk factors: maternal diabetes, birth weight >4 kg, use of forceps, asphyxia, multiple comorbidities, and Apgar score at 1 and 5 minutes. Results: A total of 168 patients were included in this study. Mean follow-up time was 313.8 weeks (minimum: 52; maximum: 1072; SD: 228.1). A total of 19 patients had an Apgar scores <7 at 5 minutes. Time delay between birth and the first consult to our clinic had an impact on shoulder outcome in the subgroup of newborns with Apgar scores <7 at 5 minutes. Conclusions: The subgroup of newborns with an Apgar score <7 at 5 minutes shows improved long-term shoulder function when promptly examined by an OBPI clinic. We recommend a “fast-track” referral for this time-sensitive population. PMID:29632767

36 CFR 64.12 - Standards for grantee financial management systems.

Science.gov (United States)

2010-07-01

... financial management systems. 64.12 Section 64.12 Parks, Forests, and Public Property NATIONAL PARK SERVICE... RIGHTS-OF-WAY § 64.12 Standards for grantee financial management systems. The grantees' Financial Management Systems shall meet the minimum standards set forth in OMB Circular A-102, Attachment G. ...

7 CFR 235.9 - Procurement and property management standards.

Science.gov (United States)

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Procurement and property management standards. 235.9... Procurement and property management standards. (a) Requirements. State agencies shall comply with the requirements of 7 CFR part 3016 concerning the procurement of supplies, equipment and other services with State...

Radiation-protection standards and waste management

International Nuclear Information System (INIS)

Rowe, W.D.

1976-01-01

This paper reviews some of the difficult questions to be addressed in the development of fundamental environmental criteria and standards for radioactive waste management. A short discussion is included of the need to develop more precise definitions of terminology, better conceptualization of long-term problems, and new concepts to express risks from waste management and to evaluate the ability of proposed technical alternatives to control such risks. EPA's plans to develop fundamental environmental criteria and generally applicable environmental radiation-protection standards for waste disposal are summarized. Finally, the principal projects in EPA's planned near-future programs are reviewed in the areas of high-level waste, transuranic solid waste, low-level waste, residual decommissioning waste, ocean disposal, and wastes containing natural radioactivity

10 CFR 603.615 - Financial management standards for-profit firms.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Financial management standards for-profit firms. 603.615... § 603.615 Financial management standards for-profit firms. (a) To avoid causing needless changes in participants' financial management systems, an expenditure-based TIA will make for-profit participants that...

Establishment and status of the radwaste management standards in China

International Nuclear Information System (INIS)

Zhuo Fengguan

1993-01-01

In the last 30 years and more, with the development of nuclear industry in China, the government, nuclear industry circles and scientists have paid great attention to the safety management of radwastes. Especially in past 10 years, with the implementation of the nuclear power programmes, the safety management of radwastes has been legalized steadily NEPA (National Environment Protection Agency, China), NNSA (National Nuclear Safety Administration) and the competent authorities concerned have engaged in establishing and promulgating policies, regulations, and a series of technical standards on the safety management of radwaste, and efforts are being made to complete and perfect related regulations and standards. The status and programs of radwaste safety management standards in China are briefly introduced, including principles, organizations and procedure for drafting the standards

Contemporary, age-based trends in the incidence and management of patients with early-stage kidney cancer.

Science.gov (United States)

Tan, Hung-Jui; Filson, Christopher P; Litwin, Mark S

2015-01-01

Although kidney cancer incidence and nephrectomy rates have risen in tandem, clinical advances have generated new uncertainty regarding the optimal management of patients with small renal tumors, especially the elderly. To clarify existing practice patterns, we assessed contemporary trends in the incidence and management of patients with early-stage kidney cancer. Using Surveillance, Epidemiology, and End Results data, we identified adult patients diagnosed with T1aN0M0 kidney cancer from 2000 to 2010. We determined age-adjusted and age-specific incidence and management rates (i.e., nonoperative, ablation, partial nephrectomy [PN], and radical nephrectomy) per 100,000 adults and determined the average annual percent change (AAPC). Finally, we compared management groups using multinomial logistic regression accounting for patient characteristics, cancer information, and county-level measures for health. From 2000 to 2010, we identified 41,645 adults diagnosed with T1aN0M0 kidney cancer. Overall incidence increased from 3.7 to 7.0 per 100,000 adults (AAPC = 7.0%, Pmanagement and ablation approached nephrectomy rates for those aged 75 to 84 years and became the predominant strategy for patients older than 84 years. Adjusting for clinical, oncological, and environmental factors, older patients less frequently underwent PN and more often received ablative or nonoperative management (P<0.001). As the incidence of early-stage kidney cancer rises, patients are increasingly treated with nonoperative and nephron-sparing strategies, especially among the most elderly. The broader array of treatment options suggests opportunities to better personalize kidney cancer care for seniors. Published by Elsevier Inc.

ASME nuclear codes and standards risk management strategic plan

International Nuclear Information System (INIS)

Balkey, Kenneth R.

2003-01-01

Over the past 15 years, several risk-informed initiatives have been completed or are under development within the ASME Nuclear Codes and Standards organization. In order to better manage the numerous initiatives in the future, the ASME Board on Nuclear Codes and Standards has recently developed and approved a Risk Management Strategic Plan. This paper presents the latest approved version of the plan beginning with a background of applications completed to date, including the recent issuance of the ASME Standard for Probabilistic Risk Assessment (PRA) for Nuclear Power Plant Applications. The paper discusses potential applications within ASME Nuclear Codes and Standards that may require expansion of the PRA Standard, such as for new generation reactors, or the development of new PRA Standards. A long-term vision for the potential development and evolution to a nuclear systems code that adopts a risk-informed approach across a facility life-cycle (design, construction, operation, maintenance, and closure) is summarized. Finally, near term and long term actions are defined across the ASME Nuclear Codes and Standards organizations related to risk management, and related U.S. regulatory activities are also summarized. (author)

Efficiency of Management Systems, Based on International Standards

Directory of Open Access Journals (Sweden)

Elena B. Gafforova

2012-03-01

Full Text Available The article considers major trends of management systems standardization development and efficiency. The authors determine possible structure of effects in the process of integrated management systems implementation.

Regional vegetation management standards for commercial pine ...

African Journals Online (AJOL)

Although the understanding gained from these trials allowed for the development of vegetation management standards, their operational and economic viability need to be tested on a commercial basis. Four pine trials were thus initiated to test the applicability of these standards when utilised on a commercial scale. Two of ...

Standardized safety management of AP1000 nuclear power plant

International Nuclear Information System (INIS)

Li Xingwen; Cao Zhiqiang; Cong Jiuyuan

2011-01-01

In 2002, China published and implemented the Law of the People's Republic of China on Work Safety and promulgated a series of guidelines and policies, which strengthened the safety management supervision. Standardization of safety, as another important step on safety supervision, comes after safety assesment and safety production licensing system, is also a permanent solution. Standardization of safety is a strategic, long term and fundamental work, which is also the basic access to achieving scientific safety management and increasing the inherent safety of an enterprise. Haiyang AP1000 nuclear power plant, adopting the modularized, 'open-top' and parallel construction means, overturned the traditional construction theory of installation work comes after the civil work and greatly shorten the construction period. At the same time, the notable increase of oversize module transportation and lifting and parallel construction raises higher demands for safety management. This article combines the characteristics and difficulties of safety management for Haiyang AP1000 nuclear power plant, puts forward ideas and methods for standardized safety management, and could also serve as reference to the safety management for other AP1000 projects. (authors)

Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma : A Propensity Score Analysis

NARCIS (Netherlands)

Olthof, Dominique C.; Joosse, Pieter; Bossuyt, Patrick M. M.; de Rooij, Philippe P.; Leenen, Loek P. H.; Wendt, Klaus W.; Bloemers, Frank W.; Goslings, J. Carel

Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE

Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma: A Propensity Score Analysis

NARCIS (Netherlands)

Olthof, Dominique C.; Joosse, Pieter; Bossuyt, Patrick M. M.; de Rooij, Philippe P.; Leenen, Loek P. H.; Wendt, Klaus W.; Bloemers, Frank W.; Goslings, J. Carel

2016-01-01

Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE primarily compared SAE

Observation Versus Embolization in Patients with Blunt Splenic Injury after Trauma: A Propensity Score Analysis

NARCIS (Netherlands)

D.C. Olthof; P. Joosse (Pieter); P.M.M. Bossuyt (Patrick); P.P. de Rooij (Philippe); L.P.H. Leenen (Luke); K.W. Wendt (Klaus); F.W. Bloemers (Frank); J.C. Goslings (Carel)

2016-01-01

textabstractBackground: Non-operative management (NOM) is the standard of care in hemodynamically stable patients with blunt splenic injury after trauma. Splenic artery embolization (SAE) is reported to increase observation success rate. Studies demonstrating improved splenic salvage rates with SAE

75 FR 27366 - OLMS Listens: Office of Labor-Management Standards Stakeholder Meeting

Science.gov (United States)

2010-05-14

... DEPARTMENT OF LABOR Office of Labor-Management Standards OLMS Listens: Office of Labor-Management Standards Stakeholder Meeting AGENCY: Office of Labor-Management Standards, Department of Labor. ACTION... stakeholders and other interested parties to provide individual comments and suggestions. All interested...

Policy, Procedures and Standards for Enterprise Information Management

Science.gov (United States)

This policy establishes a standard approach for managing information produced by, funded by, or received per regulated reporting and/or federal-wide requirements and subsequently held or cataloged in information management systems by EPA.

Nonoperative treatment of splenic trauma: usefulness of computed tomography

International Nuclear Information System (INIS)

Resende, Vivian; Tavares Junior, Wilson Campos; Vieira, Jose Nelson Mendes; Drumond, Domingos Andre Fernandes

2005-01-01

Objective: to report the results of use of conservative treatment in patients with splenic trauma and to emphasize the usefulness of computed tomography in these cases. Material and method: sixty-nine cases of pediatric patients with blunt abdominal trauma seen from from January 2001 to June 2004 at the level I trauma center were retrospectively studied. Forty-four of these patients were submitted to nonoperative treatment and the clinical follow-up was performed by computerized tomography. All patients had been diagnosed with splenic injury by computerized tomography.Results: the causes of the injuries were motor vehicle accident in 12 (27.2%) patients, bicycle accident in nine (20.4%) patients, and falls in 23 (52.2%) patients. Two (3.7%) patients died from associated injuries. The mean duration of hospital stay was six days. The mean age of the patients was nine years. Conclusion: conservative treatment for blunt splenic trauma is performed with the aim of reducing costs and risks for the patients, and computerized tomography should be routinely used. No posterior complications were observed in this approach. (author)

Developing social standards for wilderness encounters in Mount Rainier National Park: Manager-defined versus visitor-defined standards

Science.gov (United States)

Kristopher J. Lah

2000-01-01

This research compared the differences found between manager-defined and visitor-defined social standards for wilderness encounters in Mount Rainier National Park. Social standards in recreation areas of public land are defined by what is acceptable to the public, in addition to the area’s management. Social standards for the encounter indicator in Mount Rainier’s...

Hepatic trauma management in polytraumatised patients.

Science.gov (United States)

Pop, P Axentii; Pop, M; Iovan, C; Boancã, C

2012-01-01

The specialty literature of the last decade presents the nonoperative management of the closed abdominal trauma as the treatment of choice. The purpose of this study is to highlight the importance of the optimal management of hepatic lesions considering the clinical, paraclinical and therapeutic approach. Our study is based on the analysis of the clinical and paraclinical data and also on the evaluation of the treatment results in 1671 patients with abdominal trauma affecting multiple organs who were treated at the Clinic of Surgery, County Hospital of Oradea from 2008 to 2011. The non-operative approach of the hepatic trauma, applied in 52% of the patients, was indicated in stable hemodynamic status, non-bleeding hepatic lesions on the abdominal CT, and the absence of other significant abdominal lesions. The remaining 48% were treated surgically. The postoperative evolution was free of complications in 72% of the patients while the rest of 28% presented one or more postoperative complications. CT = Computer Tomography; ISS= Injury Severity Score; AIS = Abbreviated Index of Severity; AAST = American Association for the Surgery of Trauma; ARDS = Adult Respiratory Distress Syndrome. RevistaChirurgia.

Pneumoperitoneum after virtual colonoscopy: causes, risk factors, and management.

Science.gov (United States)

Baccaro, Leopoldo M; Markelov, Alexey; Wilhelm, Jakub; Bloch, Robert

2014-06-01

Computed tomographic virtual colonoscopy (CTVC) is a safe and minimally invasive modality when compared with fiberoptic colonoscopy for evaluating the colon and rectum. We have reviewed the risks for colonic perforation by investigating the relevant literature. The objectives of this study were to assess the risk of colonic perforation during CTVC, describe risk factors, evaluate ways to reduce the incidence complications, and to review management and treatment options. A formal search of indexed publications was performed through PubMed. Search queries using keywords "CT colonography," "CT virtual colonoscopy," "virtual colonoscopy," and "perforation" yielded a total of 133 articles. A total of eight case reports and four review articles were selected. Combining case reports and review articles, a total of 25 cases of colonic perforation after CTVC have been reported. Causes include, but are not limited to, diverticular disease, irritable bowel diseases, obstructive processes, malignancies, and iatrogenic injury. Both operative and nonoperative management has been described. Nonoperative management has been proven safe and successful in minimally symptomatic and stable patients. Colonic perforation after CTVC is a rare complication and very few cases have been reported. Several risk factors are recurrent in the literature and must be acknowledged at the time of the study. Management options vary and should be tailored to each individual patient.

ASME nuclear codes and standards risk management strategic planning

International Nuclear Information System (INIS)

Hill, Ralph S. III; Balkey, Kenneth R.; Erler, Bryan A.; Wesley Rowley, C.

2007-01-01

This paper is prepared in honor and in memory of the late Professor Emeritus Yasuhide Asada to recognize his contributions to ASME Nuclear Codes and Standards initiatives, particularly those related to risk-informed technology and System Based Code developments. For nearly two decades, numerous risk-informed initiatives have been completed or are under development within the ASME Nuclear Codes and Standards organization. In order to properly manage the numerous initiatives currently underway or planned for the future, the ASME Board on Nuclear Codes and Standards (BNCS) has an established Risk Management Strategic Plan (Plan) that is maintained and updated by the ASME BNCS Risk Management Task Group. This paper presents the latest approved version of the plan beginning with a background of applications completed to date, including the recent probabilistic risk assessment (PRA) standards developments for nuclear power plant applications. The paper discusses planned applications within ASME Nuclear Codes and Standards that will require expansion of the ASME PRA Standard to support new advanced light water reactor and next generation reactor developments, such as for high temperature gas-cooled reactors. Emerging regulatory developments related to risk-informed, performance- based approaches are summarized. A long-term vision for the potential development and evolution to a nuclear systems code that adopts a risk-informed approach across a facility life-cycle (design, construction, operation, maintenance, and closure) is also summarized. Finally, near term and long term actions are defined across the ASME Nuclear Codes and Standards organizations related to risk management, including related U.S. regulatory activities. (author)

Commentary on the management of type II odontoid process fractures in octogenarians: Article by Graffeo et al. and Editorial by Falavigna (J Neurosurgery Spine August 19, 2016).

Science.gov (United States)

Epstein, Nancy E

2016-01-01

Establishing a clear treatment paradigm for octogenarians with type II odontoid fractures in hampered by a literature replete with level III articles. In the study by Graffeo et al ., the authors evaluated 111 patients over the age of 79 (average age: 87) with type II odontoid fractures undergoing nonoperative (94 patients) vs. operative intervention (17 total; 15 posterior and 2 anterior). They studied multiple variables and utilized several scales [abbreviated injury scale (AIS), injury severity score (ISS), and the Glasgow coma scale (GCS)] to determine the outcomes of nonoperative vs. operative management. Graffeo et al . concluded that there were no significant differences between nonoperative and operative management for type II odontoid fractures in octogenarians. They found similar frequencies of additional cervical fractures, mechanisms of injury, GCS of 8 or under, AIS/ISS scores, and disposition to "nonhome" facilities. Furthermore, both appeared to have increased mortality rates at 1-year post injury; 13% during hospitalization, 26% within the first post-injury month, and 41% at 1 year. In the editorial by Falavigna, his major criticism of Graffeo's article was the marked disparity in the number of patients in the operative (17 patients) vs. the nonoperative group (94 patients), making it difficult to accept any conclusions as "significant". He further noted that few prior studies provided level I evidence, and that most, like this one, were level III analyses that did not "significantly" advance our knowledge as to whether to treat octogenarians with type II odontoid fractures operatively vs. nonoperatively.

Standardization Versus Innovation In Management Consultancy

Directory of Open Access Journals (Sweden)

Ciumara Tudor

2011-12-01

Full Text Available This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD, financed from the European Social Fund and by the Romanian Government under the contract number SOP HRD/89/1.5/S/62988. In this paper we propose some perspectives on the relationship between standardization and innovation in the management consulting business. Most of the consulting services are situated somewhere between absolute standardization and absolute innovation. Approaching any of these poles brings some advantages and disadvantages, both to the service providers and to their customers. It is important to find a balance between innovation and standardization to maximize the results of all agents involved.

Business School's Performance Management System Standards Design

Science.gov (United States)

Azis, Anton Mulyono; Simatupang, Togar M.; Wibisono, Dermawan; Basri, Mursyid Hasan

2014-01-01

This paper aims to compare various Performance Management Systems (PMS) for business school in order to find the strengths of each standard as inputs to design new model of PMS. There are many critical aspects and gaps notified for new model to improve performance and even recognized that self evaluation performance management is not well…

Managing the materials of tomorrow through nomenclature standardization

International Nuclear Information System (INIS)

Garstka, R.M.; Kowalchick, D.P.

1993-01-01

Virginia Power's nuclear materials management organization has developed a new system to improve material visibility, accessibility, and useability in order to optimize inventory utilization. At a previous American Nuclear Society conference, the completion of the Material Nomenclature Standardization Project and the benefits realized through this effort were reported. This paper reports on new avenues that have been taken and the trials and successes experienced as a by-product of nomenclature standardization. New programs have been established to overcome problems of the past, gain control of inventory growth, and promote stock material utilization. At Virginia Power, the materials management organization is continually challenged to take the next step, strive to set and attain higher goals, and look beyond the status quo for now approaches to improved efficiency. As the standards program came to an end, we saw that our open-quotes first stepclose quotes was a big one. Standardization and computerized sorting solved the inability to retrieve parts without manufacturer's part numbers but also opened up new challenges. Building new systems and processes to make management of the inventory more effective was envisioned as an opportunity

Comparing Sustainable Forest Management Certifications Standards: A Meta-analysis

Directory of Open Access Journals (Sweden)

Michael Rawson. Clark

2011-03-01

Full Text Available To solve problems caused by conventional forest management, forest certification has emerged as a driver of sustainable forest management. Several sustainable forest management certification systems exist, including the Forest Stewardship Council and those endorsed by the Programme for the Endorsement of Forest Certification, such as the Canadian Standards Association - Sustainable Forestry Management Standard CAN/CSA - Z809 and Sustainable Forestry Initiative. For consumers to use certified products to meet their own sustainability goals, they must have an understanding of the effectiveness of different certification systems. To understand the relative performance of three systems, we determined: (1 the criteria used to compare the Forest Stewardship Council, Canadian Standards Association - Sustainable Forestry Management, and Sustainable Forestry Initiative, (2 if consensus exists regarding their ability to achieve sustainability goals, and (3 what research gaps must be filled to improve our understanding of how forest certification systems affect sustainable forest management. We conducted a qualitative meta-analysis of 26 grey literature references (books, industry and nongovernmental organization publications and 9 primary literature references (articles in peer-reviewed academic journals that compared at least two of the aforementioned certification systems. The Forest Stewardship Council was the highest performer for ecological health and social sustainable forest management criteria. The Canadian Standards Association - Sustainable Forestry Management and Sustainable Forestry Initiative performed best under sustainable forest management criteria of forest productivity and economic longevity of a firm. Sixty-two percent of analyses were comparisons of the wording of certification system principles or criteria; 34% were surveys of foresters or consumers. An important caveat to these results is that only one comparison was based on

From Expert Protocols to Standardized Management of Infectious Diseases.

Science.gov (United States)

Lagier, Jean-Christophe; Aubry, Camille; Delord, Marion; Michelet, Pierre; Tissot-Dupont, Hervé; Million, Matthieu; Brouqui, Philippe; Raoult, Didier; Parola, Philippe

2017-08-15

We report here 4 examples of management of infectious diseases (IDs) at the University Hospital Institute Méditerranée Infection in Marseille, France, to illustrate the value of expert protocols feeding standardized management of IDs. First, we describe our experience on Q fever and Tropheryma whipplei infection management based on in vitro data and clinical outcome. Second, we describe our management-based approach for the treatment of infective endocarditis, leading to a strong reduction of mortality rate. Third, we report our use of fecal microbiota transplantation to face severe Clostridium difficile infections and to perform decolonization of patients colonized by emerging highly resistant bacteria. Finally, we present the standardized management of the main acute infections in patients admitted in the emergency department, promoting antibiotics by oral route, checking compliance with the protocol, and avoiding the unnecessary use of intravenous and urinary tract catheters. Overall, the standardization of the management is the keystone to reduce both mortality and morbidity related to IDs. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

A SURVEY ON INDIAN EXPERIENCE ON INTEGRATED MANAGEMENT STANDARDS (IMS

Directory of Open Access Journals (Sweden)

H. Khanna

2009-09-01

Full Text Available Adoption of management systems standards is a key issue in manufacturing industry in India. Following the global trend quality and environmental issues are gaining importance. However the number of ISO 14001 certified companies are much less in India as compared to ISO 9001. The integration of ISO 14001 with ISO 9001 may help companies to sustain competitive advantage and overcome disappointments with quality standards and in turn encourage companies to adopt good environmental practices. The aim of this research is to study the implementation of integrated management standards (IMS by the manufacturing organizations in India. The different aspects of integration and benefits of IMS implementation are analyzed. This r esearch is based on empirical study carried out in Indian manufacturing firms, involving the application of a questionnaire. This questionnaire was tested on 50 manufacturing companies in India. The study reveals that focus on stakeholders; top management commitment and training are critical success factors for implementation of IMS. The main benefits of integration are discussed. The small sample size is one of the major limitations of this study. The paper informs the managers in manufacturing organizations and practitioners of management system standards especially in developing countries about IMS and will enable them to adopt IMS in future so that those organizations may not implement multiple and overlapping MSS(Management System Standards.

Domain management OSSs: bridging the gap between legacy and standards-based network management systems

Science.gov (United States)

Lemley, Todd A.

1996-11-01

The rapid change in the telecommunications environment is forcing carriers to re-assess not only their service offering, but also their network management philosophy. The competitive carrier environment has taken away the luxury of throwing technology at a problem by using legacy and proprietary systems and architectures. A more flexible management environment is necessary to effectively gain, and maintain operating margins in the new market era. Competitive forces are driving change which gives carriers more choices than those that are available in legacy and standards-based solutions alone. However, creating an operational support system (OSS) with this gap between legacy and standards has become as dynamic as the services which it supports. A philosophy which helps to integrate the legacy and standards systems is domain management. Domain management relates to a specific service or market 'domain,'and its associated operational support requirements. It supports a companies definition of its business model, which drives the definition of each domain. It also attempts to maximize current investment while injecting new technology available in a practical approach. The following paragraphs offer an overview of legacy systems, standards-based philosophy, and the potential of domain management to help bridge the gap between the two types of systems.

Manipulation of the wrist for management of lateral epicondylitis: A randomized pilot study

NARCIS (Netherlands)

Struijs, Peter A. A.; Damen, Pieter-Jan; Bakker, Eric W. P.; Blankevoort, Leendert; Assendelft, Willem J. J.; van Dijk, C. Niek

2003-01-01

Background and Purpose. Lateral epicondylitis ("tennis elbow") is a common entity. Several nonoperative interventions, with varying success rates, have been described. The aim of this study was to compare the effectiveness of 2 protocols for the management of lateral epicondylitis: (1) manipulation

Organ Preservation in Rectal Adenocarcinoma: a phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management

International Nuclear Information System (INIS)

Smith, J. Joshua; Chow, Oliver S.; Gollub, Marc J.; Nash, Garrett M.; Temple, Larissa K.; Weiser, Martin R.; Guillem, José G.; Paty, Philip B.; Avila, Karin; Garcia-Aguilar, Julio

2015-01-01

Treatment of patients with non-metastatic, locally advanced rectal cancer (LARC) includes pre-operative chemoradiation, total mesorectal excision (TME) and post-operative adjuvant chemotherapy. This trimodality treatment provides local tumor control in most patients; but almost one-third ultimately die from distant metastasis. Most survivors experience significant impairment in quality of life (QoL), due primarily to removal of the rectum. A current challenge lies in identifying patients who could safely undergo rectal preservation without sacrificing survival benefit and QoL. This multi-institutional, phase II study investigates the efficacy of total neoadjuvant therapy (TNT) and selective non-operative management (NOM) in LARC. Patients with MRI-staged Stage II or III rectal cancer amenable to TME will be randomized to receive FOLFOX/CAPEOX: a) before induction neoadjuvant chemotherapy (INCT); or b) after consolidation neoadjuvant chemotherapy (CNCT), with 5-FU or capecitabine-based chemoradiation. Patients in both arms will be re-staged after completing all neoadjuvant therapy. Those with residual tumor at the primary site will undergo TME. Patients with clinical complete response (cCR) will receive non-operative management (NOM). NOM patients will be followed every 3 months for 2 years, and every 6 months thereafter. TME patients will be followed according to NCCN guidelines. All will be followed for at least 5 years from the date of surgery or—in patients treated with NOM—the last day of treatment. The studies published thus far on the safety of NOM in LARC have compared survival between select groups of patients with a cCR after NOM, to patients with a pathologic complete response (pCR) after TME. The current study compares 3-year disease-free survival (DFS) in an entire population of patients with LARC, including those with cCR and those with pCR. We will compare the two arms of the study with respect to organ preservation at 3 years, treatment

Organ Preservation in Rectal Adenocarcinoma: a phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management.

Science.gov (United States)

Smith, J Joshua; Chow, Oliver S; Gollub, Marc J; Nash, Garrett M; Temple, Larissa K; Weiser, Martin R; Guillem, José G; Paty, Philip B; Avila, Karin; Garcia-Aguilar, Julio

2015-10-23

Treatment of patients with non-metastatic, locally advanced rectal cancer (LARC) includes pre-operative chemoradiation, total mesorectal excision (TME) and post-operative adjuvant chemotherapy. This trimodality treatment provides local tumor control in most patients; but almost one-third ultimately die from distant metastasis. Most survivors experience significant impairment in quality of life (QoL), due primarily to removal of the rectum. A current challenge lies in identifying patients who could safely undergo rectal preservation without sacrificing survival benefit and QoL. This multi-institutional, phase II study investigates the efficacy of total neoadjuvant therapy (TNT) and selective non-operative management (NOM) in LARC. Patients with MRI-staged Stage II or III rectal cancer amenable to TME will be randomized to receive FOLFOX/CAPEOX: a) before induction neoadjuvant chemotherapy (INCT); or b) after consolidation neoadjuvant chemotherapy (CNCT), with 5-FU or capecitabine-based chemoradiation. Patients in both arms will be re-staged after completing all neoadjuvant therapy. Those with residual tumor at the primary site will undergo TME. Patients with clinical complete response (cCR) will receive non-operative management (NOM). NOM patients will be followed every 3 months for 2 years, and every 6 months thereafter. TME patients will be followed according to NCCN guidelines. All will be followed for at least 5 years from the date of surgery or--in patients treated with NOM--the last day of treatment. The studies published thus far on the safety of NOM in LARC have compared survival between select groups of patients with a cCR after NOM, to patients with a pathologic complete response (pCR) after TME. The current study compares 3-year disease-free survival (DFS) in an entire population of patients with LARC, including those with cCR and those with pCR. We will compare the two arms of the study with respect to organ preservation at 3 years, treatment compliance

[Wound information management system: a standardized scheme for acquisition, storage and management of wound information].

Science.gov (United States)

Liu, Hu; Su, Rong-jia; Wu, Min-jie; Zhang, Yi; Qiu, Xiang-jun; Feng, Jian-gang; Xie, Ting; Lu, Shu-liang

2012-06-01

To form a wound information management scheme with objectivity, standardization, and convenience by means of wound information management system. A wound information management system was set up with the acquisition terminal, the defined wound description, the data bank, and related softwares. The efficacy of this system was evaluated in clinical practice. The acquisition terminal was composed of the third generation mobile phone and the software. It was feasible to get access to the wound information, including description, image, and therapeutic plan from the data bank by mobile phone. During 4 months, a collection of a total of 232 wound treatment information was entered, and accordingly standardized data of 38 patients were formed automatically. This system can provide standardized wound information management by standardized techniques of acquisition, transmission, and storage of wound information. It can be used widely in hospitals, especially primary medical institutions. Data resource of the system makes it possible for epidemiological study with large sample size in future.

40 CFR 262.103 - What is the scope of the laboratory environmental management standard?

Science.gov (United States)

2010-07-01

... environmental management standard? 262.103 Section 262.103 Protection of Environment ENVIRONMENTAL PROTECTION... University Laboratories XL Project-Laboratory Environmental Management Standard § 262.103 What is the scope of the laboratory environmental management standard? The Laboratory Environmental Management Standard...

ISO 31000:2009--Setting a new standard for risk management.

Science.gov (United States)

Purdy, Grant

2010-06-01

Last year saw the publication of IS0 31000:2009, a new globally accepted standard for risk management together with a new, associated vocabulary in ISO Guide 73:2009. These were developed through a consensus-driven process over four years, through seven drafts, and involving the input of hundreds of risk management professionals around the world. The new standard supports a new, simple way of thinking about risk and risk management and is intended to begin the process of resolving the many inconsistencies and ambiguities that exist between many different approaches and definitions. While most decisionmakers seem to welcome the new standard and it has so far received very good reviews, it does create challenges for those who use language and approaches that are unique to their area of work but different from the new standard and guide. The need for compromise and change is the inevitable consequence of standardization.

Succeeding in process standardization: Explaining the fit with international management strategy

DEFF Research Database (Denmark)

Rahimi, Fatemeh; Møller, Charles; Hvam, Lars

2016-01-01

Purpose: The purpose of this paper is to explore the fit between process standardization and international management strategy of multinational corporations (MNCs) by assessing the compatibility between process standardization and corporate structural characteristics in terms of asset configuration...... and headquarters-subsidiary relationships. Design/methodology/approach: First, after a literature review on MNCs’ strategy and process standardization, the study suggests two propositions on the fit between corporate international management strategy and process standardization. Second, to empirically examine....../value: The study provides in-depth understanding of how the international management strategy and consequent structural characteristics of MNCs affects process standardization in the course of a global enterprise resource planning implementation. The study proposes conditions of fit for aligning process...

Knee Osteoarthritis: Use of investigations and non-operative management in the Australian primary care setting.

Directory of Open Access Journals (Sweden)

Daniel Bopf

2010-03-01

Full Text Available BackgroundOsteoarthritis affects 15% of Australians or around 3.2 millionpeople. This figure will rise owing to the ageing of theAustralian population. Over 38000 knee arthroplasties areperformed each year in Australia. There are limited resourcesfor arthroplasty and ever increasing numbers of patients withosteoarthritis of the knee that will ultimately require one. It istherefore important to promptly diagnose the condition andutilise simple, efficacious management options to alleviatesuffering for patients and the overburdened health system.Evaluation of current investigations and management incomparison with published guidelines is the first step.MethodNinety-five patients with 100 symptomatic knees referredfrom their GP with a provisional diagnosis of osteoarthritis,were surveyed on the investigations and management theyhad received prior to presentation. The results were thencompared with accepted clinical guidelines.ResultsThere is a disparity between the clinical guidelines and theresults of the survey from clinical practice. 27.5% of patientshad not undertaken the gold standard weight bearingradiograph prior to presentation. 6% of patients did not havea plain radiograph at all. Simple efficacious treatmentswith high levels of evidence such as physiotherapy andweight loss had only been utilised in 41% and 58%respectively. 55% had used glucosamine which is notrecommended in the guidelines.ConclusionA better awareness of the rationale for investigations byGPs and improved communication between specialistsand GPs can prevent duplication of resources andminimise the costs of investigations. Increased awarenessof the efficacy of simple treatment modalities canincrease their utilisation. Streamlining of investigation andmanagement requires a multidisciplinary approach andboth patient and service provider education.

Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds from a Shotgun: A Case Report and Literature Review

Directory of Open Access Journals (Sweden)

Paula M. Jaramillo

2018-01-01

Full Text Available Introduction. Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. Presentation of the Case. A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea, or abdominal pain. Computed tomography (CT scan of the chest shows hematoma around the aorta without injury to the blood vessel wall with an intramyocardial projectile without pericardial effusion. CT scan of the abdomen showed pellets in the transverse colon and descending colon endoluminal without extravasation of contrast medium or intra-abdominal fluid. The patient remains hemodynamically stable, and nonsurgical procedure was established. Discussion. Patients with asymptomatic intramyocardial projectiles can be safely managed without surgery. Nonsurgical management is only possible in asymptomatic patients with trauma of the colon through close surveillance and with very selective patients since standard management is surgery. Conclusion. Nonsurgical management of cardiac trauma, as well as colon penetrating trauma, can be performed in carefully selected patients with proper clinical follow-up, imaging, and laboratory studies.

The importance of international ISO standards application for enterprise management and ensuring customer satisfaction

Directory of Open Access Journals (Sweden)

Babić Jasna

2011-01-01

Full Text Available ISO standards contain requirements for quality management, environmental management, food safety management, information security systems management, risks management, social responsibility management, etc. The organizations, whose employees at all organizational levels understand the importance of correct use of standards and effects of their use, make efforts for continuous improvement of management systems. The improvements are realized through the application of requirements of certificated standardized quality systems and similar non certified standards and through application of different business excellence models.

IPMA STANDARD ELEMENTS AND FEEDBACK IN PROJECT MANAGEMENT TEACHING

Directory of Open Access Journals (Sweden)

BARTOŠKA, Jan

2011-09-01

Full Text Available The paper proposes the concept of project management teaching including the International Project Management Association (IPMA standard. The concept of teaching is theoretical and derives from the notion of competence, which the IPMA standard is based on. The paper presents a brief description of the IPMA standard and endeavours to define the notion of competence. The competence is worked with in respect to hierarchical recognition. The proposed teaching concept works with the concepts of information, knowledge and skills. The teaching proposal stems from the structure and contents of the IPMA standard elements. Furthermore, the paper elaborates the issue of embedding the elements of the IPMA standard competences into training courses. In the article, the eye of the IPMA competences is further enhanced with possible training courses and specialist areas in which the standard elements can thematically be included. The paper states that the competence elements and training courses cross one another and overlap in a manifold way. The authors also propose a way which could verify into what extent the students have actually acquired taught IPMA competence elements. The paper contains the proposal of feedback quantification for the IPMA standard and project management teaching. The results of the paper can be used as a starting premise for future research. Both the verification proposal and the embedding of the elements into teaching are derived from on-going academic experience of the authors of the article.

Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial.

Science.gov (United States)

Wall, Peter Dh; Dickenson, Edward J; Robinson, David; Hughes, Ivor; Realpe, Alba; Hobson, Rachel; Griffin, Damian R; Foster, Nadine E

2016-10-01

Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events. The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12-26 weeks in 6-10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events. PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839). ISRCTN 09754699. 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/

40 CFR 63.10895 - What are my standards and management practices?

Science.gov (United States)

2010-07-01

... Foundries § 63.10895 What are my standards and management practices? (a) If you own or operate an affected... management practices in §§ 63.10885 and 63.10886, the requirements in paragraphs (b) through (e) of this... 40 Protection of Environment 14 2010-07-01 2010-07-01 false What are my standards and management...

10 CFR 600.121 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Standards for financial management systems. 600.121... financial management systems. (a) Recipients shall relate financial data to performance data and develop....121(f) and 600.181, recipients' financial management systems shall provide for the following: (1...

40 CFR 31.20 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Standards for financial management... violation of the restrictions and prohibitions of applicable statutes. (b) The financial management systems... the financial management system of any applicant for financial assistance as part of a preaward review...

36 CFR 1207.20 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... financial management systems. (a) A State must expand and account for grant funds in accordance with State... management systems of other grantees and subgrantees must meet the following standards: (1) Financial... the financial management system of any applicant for financial assistance as part of a preaward review...

Current Trends in the Management of Blunt Solid Organ Injuries.

Science.gov (United States)

Taviloglu, Korhan; Yanar, Hakan

2009-04-01

The management of patients with solid organ injuries has changed since the introduction of technically advanced imaging tools, such as ultrasonography and multiple scan computerized tomography, interventional radiological techniques and modern intensive care units. In spite of this development in the management of these patients, major solid organ traumas can still be challenging. There has been great improvement in the non-operative management (NOM) of intra-abdominal solid organ injury in recent decades. In most cases treatment of injuries has shifted from early surgical treatment to NOM.

Management of blunt liver trauma in 134 severely injured patients.

Science.gov (United States)

Hommes, Martijn; Navsaria, Pradeep H; Schipper, Inger B; Krige, J E J; Kahn, D; Nicol, Andrew John

2015-05-01

In haemodynamic stable patients without an acute abdomen, nonoperative management (NOM) of blunt liver injuries (BLI) has become the standard of care with a reported success rate of between 80 and 100%. Concern has been expressed about the potential overuse of NOM and the fact that failed NOM is associated with higher mortality rate. The aim of this study was to evaluate factors that might indicate the need for surgical intervention, and to assess the efficacy of NOM. A single centre prospective study between 2008 and 2013 in a level-1 Trauma Centre. One hundred thirty four patients with BLI were diagnosed on CT-scan or at laparotomy. The median ISS was 25 (range 16-34). Thirty five (26%) patients underwent an early exploratory laparotomy. The indication for surgery was haemodynamic instability in 11 (31%) patients, an acute abdomen in 16 (46%), and 8 (23%) patients had CT findings of intraabdominal injuries, other than the hepatic injury, that required surgical repair. NOM was initiated in 99 (74%) patients, 36 patients had associated intraabdominal solid organ injuries. Seven patients developed liver related complications. Five (5%) patients required a delayed laparotomy (liver related (3), splenic injury (2)). NOM failure was not related to the presence of shock on admission (p=1000), to the grade of liver injury (p=0.790) or associated intraabdominal injuries (p=0.866). Physiologic behaviour or CT findings dictated the need for operative intervention. NOM of BLI has a high success rate (95%). Nonoperative management of BLI should be considered in patients who respond to resuscitation, irrespective of the grade of liver trauma. Associated intraabdominal solid organ injuries do not exclude NOM. Copyright © 2014 Elsevier Ltd. All rights reserved.

Management of postoperative pseudomeningoceles: an international survey study.

Science.gov (United States)

Tu, Albert; Tamburrini, Gianpiero; Steinbok, Paul

2014-11-01

Pseudomeningoceles are common complications after posterior fossa and intradural spinal surgery and are often asymptomatic. Management guidelines are lacking, and anecdotally, we have encountered radically different suggested treatments varying from observation to immediate surgical intervention. The goal of this study was to determine the prevailing opinions among neurosurgeons on the management of this condition. Neurosurgeons from around the world were invited via an International Society for Pediatric Neurosurgery (ISPN) and Neurosurgery ListServ e-blast to participate in a 33-question survey on the management of pseudomeningoceles, presented as simulated scenarios after posterior fossa and spinal intradural surgery. Two hundred forty-one responses were obtained. Pseudomeningoceles after posterior fossa tumor resection, in the absence of hydrocephalus, were typically managed nonoperatively for 7 to 14 days before re-exploration. Only 0.5 % of the surgeons would offer upfront repair of the pseudomeningocele. In the presence of hydrocephalus, 48 % of the neurosurgeons intervene initially with cerebrospinal fluid (CSF) diversion and would change therapy if the lesion did not resolve in 2 to 4 days. Ninety percent of the surgeons manage spinal pseudomeningoceles nonoperatively for 7-14 days before re-exploration is considered. The most common steps taken to prevent pseudomeningoceles are watertight closure, tissue glues, and duroplasty. The present zeitgeist suggests that, in the absence of hydrocephalus, initial observation is appropriate for cranial and spinal pseudomeningoceles. Operative revision should be reserved for failure of conservative treatment. If hydrocephalus is present, consideration should be made for CSF diversion. This study may serve as a guideline regarding acceptable management.

IAEA Safety Standards on Management Systems and Safety Culture

International Nuclear Information System (INIS)

Persson, Kerstin Dahlgren

2007-01-01

The IAEA has developed a new set of Safety Standard for applying an integrated Management System for facilities and activities. The objective of the new Safety Standards is to define requirements and provide guidance for establishing, implementing, assessing and continually improving a Management System that integrates safety, health, environmental, security, quality and economic related elements to ensure that safety is properly taken into account in all the activities of an organization. With an integrated approach to management system it is also necessary to include the aspect of culture, where the organizational culture and safety culture is seen as crucial elements of the successful implementation of this management system and the attainment of all the goals and particularly the safety goals of the organization. The IAEA has developed a set of service aimed at assisting it's Member States in establishing. Implementing, assessing and continually improving an integrated management system. (author)

Diagnosis and management of hook of hamate fractures.

Science.gov (United States)

Kadar, Assaf; Bishop, Allen T; Suchyta, Marissa A; Moran, Steven L

2018-06-01

The purpose of this study was to evaluate the time to diagnosis and management of hook of hamate fractures in an era of advanced imaging. We performed a retrospective study of 51 patients treated for hook of hamate fractures. Patients were sent a quickDASH questionnaire regarding the outcomes of their treatment. Hook of hamate fractures were diagnosed with advanced imaging at a median of 27 days. Clinical findings of hook of hamate tenderness had better sensitivity than carpal tunnel-view radiographs. Nonunion occurred in 24% of patients with non-operative treatment and did not occur in the operative group. Both treatment groups achieved good clinical results, with a grip strength of 80% compared with the non-injured hand and a median quickDASH score of 2. Advanced imaging improved the time to diagnosis and treatment compared to historical case series. Nonunion is common in patients treated non-operatively. IV.

The Mayo Clinic experience with Morel-Lavallée lesions: establishment of a practice management guideline.

Science.gov (United States)

Nickerson, Terry P; Zielinski, Martin D; Jenkins, Donald H; Schiller, Henry J

2014-02-01

Although uncommon, Morel-Lavallée lesions (also called closed degloving injuries) are associated with considerable morbidity in trauma patients. There is lack of consensus regarding proper management of these lesions. Management options include nonoperative therapies, along with percutaneous and operative techniques. We sought to define the factors associated with failure of percutaneous aspiration to better identify patients requiring immediate operative management. We retrospectively searched our prospectively collected database for patient records containing the terms Morel-Lavallée, closed degloving injury, or posttraumatic seroma from February 2, 2004, through December 23, 2011. Treatment methods included compression wraps or observation (nonoperative management), percutaneous aspiration, or operative management with incision/drainage or formal debridement of skin and soft tissues that resulted in wound vacuum-assisted closure placement and/or split-thickness skin graft (operative management). The treatment groups were compared using univariate analysis and χ testing. We identified 79 patients with 87 Morel-Lavallée lesions in the setting of trauma. Most were caused by motor vehicle collisions (25%). No difference was observed between the treatment groups in sex, body mass index, anticoagulation treatment, diabetes mellitus, smoking history, or alcohol use. The percutaneous aspiration group had higher rates of recurrence (56% vs. 19% and 15% in nonoperative and operative groups, respectively). The percentage of patients who had aspiration of more than 50 mL of fluid was higher for lesions that recurred than for lesions that resolved (83% vs. 33%, p = 0.02). Aspiration of more than 50 mL of fluid from Morel-Lavallée lesions was much more common among lesions that recurred (83%) than among those that resolved (33%). We therefore recommend that aspiration of more than 50 mL of fluid from a Morel-Lavallée lesion prompts operative intervention. We have now

Prospective trial of angiography and embolization for all grade III to V blunt splenic injuries: nonoperative management success rate is significantly improved.

Science.gov (United States)

Miller, Preston R; Chang, Michael C; Hoth, J Jason; Mowery, Nathan T; Hildreth, Amy N; Martin, R Shayn; Holmes, James H; Meredith, J Wayne; Requarth, Jay A

2014-04-01

Nonoperative management (NOM) of blunt splenic injury is well accepted. Substantial failure rates in higher injury grades remain common, with one large study reporting rates of 19.6%, 33.3%, and 75% for grades III, IV, and V, respectively. Retrospective data show angiography and embolization can increase salvage rates in these severe injuries. We developed a protocol requiring referral of all blunt splenic injuries, grades III to V, without indication for immediate operation for angiography and embolization. We hypothesized that angiography and embolization of high-grade blunt splenic injury would reduce NOM failure rates in this population. This was a prospective study at our Level I trauma center as part of a performance-improvement project. Demographics, injury characteristics, and outcomes were compared with historic controls. The protocol required all stable patients with grade III to V splenic injuries be referred for angiography and embolization. In historic controls, referral was based on surgeon preference. From January 1, 2010 to December 31, 2012, there were 168 patients with grades III to V spleen injuries admitted; NOM was undertaken in 113 (67%) patients. The protocol was followed in 97 patients, with a failure rate of 5%. Failure rate in the 16 protocol deviations was 25% (p = 0.02). Historic controls from January 1, 2007 to December 31, 2009 were compared with the protocol group. One hundred and fifty-three patients with grade III to V injuries were admitted during this period, 80 (52%) patients underwent attempted NOM. Failure rate was significantly higher than for the protocol group (15%, p = 0.04). Use of a protocol requiring angiography and embolization for all high-grade spleen injuries slated for NOM leads to a significantly decreased failure rate. We recommend angiography and embolization as an adjunct to NOM for all grade III to V splenic injuries. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Associated injuries, management, and outcomes of blunt abdominal aortic injury.

Science.gov (United States)

de Mestral, Charles; Dueck, Andrew D; Gomez, David; Haas, Barbara; Nathens, Avery B

2012-09-01

Blunt abdominal aortic injury (BAAI) is very rare, and current literature is limited to case series of single-center experience. Through an analysis of the National Trauma Data Bank, the largest aggregation of United States trauma registry data, our aim was to characterize the associated injury pattern, contemporary management, and in-hospital outcomes of patients with BAAI. We used a nested case-control design. The overall cohort consisted of adult patients (age ≥ 16 years) severely injured (Injury Severity Score ≥ 16) after blunt trauma who were treated at a level 1 or 2 trauma center in years 2007 to 2009. Cases were patients with BAAI and were frequency-matched by age group and mechanism to randomly selected controls at a one-to-five ratio. Multivariable matched analysis (conditional logistic regression) was used to derive adjusted measures of association between BAAI and adjacent arterial, intra-abdominal, and bony injuries. We identified 436 patients with BAAI from 180 centers. The mean Injury Severity Score was 35 ± 14, and most patients were injured in motor vehicle crashes (84%). Multivariable analysis showed injury to the thoracic aorta, renal and iliac artery, small bowel, colon, liver, pancreas, and kidney, as well as lumbar spine fractures were independently associated with BAAI. A total of 394 patients (90%) were managed nonoperatively, and 42 (10%) underwent repair. Of these 42 patients, 29 (69%) underwent endovascular repair, with 11 patients undergoing open aortic repair and two extra-anatomic bypasses. Median time from admission to repair was 1 day (interquartile range, 1-2 days). Overall mortality was 29%. A total of 271 (69%) patients managed nonoperatively survived to hospital discharge. The index of suspicion for BAAI should be raised in severely injured patients by the presence of injuries to the lumbar spine, bowel, retroperitoneal organs, and adjacent major arteries. Although endovascular repair is the most common intervention, most

IPMA Standard Competence Scope in Project Management Education

Science.gov (United States)

Bartoška, Jan; Flégl, Martin; Jarkovská, Martina

2012-01-01

The authors of the paper endeavoured to find out key competences in IPMA standard for educational approaches in project management. These key competences may be used as a basis for project management university courses. An incidence matrix was set up, containing relations between IPMA competences described in IPMA competence baseline. Further,…

25 CFR 276.7 - Standards for grantee financial management systems.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Standards for grantee financial management systems. 276.7... grantee financial management systems. (a) Grantee financial management systems for grants and subgrantee financial management systems for subgrants shall provide for: (1) Accurate, current, and complete disclosure...

A review on the risk management terminology for the use in standards

International Nuclear Information System (INIS)

Lee, Yong Hee; Lee, Jung Woon

2001-03-01

This technical report describes a result of reviews on the risk management terminology for the use in standards. Experiences in related technical fields and their definitions are reviewed according to the concepts and operational definitions of risk terminologies. It results into a draft standard for KS in the fields of product safety. Quality Assurance, Industrial and Occupational Safety, Financial Management and Risk Management, and others may show many different definitions for their own technical purpose. A draft KS standard for risk terminology must be revised and enhanced to be adopted to the product safety. However, this review does not provide a strict guide for use in the operational definitions of risk terms, but does provide a common base among application areas. The result of this review is submitted to Korea Standard Association in form of a draft KS standards, KS X 0000 : 2001 (ISO TBD : 1999), titled as ' Risk management terminology - Guidelines for use in standards '

Management of Blunt Trauma to the Spleen (Part 1

Directory of Open Access Journals (Sweden)

Seyed Abbas Banani

2010-06-01

Full Text Available AbstractSpleen is the most frequent solid organ to be injured in bluntabdominal trauma. Considering its important role in providingimmunity and preventing infection by a variety of mechanisms,every attempt should be made, if possible, to salvagethe traumatized spleen at any age particularly in children. Afterprimary resuscitation, mandatory requirements for nonoperativemanagement include absence of homodynamic instability,lack of associated major organ injury, admission inthe intensive care unit for high-grade splenic injury and in theward for milder types with close monitoring. About two thirdof the patients would respond to non-operative management.In most patients, failure of non-operative measures usuallyoccur within 12 hours of management. Determinant role ofabdominal sonography or computed tomography, and in selectedcases, diagnostic peritoneal lavage, for appropriate decisioncannot be overemphasized. However, the high status ofclinical judgment would not be replaced by any paraclinicalinvestigations. When operation is unavoidable, if possible,spleen saving procedures (splenorrhaphy or partial splenectomyshould be tried. In case of total splenectomy, autotransplantation,preferably in the omental pouch, may lead toreturn of immunity, at least partially, to prevent or reduce thechance of subsequent infection. Although total splenectomywith autograft is immunologically superior to total splenectomy-only procedure, these patients should also be protectedby vaccination and daily antibiotic for certain period of time.The essential steps for prevention of overwhelming infectionafter total splenectomy are not only immunization and administrationof daily antibiotic (up to 5 years of age or one year inolder children, but include education and information aboutthis dangerous complication. When non-operative managementis successful, the duration of activity restriction (inweeks is almost equal to the grade of splenic injury plus 2.Iran J Med Sci 2010

40 CFR 63.10390 - What management practice standard must I meet?

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 14 2010-07-01 2010-07-01 false What management practice standard must I meet? 63.10390 Section 63.10390 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY....10390 What management practice standard must I meet? You must sterilize full loads of items having a...

40 CFR 63.11561 - What are my standards and management practices?

Science.gov (United States)

2010-07-01

... standards and management practices? (a) For asphalt processing operations, you must meet the emission limits... 40 Protection of Environment 14 2010-07-01 2010-07-01 false What are my standards and management practices? 63.11561 Section 63.11561 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED...

No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study.

Science.gov (United States)

Farquhar, Jaclyn; Almarhabi, Yahya; Slobogean, Gerard; Slobogean, Bronwyn; Garraway, Naisan; Simons, Richard K; Hameed, S Morad

2016-09-01

Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols. Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols. We compared short- and long-term outcomes between these cohorts. Our patient cohorts were well matched for age, sex, injury severity scores and abbreviated injury scores. The nonoperatively managed group had significantly better outcomes than the surgical group in terms of ventilator days (3.1 v. 6.1, p = 0.012), length of stay in the intensive care unit (3.7 v. 7.4 d, p = 0.009), total hospital length of stay (16.0 v. 21.9 d, p = 0.044) and rates of pneumonia (22% v. 63%, p = 0.004). There were no significant differences in long-term outcomes, such as chest pain or dyspnea. Although considerable enthusiasm surrounds surgical fixation of flail chest injuries, our analysis does not immediately validate its universal implementation, but rather encourages the use of modern, multidisciplinary, nonoperative strategies. The role of rib fracture fixation in the modern era of chest wall trauma management should ultimately be defined by prospective, randomized trials.

Standardization and quality management in next-generation sequencing.

Science.gov (United States)

Endrullat, Christoph; Glökler, Jörn; Franke, Philipp; Frohme, Marcus

2016-09-01

DNA sequencing continues to evolve quickly even after > 30 years. Many new platforms suddenly appeared and former established systems have vanished in almost the same manner. Since establishment of next-generation sequencing devices, this progress gains momentum due to the continually growing demand for higher throughput, lower costs and better quality of data. In consequence of this rapid development, standardized procedures and data formats as well as comprehensive quality management considerations are still scarce. Here, we listed and summarized current standardization efforts and quality management initiatives from companies, organizations and societies in form of published studies and ongoing projects. These comprise on the one hand quality documentation issues like technical notes, accreditation checklists and guidelines for validation of sequencing workflows. On the other hand, general standard proposals and quality metrics are developed and applied to the sequencing workflow steps with the main focus on upstream processes. Finally, certain standard developments for downstream pipeline data handling, processing and storage are discussed in brief. These standardization approaches represent a first basis for continuing work in order to prospectively implement next-generation sequencing in important areas such as clinical diagnostics, where reliable results and fast processing is crucial. Additionally, these efforts will exert a decisive influence on traceability and reproducibility of sequence data.

Standard requirements for GCP-compliant data management in multinational clinical trials

LENUS (Irish Health Repository)

Ohmann, Christian

2011-03-22

Abstract Background A recent survey has shown that data management in clinical trials performed by academic trial units still faces many difficulties (e.g. heterogeneity of software products, deficits in quality management, limited human and financial resources and the complexity of running a local computer centre). Unfortunately, no specific, practical and open standard for both GCP-compliant data management and the underlying IT-infrastructure is available to improve the situation. For that reason the "Working Group on Data Centres" of the European Clinical Research Infrastructures Network (ECRIN) has developed a standard specifying the requirements for high quality GCP-compliant data management in multinational clinical trials. Methods International, European and national regulations and guidelines relevant to GCP, data security and IT infrastructures, as well as ECRIN documents produced previously, were evaluated to provide a starting point for the development of standard requirements. The requirements were produced by expert consensus of the ECRIN Working group on Data Centres, using a structured and standardised process. The requirements were divided into two main parts: an IT part covering standards for the underlying IT infrastructure and computer systems in general, and a Data Management (DM) part covering requirements for data management applications in clinical trials. Results The standard developed includes 115 IT requirements, split into 15 separate sections, 107 DM requirements (in 12 sections) and 13 other requirements (2 sections). Sections IT01 to IT05 deal with the basic IT infrastructure while IT06 and IT07 cover validation and local software development. IT08 to IT015 concern the aspects of IT systems that directly support clinical trial management. Sections DM01 to DM03 cover the implementation of a specific clinical data management application, i.e. for a specific trial, whilst DM04 to DM12 address the data management of trials across the unit

41 CFR 102-194.5 - What is the Standard and Optional Forms Management Program?

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is the Standard and Optional Forms Management Program? 102-194.5 Section 102-194.5 Public Contracts and Property Management... PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.5 What is the Standard and Optional...

Management of pediatric postoperative chylothorax.

Science.gov (United States)

Bond, S J; Guzzetta, P C; Snyder, M L; Randolph, J G

1993-09-01

Questions persist about the management of postoperative chylothorax in infants and children. Our experience with postoperative chylothorax over the most recent decade (1980 to 1990) has been reviewed. The type and amount of drainage, data from cardiac catheterization and echocardiography, operative decisions and details, and eventual outcomes have been cataloged. All patients were initially treated with total gut rest, with operation reserved for unabated drainage. Chylothorax developed postoperatively in 15 infants and 11 children (18 with a cardiac procedure and 8 with a noncardiac procedure). The average age was 3.1 years. Spontaneous cessation and cure occurred in 19 (73.1%) of these 26 patients, with an average drainage duration of 11.9 days (range, 4 to 30 days). Those for whom operation was chosen drained preoperatively for an average of 29.2 days (range, 25 to 40 days). There were no deaths in either group. Complications were lymphopenia (2 patients) and fungal sepsis (1 patient). The amount of drainage per day was not significantly different between patients treated operatively and those treated nonoperatively. Failure of nonoperative management was associated with venous hypertension from increased right-sided cardiac pressures or central venous thrombosis (p < 0.05, Fisher's exact test). Presumably this increased pressure is transmitted to the lymphatic system. These patients should be identified early and considered for thoracic duct suture or pleuroperitoneal shunting.

Management of acute combined fractures of the atlas and axis: A retrospective study of two trauma centers

Directory of Open Access Journals (Sweden)

Joseph DiDomenico

2017-01-01

Conclusions: This study demonstrates the variety of treatment strategies used for the management of combined C1-C2 fractures. Patients managed operatively tend to have both anterior and posterior C1 arch fractures, while patients managed nonoperatively tend to have either anterior or posterior arch fractures. In general, treatments should be tailored to patients' needs depending on the stability of the fractures, neurological state, and medical comorbidities.

Biometric identity management for standard mobile medical networks.

Science.gov (United States)

Egner, Alexandru; Soceanu, Alexandru; Moldoveanu, Florica

2012-01-01

The explosion of healthcare costs over the last decade has prompted the ICT industry to respond with solutions for reducing costs while improving healthcare quality. The ISO/IEEE 11073 family of standards recently released is the first step towards interoperability of mobile medical devices used in patient environments. The standards do not, however, tackle security problems, such as identity management, or the secure exchange of medical data. This paper proposes an enhancement of the ISO/IEEE 11073-20601 protocol with an identity management system based on biometry. The paper describes a novel biometric-based authentication process, together with the biometric key generation algorithm. The proposed extension of the ISO/IEEE 11073-20601 is also presented.

The Role of Standardization in Improving the Effectiveness of Integrated Risk Management

OpenAIRE

Ciocoiu, Carmen Nadia; Dobrea, Razvan Catalin

2010-01-01

The need of standardization in risk management is justified by the efforts to develop and introduce, during the last few years, integrated risk management frameworks inside the organizations. The financial crisis has underscored the fact that significant improvements in risk management organizations and capabilities are required. The business community and also the experts recognize that the risk management standards have an important role in improving the effectiveness of integrated risk man...

Contemporary management of flail chest.

Science.gov (United States)

Vana, P Geoff; Neubauer, Daniel C; Luchette, Fred A

2014-06-01

Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment

Directory of Open Access Journals (Sweden)

Federico Canavese

2011-01-01

Full Text Available The strategy for the treatment of idiopathic scoliosis depends essentially upon the magnitude and pattern of the deformity, and its potential for progression. Treatment options include observation, bracing and/or surgery. During the past decade, several studies have demonstrated that the natural history of adolescent idiopathic scoliosis can be positively affected by nonoperative treatment, especially bracing. Other forms of conservative treatment, such as chiropractic or osteopathic manipulation, acupuncture, exercise or other manual treatments, or diet and nutrition, have not yet been proven to be effective in controlling spinal deformity progression, and those with a natural history that is favorable at the completion of growth. Observation is appropriate treatment for small curves, curves that are at low risk of progression, and those with a natural history that is favorable at the completion of growth. Indications for brace treatment are a growing child presenting with a curve of 25°-40° or a curve less than 25° with documented progression. Curves of 20°-25° in patients with pronounced skeletal immaturity should also be treated. The purpose of this review is to provide information about conservative treatment of adolescent idiopathic scoliosis. Indications for conservative treatment, hours daily wear and complications of brace treatment as well as brace types are discussed.

Using a database to manage resolution of comments on standards

International Nuclear Information System (INIS)

Holloran, R.W.; Kelley, R.P.

1995-01-01

Features of production systems that would enhance development and implementation of procedures and other standards were first suggested in 1988 described how a database could provide the features sought for managing the content of structured documents such as standards and procedures. This paper describes enhancements of the database that manage the more complex links associated with resolution of comments. Displaying the linked information on a computer display aids comment resolvers. A hardcopy report generated by the database permits others to independently evaluate the resolution of comments in context with the original text of the standard, the comment, and the revised text of the standard. Because the links are maintained by the database, consistency between the agreed-upon resolutions and the text of the standard can be maintained throughout the subsequent reviews of the standard. Each of the links is bidirectional; i.e., the relationships between any two documents can be viewed from the perspective of either document

Training chiropractic students in weight management counseling using standardized patients.

Science.gov (United States)

Hawk, Cheryl; Ramcharan, Michael; Kruger, Carla LeRiche

2017-03-01

The aim of this study was to describe and assess an activity that trained chiropractic students to counsel patients on weight management through the use of standardized patients. This was a descriptive study using mixed methods. Students were trained to apply health behavior theory and the transtheoretical model. Standardized patients were given a case to portray with the students. Students had 15 minutes for the encounter. The encounters were assessed in 2 ways: (1) standardized patients answered a brief questionnaire about the students' performance, and (2) students answered a questionnaire about the utility of the intervention. Numerical data were extracted from the audiovisual management platform, and statistics were computed for each question. Comments made by students and patients were transferred verbatim for content analysis. A total of 102 students took part in the activity. Students' performance in the encounter was uniformly high, with over 90% "yes" responses to all questions except "gave me printed information material" and "discussed the printed material with me." The key issue identified in the comments by standardized patients was that students tended not to connect weight management with their chief complaint (low back pain). Nearly all students (97%) thought the activity would be useful to their future practice, and 97% felt it had increased their confidence in providing weight management counseling. This experiential activity was assessed to be useful to students' future practice and appeared to provide them with skills to successfully communicate with patients on weight management.

41 CFR 105-71.120 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Standards for financial... violation of the restrictions and prohibitions of applicable statutes. (b) The financial management systems... the financial management system of any applicant for financial assistance as part of a preaward review...

28 CFR 66.20 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... financial reporting requirements of the grant or subgrant. (2) Accounting records. Grantees and subgrantees... advances to the grantees. (c) An awarding agency may review the adequacy of the financial management system... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Standards for financial management...

38 CFR 43.20 - Standards for financial management systems.

Science.gov (United States)

2010-07-01

... violation of the restrictions and prohibitions of applicable statutes. (b) The financial management systems... the financial management system of any applicant for financial assistance as part of a preaward review... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Standards for financial...

36 CFR 223.218 - Consistency with plans, environmental standards, and other management requirements.

Science.gov (United States)

2010-07-01

..., environmental standards, and other management requirements. 223.218 Section 223.218 Parks, Forests, and Public... Special Forest Products § 223.218 Consistency with plans, environmental standards, and other management... with applicable land management plans. Each contract, permit, or other authorizing instrument shall...

To nearly come full circle: Nonoperative management of high-grade IV-V blunt splenic trauma is safe using a protocol with routine angioembolization.

Science.gov (United States)

Bhullar, Indermeet S; Tepas, Joseph J; Siragusa, Daniel; Loper, Todd; Kerwin, Andrew; Frykberg, Eric R

2017-04-01

Nonoperative management (NOM) of hemodynamically stable high-grade (IV-V) blunt splenic trauma remains controversial given the high failure rates (19%) that persist despite angioembolization (AE) protocols. The NOM protocol was modified in 2011 to include mandatory AE of all grade (IV-V) injuries without contrast blush (CB) along with selective AE of grade (I-V) with CB. The purpose of this study was to determine if this new AE (NAE) protocol significantly lowered the failure rates for grade (IV-V) injuries allowing for safe observation without surgery and if the exclusion of grade III injuries allowed for the prevention of unnecessary angiograms without affecting the overall failure rates. The records of patients with blunt splenic trauma from January 2000 to October 2014 at a Level I trauma center were retrospectively reviewed. Patients were divided into two groups and failure of NOM (FNOM) rates compared: NAE protocol (2011-2014) with mandatory AE for all grade (IV-V) injuries without CB and selective AE for grade (I-V) with CB versus old AE (OAE) protocol (2000-2010) with selective AE for grade (I-V) with CB. Seven hundred twelve patients underwent NOM with 522 (73%) in the OAE group and 190 (27%) in the NAE group. Evolving from the OAE to the NAE strategy resulted in a significantly lower FNOM rate for the overall group (grade I-V) (OAE vs. NAE, 4% to 1%, p = 0.04) and the grade (IV-V) group (OAE vs. NAE, 19% vs. 3%, p = 0.01). Angiograms were avoided in 113 grade (I-III) injuries with no CB; these patients had NOM with observation alone and none failed. A protocol using mandatory AE of all high-grade (IV-V) injuries without CB and selective AE of grade (I-V) with CB may provide for optimum salvage with safe NOM of the high-grade injuries (IV-V) and limited unnecessary angiograms. Therapeutic study, level IV.

MANAGEMENT OF LIVER TRAUMA

Directory of Open Access Journals (Sweden)

Dova Subba

2016-03-01

Full Text Available AIM To estimate the incidence of Liver Trauma injuries and grade their severity of injury. To assess the factors responsible for morbidity and mortality after Liver Trauma. To study the postoperative complications and the management of Liver Trauma. MATERIALS AND METHODS The present prospective study was conducted on 100 patients who were admitted to Department of General Surgery for treatment who were managed operatively or non-operatively for abdominal trauma and having liver injury forms the material of the study. This study was conducted over a span of 24 months from June 2013 to November 2015. RESULTS Maximum number of patients are in the age group of 21-30 years (46%. 85% patients (85/100 are males and 15% of patients (15/100 are females. Lapse time of injury and admission varied from 25 minutes to 66 hours and 30 minutes. 75 % of the patients (75/100 presented within 24 hours after injury. Death rate of patients who reached hospital after 24 hours of injury was higher than the patients who reached hospital within 24 hours of injury. 28% of patients (28/100 had associated bony injuries, out of which 5% of patients (5/100 expired due to primary haemorrhage of fractured femur. More than one segment was injured in many patients. Segment V is involved commonly making 55% (55/100 of patients. Next common segment involved is segment VII, making 39% (39/100. CONCLUSION Mechanism of injury is the important factor which is responsible for morbidity in liver injury. Nonoperative management proved to be safe and effective and often has been used to treat patients with liver trauma.

INTRA-ABDOMINAL INFECTION AND ACUTE ABDOMEN-EPIDEMIOLOGY, DIAGNOSIS AND GENERAL PRINCIPLES OF SURGICAL MANAGEMENT

Directory of Open Access Journals (Sweden)

Jovanović Dušan

2015-03-01

Full Text Available Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic- treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections.

45 CFR 92.20 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... with the financial reporting requirements of the grant or subgrant. (2) Accounting records. Grantees... advances to the grantees. (c) An awarding agency may review the adequacy of the financial management system... 45 Public Welfare 1 2010-10-01 2010-10-01 false Standards for financial management systems. 92.20...

15 CFR 24.20 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... financial reporting requirements of the grant or subgrant. (2) Accounting records. Grantees and subgrantees... advances to the grantees. (c) An awarding agency may review the adequacy of the financial management system... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Standards for financial management...

45 CFR 602.20 - Standards for financial management systems.

Science.gov (United States)

2010-10-01

... financial reporting requirements of the grant or subgrant. (2) Accounting records. Grantees and subgrantees... advances to the grantees. (c) An awarding agency may review the adequacy of the financial management system... 45 Public Welfare 3 2010-10-01 2010-10-01 false Standards for financial management systems. 602.20...

13 CFR 143.20 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... financial reporting requirements of the grant or subgrant. (2) Accounting records. Grantees and subgrantees... advances to the grantees. (c) An awarding agency may review the adequacy of the financial management system... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Standards for financial management...

14 CFR 1273.20 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... financial reporting requirements of the grant or subgrant. (2) Accounting records. Grantees and subgrantees... advances to the grantees. (c) An awarding agency may review the adequacy of the financial management system... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Standards for financial management systems...

10 CFR 600.220 - Standards for financial management systems.

Science.gov (United States)

2010-01-01

... financial reporting requirements of the grant or subgrant. (2) Accounting records. Grantees and subgrantees... advances to the grantees. (c) An awarding agency may review the adequacy of the financial management system... 10 Energy 4 2010-01-01 2010-01-01 false Standards for financial management systems. 600.220...

Efficacy and safety of 9 nonoperative regimens for the treatment of spinal cord injury: A network meta-analysis.

Science.gov (United States)

Ma, Da-Nian; Zhang, Xia-Qi; Ying, Jie; Chen, Zhong-Jun; Li, Li-Xin

2017-11-01

This network meta-analysis aims to compare the efficacy and safety of 9 nonoperative regimens (placebo, pregabalin, GM-1 ganglioside, venlafaxine extended-release [venlafaxine XR], fampridine, conventional over-ground training [OT], body-weight-supported treadmill training [BWSTT], robotic-assisted gait training [RAGT] + OT and body-weight-supported over-ground training [BWSOT]) in treating spinal cord injury (SCI). Clinical controlled trials of 9 nonoperative regimens for SCI were retrieved in the electronic database. Traditional pairwise and Bayesian network meta-analyses were performed to compare the efficacy and safety of 9 nonoperative regimens for the treatment of SCI. Weighted mean difference (WMD), odds ratios (OR), and surface under the cumulative ranking curve (SUCRA) were calculated using the Markov Chain Monte Carlo engine Open BUGS (V.3.4.0) and R (V.3.2.1) package gemtc (V.0.6). A total of 9 clinical controlled trials meeting the inclusion criteria were selected in this meta-analysis. On the aspect of efficacy, the results of pairwise meta-analysis indicated that the RAGT + OT and BWSOT might have the best efficacy in SCI patients in terms of a lower extremity motor score (LEMS) compared with conventional OT; the efficacy of RAGT + OT on SCI patients was relatively better than that of conventional OT in terms of walking index for spinal cord injury (WISCI). With the aspect of safety, the constipation rate of placebo on SCI patients was relatively higher than that of venlafaxine XR; however, with respect to headache and urinary tract infection, there was no significant difference in the safety of placebo, pregabalin, GM-1 ganglioside, venlafaxine XR, and fampridine on SCI patients. The results of SUCRA values suggested that BWSOT had the highest SUCRA value (75.25%) of LEMS; RAGT + OT had the highest SUCRA value (88.50%) of WISCI; venlafaxine XR had the highest SUCRA value (94.00%) of constipation; venlafaxine XR had the highest SUCRA

Norms and international standards related to reduce risk management: A literature review

Directory of Open Access Journals (Sweden)

César Fuentes

2011-09-01

Full Text Available The current work aims to develop a revision of the literature within the main concepts in the international rules and standards related to risk management in companies. By this way, there will be an analysis of issues such as the COSO - ERM model, an introduction to the ISO 27000 and 31000 standards; and the Project Management according to PMI targeted at risk management

The new international standard ISO 14001: 2004 environmental management system

International Nuclear Information System (INIS)

Oheba, Jamal Basher

2006-01-01

ISO 14001 is one standard in the ISO 14000 series of standards developed by International Organization of Standardization (ISO). Since it was published in 19096, it has rapidly become the most important environmental standard in the world. ISO 14001 is an environmental management system (EMS) that can be classified into environmental technologies provides a systematic procedure to all kind of organizations to prevent pollutions, protect environment and to improve their overall environmental performance. This new standard ISO 14001 2004 was published on November 15, 2004. It cancels and replaced the old ISO 14001-1996. Because the important of the previous standard for our local industries, firms, ...etc, this paper presents ISO 14001 concepts, issues, benefits and focuses on the stages of implementation to achieve ISO 14001-2004 certification which includes general requirements environmental policy, planning (objectives, targets ..), implementation and operations, checking and management review ...etc and presents how to apply isotop time saver software to design records, and to save time to implement ISO 14001 2004 and finally a conclusion is provided.(Author)

COMPETITIVE ADVANTAGES THROUGH THE IMPLEMENTATION OF INTERNATIONAL ENERGY MANAGEMENT STANDARDS

Directory of Open Access Journals (Sweden)

PALIEKHOVA L. L.

2016-03-01

Full Text Available Purpose. The purpose of the presented research is to explore the potential of international energy management standards to increase competitiveness of industrial enterprises under conditions of Ukrainian transitional economy. The study had the following objectives: to trace the evolution of fundamental energy efficiency standards; to discuss experience in their use in various countries; to identify factors that are key to achieving competitive advantage under the implementation ISO 50001. Methodology. This article presents a historical overview of the standardisation of principles and approaches for the purpose of the energy-efficient management. The research was carried out by studying the international documents, voluntary standards and national practices in the field of energy efficiency. Conclusions. The study examines the experiences of different countries in the field of energy management systems. The authors conducted a comparative analysis of the ISO 50001 with the other basic standards for the organisation of management. The system approach enables to identify the main factors and their impact on capacity to achieve competitive advantages, which are possible to obtain after certification to ISO 50001. Originality. The study reviewed and analysed the energy management penetration within its dynamics at time and country level. After analysing the statistical data and the results of the interviews, the authors identified 20 key factors affecting the competitiveness of enterprises that are certified to ISO 50001. All of these factors were divided into four groups, two groups represent external environment – opportunities and threats, and two groups – internal capacity – strengths and weaknesses of enterprises. Practical value. The proposed system of factors may be useful for the planning of actions towards strengthening the capacity of energy management systems in the context of the formation competitive advantages on the industrial

Academy of Nutrition and Dietetics: standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in adult weight management.

Science.gov (United States)

Jortberg, Bonnie; Myers, Eileen; Gigliotti, Linda; Ivens, Barbara J; Lebre, Monica; Burke March, Susan; Nogueira, Isadora; Nwankwo, Robin; Parkinson, Meredith R; Paulsen, Barbara; Turner, Tonya

2015-04-01

Weight management encompasses the inter-relationship of nutrition, physical activity, and health behavior change. Nutrition is key for the prevention and treatment of obesity and chronic disease and maintenance of overall health. Thus, the Weight Management Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) in Adult Weight Management as a resource for RDNs working in weight management. This document allows RDNs to assess their current skill levels and to identify areas for further professional development in this expanding practice area. This document describes the current standards for weight management practice for RDNs. The Standards of Practice represent the four steps in the Nutrition Care Process as applied to the care of patients/clients. The Standards of Professional Performance consist of six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how the standard can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for RDNs working in weight management. The Standards of Practice and Standards of Professional Performance are complementary resources for the Registered Dietitian Nutritionist in weight management. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

40 CFR 63.11550 - What are my standards and management practices?

Science.gov (United States)

2010-07-01

... my standards and management practices? (a) If you own or operate new or existing affected sources at... practices plan. The management practices plan must include the required management practices in paragraphs (a)(1) and (2) of this section and may include any other management practices that are implemented at...

75 FR 57274 - Financial Management and Assurance; Government Auditing Standards

Science.gov (United States)

2010-09-20

... GOVERNMENT ACCOUNTABILITY OFFICE Financial Management and Assurance; Government Auditing Standards.... Dalkin, Director, Financial Management and Assurance. [FR Doc. 2010-23374 Filed 9-17-10; 8:45 am] BILLING... financial and performance auditing drawn from all levels of government, private enterprise, public...

EP&R Standards Project Report: Technical Review of National Incident Management Standards

Energy Technology Data Exchange (ETDEWEB)

Stenner, Robert D.

2007-04-24

The importance and necessity for a fully developed and implemented National Incident Management System (NIMS) has been demonstrated in recent years by the impact of national events such as Hurricane Katrina in 2005. Throughout the history of emergency response to major disasters, especially when multiple response organizations are involved, there have been systemic problems in the consistency and uniformity of response operations. Identifying national standards that support the development and implementation of NIMS is key to helping solve these systemic problems. The NIMS seeks to provide uniformity and consistency for incident management by using common terminology and protocols that will enable responders to coordinate their efforts to ensure an efficient response.

The Canadian approach to nuclear codes and standards. A CSA forum for development of standards for CANDU: radioactive waste management and decommissioning

International Nuclear Information System (INIS)

Shin, T.; Azeez, S.; Dua, S.

2006-01-01

Together with the Canadian Standards Association (CSA), industry stakeholders, governments, and the public have developed a suite of standards for CANDU nuclear power plants that generate electricity in Canada and abroad. In this paper, we will describe: CSA's role in national and international nuclear standards development; the key issues and priority projects that the nuclear standards program has addressed; the new CSA nuclear committees and projects being established, particularly those related to waste management and decommissioning; the hierarchy of nuclear regulations, nuclear, and other standards in Canada, and how they are applied by AECL; the standards management activities; and the future trends and challenges for CSA and the nuclear community. CSA is an accredited Standards Development Organization (SDO) and part of the international standards system. CSA's Nuclear Strategic Steering Committee (NSSC) provides leadership, direction, and support for a standards committee hierarchy comprised of members from a balanced matrix of interests. The NSSC strategically focuses on industry challenges; a new nuclear regulatory system, deregulated energy markets, and industry restructuring. As the first phase of priority projects is nearing completion, the next phase of priorities is being identified. These priorities address radioactive waste management, environmental radiation management, decommissioning, structural, and seismic issues. As the CSA committees get established in the coming year, members and input will be solicited for the technical committees, subcommittees, and task forces for the following related subjects: Radioactive Waste Management; a) Dry Storage of Irradiated Fuel; b) Short-Term Radioactive Waste Management; c) Long-Term Storage and Disposal of Radioactive Waste. 2. Decommissioning Nuclear Power is highly regulated, and public scrutiny has focused Codes and Standards on public and worker safety. Licensing and regulation serves to control

Changes in the management of liver trauma leading to reduced mortality: 15-year experience in a major trauma centre.

Science.gov (United States)

Suen, Kary; Skandarajah, Anita R; Knowles, Brett; Judson, Rodney; Thomson, Benjamin N

2016-11-01

Worldwide, the evolution of management of liver injury has resulted in improved outcomes. The aim of this study was to examine the trend in the management and outcomes of patients with liver injury. Primary outcomes were defined as mortality and hospital length of stay. The secondary aim was to identify independent predictors of mortality. This study utilized hospital trauma registry data of all trauma patients with liver injuries admitted from 1999 to 2013. Patients in this 15-year period were divided into three periods of 5 years each and compared in terms of demographics, management and outcomes. A total of 725 patients with hepatic trauma were included. Patient demographics were similar, except for an increase in patient transfers from rural locations. Non-operative management increased significantly. There was a significant increase in the use of damage control surgery with perihepatic packing in high-grade liver injuries managed operatively. Hepatic angioembolization commenced midway through the study period. The overall mortality decreased by approximately threefold (P trauma service has led to an evolution in the management of hepatic trauma, favouring non-operative management, damage control surgery and the use of hepatic angioembolization. We experienced a significantly improved mortality within 24 h of arrival to hospital in patients with liver trauma. © 2015 Royal Australasian College of Surgeons.

32 CFR 37.620 - What financial management standards do I include for nonprofit participants?

Science.gov (United States)

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false What financial management standards do I include... financial management standards do I include for nonprofit participants? So as not to force system changes..., your expenditure-based TIA's requirements for the financial management system of any nonprofit...

Thinking Globally: How ISO 50001 - Energy Management can make industrial energy efficiency standard practice

Energy Technology Data Exchange (ETDEWEB)

McKane, Aimee; Desai, Deann; Matteini, Marco; Meffert, William; Williams, Robert; Risser, Roland

2009-08-01

Industry utilizes very complex systems, consisting of equipment and their human interface, which are organized to meet the production needs of the business. Effective and sustainable energy efficiency programs in an industrial setting require a systems approach to optimize the integrated whole while meeting primary business requirements. Companies that treat energy as a manageable resource and integrate their energy program into their management practices have an organizational context to continually seek opportunities for optimizing their energy use. The purpose of an energy management system standard is to provide guidance for industrial and commercial facilities to integrate energy efficiency into their management practices, including fine-tuning production processes and improving the energy efficiency of industrial systems. The International Organization for Standardization (ISO) has identified energy management as one of its top five priorities for standards development. The new ISO 50001 will establish an international framework for industrial, commercial, or institutional facilities, or entire companies, to manage their energy, including procurement and use. This standard is expected to achieve major, long-term increases in energy efficiency (20percent or more) in industrial, commercial, and institutional facilities and to reduce greenhouse gas (GHG) emissions worldwide.This paper describes the impetus for the international standard, its purpose, scope and significance, and development progress to date. A comparative overview of existing energy management standards is provided, as well as a discussion of capacity-building needs for skilled individuals to assist organizations in adopting the standard. Finally, opportunities and challenges are presented for implementing ISO 50001 in emerging economies and developing countries.

British Thoracic Society quality standards for the investigation and management of pulmonary nodules

Science.gov (United States)

Baldwin, David; Callister, Matthew; Akram, Ahsan; Cane, Paul; Draffan, Jeanette; Franks, Kevin; Gleeson, Fergus; Graham, Richard; Malhotra, Puneet; Pearson, Philip; Subesinghe, Manil; Waller, David; Woolhouse, Ian

2018-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the investigation and management of pulmonary nodules in the UK, together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 7 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for the investigation and management of pulmonary nodules, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. Discussion BTS Quality Standards for the investigation and management of pulmonary nodules form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline recommendations. PMID:29682290

The role of non-operative management (NOM) in blunt hepatic trauma

African Journals Online (AJOL)

Ayman Zaki Azzam

2013-01-10

Jan 10, 2013 ... and mortality after liver injuries.3 Management of hepatic inju- ries has evolved over the past 30 years. ... abdominal wall in 14 patients (32%), rib fracture in 12 patients. (27%), rebound tenderness in the right .... ture with the aim of reducing the mortality and morbidity from hemorrhage and sepsis.10,15.

University energy management improvement on basis of standards and digital technologies

Directory of Open Access Journals (Sweden)

Novikova Olga

2018-01-01

Full Text Available Nowadays to implement the energy management system it is important to fulfill not only the legal requirements but also to follow the set of recommendations prepared by international and national management standards. The purpose of this article is to prepare the concept and methodology for the optimization and improvement of the energy management system (EMS for Universities with implementation of legal requirements and recommendations from international and national management standards with the help of digital technologies. During the research the systematic analysis, complex approach, logical sampling and analogy were used. It is shown that this process should be done with the help of the process-based approach, in accordance with ISO 9001, and energy management ISO 50001. The authors developed the structure of the basic standard of energy management: "Guidelines for the energy management system". It is proved that the involvement of the technical senior students in the project of EMS improvement allows to expand their competencies for new technics and technologies. Cloud service Bitrix24 was chosen for IT-support of the project. During the study, a list of characteristics was used as a basis for creating a query to the technology department of the university. DBMS Microsoft Access was chosen for its creation. In addition, the possible results of initiating a single database containing all the information needed for accounting and control of energy supply were listed. Moreover, the possibility of automated energy management system implementation and its results were considered. The required actions described in this research can be implemented in any University, that will extend energy management to any University worldwide.

Attitudes of people with osteoarthritis towards their conservative management: a systematic review and meta-ethnography.

Science.gov (United States)

Smith, Toby O; Purdy, Rachel; Lister, Sarah; Salter, Charlotte; Fleetcroft, Robert; Conaghan, Philip G

2014-03-01

This paper determines the perceptions of people diagnosed with osteoarthritis towards their conservative management strategies. A systematic review of the published (AMED, CINAHL, EMBASE, PsychINFO, SportsDisc, MEDLINE, Cochrane Clinical Trials Registry, PubMed) and unpublished/trial registry databases (WHO International Clinical Trials Registry Platform, Current Controlled Trials, the United States National Institute of Health Trials Registry, NIHR Clinical Research Portfolio Database) searched from their inception to July 2013. Eligible studies included those which presented the attitudes or perceptions of people with osteoarthritis towards non-operative management strategies. Study quality was appraised using the CASP and the Gough's weight of evidence appraisal tools. Data were analysed through a meta-ethnography approach. Thirty-three studies including 1,314 people with osteoarthritis were sampled; the majority diagnosed with knee osteoarthritis. The overarching themes indicated people with osteoarthritis delay their diagnosis, opting for self-management and informal information gathering. This informal rather than health professional-led guidance is sought and maintained as an important resource throughout the care of this population and is valued. Diagnosis is sought at a 'critical point'. Healthcare interventions largely provided are poorly perceived. The period of subsequent self-management is an expectation before the inevitable requirement for joint replacement. There remains uncertainty regarding when this is required, but the expected failure of conservative treatment to manage pain and symptoms is common. In conclusion, patients should be enthused towards the principles of self-management and clinicians should not trivialise osteoarthritis. This may provide a more valuable perception of non-operative management to promote its adoption and adherence in managing osteoarthritis.

The First International Records Management Standard: A Point of View

Directory of Open Access Journals (Sweden)

Fahrettin Özdemirci

2003-09-01

Full Text Available In this work, The First Internatonal Records Management Standart ISO 15489 for the use of records management is examined in regard to its preparatory stu­dies, its content, and its relation and contribution to archive management. In adi- tion to these, the provisions of the standard that can contribute to handling of Turkish records are mentioned and recommendations are offered for steps to be taken.

Knowledge management for assuring high standards in nuclear safety

International Nuclear Information System (INIS)

Hahn, L.

2004-01-01

The primary incentives for introducing knowledge management in organisations active in the nuclear field are the impending loss of knowledge due to an ageing workforce and the necessity to transfer knowledge to the next generation. However, knowledge management may reach much further, and it is shown that ultimately, the goals of knowledge management are congruent with establishing, maintaining and further developing high standards of safety. Knowledge-based activities to reach these goals are discussed, and examples given for producing, utilising and sharing knowledge in organisations and in national and international networks. (author)

Compliance with standard treatment guidelines in the management ...

African Journals Online (AJOL)

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

NASA SensorWeb and OGC Standards for Disaster Management

Science.gov (United States)

Mandl, Dan

2010-01-01

I. Goal: Enable user to cost-effectively find and create customized data products to help manage disasters; a) On-demand; b) Low cost and non-specialized tools such as Google Earth and browsers; c) Access via open network but with sufficient security. II. Use standards to interface various sensors and resultant data: a) Wrap sensors in Open Geospatial Consortium (OGC) standards; b) Wrap data processing algorithms and servers with OGC standards c) Use standardized workflows to orchestrate and script the creation of these data; products. III. Target Web 2.0 mass market: a) Make it simple and easy to use; b) Leverage new capabilities and tools that are emerging; c) Improve speed and responsiveness.

Realizing business benefits from company IT standardization : Case study research into the organizational value of IT standards, towards a company IT standardization management framework

NARCIS (Netherlands)

van Wessel, R.M.

2008-01-01

From a practical point of view, this research provides insight into how company IT standards affect business process performance. Furthermore it gives recommendations on how to govern and manage such standards successfully with regard to their selection, implementation and usage. After evaluating

Software life cycle management standards real-world solutions and scenarios for savings

CERN Document Server

Wright, David

2011-01-01

Software Life Cycle Management Standards will help you apply ISO/IEC 19770 to your business and enjoy the rewards it offers. David Wright calls on his vast experience to explain how the Standard applies to the whole of the software life cycle, not just the software asset management aspects. His informative guide gives up-to-date information using practical examples, clear diagrams and entertaining anecdotes.

Systematic review: work-related stress and the HSE management standards.

Science.gov (United States)

Brookes, K; Limbert, C; Deacy, C; O'Reilly, A; Scott, S; Thirlaway, K

2013-10-01

The Health and Safety Executive (HSE) has defined six management standards representing aspects of work that, if poorly managed, are associated with lower levels of employee health and productivity, and increased sickness absence. The HSE indicator tool aims to measure organizations' performance in managing the primary stressors identified by the HSE management standards. The aims of the study are to explore how the HSE indicator tool has been implemented within organizations and to identify contexts in which the tool has been used, its psychometric properties and relationships with alternative measures of well-being and stress. Studies that matched specific criteria were included in the review. Abstracts were considered by two researchers to ensure a reliable process. Full texts were obtained when abstracts met the inclusion criteria. Thirteen papers were included in the review. Using factor analysis and measures of reliability, the studies suggest that the HSE indicator tool is a psychometrically sound measure. The tool has been used to measure work-related stress across different occupational groups, with a clear relationship between the HSE tool and alternative measures of well-being. Limitations of the tool and recommendations for future research are discussed. The HSE indicator tool is a psychometrically sound measure of organizational performance against the HSE management standards. As such it can provide a broad overview of sources of work-related stress within organizations. More research is required to explore the use of the tool in the design of interventions to reduce stress, and its use in different contexts and with different cultural and gender groups.

Evaluation and percutaneous management of atherosclerotic peripheral vascular disease

International Nuclear Information System (INIS)

Widlus, D.M.; Osterman, F.A. Jr.

1989-01-01

Atherosclerotic peripheral vascular disease (PVD) of the lower extremities deprives a person of the ability to exercise to their satisfaction, later of the ability to perform the activities of their daily life, and finally of their legs themselves. Peripheral vascular disease has long been managed by the vascular surgeon utilizing endarterectomy and peripheral arterial bypass. Patient acceptance of nonsurgical, percutaneous procedures such as percutaneous transluminal balloon angioplasty (PTA) is high. Increased utilization of these procedures has led to improved techniques and adjuncts to therapy, as well as more critical review of long-term results. This article will review the evaluation and nonoperative management of PVD, with an emphasis on the newer modalities of management presently being investigated

25 CFR 900.46 - What requirements are imposed upon the Secretary for financial management by these standards?

Science.gov (United States)

2010-04-01

... financial management by these standards? 900.46 Section 900.46 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT... Management Systems Standards for Financial Management Systems § 900.46 What requirements are imposed upon the Secretary for financial management by these standards? The Secretary shall establish procedures, consistent...

77 FR 66638 - The Standard on Process Safety Management of Highly Hazardous Chemicals; Extension of the Office...

Science.gov (United States)

2012-11-06

... Standard on Process Safety Management of Highly Hazardous Chemicals; Extension of the Office of Management...) approval of the information collection requirements specified in the Standard on Process Safety Management...: The Standard on Process Safety Management of Highly Hazardous Chemicals (29 CFR 1910.119). OMB Number...

Understanding information retrieval systems management, types, and standards

CERN Document Server

Bates, Marcia J

2011-01-01

In order to be effective for their users, information retrieval (IR) systems should be adapted to the specific needs of particular environments. The huge and growing array of types of information retrieval systems in use today is on display in Understanding Information Retrieval Systems: Management, Types, and Standards, which addresses over 20 types of IR systems. These various system types, in turn, present both technical and management challenges, which are also addressed in this volume. In order to be interoperable in a networked environment, IR systems must be able to use various types of

Patellar Instability Management: A Survey of the International Patellofemoral Study Group.

Science.gov (United States)

Liu, Joseph N; Steinhaus, Michael E; Kalbian, Irene L; Post, William R; Green, Daniel W; Strickland, Sabrina M; Shubin Stein, Beth E

2017-10-01

Although patellofemoral instability is among the most prevalent knee disorders, the management of patients with this condition is complex and remains variable, given the lack of long-term, high-level clinical outcome studies to compare various operative and nonoperative modalities. To discover a consensus within treatment controversies in patellofemoral instability among experienced knee surgeons with a specific interest in the patellofemoral joint. Expert opinion; Level of evidence, 5. A 3-step modified Delphi technique was used to establish a consensus. A 34-question, case-based online survey regarding patellofemoral instability was distributed to all active members of the International Patellofemoral Study Group. Consensus statements were generated if at least 66% of the respondents agreed and then redistributed to the same panel. Modifications to the consensus statements were made based on the iterative feedback process until no discordance was encountered in the third stage. Eight consensus statements were achieved. Nonoperative management is the current standard of care for a first-time dislocation in the absence of an osteochondral fragment or loose body requiring excision (100% agreement). In patients with a first-time dislocation with an operative osteochondral fracture requiring excision or repair, patellar instability should be addressed concurrently (89% agreement). Recurrent instability should be treated surgically, with most surgeons favoring medial reconstruction (77%-86% agreement). While there is general agreement that bony procedures should be performed to correct underlying bony deformities, there is no consensus regarding the most appropriate type of procedure performed. Lateral release should not be performed in isolation for the treatment of patellar instability (89% agreement). Despite the consensus generated in this study, our current understanding remains limited by a lack of high-level evidence as well as the numerous complex variables

Standardized Curriculum for Food Production, Management and Services.

Science.gov (United States)

Mississippi State Dept. of Education, Jackson. Office of Vocational, Technical and Adult Education.

Standardized vocational education course titles and core contents for two courses in Mississippi are provided: food production, management, and services I and II. The first course contains the following units: (1) Vocational Industrial Clubs of America (VICA); (2) sanitation; (3) safety; (4) front of the house operations; (5) beverages; (6) food…

Standard Practice for Quality Management Systems for Nondestructive Testing Agencies

CERN Document Server

American Society for Testing and Materials. Philadelphia

2009-01-01

1.1 This practice covers general requirements for the establishment and maintenance of a quality management system for agencies engaged in nondestructive testing (NDT). 1.2 This practice utilizes criteria contained in Practice E 543. 1.3 This practice utilizes criteria contained in American National Standard ANSI/ISO/ASQ Q9001–2000, Quality management systems—Requirements. 1.4 This practice recognizes the importance of establishing minimum safety criteria. 1.5 The use of SI or inch-pound units, or combinations thereof, will be the responsibility of the technical committee whose standards are referred to in this standard. 1.6 This practice does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this practice to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

DIFFERENCES IN MANAGER ASSESSMENTS OF ISO 14000 STANDARD IMPLEMENTATION IN TURKEY

Directory of Open Access Journals (Sweden)

Sıtkı Gözlü

2005-12-01

Full Text Available This study reports the results of a survey about the improvements achieved as result of ISO 14000 Environmental Management System (EMS standard implementation and the differences of improvements with respect to firm characteristics. A survey has been conducted in order to explain the improvements related to environmental management process and overall firm performance. The survey involved sixty-six enterprises implementing ISO 14000 EMS standard in Turkey. In order to assess improvements obtained from ISO 14000 EMS implementation, statements related to environmental management process and overall firm performance indicators have been prepared. The statements in this study are relevant to previous research. A factor analysis was employed to determine the factors of the variables explaining improvements. Nine factors have been identified related to achieved improvements, such as establishment of pro-active environmental management system, effectiveness in resource utilization, effectiveness of process control, relationships with industry and government, meeting expectations of stakeholders, demonstration of social responsibility, profitability, productivity, and competitiveness. Then, a T- test was conducted to determine the differences of managers’ assessments with respect to certain firm characteristics. The findings have shown that there are differences in the assessments of improvements achieved as a result of ISO 14000 EMS standard implementation with respect to sales volume, foreign-capital possession, and ISO 14000 EMS standard implementation. On the other hand, industrial sector, age of establishment, and export orientation are not statistically significant for the differences in the assessments of improvements.

77 FR 64920 - Revisions to Reliability Standard for Transmission Vegetation Management

Science.gov (United States)

2012-10-24

... reliability of the Bulk Electric System.'' NERC defines ``System Operating Limit'' as ``[t]he value (such as... values or gives reason to revisit the Reliability Standard. Accordingly, consistent with the activity...] Revisions to Reliability Standard for Transmission Vegetation Management AGENCY: Federal Energy Regulatory...

ISO 14000 - the International Environmental Management Standard: Potential impacts on environmental management and auditing in the electric power generation industry

International Nuclear Information System (INIS)

Gauntlett, S.B.; Pierce, J.L.; Pierce, J.L.

1995-01-01

In the framework of environmental management, the concept of voluntary environmental compliance auditing is not in itself a new development. Environmentally conscious firms have for more than a decade, undertaken voluntary audits to help achieve and maintain compliance with environmental regulations and to help identify and correct unregulated or poorly regulated environmental hazard. The firms undertaking the audits were motivated by a desire to mitigate legal and financial risks and/or the desire to be a highly responsible member of the corporate community. Much of the early attention to environmental auditing was in the chemical process industries. Today, there are four current trends affecting environmental auditing: (1) the practice is becoming widespread in all industry groups in both large and small firms; (2) environmental management and audit methodolgies and approaches are being codified in the form of written national and International standards; (3) environmental management programs and in-house audits are increasingly being certified by independent auditors (who are not associated with regulatory agencies); and (4) the certifications are being viewed as marketing and public relations tools. The adoption of ISO 14000 is destined to become the most significant development in international environmental management and auditing. International standards for the development of Environmental Management Systems and the execution of environmental audits do not currently exist. Individual countries, such as England and France, have national standards. One multi-national standard currently exists--the European Economic Community's Eco-Management and Audit Scheme (EMAS). The United States does not have a national environmental management and auditing standard

78 FR 22773 - Revisions to Reliability Standard for Transmission Vegetation Management; Correction

Science.gov (United States)

2013-04-17

...; Order No. 777] Revisions to Reliability Standard for Transmission Vegetation Management; Correction... modifying certain Reliability Standards. DATES: Effective on May 28, 2013. FOR FURTHER INFORMATION CONTACT... Requirement R2 of Reliability Standard FAC-003-2 within 45 days of the effective date of the Final Rule, while...

Development of criteria and standards for management of low-level radioactive waste

International Nuclear Information System (INIS)

Grey, A.E.; Falconer, K.L.

1980-08-01

The basic need for criteria and standards for radioactive waste management is to ensure compliance with Federal and State regulations applicable to this activity. In addition, criteria and standards can establish the parameters by which a radioactive waste disposal site is selected, the form in which the waste is to be disposed, how a disposal site is to be operated, and how that site is to be closed when it reaches the end of its useful life. For developing criteria and standards, this report discusses the nature of low-level radioactive waste and the role government agencies play in regulating its management. It describes subject areas for which criteria and standards could be developed, current and evolving requirements, and future suggested analyses

[Associated factors to non-operative management failure of hepatic and splenic lesions secondary to blunt abdominal trauma in children].

Science.gov (United States)

Echavarria Medina, Adriana; Morales Uribe, Carlos Hernando; Echavarria R, Luis Guillermo; Vélez Marín, Viviana María; Martínez Montoya, Jorge Alberto; Aguillón, David Fernando

2017-01-01

The non operative management (NOM) is the standard management of splenic and liver blunt trauma in pediatric patients.Hemodynamic instability and massive transfusions have been identified as management failures. Few studies evaluate whether there exist factors allowing anticipation of these events. The objective was to identify factors associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma. Retrospective analysis between 2007-2015 of patients admitted to the pediatric surgery at University Hospital Saint Vincent Foundation with liver trauma and/or closed Spleen. 70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP) 2 g/dl in the first 24 hours (p = 0.0009; RR = 15.3), and transfusion of 3 or more units of red blood cells (RBC) (0.00001; RR = 17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM. Children with blunted hepatic or splenic trauma respond to NOM. Factors such as BP 2 g/dl in the first 24 hours and transfusion of 3 or more units of RBC were associated with the failure in NOM.

Technical Review of Law Enforcement Standards and Guides Relative to Incident Management

Energy Technology Data Exchange (ETDEWEB)

Stenner, Robert D.; Salter, R.; Stanton, J. R.; Fisher, D.

2009-03-24

In an effort to locate potential law enforcement-related standards that support incident management, a team from the Pacific Northwest National Laboratory (PNNL) contacted representatives from the National Institute of Standards-Office of Law Enforcement Standards (NIST-OLES), National Institute of Justice (NIJ), Federal Bureau of Investigation (FBI), Secret Service, ASTM International committees that have a law enforcement focus, and a variety of individuals from local and regional law enforcement organizations. Discussions were held with various state and local law enforcement organizations. The NIJ has published several specific equipment-related law enforcement standards that were included in the review, but it appears that law enforcement program and process-type standards are developed principally by organizations that operate at the state and local level. Input is provided from state regulations and codes and from external non-government organizations (NGOs) that provide national standards. The standards that are adopted from external organizations or developed independently by state authorities are available for use by local law enforcement agencies on a voluntary basis. The extent to which they are used depends on the respective jurisdictions involved. In some instances, use of state and local disseminated standards is mandatory, but in most cases, use is voluntary. Usually, the extent to which these standards are used appears to depend on whether or not jurisdictions receive certification from a “governing” entity due to their use and compliance with the standards. In some cases, these certification-based standards are used in principal but without certification or other compliance monitoring. In general, these standards appear to be routinely used for qualification, selection for employment, and training. In these standards, the term “Peace Officer” is frequently used to refer to law enforcement personnel. This technical review of national law

A rare case of splenic pseudoaneurysm in pediatric splenic blunt trauma patient: Review of diagnosis and management

Directory of Open Access Journals (Sweden)

Roger Chen Zhu

2015-01-01

Discussion & conclusion: Questions still remain regarding the timing of repeat imaging for diagnosis of SPA following non-operative blunt splenic trauma, which patients should be imaged, and how to manage SPA upon diagnosis. More clinical study and basic science research is warranted to study the disease process of SPA in pediatric patient. We believe that our proposed management algorithm timely detect formation of delayed SPA formation and addresses the possible fatal disease course of pediatric SPA.

Trust Management in P2P systems using Standard TuLiP

NARCIS (Netherlands)

Czenko, M.R.; Doumen, J.M.; Etalle, Sandro

2008-01-01

In this paper we introduce Standard TuLiP - a new logic based Trust Management system. In Standard TuLiP, security decisions are based on security credentials, which can be issued by different entities and stored at different locations. Standard TuLiP directly supports the distributed credential

Trust management in P2P systems using standard TuLiP

NARCIS (Netherlands)

Czenko, M.; Doumen, J.M.; Etalle, S.; Karabulut, Y.; Mitchell, J.C.; Herrmann, P.; Jensen, C.D.

2008-01-01

In this paper we introduce Standard TuLiP - a new logic based Trust Management system. In Standard TuLiP, security decisions are based on security credentials, which can be issued by different entities and stored at different locations. Standard TuLiP directly supports the distributed credential

Trust Management in P2P Systems Using Standard TuLiP

NARCIS (Netherlands)

Czenko, M.R.; Doumen, J.M.; Etalle, Sandro

2008-01-01

In this paper we introduce Standard TuLiP - a new logic based Trust Management system. In Standard TuLiP, security decisions are based on security credentials, which can be issued by different entities and stored at different locations. Standard TuLiP directly supports the distributed credential

The Standard of Management and Application of Cultural Heritage Documentation

Directory of Open Access Journals (Sweden)

Yen Ya Ning

2011-12-01

Full Text Available Using digital technology for cultural heritage documentation is a global trend in the 21 st century. Many important techniques are currently under development, including 3D digital imaging, reverse engineering, GIS (Geographic Information Systems etc. However, no system for overall management or data integration is yet available. Therefore, we urgently need such a system to efficiently manage and interpret data for the preservation of cultural heritages. This paper presents a digitizing process developed in Taiwan by the authors. To govern and manage cultural property, three phases of property conservation, registration, restoration and management, has been set up along a timeline. In accordance with the laws of cultural property, a structural system has been built for project management, including data classification and data interpretation with self-documenting characteristics. Through repository information and metadata, a system catalogue (also called data dictionary (Figure 1 was created. The primary objective of the study is to create an integrated technology for an efficient management of databases. Several benefits could be obtained from this structural standard: (1 cultural heritage management documentation can be centralized to minimize the possibility of data re-entry resulting inconsistency, and also to facilitate simultaneous updating of data; (2 since multiple data can be simultaneously retrieved and saved in real time, the incidence of errors can be reduced; (3 this system could be easily tailored to meet the administrative requirements for the standardization of documentation exchanged between cultural properties institutions and various county and city governments.

Early appendectomy reduces costs in children with perforated appendicitis.

Science.gov (United States)

Church, Joseph T; Klein, Edwin J; Carr, Benjamin D; Bruch, Steven W

2017-12-01

Perforated appendicitis can be managed with early appendectomy, or nonoperative management followed by interval appendectomy. We aimed to identify the strategy with the lowest health care utilization and cost. We retrospectively reviewed the medical records of all children ≤18 years old with perforated appendicitis admitted to a single institution between January 2009 and March 2016. After excluding immunosuppressed patients and transfers from outside hospitals, we grouped the remaining patients by early or interval appendectomy. Cost accounting data were obtained from our institutional database. The primary outcome was total hospital cost over 2 y from initial admission for appendicitis. Other outcomes analyzed included initial admission costs, number of admissions, emergency room and clinic visits, percutaneous procedures, cross-sectional and overall imaging studies, and length of stay. A total of 203 children with perforated appendicitis were identified. After exclusion of immunosuppressed patients and outside hospital transfers, 94 patients were included in the study. Thirty-nine underwent early appendectomy and 55 initial nonoperative management; of these, 54 underwent elective interval appendectomy. Five of 55 patients (9%) failed initial nonoperative management and required earlier-than-planned appendectomy. Total cost over 2 y was significantly lower with early appendectomy than initial nonoperative management ($19,300 ± 14,300 versus $26,000 ± 17,500; P = 0.05). Early appendectomy resulted in fewer hospital admissions, clinic visits, invasive procedures, and imaging studies. Early appendectomy results in lower hospital costs and less health care utilization compared with initial nonoperative management with elective interval appendectomy. A prospective study will shed more light on this question and can assess the role of nonoperative management without interval appendectomy in children with perforated appendicitis. Copyright © 2017 Elsevier

Investigations on international standardization of environmental management systems. 3; Kankyo kanri system no kokusai hyojunka ni kansuru chosa. 3

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-03-01

Japan as an ISO member country identifies the state of discussions in the environmental management standard deliberation committee at ISO. Investigations were performed on international standardization of environmental management systems for the purpose of participating and cooperating in preparing and establishing international standards related to environmental management, and playing part in working, solving and improving environmental problems. Under the circumstances that environmental problems are drawing worldwide interest, the International Organization for Standardization (ISO) has been carrying out since 1993 deliberations on environmental management standards to institutionalize environmental management rules to check effects of business activities on the environment. The International Organization for Standardization/Environmental Management Technical Committee (ISO/TC207) was installed, at which series number of 1400 order was allotted for environmental management related standards, and major standards have come to a final stage of standard formulation at the TC207 Oslo conference in June 1995. In Japan, the Ministry of International Trade and Industry has established an environmental management standard deliberation committee composed of people of experience or academic standing to advance discussions on how the environmental management should be in business entities through deliberations on ISO standards.

IMPROVING MANAGEMENT ACCOUNTING AND COST CALCULATION IN DAIRY INDUSTRY USING STANDARD COST METHOD

Directory of Open Access Journals (Sweden)

Bogdănoiu Cristiana-Luminiţa

2013-04-01

Full Text Available This paper aims to discuss issues related to the improvement of management accounting in the dairy industry by implementing standard cost method. The methods used today do not provide informational satisfaction to managers in order to conduct effectively production activities, which is why we attempted the standard cost method, it responding to the managers needs to obtain the efficiency of production, and all economic entities. The method allows an operative control of how they consume manpower and material resources by pursuing distinct, permanent and complete deviations during the activity and not at the end of the reporting period. Successful implementation of the standard method depends on the accuracy by which standards are developed and promotes consistently anticipated calculation of production costs as well as determination, tracking and controlling deviations from them, leads to increased practical value of accounting information and business improvement.

Proposal for implementation risk management according ABNT NBR ISO 31000 standard applied to internal audit process of Integrated Management System of IPEN

International Nuclear Information System (INIS)

Scapin Junior, Wilson S.; Salvetti, Tereza C.; Longo, Guilherme C.

2015-01-01

The paper objective is to establish a risk management methodology applied to internal audits processes of IPEN Integrated Management System (IMS). In continuous seeking of updating methodologies to assist effective management based on the constant changes in the organizational world, and the development of management tools used for decision making, risk management demonstrates trends to be a new tool with high efficiency. This trend is accentuated by the fact that risk management is being incorporated into the new revision of quality management standard ISO 9001, estimated conclusion in November 2015. The identification, evaluation and treatment of risks are present in eleven items of its ten requirements at new revision. From the conclusion of the review, all organizations certified by that standard should make the necessary changes in their systems to meet the new requirements. This proposal will provide anticipate the changes that will occur in the management system of IPEN in accordance with this new revision. With the character of a pilot program to implement the organizational culture change in relationship to new concepts related to risks and implementation of risk management all other system processes that will be affected by the new revision of this standard. The methodology used for this paper is supported by the standards ABNT NBR ISO 31000. (author)

Proposal for implementation risk management according ABNT NBR ISO 31000 standard applied to internal audit process of Integrated Management System of IPEN

Energy Technology Data Exchange (ETDEWEB)

Scapin Junior, Wilson S.; Salvetti, Tereza C.; Longo, Guilherme C., E-mail: wsscapin@ipen.br, E-mail: salvetti@ipen.br, E-mail: glongo@ipen.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

2015-07-01

The paper objective is to establish a risk management methodology applied to internal audits processes of IPEN Integrated Management System (IMS). In continuous seeking of updating methodologies to assist effective management based on the constant changes in the organizational world, and the development of management tools used for decision making, risk management demonstrates trends to be a new tool with high efficiency. This trend is accentuated by the fact that risk management is being incorporated into the new revision of quality management standard ISO 9001, estimated conclusion in November 2015. The identification, evaluation and treatment of risks are present in eleven items of its ten requirements at new revision. From the conclusion of the review, all organizations certified by that standard should make the necessary changes in their systems to meet the new requirements. This proposal will provide anticipate the changes that will occur in the management system of IPEN in accordance with this new revision. With the character of a pilot program to implement the organizational culture change in relationship to new concepts related to risks and implementation of risk management all other system processes that will be affected by the new revision of this standard. The methodology used for this paper is supported by the standards ABNT NBR ISO 31000. (author)

Review of Special Standards in Quality Management Systems Audits in Automotive Production

Science.gov (United States)

Šurinová, Yulia

2013-12-01

Quality management systems (QMS) in automotive industry generally have several differences in comparison with other industrial branches. Different customers have their own specific requirements, including requirements for quality audits. Audits are one of the coretools of quality management to make the PDCA (Plan - Do - Check - Act) cycle work. As a matter of fact, compliance with ISO/TS 16949:2009 requirements is a condition for supplying the automotive industry. However, there are some standards which co-exist together with the ISO 9001 based management systems and technical specification for QMS in automotive ISO/TS16949. Which are those specific standards in automotive industry and what standard to use and why - those are the questions to be answered in this paper. The aim of the paper is to review what standards are used for audits implementation in automotive industry in the Slovak Republic, and why the organizations keep following those "extra" standards even if certification for ISO/TS 16949 is required by all the car makers. The paper is structured as follows: after short introduction to the topic and related terms, presented is our methodology. . In the third section, the achieved results are discussed. And finally, the principal findings of the paper, limitations and conclusions are presented.

International Financial Reporting Standards and Earnings Management in Latin America

Directory of Open Access Journals (Sweden)

Alex Augusto Timm Rathke

2016-05-01

Full Text Available This study analyzes the level of earnings management in Latin America after the adoption of the International Financial Reporting Standards (IFRS and analyzes the role of cross-listing in the United States. The literature on earnings management in less developed countries is still under construction, and few studies focus on this issue, especially with respect to Latin America, despite its relevant role in the global economy. This paper fills this gap in the literature as it analyzes the level of IFRS earnings management regarding the first and main Latin American countries applying IFRS (Brazil and Chile, when compared to the main Anglo-Saxon countries with IFRS tradition (United Kingdom and Australia, and with the main Continental European economies (France and Germany. The results show that Latin American firms present a higher level of earnings management than Continental European and Anglo-Saxon firms, and this opportunistic behavior remains significant when only global players with cross-listing in the United States are analyzed. Thus, even with a unique set of high quality accounting standards (IFRS and strong reporting incentives, countries’ specific characteristics still play an important role in the way IFRS is implemented in each country.

Clinical Factors Associated with the Non-Operative Airway Management of Patients with Robin Sequence

Directory of Open Access Journals (Sweden)

Frank P. Albino

2016-11-01

Full Text Available BackgroundThe indications for surgical airway management in patients with Robin sequence (RS and severe airway obstruction have not been well defined. While certain patients with RS clearly require surgical airway intervention and other patients just as clearly can be managed with conservative measures alone, a significant proportion of patients with RS present with a more confusing and ambiguous clinical course. The purpose of this study was to describe the clinical features and objective findings of patients with RS whose airways were successfully managed without surgical intervention.MethodsThe authors retrospectively reviewed the medical charts of infants with RS evaluated for potential surgical airway management between 1994 and 2014. Patients who were successfully managed without surgical intervention were included. Patient demographics, nutritional and respiratory status, laboratory values, and polysomnography (PSG findings were recorded.ResultsThirty-two infants met the inclusion criteria. The average hospital stay was 16.8 days (range, 5–70 days. Oxygen desaturation (<70% by pulse oximetry occurred in the majority of patients and was managed with temporary oxygen supplementation by nasal cannula (59% or endotracheal intubation (31%. Seventy-five percent of patients required a temporary nasogastric tube for nutritional support, and a gastrostomy tube placed was placed in 9%. All patients continued to gain weight following the implementation of these conservative measures. PSG data (n=26 demonstrated mild to moderate obstruction, a mean apneahypopnea index (AHI of 19.2±5.3 events/hour, and an oxygen saturation level <90% during only 4% of the total sleep time.ConclusionsNonsurgical airway management was successful in patients who demonstrated consistent weight gain and mild to moderate obstruction on PSG, with a mean AHI of <20 events/hour.

7 CFR 205.206 - Crop pest, weed, and disease management practice standard.

Science.gov (United States)

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Crop pest, weed, and disease management practice... Requirements § 205.206 Crop pest, weed, and disease management practice standard. (a) The producer must use management practices to prevent crop pests, weeds, and diseases including but not limited to: (1) Crop...

Non-operative treatment of spontaneous spinal epidural hematomas: a review of the literature and a comparison with operative cases : a review of the literature and a comparison with operative cases

NARCIS (Netherlands)

Groen, R J M

OBJECTIVE: To identify factors that favour spontaneous recovery in patients who suffered a spontaneous spinal epidural hematoma (SSEH). METHODS: The literature was reviewed regarding non-operative cases of SSEH (SSEH(cons)). Sixty-two cases from the literature and 2 of our own cases were collected,

Best practices in selecting performance measures and standards for effective asset management.

Science.gov (United States)

2011-06-01

"This report assesses and provides guidance on best practices in performance measurement, management and standards : setting for effective Transportation Asset Management (TAM). The study is conducted through a literature review, a : survey of the 50...

Management of pediatric splenic injuries in Canada.

Science.gov (United States)

McDonald, Lindsay A; Yanchar, Natalie L

2012-03-01

Nonoperative management (NOM) of blunt splenic injuries has become the standard of care in hemodynamically stable children. This study compares the management of these injuries between pediatric and nonpediatric hospitals in Canada. Data were obtained from the Canadian Institute of Health Information trauma database on all patients aged 2 to 16 years, admitted to a Canadian hospital with a diagnosis of splenic injury between May 2002 and April 2004. Variables included age, sex, associated major injuries, splenic procedures, intensive care unit (ICU) admissions, blood transfusions, and length of stay. Hospitals were coded as pediatric or nonpediatric. Univariate analysis and logistic regression were used to determine associations between hospital type and outcomes. Of 1284 cases, 654 were managed at pediatric hospitals and 630 at nonpediatric centers. Patients at pediatric centers tended to be younger and more likely to have associated major injuries. Controlling for covariates, including associated major injuries, patients managed at pediatric centers were less likely to undergo splenectomy compared with those managed at nonpediatric centers (odds ratio [OR], 0.2; 95% confidence interval, 0.1-0.4). The risk of receiving blood products, admission to the ICU, and staying in hospital for more than 5 days was associated only with having associated major injuries. Even in the presence of other major injuries, successful NOM of blunt splenic injuries occurs more frequently in pediatric hospitals in Canada. This has policy relevance regarding education of adult surgeons about the appropriateness of NOM in children and developing guidelines on appropriate regional triaging of pediatric patients with splenic injury in Canada. Copyright © 2012 Elsevier Inc. All rights reserved.

National Incident Management System (NIMS) Standards Review Panel Workshop Summary Report

Energy Technology Data Exchange (ETDEWEB)

Stenner, Robert D.; Kirk, Jennifer L.; Stanton, James R.; Shebell, Peter; Schwartz, Deborah S.; Judd, Kathleen S.; Gelston, Gariann M.

2006-02-07

The importance and need for full compliant implementation of NIMS nationwide was clearly demonstrated during the Hurricane Katrina event, which was clearly expressed in Secretary Chertoff's October 4, 2005 letter addressed to the State's governors. It states, ''Hurricane Katrina was a stark reminder of how critical it is for our nation to approach incident management in a coordinated, consistent, and efficient manner. We must be able to come together, at all levels of government, to prevent, prepare for, respond to, and recover from any emergency or disaster. Our operations must be seamless and based on common incident management doctrine, because the challenges we face as a nation are far greater than capabilities of any one jurisdiction.'' The NIMS is a system/architecture for organizing response on a ''national'' level. It incorporations ICS as a main component of that structure (i.e., it institutionalizes ICS in NIMS). In a paper published on the NIMS Website, the following statements were made: ''NIMS represents a core set of doctrine, principles, terminology, and organizational processes to enable effective, efficient and collaborative incident management at all levels. To provide the framework for interoperability and compatibility, the NIMS is based on a balance between flexibility and standardization.'' Thus the NIC is challenged with the need to adopt quality SDO generated standards to support NIMS compliance, but in doing so maintain the flexibility necessary so that response operations can be tailored for the specific jurisdictional and geographical needs across the nation. In support of this large and complex challenge facing the NIC, the Pacific Northwest National Laboratory (PNNL) was asked to provide technical support to the NIC, through their DHS Science and Technology ? Standards Portfolio Contract, to help identify, review, and develop key standards for NIMS compliance. Upon

Evaluation and Management of Traumatic Diaphragmatic Injuries: A Practice Management Guideline from the Eastern Association for the Surgery of Trauma.

Science.gov (United States)

McDonald, Amy A; Robinson, Bryce R H; Alarcon, Louis; Bosarge, Patrick L; Dorion, Heath; Haut, Elliott R; Juern, Jeremy; Madbak, Firas; Reddy, Srinivas; Weiss, Patricia; Como, John J

2018-04-02

Traumatic diaphragm injuries (TDI) pose both diagnostic and therapeutic challenges in both the acute and chronic phases. There are no published practice management guidelines to date for TDI. We aim to formulate a practice management guideline for TDI using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group formulated five Patient, Intervention, Comparator, Outcome (PICO) questions regarding the following topics: 1) diagnostic approach (laparoscopy vs. computed tomography); 2) non-operative management of penetrating right-sided injuries; 3) surgical approach (abdominal or thoracic) for acute TDI, including 4) the use of laparoscopy; and 5) surgical approach (abdominal or thoracic) for delayed TDI. A systematic review was undertaken and last updated December 2016. RevMan 5 (Cochran Collaboration) and GRADEpro (Grade Working Group) software were utilized. Recommendations were voted on by working group members. Consensus was obtained for each recommendation. A total of 56 articles were utilized to formulate the recommendations. Most studies were retrospective case series with variable reporting of outcomes measures and outcomes frequently not stratified to intervention or comparator. The overall quality of the evidence was very low for all PICOs. Therefore, only conditional recommendations could be made. Recommendations were made in favor of laparoscopy over CT for diagnosis, non-operative vs. operative approach for right-sided penetrating injuries, abdominal vs. thoracic approach for acute TDI, and laparoscopy (with the appropriate skill set and resources) vs. open approach for isolated TDI. No recommendation could be made for the preferred operative approach for delayed TDI. Very low-quality evidence precluded any strong recommendations. Further study of the diagnostic and therapeutic approaches to TDI is warranted. Guideline LEVEL OF EVIDENCE: 4.

Contribution to Energy Management of the Main Standards for Environmental Management Systems: The Case of ISO 14001 and EMAS

Directory of Open Access Journals (Sweden)

Iker Laskurain

2017-11-01

Full Text Available The adoption of Energy Management Systems (EnMSs based on international standards has gained momentum since the ISO 50001 standard was launched in 2011. Before that, the potential to improve the energy management with Environmental Management Systems (EMSs based on ISO 14001 and EMAS was identified in the literature. However, no in-depth analysis reported in the literature has explored this claim. The need for research is now even more evident with the development of new versions of the standards for environmental management―ISO 14001:2015 and EMAS III. Since many companies that already have a certified EMSs might be uncertain whether to adopt an ISO 50001 based EnMSs, the present work aims to shed light on the contribution of ISO 14001:2015 and EMAS III to energy management. Furthermore, the work summarizes the results of an empirical exploratory study carried out in eight Spanish organizations, four with an EMS implemented and certified based on ISO 14001:2015 and four more with an EMS registered to EMAS III. The findings show that both ISO14001 and EMAS certified organizations carry out energy management practices, even though they have no formal EnMSs implemented. Implications for managers and policy makers are discussed, together with avenues for further research.

A Survey of Fellowship-Trained Upper Extremity Surgeons on Treatment of Lateral Epicondylitis.

Science.gov (United States)

Niedermeier, Steven R; Crouser, Nisha; Speeckaert, Amy; Goyal, Kanu S

2018-04-01

The aim of the study is to investigate current management strategies for lateral epicondylitis by fellowship-trained upper extremity surgeons. A 17-question survey of treatment approaches and outcomes related to lateral epicondylitis was sent to 3354 surgeons using the American Society for Surgery of the Hand and American Shoulder and Elbow Surgeons member databases. Six hundred twelve upper extremity surgeons completed the survey. The 6 most frequently prescribed nonoperative treatments for lateral epicondylitis were home exercise program/stretching (81%), nonsteroidal anti-inflammatory drugs (75%), steroid injection (71%), counterforce bracing (68%), formal physical therapy (65%), and wrist brace (47%). Less commonly performed nonoperative treatment measures included platelet-rich plasma injection (16%), Tenex procedure (6%), and iontophoresis (2%). There is a lack of consensus in the literature for the management of lateral epicondylitis, which is reflected by individual variation in clinical treatment among the experts. Future prospective randomized control studies are needed to establish evidence-based practice standards for this common diagnosis.

Implementation of a standardized out-of-hospital management method for Parkinson dysphagia.

Science.gov (United States)

Wei, Hongying; Sun, Dongxiu; Liu, Meiping

2017-12-01

Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia. Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention. Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (pdysphagia complications and improve the quality of life in patients with PD.

Contemporary evaluation and management of renal trauma.

Science.gov (United States)

Chouhan, Jyoti D; Winer, Andrew G; Johnson, Christina; Weiss, Jeffrey P; Hyacinthe, Llewellyn M

2016-04-01

Renal trauma occurs in approximately 1%-5% of all trauma cases. Improvements in imaging and management over the last two decades have caused a shift in the treatment of this clinical condition. A systematic search of PubMed was performed to identify relevant and contemporary articles that referred to the management and evaluation of renal trauma. Computed tomography remains a mainstay of radiological evaluation in hemodynamically stable patients. There is a growing body of literature showing that conservative, non-operative management of renal trauma is safe, even for Grade IV-V renal injuries. If surgical exploration is planned due to other injuries, a conservative approach to the kidney can often be utilized. Follow up imaging may be warranted in certain circumstances. Urinoma, delayed bleeding, and hypertension are complications that require follow up. Appropriate imaging and conservative approaches are a mainstay of current renal trauma management.

Management of vacuum leak-detection processes, calibration, and standards

International Nuclear Information System (INIS)

Wilson, N.G.

1985-01-01

Vacuum leak detection requires integrated management action to ensure the successful production of apparatus having required leak tightness. Implementation of properly planned, scheduled, and engineered procedures and test arrangements are an absolute necessity to prevent unexpected, impractical, technically inadequate, or unnecessarily costly incidents in leak-testing operations. The use of standard procedures, leak standards appropriate to the task, and accurate calibration systems or devices is necessary to validate the integrity of any leak-test procedure. In this paper, the need for implementing these practices is discussed using case histories of typical examples of large complex vacuum systems. Aggressive management practices are of primary importance throughout a project's life cycle to ensure the lowest cost; this includes successful leak testing of components. It should be noted that the opinions and conclusions expressed in this paper are those of the author and are not those of the Los Alamos National Laboratory or the Department of Energy

75 FR 62323 - Pesticide Management and Disposal; Standards for Pesticide Containers and Containment; Change to...

Science.gov (United States)

2010-10-08

... Pesticide Management and Disposal; Standards for Pesticide Containers and Containment; Change to Labeling... the pesticide container and containment regulations to provide an 8-month extension of the labeling... titled ``Pesticide Management and Disposal; Standards for Pesticide Containers and Containment'' (71 FR...

78 FR 49663 - Enhanced Risk Management Standards for Systemically Important Derivatives Clearing Organizations

Science.gov (United States)

2013-08-15

... COMMODITY FUTURES TRADING COMMISSION 17 CFR Part 39 RIN 3038-AC98 Enhanced Risk Management...'') is adopting final regulations to implement enhanced risk management standards for systemically..., strengthen the risk management practices of DCOs, and increase overall confidence in the financial system by...

Applicability Evaluation of Job Standards for Diabetes Nutritional Management by Clinical Dietitian.

Science.gov (United States)

Baek, Young Jin; Oh, Na Gyeong; Sohn, Cheong-Min; Woo, Mi-Hye; Lee, Seung Min; Ju, Dal Lae; Seo, Jung-Sook

2017-04-01

This study was conducted to evaluate applicability of job standards for diabetes nutrition management by hospital clinical dietitians. In order to promote the clinical nutrition services, it is necessary to present job standards of clinical dietitian and to actively apply these standardized tasks to the medical institution sites. The job standard of clinical dietitians for diabetic nutrition management was distributed to hospitals over 300 beds. Questionnaire was collected from 96 clinical dietitians of 40 tertiary hospitals, 47 general hospitals, and 9 hospitals. Based on each 5-point scale, the importance of overall duty was 4.4 ± 0.5, performance was 3.6 ± 0.8, and difficulty was 3.1 ± 0.7. 'Nutrition intervention' was 4.5 ± 0.5 for task importance, 'nutrition assessment' was 4.0 ± 0.7 for performance, and 'nutrition diagnosis' was 3.4 ± 0.9 for difficulty. These 3 items were high in each category. Based on the grid diagram, the tasks of both high importance and high performance were 'checking basic information,' 'checking medical history and therapy plan,' 'decision of nutritional needs,' 'supply of foods and nutrients,' and 'education of nutrition and self-management.' The tasks with high importance but low performance were 'derivation of nutrition diagnosis,' 'planning of nutrition intervention,' 'monitoring of nutrition intervention process.' The tasks of both high importance and high difficulty were 'derivation of nutrition diagnosis,' 'planning of nutrition intervention,' 'supply of foods and nutrients,' 'education of nutrition and self-management,' and 'monitoring of nutrition intervention process.' The tasks of both high performance and high difficulty were 'documentation of nutrition assessment,' 'supply of foods and nutrients,' and 'education of nutrition and self-management.'

A designated centre for people with disabilities operated by Brothers of Charity Services South East, Waterford

LENUS (Irish Health Repository)

Hirpara, Kieran Michael

2012-01-01

Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means. A review of the literature supporting various modalities of conservative management is presented, and it is concluded that although effective, nonoperative treatment is labour intensive, requiring regular review and careful selection of medications and physical therapy on a case by case basis.

Data Management Standards in Computer-aided Acquisition and Logistic Support (CALS)

Science.gov (United States)

Jefferson, David K.

1990-01-01

Viewgraphs and discussion on data management standards in computer-aided acquisition and logistic support (CALS) are presented. CALS is intended to reduce cost, increase quality, and improve timeliness of weapon system acquisition and support by greatly improving the flow of technical information. The phase 2 standards, industrial environment, are discussed. The information resource dictionary system (IRDS) is described.

Research on the management and endorsement of nuclear safety standards in the United States and its revelation for China

Science.gov (United States)

Liu, Ting; Tian, Yu; Yang, Lili; Gao, Siyi; Song, Dahu

2018-01-01

This paper introduces the American standard system, the Nuclear Regulatory Commission (NRC)’s responsibility, NRC nuclear safety regulations and standards system, studies on NRC’s standards management and endorsement mode, analyzes the characteristics of NRC standards endorsement management, and points out its disadvantages. This paper draws revelation from the standard management and endorsement model of NRC and points suggestion to China’s nuclear and radiation safety standards management.The issue of the “Nuclear Safety Law”plays an important role in China’s nuclear and radiation safety supervision. Nuclear and radiation safety regulations and standards are strong grips on the implementation of “Nuclear Safety Law”. This paper refers on the experience of international advanced countriy, will effectively promote the improvement of the endorsed management of China’s nuclear and radiation safety standards.

1998 Annual Study Report. Standardization of color reproduction management; 1998 nendo seika hokokusho. Iro saigen kanri (color management) no hyojunka

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-03-01

Standardization of color reproduction management is aimed at realization of the most urgently needed areas of the color reproduction management for international standardization. This R and D program is aimed at drafting the standards for color information devices and their characteristics, and proposing the drafts. Factors which deteriorate color reproduction stability of input and output devices are classified and analyzed, devices for evaluation are selected, and extents of the deterioration are measured and evaluated, in order to extract the problems involved in the color reproduction models for the current input and output devices. Standardization of color management on the multi-spectrum color images is attempted for business printing, where effectiveness of a fluorescent ink containing a fluorescent material is noted for expansion of the color reproduction range for printing color images with the conventional YMCK inks. Basic aspects of the fluorescent colors are measured, to verify the methods for measuring fluorescent body colors. As a result, new knowledge is obtained. The standard images for flesh color evaluation are produced, and the methods for analyzing the data obtained by the tests, including the subjective tests, are established. These lead to establishment of the standards for preferred flesh color of the yellow races. (NEDO)

Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization.

Science.gov (United States)

Bansal, Samiksha; Karrer, Frederick M; Hansen, Kristine; Partrick, David A

2015-08-01

Splenic artery embolization (SAE) in the presence of contrast blush (CB) has been recommended to reduce the failure rate of nonoperative management. We hypothesized that the presence of CB on computed tomography has minimal impact on patient outcomes. A retrospective review was conducted of all children (splenic trauma over a 10-year period at a level 1 pediatric trauma center. Data are presented as mean ± standard error of mean. Seven hundred forty children sustained blunt abdominal trauma, of which 549 had an identified solid organ injury. Blunt splenic injury was diagnosed in 270 of the 740 patients. All patients were managed nonoperatively without SAE. CB was seen on computed tomography in 47 patients (17.4%). There were no significant differences in the need for blood transfusion (12.5% vs 11.1%) or length of stay (3.1 vs 3.3 days) or need for splenectomy when compared in children with or without CB. Pediatric trauma patients with blunt splenic injuries can be safely managed without SAE and physiologic response and hemodynamic stability should be the primary determinants of appropriate management. Copyright © 2015 Elsevier Inc. All rights reserved.

The Assessment Of The Level Of Management Control Standards Completion In Treasury Sector

Directory of Open Access Journals (Sweden)

Kulińska Ewa

2015-06-01

Full Text Available This paper concerns the rules of the functioning of management control standards used in the Treasury Control Office. Its purpose is to present research results conducted in the years 2013–2014 in Polish Treasury Control Offices. Obtained results are the effect of applying author’s model of the assessment of management control implementation. The research was conducted for management personnel and the rest of offices employees separately. Significant discrepancies between these two groups of respondents were indicated. Based on the results, the areas of deviation from expected level of management control standards were established and the areas where implementation of control mechanisms relying on increasing the supervision of board of directors over managers were indicated, providing permanent and efficient elements of managers supervision over subordinate employees and making purposes and tasks put on the Treasury Control Office for given year more precise and familiarization of employees and carrying out trainings and series of other corrective measures.

Does angiography increase the risk of impairment in renal function during non-operative management of patients with blunt splenic injuries? A cross-sectional study in southern Taiwan.

Science.gov (United States)

Hsieh, Ting-Min; Tsai, Tzu-Hsien; Lin, Chih-Che; Hsieh, Ching-Hua

2016-10-21

The aim of the present study was to assess whether angiography after contrast-enhanced CT (CECT) as per the policy of non-operative management would add to the risk of acute kidney injury in patients with blunt splenic injuries (BSIs). Cross-sectional study. Taiwan. Patients with BSI aged >16 years, admitted to a level I trauma centre during the period of January 2004 to December 2014, were retrospectively reviewed. A total of 326 patients with BSI with CECT were included in the study, of whom 100 underwent subsequent angiography and 226 did not. Incidence of contrast-induced nephropathy (CIN) and renal function as measured by the 48-hour serum creatinine (SCr) levels. No significant difference between the patients who underwent angiography and those who did not in terms of the initial haemoglobin (Hb), SCr or estimated glomerular filtration rate (eGFR) level on arrival at the emergency department, 48 hours later, or at discharge. No significant difference in the incidence of CIN was found between these two groups of patients regardless of the criteria for identifying CIN. In the group of patients aged ≥55 years, those who underwent angiography had a significantly worse 48-hour SCr level than those who did not undergo the treatment. In addition, there was no significant difference in the 48-hour SCr level between the two groups of patients when subgrouping the patients according to sex, large haemoperitoneum revealed on CT, systolic blood pressure, initial Hb, initial SCr and initial eGFR levels. This study demonstrated that angiography does not increase the incidence of CIN, and was not a risk factor to renal function impairment in patients with BSI who had undergone CECT. 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/.

7 CFR 205.203 - Soil fertility and crop nutrient management practice standard.

Science.gov (United States)

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Soil fertility and crop nutrient management practice standard. 205.203 Section 205.203 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) ORGANIC FOODS PRODUCTION ACT...

Implementation of a standardized out-of-hospital management method for Parkinson dysphagia

Directory of Open Access Journals (Sweden)

Hongying Wei

Full Text Available Summary Objective: Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD patients with dysphagia. Method: Two-hundred seventeen (217 voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention. Results: Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01. Conclusion: Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.

Management control and status reports documentation standard and Data Item Descriptions (DID). Volume of the information system life-cycle and documentation standards, volume 5

Science.gov (United States)

Callender, E. David; Steinbacher, Jody

1989-01-01

This is the fifth of five volumes on Information System Life-Cycle and Documentation Standards. This volume provides a well organized, easily used standard for management control and status reports used in monitoring and controlling the management, development, and assurance of informations systems and software, hardware, and operational procedures components, and related processes.

Visual operations management tools in oil pipelines and terminals standardization processes

Energy Technology Data Exchange (ETDEWEB)

De Ludovico Almeida, Maria Fatima [Pontifical Catholic University of Rio de Janeiro (Brazil); Santiago, Adilson; Senra Ribeiro, Kassandra; Mendonca Arruda, Daniela [Petrobras Transporte (Brazil)

2010-07-01

Visual operations management (VOM) takes advantage of visual cues to communicate information, simplify processes and improve the quality and safety of operations. Because of heightened competition, the importance of standardization and quality management processes has become more evident for pipeline companies. Petrobras Transporte's marine terminal units has been working over the last years to be recognized as a reference in the activities it pursues. This is based on the Petrobras Transporte's strategic plan 2020, which foresees amongst others, the specialization of technical workforce, operational safety excellence, capital discipline, customer satisfaction, the search for new technologies and markets and the rendering of new services. To achieve these goals, the Marine Terminals standardization program must be adhered to. Focusing on communication and adoption of standards and procedures, this paper describes how visual guides were conceived and implemented within Petrobras Transporte to enable operators and technicians to meet operational, environmental and occupational health and safety requirements.

Integration of Standardized Management Systems: A Dilemma?

Directory of Open Access Journals (Sweden)

Manuel Ferreira Rebelo

2015-06-01

Full Text Available The growing proliferation of management systems standards (MSSs, and their individualized implementation, is a real problem faced by organizations. On the other hand, MSSs are aimed at improving efficiency and effectiveness of organizational responses in order to satisfy the requirements, needs and expectations of the stakeholders. Each organization has its own identity and this is an issue that cannot be neglected; hence, two possible approaches can be attended. First, continue with the implementation of individualized management systems (MSs; or, integrate the several MSSs versus related MSs into an integrated management system (IMS. Therefore, in this context, organizations are faced with a dilemma, as a result of the increasing proliferation and diversity of MSSs. This paper takes into account the knowledge gained through a case study conducted in the context of a Portuguese company and unveils some of the advantages and disadvantages of integration. A methodology is also proposed and presented to support organizations in developing and structuring the integration process of their individualized MSs, and consequently minimize problems that are generators of inefficiencies, value destruction and loss of competitiveness. The obtained results provide relevant information that can support Top Management decision in solving that dilemma and consequently promote a successful integration, including a better control of business risks associated to MSSs requirements and enhancing sustainable performance, considering the context in which organizations operate.

Trust Management in P2P systems using Standard TuLiP

OpenAIRE

Czenko, M.R.; Doumen, J.M.; Etalle, Sandro

2008-01-01

In this paper we introduce Standard TuLiP - a new logic based Trust Management system. In Standard TuLiP, security decisions are based on security credentials, which can be issued by different entities and stored at different locations. Standard TuLiP directly supports the distributed credential storage by providing a sound and complete Lookup and Inference AlgoRithm (LIAR). In this paper we focus on (a) the language of Standard TuLiP and (b) on the practical considerations which arise when d...

Lean environmental management integration system for sustainability of ISO 14001:2004 standard implementation

Directory of Open Access Journals (Sweden)

Perumal Puvanasvaran

2014-10-01

Full Text Available Purpose: The purpose of this study is to present a model for integrating Lean Principles with ISO 14001 Environmental Management System.Design/methodology/approach: To achieve the objective of the study, the methodology used in this study is based on preliminary literature review of ISO 14001 standards and Lean Principles as well as certain case reports from various proponents and authors of ISO 14001 and Lean as noted in various articles and journals and some books.Findings and Originality/value: The findings of this study are a new model called Lean Environmental Management Integration System (LEMIS has been developed and leads to the creation of these measurement standards for evaluating the organization, making its environmental efforts more realistic, focused and attainable.Research limitations/implications: Future research should be conducted case studies in this direction are required to be conducted for examining the feasibility of amalgamation and implementing ISO 14001:2004 standards with the philosophy of Lean Principles to enable the achievement of world class standards.Practical implications: This model helps to eliminate any wasteful processes in the organization’s implementation of the ISO 14001 standard thus leading to higher environmental performance.  Integrating the standard with Lean principles through LEMIS model helps to specify these performance measures making the standard achieve sustainability and continual improvement.Originality/value: This study presents a unique approach of integrating the two main models, namely Lean Principles and ISO 14001 Environmental Management System, as a single framework benefiting contemporary organizations.

Standard hazard analysis, critical control point and hotel management

Directory of Open Access Journals (Sweden)

Vujačić Vesna

2017-01-01

Full Text Available Tourism is a dynamic category which is continuously evolving in the world. Specificities that have to be respected in the execution in relation to the food industry are connected with the fact that the main differences which exist regarding the food serving procedure in catering, numerous complex recipes and production technologies, staff fluctuation, old equipment. For an effective and permanent implementation, the HACCP concept is very important for building a serious base. In this case, the base is represented by the people handling the food. This paper presents international ISO standards, the concept of HACCP and the importance of its application in the tourism and hospitality industry. The concept of HACCP is a food safety management system through the analysis and control of biological, chemical and physical hazards in the entire process, from raw material production, procurement, handling, to manufacturing, distribution and consumption of the finished product. The aim of this paper is to present the importance of the application of HACCP concept in tourism and hotel management as a recognizable international standard.

Interdisciplinary Management of Cystic Neoplasms of the Pancreas

Directory of Open Access Journals (Sweden)

Linda S. Lee

2012-01-01

Full Text Available Cystic neoplasms of the pancreas are increasingly recognized due to the frequent use of abdominal imaging. It is reported that up to 20% of abdominal cross-sectional scans identify incidental asymptomatic pancreatic cysts. Proper characterization of pancreatic cystic neoplasms is important not only to recognize premalignant lesions that will require surgical resection, but also to allow nonoperative management of many cystic lesions that will not require resection with its inherent morbidity. Though reliable biomarkers are lacking, a wide spectrum of diagnostic modalities are available to evaluate pancreatic cystic neoplasms, including radiologic, endoscopic, laboratory, and pathologic analysis. An interdisciplinary approach to management of these lesions which incorporates recent, specialty-specific advances in the medical literature is herein suggested.

Standardi za upravljanje sigurnošću podataka / Standards for management data security

Directory of Open Access Journals (Sweden)

Dejan Vuletić

2006-10-01

Full Text Available U radu su analizirani osnovni pojmovi vezani za upravljanje sigurnošću podataka. Ukazano je na potrebu i značaj standardizacije u oblasti informaciono-komunikacionih tehnologija, naročito prema standardima Međunarodne organizacije za standardizaciju (International Standardization Organization - ISO. U završnom delu rada prikazane su proaktivne i reaktivne aktivnosti u upravljanju sigurnošću podataka. / In this article basic notions of management data security are analyzed. We indicated demand and importance of standardization in information-communication technology domain, especially according to International Standardization Organization. In the final part of the article we illustrated both proactive and reactive activities in management data security.

An application of the IAEA GCS-R-3 Standard in Nuclear Quality Management System

Energy Technology Data Exchange (ETDEWEB)

Kim, D. I.; Juhn, P. E. [TUEV SUED Korea, Seoul (Korea, Republic of); Kwon, M. J. [TUEV SUED KOCEN, Seoul (Korea, Republic of)

2012-03-15

IAEA GCS-R-3 Standard (2006) is intended to help nuclear community establishing a nuclear quality management system that integrates such 6 elements as safety, health, environment, security, quality and economics. In the present paper, the management principles of GCS-R-3 Standard are compared with those of ISO 9001 and ASME N/A-1 Codes and Standards. The paper also summarizes the worldwide survey on application of GS-R-3, which was conducted by the TUEV SUED Korea in 2011. The result concludes that the top priority should be given to safety upon which the management system must be based, in proper coordination with other 5 elements to enhance nuclear safety, in particular after Fukushima Dais-Ici nuclear power accidents on 11{sup th} March 2011 in Japan.

Exploring Chinese cultural standards through the lens of German managers: A case study approach

Directory of Open Access Journals (Sweden)

Roger Moser

2011-06-01

Full Text Available The ability to understand one’s own culture and to deal with specificities of foreign cultures is one of the core requirements in today’s international business. Management skills are partially culture specific and a management approach that is appropriate in one cultural context may not be appropriate in another. Several business activities of companies nowadays take place abroad, which requires managers to interact with different cultures. This paper aims to analyse cultural characteristics, especially in a Sino-German business context. Based on literature analysis and case study research, relevant cultural standards in China were identified from the German perspective. The result differentiates three superordinate cultural areas and five specific cultural standards and analyses different influence factors on the dimensions of the identified Chinese cultural standards.

Key elements on implementing an occupational health and safety management system using ISO 45001 standard

Directory of Open Access Journals (Sweden)

Darabont Doru Costin

2017-01-01

Full Text Available Occupational health and safety (OHS management system is one of the main elements of the company’s general management system. During last decade, Romanian companies gained a valuable experience on implementing this type of management systems, using OHSAS 18001 referential and standard. However, the projected release of the ISO 45001 represents a new approach which requires the companies to take in consideration new key elements for a successful implementation of the OHS management system. The aim of the paper is to identify and analyse these key elements, by integration of the following issues: standard requirements, Romanian OHS legislation and good practice examples, including the general control measures for new and emerging risks such as psycho-social risks, workforce ageing and new technologies. The study results represent an important work instrument for each company interested to implement or upgrade its OHS management system using ISO 45001 standard and could be used regardless the company size or activity domain.

SRS ES ampersand H standards compliance program management plan

International Nuclear Information System (INIS)

Hearn, W.H.

1993-01-01

On March 8, 1990, the Defense Nuclear Facilities Safety Board (DNFSB) issued Recommendation 90-2 to the Secretary of Energy. This recommendation, based upon the DNFSB's initial review and evaluation of the content and implementation of standards relating to the design, construction, operations, and decommissioning of defense nuclear facilities of the Department of Energy (DOE), called for three actions: (1) identification of specific standards that apply to design, construction, operation and decommissioning of DOE facilities; (2) assessment of the adequacy of those standards for protecting public health and safety; and (3) determination of the extent to which they have and are being implemented. This document defines the elements of the SRS program required to support the HQ program in response to DNFSB Recommendation 90-2. The objective is to ensure a consistent approach for all sitewide ES and H Standards Compliance Program efforts that satisfied the intent of Recommendation 90-2 and the HQ 90-2 Implementation Plan in a cost-effective manner. The methodology and instructions for implementation of the SRS program are contained in the Standards Compliance Program Implementation Plan. The Management Plan shall be used in conjunction with the Implementation Plan

Integrated Pest Management as European standard – is it possible?

Directory of Open Access Journals (Sweden)

Lisa Nilsen

2011-08-01

Full Text Available As part of the work within the European Committee for Standardization (CEN, standards for conservation of cultural property are being developed in CEN/TC (Technical Committee 346, Conservation of Cultural Property. In Working Group 4 Environment, a draft is being prepared to create a proposal for standardised Integrated Pest Management. The author of this paper welcomes delegates to the Meeting on Cultural Heritage Pests in Piacenza to contribute to the discussion regarding standardised methods for pest control in the cultural heritage sector.

The role of non-operative management (NOM in blunt hepatic trauma

Directory of Open Access Journals (Sweden)

Ayman Zaki Azzam

2013-09-01

. KEYWORDS: Blunt liver trauma, Non operative management, Failure of non operative management

Spleen artery embolization increases the success of nonoperative management following blunt splenic injury

Directory of Open Access Journals (Sweden)

Isaac Chun-Jen Chen

2011-08-01

Conclusion: Performance of SAE for the patients with blunt splenic injury could increase the successful rate of NOM significantly and safely. An algorithm including the angioembolization might be beneficial in the management of patients with blunt spleen trauma.

78 FR 44557 - Revision to Transmission Vegetation Management Reliability Standard; Notice of Compliance Filing

Science.gov (United States)

2013-07-24

... Transmission Vegetation Management Reliability Standard; Notice of Compliance Filing Take notice that on July 12, 2013, the North American Electric Reliability Corporation (NERC), pursuant to Order No. 777 \\1... Reliability Standard FAC-003-2 to its Web site. \\1\\ Revisions to Reliability Standard for Transmission...

The European Community eco-management and audit regulations and the ISO standard 14001 for eco-management systems: significance and consequences for the eco-management of utilities

International Nuclear Information System (INIS)

Gudet, C.

1996-01-01

Various companies in the electrical industries have concerned themselves with the EMAS regulations and the private sector industries standards BS 7750 and ISO 14001. In various pilot experiments, investigations were carried out on the suitability of these management instruments for utilities. Several power plants in Holland and England have already instituted standards-complying environmental management systems and had them partly certificated. The paper shows in which existing legal frameworks the new management instruments have an effect and what elements they consist of. There is shown, on the basis of an example, which regions of the utility are affected by the environmental management system and how it is co-ordinated into the whole company organisation. (author) 4 figs., 11 refs

75 FR 61143 - Financial Management and Assurance; Government Auditing Standards

Science.gov (United States)

2010-10-04

... GOVERNMENT ACCOUNTABILITY OFFICE Financial Management and Assurance; Government Auditing Standards Correction In notice document 2010-23374 beginning on page 57274 in the issue of Monday, September 20, 2010 make the following corrections: 1. On page 57275, in the first column, under the ADDRESSES section, in...

Current management of peptic ulcer perforations

International Nuclear Information System (INIS)

Menakuru, S.R.

2004-01-01

Perforation is a life-threatening complication of peptic ulcer disease. Smoking and use of non-steroidal anti-inflammatory drugs are important risk factors for perforation. Diagnosis is made clinically and confirmed by the presence of pneumoperitoneum on radiographs. Nonoperative management is successful in patients identified to have a spontaneously sealed perforation proven by water-soluble contrast gastroduodenogram. Operative management consists of the time-honoured practice of mental patch closure, but now this can be done by laparoscopic methods. The practice of addition of acid-reducing procedures is currently being debated though it continues to be recommended in good-risk patients. Laparoscopic approaches to closure of duodenal perforation are now being applied widely and may become the gold standard in the future especially in patients with < 10 mm perforation size presenting within the first 24 hours of onset of pain. The role of Helicobacter pylori in duodenal ulcer perforation is controversial and more studies are needed to answer this question though recent indirect evidence suggests that eradicating H pylori may reduce the necessity for adding acid reducing procedures and the associated morbidity. Perforation is a life-threatening complication of peptic ulcer disease. The management of peptic ulcer disease has evolved over the decades, due to advances in operative techniques, bacteriology and pharmacology. While the recognition of the role of Helicobacter pylori (H. pylori) in peptic ulceration has resulted in a paradigm shift in the management of uncomplicated peptic ulcers, debate continues about the appropriate management of perforated duodenal bulb and prepyloric ulcers. A new dimension has been added to this controversy by the advent of laparoscopic techniques for closing the perforation. A Medline search of all articles dealing with the management of peptic ulcer perforation published after 1985 was undertaken. The short listed articles were

Forest management practices and the occupational safety and health administration logging standard

Science.gov (United States)

John R. Myers; David Elton Fosbroke

1995-01-01

The Occupational Safety and Health Administration (OSHA) has established safety and health regulations for the logging industry. These new regulations move beyond the prior OSHA pulpwood harvesting standard by including sawtimber harvesting operations. Because logging is a major tool used by forest managers to meet silvicultural goals, managers must be aware of what...

Management plan documentation standard and Data Item Descriptions (DID). Volume of the information system life-cycle and documentation standards, volume 2

Science.gov (United States)

Callender, E. David; Steinbacher, Jody

1989-01-01

This is the second of five volumes of the Information System Life-Cycle and Documentation Standards. This volume provides a well-organized, easily used standard for management plans used in acquiring, assuring, and developing information systems and software, hardware, and operational procedures components, and related processes.

Practical standard for nuclear power plant life management programs: 2007

International Nuclear Information System (INIS)

2006-03-01

The standard specifies the method of implementing nuclear power plant life management programs. The plant life management programs evaluate the integrity of the plant structures, systems and components, assessing if appropriate measures are taken against existing aging phenomena, if there are possibilities of occurrence and development of aging phenomena and if a sufficient level of margin is maintained to assure the integrity throughout the future operating period. The programs also assess the validity of the current maintenance activities, such as trend monitoring, walkdowns, periodic tests and inspections, repair and replacement work for the purpose of preventive maintenance, and utilization of lessons learned from past trouble experience, in order to newly identify maintenance measures. The technical evaluation on aging phenomena is conducted to establish the 10 year maintenance program for nuclear power plants until the plant reaches 30 years of service. The standard was established and issued by the Atomic Energy Society of Japan (AESJ) through the discussion of experts in the associated fields. (T. Tanaka)

Capacity Management as a Service for Enterprise Standard Software

Directory of Open Access Journals (Sweden)

Hendrik Müller

2017-12-01

Full Text Available Capacity management approaches optimize component utilization from a strong technical perspective. In fact, the quality of involved services is considered implicitly by linking it to resource capacity values. This practice hinders to evaluate design alternatives with respect to given service levels that are expressed in user-centric metrics such as the mean response time for a business transaction. We argue that utilized historical workload traces often contain a variety of performance-related information that allows for the integration of performance prediction techniques through machine learning. Since enterprise applications excessively make use of standard software that is shipped by large software vendors to a wide range of customers, standardized prediction models can be trained and provisioned as part of a capacity management service which we propose in this article. Therefore, we integrate knowledge discovery activities into well-known capacity planning steps, which we adapt to the special characteristics of enterprise applications. Using a real-world example, we demonstrate how prediction models that were trained on a large scale of monitoring data enable cost-efficient measurement-based prediction techniques to be used in early design and redesign phases of planned or running applications. Finally, based on the trained model, we demonstrate how to simulate and analyze future workload scenarios. Using a Pareto approach, we were able to identify cost-effective design alternatives for an enterprise application whose capacity is being managed.

Research on a Valuation Standard and the Actual Condition About Security Management in PACS

International Nuclear Information System (INIS)

Jeong, Jae Ho; Son, Gi Gyeong; Kang, Hee Doo; Dong, Kyung Rae; Kweon, Dae Cheol; Kim, Hyun Soo

2008-01-01

This study is to prepare an evaluation standard about personal information protection and security management of a medical institution and to build up a grade standard of evaluation in PACS environment. We built up evaluation index based on 10 detailed items in four big categories (political security, technical security, data management security and physical security) by referring to ISO17799 (BS 7799), HIPPA (Health Insurance and Portability and Accountability Act of 1996) and domestic medical law. We have investigated at the thirty places where medical facility with the extracted security criteria and security evaluation index. Average score of physical security list, one of the big categories, was 18.5/20 (93%) at all medical institutions. Political security score was 18.5/30 (62%), data management security score was 12/20 (60%) and technical security score was 17.5/30 (58%). Therefore, security evaluation score was average 67 in 30 general hospitals, which was 4th level. The results showed that it is necessary to establish evaluation and management standard about personal information protection and security consciousness which are weak in PACS environment.

Operative Versus Non-operative Treatment of Grade III Acromioclavicular Joint Dislocations and the Use of SurgiLig: a Retrospective Review.

Science.gov (United States)

Younis, Fizan; Ajwani, Sanil; Bibi, Asia; Riley, Eleanor; Hughes, Peter J

2017-12-30

Acromioclavicular joint dislocations are common shoulder girdle injuries. The treatment of grade III acromioclavicular joint dislocations is controversial. Furthermore, the literature on the use of the Sur-giligTM synthetic ligament for reconstruction of dislocations is sparse. This retrospective review aimed to establish whether operative treatment was superior to non-operative treatment in grade III acromioclavicular joint dislocations treated at our institute over a 5-year period. We also reviewed the effectiveness of reconstruction with SurgiligTM after acute and chronic dislocations across all grades of acromioclavicular joint dislocations. Twenty-five patients completed full follow-up with grade III dislocations. The mean follow-up in the operated group was 3.56 years and in the non-operated group this was 3.29 years. The mean Oxford Shoul-der Score (OSS) in the operated group was 39.8, whereas the mean OSS in the non-operated group was 45.9 (p=0.01). The mean pain score in the operated group was 2.2, and in the non-operated group this was 1.6. The mean satisfaction score in the operated group was 8.2 and that in the non-operated group was 7.8. There was no statistically significant difference in pain or satisfaction scores. In respect to the cohort treated with Surg-iligTM synthetic ligament, 22 patients across all grades of dislocations had this procedure performed. The mean post-operative Oxford Shoulder Score (OSS) was 40. 1. Non-operative treatment is not inferior to operative treatment for grade III acromioclavicular joint dislocations. The data from this study demonstrat-ed that the non-operated group had superior Ox-ford Shoul-der Scores that were statistically significant. 2. Additionally, the use of the SurgiligTM ligament appears to be effective in treating both chronic and acute acromioclavicular joint dislocations.

Does different duration of non-operative immobilization have an effect on the redislocation rate of primary patellar dislocation?

DEFF Research Database (Denmark)

Kaewkongnok, Bo; Bøvling, Anders; Milandt, Nikolaj

2018-01-01

BACKGROUND: Immobilization devices such as plaster splints, casts and braces have been used for first time patellar dislocation (FTPD) in order to prevent redislocation. This study evaluates different non-operative immobilization regimes upon rates of redislocation. METHODS: A retrospective cohort...... study with a study population of 1366 in which 601 subjects under 30years with FTPD were included from three hospitals. Exclusion criteria were osteochondral fracture, ligament injury and subluxation. Subjects were divided into five groups; unknown/none, two weeks of brace, two weeks of brace followed...... by bandage, four weeks of brace and six weeks of brace with increasing of range of motion. Radiographs were evaluated for trochlear dysplasia (TD), patella alta, trochlear depth and growth zone. Crude analysis and logistic regression adjusted for radiographic assessments, age, gender and rehabilitation...

The toilet sanitation management to meet healthy house standards

Science.gov (United States)

Studyanto, Anung B.; Musfiroh, Mujahidatul; Sholahuddin

2018-03-01