Sample records for ract guideline limitations
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40 CFR 52.2237 - NOX RACT and NOX conformity exemption.
2010-07-01
... 40 Protection of Environment 4 2010-07-01 2010-07-01 false NOX RACT and NOX conformity exemption... RACT and NOX conformity exemption. Approval. EPA is approving the section 182(f) oxides of nitrogen (NOX) reasonably available control technology (RACT) and NOX conformity exemption request submitted by...
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RACT/BACT/LAER Clearninghouse (RBLC)
U.S. Environmental Protection Agency — OAR??s RACT, BACT, LAER Clearinghouse (RBLC) data asset contains summary information on selected air permitting actions from EPA, state, and local permitting...
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RACT_BACT_LAER Clearninghouse (RBLC)
U.S. Environmental Protection Agency — OAR's RACT, BACT, LAER Clearinghouse (RBLC) data asset contains summary information on selected air permitting actions from EPA, state, and local permitting agencies...
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RACT/BACT/LAER Clearninghouse (RBLC)
U.S. Environmental Protection Agency — OAR's RACT, BACT, LAER Clearinghouse (RBLC) data asset contains summary information on selected air permitting actions from EPA, state, and local permitting agencies...
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2010-07-01
...) What is the Reasonably Available Control Measures (RACM) requirement for areas designated nonattainment... 40 Protection of Environment 2 2010-07-01 2010-07-01 false What requirements apply for reasonably available control technology (RACT) and reasonably available control measures (RACM) under the 8-hour NAAQS...
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Pediatric Sepsis Guidelines: Summary for resource-limited countries
Khilnani, Praveen; Singhi, Sunit; Lodha, Rakesh; Santhanam, Indumathi; Sachdev, Anil; Chugh, Krishan; Jaishree, M.; Ranjit, Suchitra; Ramachandran, Bala; Ali, Uma; Udani, Soonu; Uttam, Rajiv; Deopujari, Satish
2010-01-01
Justification: Pediatric sepsis is a commonly encountered global issue. Existing guidelines for sepsis seem to be applicable to the developed countries, and only few articles are published regarding application of these guidelines in the developing countries, especially in resource-limited countries such as India and Africa. Process: An expert representative panel drawn from all over India, under aegis of Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to discuss and draw guidelines for clinical practice and feasibility of delivery of care in the early hours in pediatric patient with sepsis, keeping in view unique patient population and limited availability of equipment and resources. Discussion included issues such as sepsis definitions, rapid cardiopulmonary assessment, feasibility of early aggressive fluid therapy, inotropic support, corticosteriod therapy, early endotracheal intubation and use of positive end expiratory pressure/mechanical ventilation, initial empirical antibiotic therapy, glycemic control, and role of immunoglobulin, blood, and blood products. Objective: To achieve a reasonable evidence-based consensus on the basis of published literature and expert opinion to formulating clinical practice guidelines applicable to resource-limited countries such as India. Recommendations: Pediatric sepsis guidelines are presented in text and flow chart format keeping resource limitations in mind for countries such as India and Africa. Levels of evidence are indicated wherever applicable. It is anticipated that once the guidelines are used and outcomes data evaluated, further modifications will be necessary. It is planned to periodically review and revise these guidelines every 3–5 years as new body of evidence accumulates. PMID:20606908
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2012-07-24
... emission limitation with which the major stationary source must currently comply. * * *'' The reference in... limitation with which the major stationary source must currently comply. * * *'' The reference in subsection... BACT to RACT), potential under estimations of the air quality impacts of stationary source operations...
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40 CFR 420.07 - Effluent limitations guidelines and standards for pH.
2010-07-01
...) EFFLUENT GUIDELINES AND STANDARDS IRON AND STEEL MANUFACTURING POINT SOURCE CATEGORY General Provisions § 420.07 Effluent limitations guidelines and standards for pH. (a) The pH level in process wastewaters... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Effluent limitations guidelines and...
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Lugtenberg, Marjolein; Burgers, Jako S.; Clancy, Carolyn; Westert, Gert P.; Schneider, Eric C.
2011-01-01
Background Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity. Methodology/Principal Findings We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines. Conclusions/Significance Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more
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2010-03-08
... Effluent Limitations Guidelines and Standards for the Construction and Development Point Source Category... technology-based Effluent Limitations Guidelines and New Source Performance Standards for the Construction... technology-based Effluent Limitations Guidelines and New Source Performance Standards for the Construction...
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2010-07-01
... effluent limitations guidelines for existing sources, standards of performance for new sources and... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GENERAL PROVISIONS § 401.12 Law authorizing establishment of effluent limitations guidelines for existing sources, standards of performance...
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End-of-life content in treatment guidelines for life-limiting diseases.
Mast, Kimberly R; Salama, Marybeth; Silverman, Gabriel K; Arnold, Robert M
2004-12-01
Clinical guidelines are systematically developed statements that influence medical practice, education, and funding. Guidelines represent the consensus of leaders, often based on systematic reviews of the literature, regarding the "state of the art." To assess the degree to which end-of-life care is integrated into nationally developed guidelines for chronic, noncurable, life-limiting diseases. Four compendia were reviewed: The Healthcare Standards Directory ECRI, 2001; the Clinical Practice Guidelines Directory, 2000 edition; the National Guidelines Clearinghouse, (guideline.gov); and the National Library of Medicine's MEDLINE database on the OVID platform for guidelines on nine chronic diseases (chronic obstructive pulmonary disease, end-stage liver disease, amyotrophic lateral sclerosis, congestive heart failure, dementia, cerebrovascular accident, end-stage renal disease, cancer [breast, colon, prostate, lung], and human immunodeficiency virus). They were assessed by two reviewers for end-of-life content in 15 domains (e.g., epidemiology of death, symptom management, spiritual, family roles, and settings of care), the presence of eight specific terms dealing with palliative care, integration of palliative care information into the guideline, and descriptive variables. Not available. Each guideline was examined and rated on a 0-2 scale (0, absent content; 1, minimal content; 2, helpful content) using 15 end-of-life content domains. Scores from domains were summed and classified into 3 categories: 4 or less, minimal; 5-12, moderate; and more than 12, significant content. Ten percent of guidelines had significant palliative care content, 64% had minimal content, and 26% had moderate content. The least addressed domains dealt with spirituality, ethics, advocacy and family roles. When guidelines that dealt solely with prevention, acute exacerbations or complications of an illness, or specific treatment modalities were excluded 28% and 16% of these general guidelines
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Proposal for the development of ICNIRP guidelines on limits for optical radiation exposure
Energy Technology Data Exchange (ETDEWEB)
Siekmann, H. [Berufsgenossenschaftliches Institut fuer Arbeitsschutz - FIA, Sankt Augustin (Germany); Reidenbach, H.D. [Fachhochschule Koeln (Germany)
2004-07-01
Guidelines on limits of exposure to incoherent ultraviolet radiation, to incoherent visible and infrared radiation and to laser radiation have been published by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). These guidelines are accepted globally and form the basis for risk assessment procedures for optical radiation in many countries. With the appearance of new scientific cognition the ICNIRP guidelines will be revised from time to time. A revision may also concern more formal aspects. Some proposals for the development of the ICNIRP limit value recommendations for optical radiation exposures follow. (orig.)
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[Brazilian guidelines for marketing baby food: history, limitations and perspectives].
Monteiro, Renata
2006-05-01
The objective of this paper is to present and discuss Brazilian policy concerning actions to protect breastfeeding, especially the history, international and national background, limitations, and perspectives of the Brazilian Guidelines for the Marketing of Baby Food, Pacifiers and Bottles. The Brazilian Guidelines, which play a crucial role in protecting breastfeeding against industry marketing strategies, were based on the International Code of Marketing of Breastmilk Substitutes, proposed by the World Health Organization in 1981. The first version of the Brazilian Guidelines was released in 1988, and there were subsequent revisions in 1992 and 2001/2002. In 2006, the Guidelines became national law. However, the strides made over this period in terms of regulation have been few because the law is not always observed. Thus, it is essential that all actors involved, including government officials, manufacturers and sellers of baby food and other baby products, teaching and health professionals and their associations, international bodies, and non-governmental organizations make a commitment to enforce the current law.
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2013-07-12
... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 423 [EPA-HQ-OW-2009-0819. FRL-9832-7; EPA-HQ-RCRA-2013-0209] RIN 2040-AF14 Effluent Limitations Guidelines and Standards for the Steam Electric Power... proposed rule entitled, ``Effluent Limitations Guidelines and Standards for the Steam Electric Power...
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2013-01-03
..., Section 610 Review of NPDES Permit Regulation and Effluent Limitations Guidelines Standards for..., FRL-9764-8] Section 610 Review of NPDES Permit Regulation and Effluent Limitations Guidelines Standards for Concentrated Animal Feeding Operations (CAFOs); Extension of Comment Period AGENCY...
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2010-07-01
... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS SOAP AND DETERGENT MANUFACTURING POINT SOURCE CATEGORY Manufacture of Liquid Soaps Subcategory § 417.82 Effluent limitations guidelines representing the...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS ASBESTOS MANUFACTURING POINT SOURCE CATEGORY Asbestos Paper (Elastomeric Binder) Subcategory § 427.43 Effluent limitations guidelines representing the degree of effluent...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS ASBESTOS MANUFACTURING POINT SOURCE CATEGORY Asbestos Paper (Starch Binder) Subcategory § 427.33 Effluent limitations guidelines representing the degree of effluent...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Canned and Preserved Fruits Subcategory § 407.67 Effluent limitations guidelines...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Canned and Preserved Vegetables Subcategory § 407.77 Effluent limitations guidelines...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS SOAP AND DETERGENT MANUFACTURING POINT SOURCE CATEGORY Manufacture of Liquid Soaps Subcategory § 417.83 Effluent limitations guidelines representing the degree of...
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2010-07-01
... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS SOAP AND DETERGENT MANUFACTURING POINT SOURCE CATEGORY Manufacture of Liquid Detergents Subcategory § 417.162 Effluent limitations guidelines... available (BPT): (a) For normal liquid detergent operations the following values pertain: Effluent...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS SOAP AND DETERGENT MANUFACTURING POINT SOURCE CATEGORY Manufacture of Liquid Detergents Subcategory § 417.163 Effluent limitations guidelines representing the degree... subpart after application of the best available technology economically achievable: (a) For normal liquid...
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2010-07-01
... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Effluent limitations guidelines... technology currently available. 428.62 Section 428.62 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS RUBBER MANUFACTURING POINT SOURCE CATEGORY Medium...
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2010-07-01
... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Effluent limitations guidelines... economically achievable. 428.63 Section 428.63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS RUBBER MANUFACTURING POINT SOURCE CATEGORY Medium-Sized General...
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2010-07-21
... monitoring data was collected following 40 CFR part 58; EPA's ``Quality Assurance Handbook for Air Pollution... limits applicable to various industries and generic Reasonably Available Control Technology (RACT....F would have allowed Gates Rubber Company to satisfy VOC RACT requirements in Regulation Number 7...
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2010-07-01
... SOURCE CATEGORY Chrome Pigments Production Subcategory § 415.342 Effluent limitations guidelines... available (BPT): Subpart AH—Chrome Pigments Pollutant or pollutant property BPT effluent limitations Maximum...
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2010-07-01
... CATEGORY Cadmium Pigments and Salts Production Subcategory § 415.647 Effluent limitations guidelines... subject to this subpart and producing cadmium pigments must achieve the following effluent limitations...
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2010-07-01
... CATEGORY Cadmium Pigments and Salts Production Subcategory § 415.643 Effluent limitations guidelines... subject to this subpart and producing cadmium pigments must achieve the following effluent limitations...
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Directory of Open Access Journals (Sweden)
Tsima BM
2016-08-01
Full Text Available Billy M Tsima,1 Vincent Setlhare,1 Oathokwa Nkomazana2 1Department of Family Medicine and Public Health, 2Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana Background: Botswana’s health care system is based on a primary care model. Various national guidelines exist for specific diseases. However, most of the guidelines address management at a tertiary level and often appear nonapplicable for the limited resources in primary care facilities. An integrated symptom-based guideline was developed so as to translate the Botswana national guidelines to those applicable in primary care. The Botswana Primary Care Guideline (BPCG integrates the care of communicable diseases, including HIV/AIDS and noncommunicable diseases, by frontline primary health care workers.Methods: The Department of Family Medicine, Faculty of Medicine, University of Botswana, together with guideline developers from the Knowledge Translation Unit (University of Cape Town collaborated with the Ministry of Health to develop the guideline. Stakeholder groups were set up to review specific content of the guideline to ensure compliance with Botswana government policy and the essential drug list.Results: Participants included clinicians, academics, patient advocacy groups, and policymakers from different disciplines, both private and public. Drug-related issues were identified as necessary for implementing recommendations of the guideline. There was consensus by working groups for updating the essential drug list for primary care and expansion of prescribing rights of trained nurse prescribers in primary care within their scope of practice. An integrated guideline incorporating common symptoms of diseases seen in the Botswana primary care setting was developed.Conclusion: The development of the BPCG took a broad consultative approach with buy in from relevant stakeholders. It is anticipated that implementation of the BPCG will translate into better
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2011-08-24
... Large Appliance and Metal Furniture Coatings AGENCY: Environmental Protection Agency (EPA). ACTION... Technology (RACT) for sources covered by EPA's Control Techniques Guidelines (CTG) standards for large appliance and metal furniture coatings. These amendments will reduce emissions of volatile organic compound...
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2011-08-24
... Large Appliance and Metal Furniture Coatings AGENCY: Environmental Protection Agency (EPA). ACTION... to adopt Reasonably Available Control Technology (RACT) for sources covered by EPA's Control Techniques Guidelines (CTG) standards for large appliance and metal furniture coatings. In the Final Rules...
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NASA Safety Standard: Guidelines and Assessment Procedures for Limiting Orbital Debris
1995-01-01
Collision with orbital debris is a hazard of growing concern as historically accepted practices and procedures have allowed man-made objects to accumulate in orbit. To limit future debris generation, NASA Management Instruction (NMI) 1700.8, 'Policy to Limit Orbital Debris Generation,' was issued in April of 1993. The NMI requires each program to conduct a formal assessment of the potential to generate orbital debris. This document serves as a companion to NMI 1700.08 and provides each NASA program with specific guidelines and assessment methods to assure compliance with the NMI. Each main debris assessment issue (e.g., Post Mission Disposal) is developed in a separate chapter.
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Summary of the technical guidelines used in the project: The economics of greenhouse gas limitations
International Nuclear Information System (INIS)
Halsnaes, Kirsten
1998-01-01
This document is a summary version of the technical guidelines for climate change mitigation assessment developed as a part of the Global Environment Facility (GEF) project The Economics of Greenhouse Gas Limitations; Technical guidelines (UNEP 1998). The objectives of this project have been to support the development of a methodology, an implementing framework and a reporting system which countries can use in the construction of national climate change policies and in meeting their future reporting obligations under the FCCC. The methodological framework developed in the guidelines covers key economic concepts, scenario building, modelling tools and common assumptions. It was used by several country studies included in the project. (au)
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2012-05-14
... Technology Transfer and Advancement Act of 1995 (15 U.S.C. 272 note) because application of those... Technology (RACT) for sources covered by EPA's Control Techniques Guidelines (CTG) for offset lithographic..., unless the comment includes information claimed to be Confidential Business Information (CBI) or other...
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2010-07-01
... CATEGORY Potassium Metal Production Subcategory § 415.113 Effluent limitations guidelines representing the...): There shall be no discharge of process wastewater pollutants to navigable waters. ...
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Value and limitations of clinical practice guidelines in neonatology.
Polin, Richard A; Lorenz, John M
2015-12-01
Given the overwhelming size of the neonatal literature, clinicians must rely upon expert panels such as the Committee on Fetus and Newborn in the USA and the National Institute for Healthcare and Excellence in the UK for guidance. Guidelines developed by expert panels are not equivalent to evidence-based medicine and are not rules, but do provide evidence-based recommendations (when possible) and at minimum expert consensus reports. The standards used to develop evidence-based guidelines differ among expert panels. Clinicians must be able judge the quality of evidence from an expert panel, and decide whether a recommendation applies to their neonatal intensive care unit or infant under their care. Furthermore, guidelines become outdated within a few years and must be revised or discarded. Clinical practice guidelines should not always be equated with standard of care. However, they do provide a framework for determining acceptable care. Clinicians do not need to follow guidelines if the recommendations are not applicable to their population or infant. However, if a plan of care is not consistent with apparently applicable clinical practice guidelines, the medical record should include an explanation for the deviation from the relevant practice guideline. Copyright © 2015 Elsevier Ltd. All rights reserved.
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2010-07-01
... SOURCE CATEGORY Potassium Metal Production Subcategory § 415.112 Effluent limitations guidelines... available (BPT): There shall be no discharge of process wastewater pollutants to navigable waters. ...
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2010-07-01
... economically achievable. 406.73 Section 406.73 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY....73 Effluent limitations guidelines representing the degree of effluent reduction attainable by the...
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2010-07-01
... economically achievable. 418.73 Section 418.73 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Fertilizer Production Subcategory § 418.73 Effluent limitations guidelines representing the degree of...
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2010-07-01
... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GLASS MANUFACTURING POINT SOURCE CATEGORY Television... stream): Effluent characteristic Effluent limitations Maximum for any 1 day Average of daily values for...
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2010-07-01
... technology currently available. 406.32 Section 406.32 Protection of Environment ENVIRONMENTAL PROTECTION... Milling Subcategory § 406.32 Effluent limitations guidelines representing the degree of effluent reduction...
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2010-07-01
... technology currently available. 406.42 Section 406.42 Protection of Environment ENVIRONMENTAL PROTECTION... Milling Subcategory § 406.42 Effluent limitations guidelines representing the degree of effluent reduction...
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2010-07-01
... technology currently available. 406.52 Section 406.52 Protection of Environment ENVIRONMENTAL PROTECTION... Milling Subcategory § 406.52 Effluent limitations guidelines representing the degree of effluent reduction...
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2010-07-01
... technology currently available. 406.12 Section 406.12 Protection of Environment ENVIRONMENTAL PROTECTION... Subcategory § 406.12 Effluent limitations guidelines representing the degree of effluent reduction attainable...
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2010-07-01
... economically achievable. 406.33 Section 406.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Subcategory § 406.33 Effluent limitations guidelines representing the degree of effluent reduction attainable...
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2010-07-01
... economically achievable. 406.53 Section 406.53 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Subcategory § 406.53 Effluent limitations guidelines representing the degree of effluent reduction attainable...
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2010-07-01
... economically achievable. 424.73 Section 424.73 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Chromium Subcategory § 424.73 Effluent limitations guidelines representing the degree of effluent reduction...
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2010-07-01
... Industrial Sand Subcategory § 436.42 Effluent limitations guidelines representing the degree of effluent... 6.0 and water quality criteria in water quality standards approved under the Act authorize such lower pH, the pH limitation for such discharge may be adjusted downward to the pH water quality...
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2010-07-01
... economically achievable. 417.73 Section 417.73 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Manufacture of Bar Soaps Subcategory § 417.73 Effluent limitations guidelines representing the degree of...
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2010-07-01
... Carbon Black Lamp Process Subcategory § 458.42 Effluent limitations guidelines representing the degree of... shall be no discharge of process waste water pollutants into navigable waters. [60 FR 33972, June 29...
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2013-03-19
... Administrative Procedure Act (APA) which, upon finding ``good cause,'' authorizes agencies to dispense with... action addressing approval of the Georgia RACT rules. EPA also finds that there is good cause under APA.... Section 553(d)(3) of the APA allows an effective date less than 30 days after publication ``as otherwise...
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Guidelines for limiting exposure to time-varying electric and magnetic fields (1 Hz to 100 kHz)
International Nuclear Information System (INIS)
Anon.
2011-01-01
This paper is the French translation of an article from the International Commission on Non-Ionizing Radiation Protection (ICNIRP) Guidelines, entitled 'Guidelines for Limiting Exposure to Time-Varying Electric and Magnetic Fields (1 Hz To 100 kHz)'. In This document, guidelines are established for the protection of humans exposed to electric and magnetic fields in the low-frequency range of the electromagnetic spectrum. The general principles for the development of ICNIRP guidelines are published elsewhere (ICNIRP 2002). For the purpose of this document, the low-frequency range extends from 1 Hz to 100 kHz. Above 100 kHz, effects such as heating need to be considered, which are covered by other ICNIRP guidelines. However, in the frequency range from 100 kHz up to approximately 10 MHz protection from both, low frequency effects on the nervous system as well as high frequency effects need to be considered depending on exposure conditions. Therefore, some guidance in this document is extended to 10 MHz to cover the nervous system effects in this frequency range. Guidelines for static magnetic fields have been issued in a separate document (ICNIRP 2009). Guidelines applicable to movement-induced electric fields or time-varying magnetic fields up to 1 Hz will be published separately. This publication replaces the low-frequency part of the 1998 guidelines (ICNIRP 1998). ICNIRP is currently revising the guidelines for the high-frequency portion of the spectrum (above 100 kHz). (authors)
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2010-07-01
... representing the degree of effluent reduction attainable by the application of the best available technology economically achievable. 424.13 Section 424.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Furnaces With Wet Air Pollution Control Devices Subcategory § 424.13 Effluent limitations guidelines...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GLASS MANUFACTURING POINT SOURCE CATEGORY Incandescent Lamp... technology economically achievable: (a) [Reserved] (b) Any manufacturing plant which frosts incandescent lamp... characteristic Effluent limitations Maximum for any 1 day Average of daily values for 30 consecutive days shall...
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2010-07-01
... control technology. 406.17 Section 406.17 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 406.17 Effluent limitations guidelines representing the degree of effluent reduction attainable by the...] Effective Date Note: Section 406.17 was indefinitely suspended at 45 FR 45582, July 7, 1980. ...
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2010-07-01
... Incandescent Lamp Envelope Manufacturing Subcategory § 426.122 Effluent limitations guidelines representing the...): (a) Any manufacturing plant which produces incandescent lamp envelopes shall meet the following... any 1 day Average of daily values for 30 consecutive days shall not exceed— Metric units (g/kkg of...
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Computerization of guidelines: towards a "guideline markup language".
Dart, T; Xu, Y; Chatellier, G; Degoulet, P
2001-01-01
Medical decision making is one of the most difficult daily tasks for physicians. Guidelines have been designed to reduce variance between physicians in daily practice, to improve patient outcomes and to control costs. In fact, few physicians use guidelines in daily practice. A way to ease the use of guidelines is to implement computerised guidelines (computer reminders). We present in this paper a method of computerising guidelines. Our objectives were: 1) to propose a generic model that can be instantiated for any specific guidelines; 2) to use eXtensible Markup Language (XML) as a guideline representation language to instantiate the generic model for a specific guideline. Our model is an object representation of a clinical algorithm, it has been validated by running two different guidelines issued by a French official Agency. In spite of some limitations, we found that this model is expressive enough to represent complex guidelines devoted to diabetes and hypertension management. We conclude that XML can be used as a description format to structure guidelines and as an interface between paper-based guidelines and computer applications.
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2010-07-01
... control technology. 424.17 Section 424.17 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Furnaces With Wet Air Pollution Control Devices Subcategory § 424.17 Effluent limitations guidelines... control technology. Except as provided in §§ 125.30 through 125.32, any existing point source subject to...
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2010-07-01
... this paragraph, which may be discharged from the carbon black lamp process by a point source subject to... Lamp Process Subcategory § 458.43 Effluent limitations guidelines representing the degree of effluent... achievable: There shall be no discharge of process waste water pollutants to navigable waters. ...
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2010-07-01
... control technology (BCT). 406.27 Section 406.27 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 406.27 Effluent limitations guidelines representing the degree of effluent reduction attainable by the... conventional pollutants (which are defined in § 401.16) in § 406.22 of this subpart for the best practicable...
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2010-07-01
... control technology (BCT). 406.47 Section 406.47 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Subcategory § 406.47 Effluent limitations guidelines representing the degree of effluent reduction attainable... specified for conventional pollutants (which are defined in § 401.16) in § 406.42 of this subpart for the...
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2010-07-01
... control technology (BCT). 406.37 Section 406.37 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Subcategory § 406.37 Effluent limitations guidelines representing the degree of effluent reduction attainable... specified for conventional pollutants (which are defined in § 401.16) in § 406.32 of this subpart for the...
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2010-07-01
... operation of spray drying towers as defined above, the following values pertain: Effluent characteristic...) 1 Within the range 6.0 to 9.0. (b) For air quality restricted operation of a spray drying tower, but... Manufacture of Spray Dried Detergents Subcategory § 417.153 Effluent limitations guidelines representing the...
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2010-07-01
... available (BPT): (a) For normal operation of spray drying towers as defined above, the following values... operation of a spray drying tower, but only when a high rate of wet scrubbing is in operation which produces... CATEGORY Manufacture of Spray Dried Detergents Subcategory § 417.152 Effluent limitations guidelines...
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2010-07-01
... Construction Sand and Gravel Subcategory § 436.32 Effluent limitations guidelines representing the degree of... unaltered by man's activities, is or would be less than 6.0 and water quality criteria in water quality... adjusted downward to the pH water quality criterion for the receiving waters. In no case shall a pH...
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Palta, Manisha; Lee, W Robert
2011-01-01
In the last 2 decades, guidelines have been developed to improve quality of patient care. A recent editorial of guideline development procedures suggested the process has significant limitations that affect their scientific validity.(1) This prompted us to review oncology treatment guidelines to determine if such limitations are widespread. We performed a review of oncology treatment guidelines registered at the National Guidelines Clearinghouse (www.guideline.gov). Each guideline was independently reviewed by 2 authors and the following criteria were assessed: coordinating organization, guideline panel composition, reporting conflict of interest, peer review, dissent, expiration date, PubMed citation, and evidence-based scoring and grading of recommendations. Disagreements were resolved by consensus in subsequent discussions. Sixty-four guidelines were reviewed (39 [61%] were developed by a medical specialty society and 25 [39%] were developed by government agencies). Fifty (78%) guideline panels were multidisciplinary and 44 (69%) included individuals with epidemiologic and health services research expertise. Potential conflicts of interest were disclosed in 43 (67%) guidelines. Sixty (94%) guidelines underwent peer review, with external review in 31 (48%). Seventeen (27%) guidelines are indexed by PubMed. Fifty-one (80%) guidelines included evidence-based methodologies and 46 (72%) used evidence-based scoring of recommendations. Significant differences were observed according to coordinating organization (eg, disclosure of conflict of interest in 46% of guidelines developed by medical specialty societies versus 100% authored by government agencies [P <.0001]). The majority of oncology-related treatment guidelines registered at the National Guidelines Clearinghouse satisfy most of the criteria for sound guideline development. Significant differences in these criteria were observed according to the coordinating organization that developed the guideline. Copyright
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Mulder, Roger; Singh, Ajeet B; Hamilton, Amber; Das, Pritha; Outhred, Tim; Morris, Grace; Bassett, Darryl; Baune, Bernhard T; Berk, Michael; Boyce, Philip; Lyndon, Bill; Parker, Gordon; Malhi, Gin S
2018-02-01
Randomised controlled trials (RCTs) are considered the 'gold standard' by which novel psychotropic medications and psychological interventions are evaluated and consequently adopted into widespread clinical practice. However, there are some limitations to using RCTs as the basis for developing treatment guidelines. While RCTs allow researchers to determine whether a given medication or intervention is effective in a specific patient sample, for practicing clinicians it is more important to know whether it will work for their particular patient in their particular setting. This information cannot be garnered from an RCT. These inherent limitations are exacerbated by biases in design, recruitment, sample populations and data analysis that are inevitable in real-world studies. While trial registration and CONSORT have been implemented to correct and improve these issues, it is worrying that many trials fail to achieve such standards and yet their findings are used to inform clinical decision making. This perspective piece questions the assumptions of RCTs and highlights the widespread distortion of findings that currently undermine the credibility of this powerful design. It is recommended that the clinical guidelines include advice as to what should be considered good and relevant evidence and that external bodies continue to monitor RCTs to ensure that the outcomes published indeed reflect reality. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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29 CFR 1608.11 - Limitations on the application of these guidelines.
2010-07-01
... Guidelines are applicable only with respect to the circumstances described in § 1608.1(d), of this part. They... complained of, these Guidelines are inapplicable. (c) Currency of plan or program. Under section 713(b)(1), persons may rely on the plan or program only during the time when it is current. Currency is related to...
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2013-06-10
... reasonably available control technology (RACT) for nitrogen oxides (NO X ) and volatile organic compounds... revision demonstrates that all requirements for RACT are met through: Certification that previously adopted... for the 8-hour ozone NAAQS that states meet the CAA RACT requirements, either through a certification...
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Energy Technology Data Exchange (ETDEWEB)
Halsnaes, K.; Painuly, J.P.; Turkson, J.; Meyer, H.J.; Markandya, A.
1999-09-01
This document is a summary version of the methodological guidelines for climate change mitigation assessment developed as part of the Global Environment Facility (GEF) project Economics of Greenhouse Gas Limitations; Methodological Guidelines. The objectives of this project have been to develop a methodology, an implementing framework and a reporting system which countries can use in the construction of national climate change mitigation policies and in meeting their future reporting obligations under the FCCC. The methodological framework developed in the Methodological Guidelines covers key economic concepts, scenario building, modelling tools and common assumptions. It was used by several country studies included in the project. (au) 13 refs.
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2013-02-26
... volatile organic compounds (VOCs) satisfies the RACT requirements set forth by the Clean Air Act (CAA). This SIP revision demonstrates that all requirements for RACT are met either through Certification that..., either through a certification that previously adopted RACT controls in their SIP approved by EPA under...
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2012-07-13
... control technology (RACT) for oxides of nitrogen (NO X ) and volatile organic compounds (VOCs) for the... certification that previously adopted RACT controls in Maryland's SIP, which were approved by EPA under the 1... through (1) certification that previously adopted RACT controls in Maryland's SIP that were approved by...
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2012-03-15
... nitrogen (NO X ) and volatile organic compounds (VOCs) set forth by the Clean Air Act (CAA) with respect to... meet the CAA RACT requirements, either through a certification that previously adopted RACT controls in... requirements that represent RACT control levels, either in lieu of or in conjunction with a certification. In...
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Interim guidelines on limits of exposure to 50/60 Hz electric and magnetic fields (1989)
International Nuclear Information System (INIS)
1989-12-01
Public concern is growing and in many countries regulatory and advisory agencies have been requested to evaluate possible adverse effects of extremely low frequency electromagnetic fields on human health (Grandolfo and Vecchia, 1989). From a review of the scientific literature it is apparent that gaps exist in our knowledge and more data need to be collected to answer unresolved questions concerning biological effects of exposure to these fields. On the other hand, analysis of the existing literature does not provide evidence that exposure at present day levels has a public health impact which would require corrective action. In several countries there is an ongoing controversy between proponents of restrictive protective measures and advocates of technological growth leading to an increase in exposure levels. It thus appeared that there was a need for guidelines on exposure limits based on a objective analysis of currently available knowledge. These guidelines are intended to protect the health of humans from the potentially harmful effects of exposure to electric and magnetic fields at frequencies of 50/60 Hz, and are primarily based on established or predicted effects. 43 refs., 1 tab
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2013-12-13
... to EPA. See NRDC v. EPA, 571 F.3d 1245 (D.C. Cir. 2009). Since the Philadelphia County 2006 SIP... Call constitutes RACT for EGU sources in Philadelphia County. Thus, AMS needs to perform a NO X RACT... 52.2020(d)(1)) continue to represent adequately RACT for the 1997 8-hour ozone NAAQS; or (2) perform...
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40 CFR 52.1173 - Control strategy: Particulates.
2010-07-01
... battery” or “trips per system”; (d) the 40% opacity fugitive emissions limitation refers to an... and submits an acceptable test method for application of Rule 336.1331, Table 32 to quench towers, or, in the alternative, adopts and submits a limitation reflecting RACT for quench tower emissions based...
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Characteristics of effective clinical guidelines for general practice.
Burgers, J.S.; Grol, R.P.T.M.; Zaat, J.O.M.; Spies, T.H.; Bij, A.K. van der; Mokkink, H.G.A.
2003-01-01
BACKGROUND: The use of clinical guidelines in general practice is often limited. Research on barriers to guideline adherence usually focuses on attitudinal factors. Factors linked to the guideline itself are much less studied. AIM: To identify characteristics of effective clinical guidelines for
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International Nuclear Information System (INIS)
Lehnert, G.; Philpot, L.
1995-11-01
This report documents the initial results of the Nuclear Energy Institute License Renewal Implementation Guideline Task Force over the period August 1994 to July 1995 to develop guidance for complying with technical requirements of 10CFR54. The report also provided a starting point for the development of NEI 95-10, ''Industry Guideline for Implementing the Requirements of 10CCR54-The License Renewal Rule''. Information in this document can be used by utilities to prepare the technical material needed in an application for license renewal (LR) of a nuclear power unit. This guideline provides methods for identifying systems, structures, and components (SSCs) and their intended functions within the scope of license renewal. It identifies structures and components (SCs) requiring aging management review and methods for performing the aging management review. The guideline provides a process for identifying and evaluating time-limited aging analyses
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State Emergency Department Opioid Guidelines: Current Status.
Broida, Robert I; Gronowski, Tanner; Kalnow, Andrew F; Little, Andrew G; Lloyd, Christopher M
2017-04-01
The purpose of this study was to evaluate and categorize current state-sponsored opioid guidelines for the practice of emergency medicine (EM). We conducted a comprehensive search of EM-specific opioid prescribing guidelines and/or policies in each state to determine current state involvement in EM opioid prescribing, as well as to evaluate some of the specifics of each guideline or policy. The search was conducted using an online query and a follow-up email request to each state chapter of ACEP. We found that 17 states had emergency department-specific guidelines. We further organized the guidelines into four categories: limiting prescriptions for opioids with 67 total recommendations; preventing/diverting abuse with 56 total recommendations; addiction-related guidelines with 29 total recommendations; and a community resources section with 24 total recommendations. Our results showed that current state guidelines focus on providers limiting opioid pain prescriptions and vetting patients for possible abuse/diversion. This study highlights the 17 states that have addressed opioid prescribing guidelines and categorizes their efforts to date. It is hoped that this study will provide the basis for similar efforts in other states.
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Guidelines for setting speed limits
CSIR Research Space (South Africa)
Wium, DJW
1986-02-01
Full Text Available , parking and loading manoeuvres, access to bounding properties, intersections, width of road without central median and clear roadside area. The method should result in greater uniformity in speed limits for similar circumstances as set by different...
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Bioassay guideline 2: guidelines for tritium bioassay
International Nuclear Information System (INIS)
1983-01-01
This guideline is one of a series under preparation by the Federal-Provincial Working Group on Bioassay and In Vivo Monitoring Criteria. In this report tritium compounds have been grouped into four categories for the purpose of calculating Annual Limits on Intake and Investigation Levels: tritium gas, tritiated water, tritium-labelled compounds and nucleic acid precursors
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Design Guidelines for Low Crested Structures
DEFF Research Database (Denmark)
Burcharth, H. F.; Lamberti, Alberto
2004-01-01
1998-2002. The Guidelines comprise engineering aspects related to morphological impact and structure stability, biological aspects related to ecological impact, and socio-economical aspects related to the implementation of LCS-schemes. The guidelines are limited to submerged and regularly overtopped......The paper presents an overview of the design guidelines for low crested structures (LCS's) to be applied in coastal protection schemes. The design guidelines are formulated as a part of the research project: Environmental Design of Low Crested Coastal Defence Structures (DELOS) within the EC 5FP...
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A review of clinical guidelines.
LENUS (Irish Health Repository)
Andrews, E J
2012-02-03
BACKGROUND: Clinical guidelines are increasingly used in patient management but few clinicians are familiar with their origin or appropriate application. METHODS: A Medline search using the terms \\'clinical guidelines\\' and \\'practice guidelines\\' was conducted. Additional references were sourced by manual searching from the bibliographies of articles located. RESULTS AND CONCLUSION: Clinical guidelines originated in the USA in the early 1980s, initially as a cost containment exercise. Significant improvements in the process and outcomes of care have been demonstrated following their introduction, although the extent of improvement varies considerably. The principles for the development of guidelines are well established but many published guidelines fall short of these basic quality criteria. Guidelines are only one aspect of improving quality and should be used within a wider framework of promoting clinical effectiveness. Understanding their limitations as well as their potential benefits should enable clinicians to have a clearer view of their place in everyday practice.
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Clinical practice guidelines in patient management
Directory of Open Access Journals (Sweden)
Santosh Kumar
2001-01-01
Full Text Available Efforts have always been made to evolve certain prin-ciples to reduce the variability in the management of patients and make medical care more appropriate. These efforts have become almost a movement since 1980s as evidenced in the development of clinical practice guide-lines in all medical disciplines. This article describes the need for clinical practice guidelines and their de-velopment methods and qualities. Advantages and limi-tations of clinical practice guidelines are enumerated. The salient features of various available clinical prac-tice guidelines in urology are also described.
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Updated clinical guidelines experience major reporting limitations
Directory of Open Access Journals (Sweden)
Robin W.M. Vernooij
2017-10-01
Full Text Available Abstract Background The Checklist for the Reporting of Updated Guidelines (CheckUp was recently developed. However, so far, no systematic assessment of the reporting of updated clinical guidelines (CGs exists. We aimed to examine (1 the completeness of reporting the updating process in CGs and (2 the inter-observer reliability of CheckUp. Methods We conducted a systematic assessment of the reporting of the updating process in a sample of updated CGs using CheckUp. We performed a systematic search to identify updated CGs published in 2015, developed by a professional society, reporting a systematic review of the evidence, and containing at least one recommendation. Three reviewers independently assessed the CGs with CheckUp (16 items. We calculated the median score per item, per domain, and overall, converting scores to a 10-point scale. Multiple linear regression analyses were used to identify differences according to country, type of organisation, scope, and health topic of updated CGs. We calculated the intraclass coefficient (ICC and 95% confidence interval (95% CI for domains and overall score. Results We included in total 60 updated CGs. The median domain score on a 10-point scale for presentation was 5.8 (range 1.7 to 10, for editorial independence 8.3 (range 3.3 to 10, and for methodology 5.7 (range 0 to 10. The median overall score on a 10-point scale was 6.3 (range 3.1 to 10. Presentation and justification items at recommendation level (respectively reported by 27 and 38% of the CGs and the methods used for the external review and implementing changes in practice were particularly poorly reported (both reported by 38% of the CGs. CGs developed by a European or international institution obtained a statistically significant higher overall score compared to North American or Asian institutions (p = 0.014. Finally, the agreement among the reviewers on the overall score was excellent (ICC 0.88, 95% CI 0.75 to 0.95. Conclusions The
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49 CFR 350.339 - What are tolerance guidelines?
2010-10-01
... 49 Transportation 5 2010-10-01 2010-10-01 false What are tolerance guidelines? 350.339 Section 350... MOTOR CARRIER SAFETY ASSISTANCE PROGRAM Funding § 350.339 What are tolerance guidelines? Tolerance guidelines set forth the limited deviations from the FMCSRs allowed in your State's laws and regulations...
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2013-09-09
... reasonably available control technology (RACT) for oxides of nitrogen (NO X ) and volatile organic compounds... are approving updates to two existing regulations limiting emissions of volatile organic compounds... certification in Massachusetts' January 31, 2008 SIP submittal that demonstrates that the state has adopted air...
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Implementation guidelines for seismic PSA
International Nuclear Information System (INIS)
Coman, Ovidiu; Samaddar, Sujit; Hibino, Kenta; )
2014-01-01
The presentation was devoted to development of guidelines for implementation of a seismic PSA. If successful, these guidelines can close an important gap. ASME/ANS PRA standards and the related IAEA Safety Guide (IAEA NS-G-2.13) describe capability requirements for seismic PSA in order to support risk-informed applications. However, practical guidance on how to meet these requirements is limited. Such guidelines could significantly contribute to improving risk-informed safety demonstration, safety management and decision making. Extensions of this effort to further PSA areas, particularly to PSA for other external hazards, can enhance risk-informed applications
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BWR emergency procedure guidelines
International Nuclear Information System (INIS)
Post, J.S.; Karner, E.F.; Stratman, R.A.
1984-01-01
This chapter describes plans for dealing with reactor accidents developed by the Boiling Water Reactor (BWR) Owners' Group in response to post-Three Mile Island US NRC requirements. The devised Emergency Procedure Guidelines (EPGs), applicable to all BWRs, are symptom-based rather than event-based. According to the EPGs, the operator does not need to identify what event is occurring in the plant in order to decide what action to take, but need only observe the symptoms (values and trends of key control parameters) which exist and take appropriate action to control these symptoms. The original objective was to provide reactor operator guidance in responding to a small break loss-of-coolant accident (LOCA), but subsequent revisions have included other types of reactor accidents. Topics considered include the reactor pressure vessel (RPV) control guideline, the primary containment control guideline, the secondary containment control guideline, the radioactivity release control guideline, multiple failures vs. the design basis, safe limits vs. technical specifications, the technical status, licensing, and implementation. The EPGs are based upon maintaining both adequate core cooling and primary containment integrity
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International Nuclear Information System (INIS)
1993-01-01
The report provides an overview of the benefits analysis of the effluent limitation guidelines for offshore oil and gas facilities. Regulatory options were evaluated for two wastestreams: (1) drilling fluids (muds) and cuttings; and (2) produced water. The analysis focuses on the human health-related benefits of the regulatory options considered. These health risk reduction benefits are associated with reduced human exposure to various carcinogenic and noncarcinogenic contaminants, including lead, by way of consumption of shrimp and recreationally caught finfish from the Gulf of Mexico. Most of the health-risk reduction benefits analysis is based upon a previous report (RCG/Hagler, Bailly, January 1991), developed in support of the proposed rulemaking. Recreational, commercial, and nonuse benefits have not been estimated for these regulations, due to data limitations and the difficulty of estimating these values for effluent controls in the open-water marine environment
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Closed cooling water chemistry guidelines revision
International Nuclear Information System (INIS)
McElrath, Joel; Breckenridge, Richard
2014-01-01
This second revision of the Closed Cooling Water Chemistry Guideline addresses the use of chemicals and monitoring methods to mitigate corrosion, fouling, and microbiological growth in the closed cooling-water (CCW) systems of nuclear and fossil-fueled power plants. This revision has been endorsed by the utility chemistry community and represents another step in developing a more proactive chemistry program to limit or control closed cooling system degradation with increased consideration of corporate resources and plant-specific design and operating concerns. These guidelines were developed using laboratory data, operating experience, and input from organizations and utilities within and outside of the United States of America. It is the intent of the Revision Committee that these guidelines are applicable to all nuclear and fossil-fueled generating stations around the world. A committee of industry experts—including utility specialists, Institute of Nuclear Power Operations representatives, water-treatment service-company representatives, consultants, a primary contractor, and EPRI staff—collaborated in reviewing available data on closed cooling-water system corrosion and microbiological issues. Recognizing that each plant owner has a unique set of design, operating, and corporate concerns, the Guidelines Committee developed a methodology for plant-specific optimization. The guideline provides the technical basis for a reasonable but conservative set of chemical treatment and monitoring programs. The use of operating ranges for the various treatment chemicals discussed in this guideline will allow a power plant to limit corrosion, fouling, and microbiological growth in CCW systems to acceptable levels. The guideline now includes closed cooling chemistry regimes proven successful in use in the international community. The guideline provides chemistry constraints for the use of phosphates control, as well as pure water with pH control. (author)
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Directory of Open Access Journals (Sweden)
Gagliardi Anna R
2012-07-01
Full Text Available Abstract Background Guidelines are important tools that inform healthcare delivery based on best available research evidence. Guideline use is in part based on quality of the guidelines, which includes advice for implementation and has been shown to vary. Others hypothesized this is due to limited instructions in guideline development manuals. The purpose of this study was to examine manual instructions for implementation advice. Methods We used a directed and summative content analysis approach based on an established framework of guideline implementability. Six manuals identified by another research group were examined to enumerate implementability domains and elements. Results Manuals were similar in content but lacked sufficient detail in particular domains. Most frequently this was Accomodation, which includes information that would help guideline users anticipate and/or overcome organizational and system level barriers. In more than one manual, information was also lacking for Communicability, information that would educate patients or facilitate their involvement in shared decision making, and Applicability, or clinical parameters to help clinicians tailor recommendations for individual patients. Discussion Most manuals that direct guideline development lack complete information about incorporating implementation advice. These findings can be used by those who developed the manuals to consider expanding their content in these domains. It can also be used by guideline developers as they plan the content and implementation of their guidelines so that the two are integrated. New approaches for guideline development and implementation may need to be developed. Use of guidelines might be improved if they included implementation advice, but this must be evaluated through ongoing research.
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Straker, L; Maslen, B; Burgess-Limerick, R; Johnson, P; Dennerlein, J
2010-04-01
Computer use by children is common and there is concern over the potential impact of this exposure on child physical development. Recently principles for child-specific evidence-based guidelines for wise use of computers have been published and these included one concerning the facilitation of appropriate physical development. This paper reviews the evidence and presents detailed guidelines for this principle. The guidelines include encouraging a mix of sedentary and whole body movement tasks, encouraging reasonable postures during computing tasks through workstation, chair, desk, display and input device selection and adjustment and special issues regarding notebook computer use and carriage, computing skills and responding to discomfort. The evidence limitations highlight opportunities for future research. The guidelines themselves can inform parents and teachers, equipment designers and suppliers and form the basis of content for teaching children the wise use of computers. STATEMENT OF RELEVANCE: Many children use computers and computer-use habits formed in childhood may track into adulthood. Therefore child-computer interaction needs to be carefully managed. These guidelines inform those responsible for children to assist in the wise use of computers.
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REVIEW OF CONCENTRATION STANDARDS AND GUIDELINES FOR FUNGI IN INDOOR AIR
The paper reviews and compares existing guidelines for indoor airborne fungi, discusses limitations of existing guidelines, and identifies research needs that should contribute to the development of realistic and useful guidelines for these important air pollutants. (NOTE: Exposu...
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Syrogiannis, Andreas; Rotchford, Alan P; Agarwal, Pankaj Kumar; Kumarasamy, Manjula; Montgomery, Donald; Burr, Jennifer; Sanders, Roshini
2015-01-01
To describe the pattern of glaucoma-service delivery in Scotland and identify areas for improvement, taking into account Scottish General Ophthalmic Services (GOS) arrangements and the Eye Care Integration project, and to design Scottish Intercollegiate Guidelines Network (SIGN) guidelines to refine the primary and secondary interface of glaucoma care. A glaucoma-survey questionnaire was sent to all consultant glaucomatologists in Scotland. The design of SIGN guidelines was based on the results of the questionnaire using SIGN methodology. Over 90% of Scottish glaucoma care is triaged and delivered within hospital services. Despite GOS referral, information is variable. There are no consistent discharge practices to the community. These results led to defined research questions that were answered, thus formulating the content of the SIGN guidelines. The guideline covers the assessment of patients in primary care, referral criteria to hospital, discharge criteria from hospital to community, and monitoring of patients at risk of glaucoma. With increasing age and limitations to hospital resources, refining glaucoma pathways between primary and secondary care has become a necessity. Scotland has unique eye care arrangements with both the GOS and Eye Care Integration project. It is hoped that implementation of SIGN guidelines will identify glaucoma at the earliest opportunity and reduce the rate of false-positive referrals to hospital.
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OSART guidelines. 1994 edition
International Nuclear Information System (INIS)
1994-05-01
These guidelines have been prepared to provide a basic structure and common reference both across the various areas covered by an OSART mission and across all the missions in the programme. As such, they are addressed, principally, to the team members of OSART missions but they will also provide guidance to a host nuclear plant preparing to receive a mission. The guidelines are intended to help each expert to formulate his review in the light of this own experience. They are not all inclusive and should not limit the expert's investigations, but are better considered as illustrating the adequate requirements for his review
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40 CFR 52.2070 - Identification of plan.
2010-07-01
... 16203 Limits idling for diesel on-highway and non-road engines. Rhode Island Motor Vehicle Safety and... Education and Training Center in Newport File No. 96-07-AP 3/4/1996 9/2/1997, 62 FR 46202 Alternative NOX RACT. An administrative consent agreement between RIDEM and Naval Education and Training Center in...
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Ecologo guidelines spark disagreement
International Nuclear Information System (INIS)
Anon.
1999-01-01
Defining what renewable means has been a challenge, but the authors of a new set of guidelines for the Ecologo certification of renewable low-impact electrcity expect after some delay to have the new rules on the street by March 2000.. There was contention in developing the guideline, according to Terra Choice Environmental Services, the company that created and applied criteria for Ecologo certification under the federal government's Environmetal Choice Program. Interim guidleines were developed and have been in place for renewable power since 1996, and have since been used to certify wood-waste biomass, landfill gas, small hydro and wind power plants, in addition to three green power marketing programs. The first draft of the revised guidelines was issued in March. It was one of the harder guidelines to have been worked on because Canadian power producers did not readily agree on what should qualify as renewable, particularly around the whole area of hydro. While small run-of-river hydro plants will continue to fit within the Ecologo guidelines, larger projects will not. Wind power producers are relatively happy with the latest version of TerraChoice's draft guidelines, released at the end of November. A significant revision of the original rules is a limit on the amount of older generation green power marketers who want to promote the green power Ecologo electricity can sell. At least 50% of their capacity must originate from plants installed after January 1, 1991
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Web Accessibility and Guidelines
Harper, Simon; Yesilada, Yeliz
Access to, and movement around, complex online environments, of which the World Wide Web (Web) is the most popular example, has long been considered an important and major issue in the Web design and usability field. The commonly used slang phrase ‘surfing the Web’ implies rapid and free access, pointing to its importance among designers and users alike. It has also been long established that this potentially complex and difficult access is further complicated, and becomes neither rapid nor free, if the user is disabled. There are millions of people who have disabilities that affect their use of the Web. Web accessibility aims to help these people to perceive, understand, navigate, and interact with, as well as contribute to, the Web, and thereby the society in general. This accessibility is, in part, facilitated by the Web Content Accessibility Guidelines (WCAG) currently moving from version one to two. These guidelines are intended to encourage designers to make sure their sites conform to specifications, and in that conformance enable the assistive technologies of disabled users to better interact with the page content. In this way, it was hoped that accessibility could be supported. While this is in part true, guidelines do not solve all problems and the new WCAG version two guidelines are surrounded by controversy and intrigue. This chapter aims to establish the published literature related to Web accessibility and Web accessibility guidelines, and discuss limitations of the current guidelines and future directions.
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Dose calculation with respiration-averaged CT processed from cine CT without a respiratory surrogate
International Nuclear Information System (INIS)
Riegel, Adam C.; Ahmad, Moiz; Sun Xiaojun; Pan Tinsu
2008-01-01
Dose calculation for thoracic radiotherapy is commonly performed on a free-breathing helical CT despite artifacts caused by respiratory motion. Four-dimensional computed tomography (4D-CT) is one method to incorporate motion information into the treatment planning process. Some centers now use the respiration-averaged CT (RACT), the pixel-by-pixel average of the ten phases of 4D-CT, for dose calculation. This method, while sparing the tedious task of 4D dose calculation, still requires 4D-CT technology. The authors have recently developed a means to reconstruct RACT directly from unsorted cine CT data from which 4D-CT is formed, bypassing the need for a respiratory surrogate. Using RACT from cine CT for dose calculation may be a means to incorporate motion information into dose calculation without performing 4D-CT. The purpose of this study was to determine if RACT from cine CT can be substituted for RACT from 4D-CT for the purposes of dose calculation, and if increasing the cine duration can decrease differences between the dose distributions. Cine CT data and corresponding 4D-CT simulations for 23 patients with at least two breathing cycles per cine duration were retrieved. RACT was generated four ways: First from ten phases of 4D-CT, second, from 1 breathing cycle of images, third, from 1.5 breathing cycles of images, and fourth, from 2 breathing cycles of images. The clinical treatment plan was transferred to each RACT and dose was recalculated. Dose planes were exported at orthogonal planes through the isocenter (coronal, sagittal, and transverse orientations). The resulting dose distributions were compared using the gamma (γ) index within the planning target volume (PTV). Failure criteria were set to 2%/1 mm. A follow-up study with 50 additional lung cancer patients was performed to increase sample size. The same dose recalculation and analysis was performed. In the primary patient group, 22 of 23 patients had 100% of points within the PTV pass γ criteria
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40 CFR 52.2037 - Control strategy plans for attainment and rate-of-progress: Ozone.
2010-07-01
... minimize VOC emissions. (d) NOX RACT determination for the no. 2 glass melting furnace and the four kilns... of steel processed and 11.0 TPY. (f) Pennsylvania Electric Company—Williamsburg Station—VOC and NOX RACT determination for three emission units at Pennsylvania Electric Company (Penelec)—Williamsburg...
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2010-02-24
... for Lake and Porter Counties in Indiana AGENCY: Environmental Protection Agency (EPA). ACTION: Final... available control technology (RACT) requirements for the Lake and Porter County portion of the Chicago-Gary... subsequently submitted the required VOC RACT rules for the Lake and Porter County portion of that nonattainment...
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Treatise on water hammer in hydropower standards and guidelines
International Nuclear Information System (INIS)
Bergant, A; Mazij, J; Karney, B; Pejović, S
2014-01-01
This paper reviews critical water hammer parameters as they are presented in official hydropower standards and guidelines. A particular emphasize is given to a number of IEC standards and guidelines that are used worldwide. The paper critically assesses water hammer control strategies including operational scenarios (closing and opening laws), surge control devices (surge tank, pressure regulating valve, flywheel, etc.), redesign of the water conveyance system components (tunnel, penstock), or limitation of operating conditions (limited operating range) that are variably covered in standards and guidelines. Little information is given on industrial water hammer models and solutions elsewhere. These are briefly introduced and discussed in the light of capability (simple versus complex systems), availability of expertise (in house and/or commercial) and uncertainty. The paper concludes with an interesting water hammer case study referencing the rules and recommendations from existing hydropower standards and guidelines in a view of effective water hammer control. Recommendations are given for further work on development of a special guideline on water hammer (hydraulic transients) in hydropower plants
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Treatise on water hammer in hydropower standards and guidelines
Bergant, A.; Karney, B.; Pejović, S.; Mazij, J.
2014-03-01
This paper reviews critical water hammer parameters as they are presented in official hydropower standards and guidelines. A particular emphasize is given to a number of IEC standards and guidelines that are used worldwide. The paper critically assesses water hammer control strategies including operational scenarios (closing and opening laws), surge control devices (surge tank, pressure regulating valve, flywheel, etc.), redesign of the water conveyance system components (tunnel, penstock), or limitation of operating conditions (limited operating range) that are variably covered in standards and guidelines. Little information is given on industrial water hammer models and solutions elsewhere. These are briefly introduced and discussed in the light of capability (simple versus complex systems), availability of expertise (in house and/or commercial) and uncertainty. The paper concludes with an interesting water hammer case study referencing the rules and recommendations from existing hydropower standards and guidelines in a view of effective water hammer control. Recommendations are given for further work on development of a special guideline on water hammer (hydraulic transients) in hydropower plants.
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Cavazos, J M; Naik, A D; Woofter, A; Abraham, N S
2008-09-15
Despite wide availability of physician guidelines for safer use of nonsteroidal anti-inflammatory drugs (NSAIDs) and widespread use of these drugs in the US, NSAID prescribing guidelines have been only modestly effective. To identify and describe comprehensively barriers to provider adherence to NSAID prescribing guidelines. We conducted interviews with 25 physicians, seeking to identify the major influences explaining physician non-adherence to guidelines. Interviews were standardized and structured probes were used for clarification and detail. All interviews were audio-taped and transcribed. Three independent investigators analysed the transcripts, using the constant-comparative method of qualitative analysis. Our analysis identified six dominant physician barriers explaining non-adherence to established NSAID prescribing guidelines. These included (i) lack of familiarity with guidelines, (ii) perceived limited validity of guidelines, (iii) limited applicability of guidelines among specific patients, (iv) clinical inertia, (v) influences of prior anecdotal experiences and (vi) medical heuristics. A heterogeneous set of influences are barriers to physician adherence to NSAID prescribing guidelines. Suggested measures for improving guideline-concordant prescribing should focus on measures to improve physician education and confidence in guidelines, implementation of physician/pharmacist co-management strategies and expansion of guideline scope.
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Radiofrequency protection guidelines and standards: basic concepts and principles
International Nuclear Information System (INIS)
Czerski, P.
1985-01-01
Over the past quarter of a century, radiofrequency radiation protection guidelines and standards evolved gradually and are continuously revised and refined. The scientific rationales presented for proposed exposure limits are achieving a considerable scientific sophistication. With increasing scientific validity of the presented arguments, the values of exposure limits are converging and one may hope that they will become convincing and acceptable to all schools of thought. Still more research is needed to refine the available exposure limits. This is recognized by ANSI who revise their recommendations periodically and are now engaged in the preparation of the next revision. INIRC/IRPA is also reconsidering their interim guideline. The Australian Standards Association also stressed the temporary nature of their exposure limits
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Canadian sedentary behaviour guidelines for children and youth.
Tremblay, Mark S; Leblanc, Allana G; Janssen, Ian; Kho, Michelle E; Hicks, Audrey; Murumets, Kelly; Colley, Rachel C; Duggan, Mary
2011-02-01
The Canadian Society for Exercise Physiology (CSEP), in partnership with the Healthy Active Living and Obesity Research Group (HALO) at the Children's Hospital of Eastern Ontario Research Institute, and in collaboration with ParticipACTION, and others, has developed the Canadian Sedentary Behaviour Guidelines for Children (aged 5-11 years) and Youth (aged 12-17 years). The guidelines include a preamble to provide context, followed by the specific recommendations for sedentary behaviour. The entire development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process and the recommendations are based on evidence from a systematic review and interpretation of the research evidence. The final guidelines benefitted from an extensive online consultation process with 230 domestic and international stakeholders and key informants. The final guideline recommendations state that for health benefits, children (aged 5-11 years) and youth (aged 12-17 years) should minimize the time that they spend being sedentary each day. This may be achieved by (i) limiting recreational screen time to no more than 2 h per day - lower levels are associated with additional health benefits; and (ii) limiting sedentary (motorized) transport, extended sitting time, and time spent indoors throughout the day. These are the first evidence-based Canadian Sedentary Behaviour Guidelines for Children and Youth and provide important and timely recommendations for the advancement of public health based on a systematic synthesis, interpretation, and application of the current scientific evidence.
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2011-07-19
... nitrogen (NO X ) and volatile organic compounds (VOCs) set forth by the Clean Air Act (CAA) with respect to... reasonably available control technology (RACT) on all major volatile organic compound (VOC) and nitrogen..., either through a certification that previously adopted RACT controls in their SIP approved by EPA under...
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2011-10-25
... RACT requirements for volatile organic compounds (VOCs) set forth by the Clean Air Act (CAA or Act.... These requirements are based on (1) Missouri's RACT analysis and certification that previously adopted... Storage, Loading and Transfer. Fixed Roof Tanks. 10 CSR 10-5.420 Control of Equipment Synthetic Organic...
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[Progress in methodological characteristics of clinical practice guideline for osteoarthritis].
Xing, D; Wang, B; Lin, J H
2017-06-01
At present, several clinical practice guidelines for the treatment of osteoarthritis have been developed by institutes or societies. The ultimate purpose of developing clinical practice guidelines is to formulate the process in the treatment of osteoarthritis effectively. However, the methodologies used in developing clinical practice guidelines may place an influence on the transformation and application of that in treating osteoarthritis. The present study summarized the methodological features of individual clinical practice guideline and presented the tools for quality evaluation of clinical practice guideline. The limitations of current osteoarthritis guidelines of China are also indicated. The review article might help relevant institutions improve the quality in developing guide and clinical transformation.
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2011-08-04
... consists of a source-specific reasonably available control technology (RACT) determination for controlling... . SUPPLEMENTARY INFORMATION: Table of Contents I. EPA's Proposed Action A. What action is EPA proposing today? B. Why is EPA proposing this action? C. What are the Clean Air Act requirements for NO X RACT? D. What is...
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Methodological guidelines for developing accident modification functions
DEFF Research Database (Denmark)
Elvik, Rune
2015-01-01
This paper proposes methodological guidelines for developing accident modification functions. An accident modification function is a mathematical function describing systematic variation in the effects of road safety measures. The paper describes ten guidelines. An example is given of how to use...... limitations in developing accident modification functions are the small number of good evaluation studies and the often huge variation in estimates of effect. It is therefore still not possible to develop accident modification functions for very many road safety measures. © 2015 Elsevier Ltd. All rights...... the guidelines. The importance of exploratory analysis and an iterative approach in developing accident modification functions is stressed. The example shows that strict compliance with all the guidelines may be difficult, but represents a level of stringency that should be strived for. Currently the main...
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DEFF Research Database (Denmark)
Guyatt, Gordon H; Thorlund, Kristian; Oxman, Andrew D
2013-01-01
Presenting continuous outcomes in Summary of Findings tables presents particular challenges to interpretation. When each study uses the same outcome measure, and the units of that measure are intuitively interpretable (e.g., duration of hospitalization, duration of symptoms), presenting differences...... and absolute effects, presenting the ratio of the means of intervention and control groups, and presenting the results in minimally important difference units. We outline the merits and limitations of each alternative and provide guidance for meta-analysts and guideline developers....
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International Nuclear Information System (INIS)
Littarru, P.
2000-01-01
The present paper expounds the main Italian laws and some international laws and guidelines on the problem of environmental impact of odours, with the attempt to arrive to an odours disturbing criterion as objective and applicable as possible [it
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A comparative review of the pharmacoeconomic guidelines in South Africa.
Carapinha, João L
2017-01-01
To compare the pharmacoeconomic guidelines in South Africa (SA) with other middle- and high-income countries. A comparative review of key features of the pharmacoeconomic guidelines in SA was undertaken using the Comparative Table of Pharmacoeconomic Guidelines developed by the International Society of Pharmacoeconomics and Outcomes Research, and published country-level pharmacoeconomics guidelines. A random sample of guidelines in high- and middle-income countries were analyzed if data on all key features were available. Key features of the pharmacoeconomic guidelines in SA were compared with those in other countries, and divergent features were identified and elaborated. Five upper middle-income countries (Brazil, Colombia, Cuba, Malaysia, and Mexico), one lower middle-income country (Egypt), and six high-income countries (Germany, Ireland, Norway, Portugal, Taiwan, and the Netherlands) were analyzed. The pharmacoeconomic guidelines in SA differ in important areas when compared with other countries. In SA, the study perspective and costs are limited to private health-insurance companies, complex modelling is discouraged and models require pre-approval, equity issues are not explicitly stated, a budget impact analysis is not required, and pharmacoeconomic submissions are voluntary. Future updates to the pharmacoeconomic guidelines in SA may include a societal perspective with limitations, incentivize complex and transparent models, and integrate equity issues. The pharmacoeconomic guidelines could be improved by addressing conflicting objectives with policies on National Health Insurance, incentivize private health insurance companies to disclose reimbursement data, and require the inclusion of a budget impact analysis in all pharmacoeconomic submissions. Further research is also needed on the impact of mandatory pharmacoeconomic submissions in middle-income countries.
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International Nuclear Information System (INIS)
1993-01-01
For all major rulemaking actions, Executive Order 12291 requires a Regulatory Impact Analysis (RIA), in which benefits of the regulation are compared to costs imposed by the regulation. The report presents the Environmental Protection Agency's (EPA, or the Agency) RIA of the final rule on the effluent limitations guidelines for the Offshore Subcategory of the Oil and Gas Extraction Industry. The principal requirement of the Executive Order is that the Agency perform an analysis comparing the benefits of the regulation to the costs that the regulation imposes. Three types of benefits are analyzed in this RIA: quantified and monetized benefits; quantified and non-monetized benefits; and non-quantified and non-monetized benefits
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Implementing guidelines: Proposed definitions of neuropsychology services in pediatric oncology.
Baum, Katherine T; Powell, Stephanie K; Jacobson, Lisa A; Gragert, Marsha N; Janzen, Laura A; Paltin, Iris; Rey-Casserly, Celiane M; Wilkening, Greta N
2017-08-01
Several organizations have published guidelines for the neuropsychological care of survivors of childhood cancer. However, there is limited consensus in how these guidelines are applied. The model of neuropsychology service delivery is further complicated by the variable terminology used to describe recommended services. In an important first step to translate published guidelines into clinical practice, this paper proposes definitions for specific neuropsychological processes and services, with the goal of facilitating consistency across sites to foster future clinical program development and to clarify clinical practice guidelines. © 2017 Wiley Periodicals, Inc.
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Radiation protection guidelines for space missions
International Nuclear Information System (INIS)
Fry, R.J.; Nachtwey, D.S.
1988-01-01
The current radiation protection guidelines of the National Aeronautics and Space Administration (NASA) were recommended in 1970. The career limit was set at 4.0 Sv (400 rem). Using the same approach as in 1970 but current risk estimates, a considerably lower career limit would obtain today. Also, there is now much more information about the radiation environments that will be experienced in different missions. Furthermore, since 1970 women have joined the ranks of the astronauts. For these and other reasons, it was considered necessary to re-examine the radiation protection guidelines. This task has been undertaken by the National Council on Radiation Protection and Measurements Scientific Committee 75. Within the magnetosphere, the radiation environment varies with altitude and inclination of the orbit. In outer space missions, galactic cosmic rays, with the small but important heavy-ion component, determine the radiation environment. The new recommendations for career dose limits, based on lifetime excess risk of cancer mortality, take into account age at first exposure and sex. The career limits range from 1.0 Sv (100 rem) for a 24-y-old female up to 4.0 Sv (400 rem) for a 55-y-old male, compared with the previous single limit of 4.0 Sv (400 rem). The career limit for the lens of the eye has been reduced from 6.0 Sv (600 rem) to 4.0 Sv (400 rem)
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Shnier, Adrienne; Lexchin, Joel; Romero, Mirna; Brown, Kevin
2016-08-15
medical associations, we encourage them to develop formal policies to limit the potential influence of FCOI on guideline recommendations.
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The 2015 Dutch food-based dietary guidelines.
Kromhout, D; Spaaij, C J K; de Goede, J; Weggemans, R M
2016-08-01
The objective of this study was to derive food-based dietary guidelines for the Dutch population. The dietary guidelines are based on 29 systematic reviews of English language meta-analyses in PubMed summarizing randomized controlled trials and prospective cohort studies on nutrients, foods and food patterns and the risk of 10 major chronic diseases: coronary heart disease, stroke, heart failure, diabetes, breast cancer, colorectal cancer, lung cancer, chronic obstructive pulmonary disease, dementia and depression. The committee also selected three causal risk factors for cardiovascular diseases or diabetes: systolic blood pressure, low-density lipoprotein cholesterol and body weight. Findings were categorized as strong or weak evidence, inconsistent effects, too little evidence or effect unlikely for experimental and observational data separately. Next, the committee selected only findings with a strong level of evidence for deriving the guidelines. Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospective cohort studies. Plausible evidence was based on strong evidence from prospective cohort studies only. A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated. There are 10 new guidelines on legumes, nuts, meat, dairy produce, cereal products, fats and oils, tea, coffee and sugar-containing beverages. Three guidelines on vegetables, fruits, fish and alcoholic beverages have been sharpened, and the 2006 guideline on salt stayed the same. A separate guideline has been formulated on nutrient supplements. Completely food-based dietary guidelines can be derived in a systematic and transparent way.
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Guidelines - let's take a break and then move forward together!
DEFF Research Database (Denmark)
Bro, Flemming; Waldorff, Frans Boch
2004-01-01
With our limited resources, the national colleges of general practice in the Nordic countries should select only a few important topics and only get involved in guideline preparations if they have a primary care perspective. We need not develop our own guidelines from scratch, but should take...
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Initiatives for regional dialogue consideration of regional disarmament guidelines
International Nuclear Information System (INIS)
Marschik, R.
1994-01-01
The General Assembly of the United Nations adopted guidelines and recommendations for regional approaches to disarmament within the context of global security. The guidelines contain 52 principles on: relationship between regional disarmament, arm limitation and global security; general guidelines and recommendations for regional disarmament efforts; possible ways and means to assist and implement these efforts; possible role of the United Nations in aiding these efforts. Experiences gained in Europe and Near East are analysed in the framework of the situation in Northeast, South and Southeast Asia
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International Nuclear Information System (INIS)
2017-01-01
Since 2004, the environment programme of the IAEA has included activities aimed at developing a set of procedures for analytical measurements of radionuclides in food and the environment. Reliable, comparable and fit for purpose results are essential for any analytical measurement. Guidelines and national and international standards for laboratory practices to fulfil quality assurance requirements are extremely important when performing such measurements. The guidelines and standards should be comprehensive, clearly formulated and readily available to both the analyst and the customer. ISO 11929:2010 is the international standard on the determination of the characteristic limits (decision threshold, detection limit and limits of the confidence interval) for measuring ionizing radiation. For nuclear analytical laboratories involved in the measurement of radioactivity in food and the environment, robust determination of the characteristic limits of radioanalytical techniques is essential with regard to national and international regulations on permitted levels of radioactivity. However, characteristic limits defined in ISO 11929:2010 are complex, and the correct application of the standard in laboratories requires a full understanding of various concepts. This publication provides additional information to Member States in the understanding of the terminology, definitions and concepts in ISO 11929:2010, thus facilitating its implementation in Member State laboratories.
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Design Guidelines for New Generation Network Architecture
Harai, Hiroaki; Fujikawa, Kenji; Kafle, Ved P.; Miyazawa, Takaya; Murata, Masayuki; Ohnishi, Masaaki; Ohta, Masataka; Umezawa, Takeshi
Limitations are found in the recent Internet because a lot of functions and protocols are patched to the original suite of layered protocols without considering global optimization. This reveals that end-to-end argument in the original Internet was neither sufficient for the current societal network and nor for a sustainable network of the future. In this position paper, we present design guidelines for a future network, which we call the New Generation Network, which provides the inclusion of diverse human requirements, reliable connection between the real-world and virtual network space, and promotion of social potentiality for human emergence. The guidelines consist of the crystal synthesis, the reality connection, and the sustainable & evolutional guidelines.
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Guidelines - let's take a break and then move forward together!
DEFF Research Database (Denmark)
Bro, Flemming; Waldorff, Frans Boch
2004-01-01
With our limited resources, the national colleges of general practice in the Nordic countries should select only a few important topics and only get involved in guideline preparations if they have a primary care perspective. We need not develop our own guidelines from scratch, but should take exi...
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Actinic Keratosis Clinical Practice Guidelines: An Appraisal of Quality
Directory of Open Access Journals (Sweden)
Joslyn S. Kirby
2015-01-01
Full Text Available Actinic keratosis (AK is a common precancerous skin lesion and many AK management guidelines exist, but there has been limited investigation into the quality of these documents. The objective of this study was to assess the strengths and weaknesses of guidelines that address AK management. A systematic search for guidelines with recommendations for AK was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE II was used to appraise the quality of guidelines. Multiple raters independently reviewed each of the guidelines and applied the AGREE II tool and scores were calculated. Overall, 2,307 citations were identified and 7 fulfilled the study criteria. The Cancer Council of Australia/Australian Cancer Network guideline had the highest mean scores and was the only guideline to include a systematic review, include an evidence rating for recommendations, and report conflicts of interest and funding sources. High-quality, effective guidelines are evidence-based with recommendations that are concise and organized, so practical application is facilitated. Features such as concise tables, pictorial diagrams, and explicit links to evidence are helpful. However, the rigor and validity of some guidelines were weak. So, it is important for providers to be aware of the features that contribute to a high-quality, practical document.
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Statistical guidelines for planning a limited drilling program
International Nuclear Information System (INIS)
Campbell, K.
1988-06-01
Site characterization for potential nuclear waste repository at Yucca Mountain in south-central Nevada will include the construction of a limited number of new drill holes to depths below the repository horizon from which information about the properties of the surrounding and underlying tuffs can be obtained. Quantitative techniques to estimate the amount of information to be gained from a proposed drilling plan are developed. These estimates are to be compared with economic costs and with risk analysis requirements for the potential repository. In some cases the existing data, although extremely limited, are sufficient for preliminary application of these methods. 33 refs., 19 figs., 3 tabs
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Soil and groundwater remediation guidelines for methanol
International Nuclear Information System (INIS)
2010-12-01
Methanol is used by oil and gas operators to inhibit hydrate formation in the recovery of heavy oils, in natural gas production and transport, as well as in various other production applications. Emissions from methanol primary occur from miscellaneous solvent usage, methanol production, end-product manufacturing, and storage and handling losses. This document provided soil and groundwater remediation guidelines for methanol releases into the environment. The guidelines were consistent with the Alberta Environment tier 1 soil and groundwater framework. The chemical and physical properties of methanol were reviewed. The environmental fate and behavior of methanol releases was discussed, and the behaviour and effects of methanol in terrestrial and aquatic biota were evaluated. The toxicity of methanol and its effects in humans and mammalian species were reviewed. Soil quality and ground water quality guidelines were presented. Surface water and soil guideline calculation methods were provided, and ecological exposure and ground water pathways were discussed. Management limits for methanol concentrations were also provided. 162 refs., 18 tabs., 4 figs.
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Korean Society of Cardiovascular Imaging Guidelines for Cardiac Computed Tomography
International Nuclear Information System (INIS)
Kim, Young Jin; Choi, Byoung Wook; Choe, Kyu Ok; Yong, Hwan Seok; Kim, Yang Min; Choe, Yeon Hyeon; Lim, Tae Hwan; Park, Jae Hyung
2011-01-01
The Korean Society of Cardiovascular Imaging (KOCSI) has issued a guideline for the use of cardiac CT imaging in order to assist clinicians and patients in providing adequate level of medical service. In order to establish a guideline founded on evidence based medicine, it was designed based on comprehensive data such as questionnaires conducted in international and domestic hospitals, intensive journal reviews, and with experts in cardiac radiology. The recommendations of this guideline should not be used as an absolute standard and medical professionals can always refer to methods non-adherent to this guideline when it is considered more reasonable and beneficial to an individual patient's medical situation. The guideline has its limitation and should be revised appropriately with the advancement medical equipment technology and public health care system. The guideline should not be served as a measure for standard of care. KOCSI strongly disapproves the use of the guideline to be used as the standard of expected practice in medical litigation processes.
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Jauch, Edward C; Saver, Jeffrey L; Adams, Harold P; Bruno, Askiel; Connors, J J Buddy; Demaerschalk, Bart M; Khatri, Pooja; McMullan, Paul W; Qureshi, Adnan I; Rosenfield, Kenneth; Scott, Phillip A; Summers, Debbie R; Wang, David Z; Wintermark, Max; Yonas, Howard
2013-03-01
The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.
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Directory of Open Access Journals (Sweden)
Rochelle P Walensky
2010-12-01
Full Text Available The new 2010 World Health Organization (WHO HIV treatment guidelines recommend earlier antiretroviral therapy (ART initiation (CD4<350 cells/µl instead of CD4<200 cells/µl, multiple sequential ART regimens, and replacement of first-line stavudine with tenofovir. This paper considers what to do first in resource-limited settings where immediate implementation of all of the WHO recommendations is not feasible.We use a mathematical model and local input data to project clinical and economic outcomes in a South African HIV-infected cohort (mean age = 32.8 y, mean CD4 = 375/µl. For the reference strategy, we assume that all patients initiate stavudine-based ART with WHO stage III/IV disease and receive one line of ART (stavudine/WHO/one-line. We rank-in survival, cost-effectiveness, and equity terms-all 12 possible combinations of the following: (1 stavudine replacement with tenofovir, (2 ART initiation (by WHO stage, CD4<200 cells/µl, or CD4<350 cells/µl, and (3 one or two regimens, or lines, of available ART. Projected life expectancy for the reference strategy is 99.0 mo. Considering each of the guideline components separately, 5-y survival is maximized with ART initiation at CD4<350 cells/µl (stavudine/<350/µl/one-line, 87% survival compared with stavudine/WHO/two-lines (66% and tenofovir/WHO/one-line (66%. The greatest life expectancies are achieved via the following stepwise programmatic additions: stavudine/<350/µl/one-line (124.3 mo, stavudine/<350/µl/two-lines (177.6 mo, and tenofovir/<350/µl/two-lines (193.6 mo. Three program combinations are economically efficient: stavudine/<350/µl/one-line (cost-effectiveness ratio, US$610/years of life saved [YLS], tenofovir/<350/µl/one-line (US$1,140/YLS, and tenofovir/<350/µl/two-lines (US$2,370/YLS.In settings where immediate implementation of all of the new WHO treatment guidelines is not feasible, ART initiation at CD4<350 cells/µl provides the greatest short- and long
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Empirical influence of the multicultural guidelines: A brief report.
Fouad, Nadya A; Santana, Mercedes; Ghosh, Arpita
2017-10-01
In 2002, the American Psychological Association (APA) Council of Representatives approved the "Guidelines for Multicultural Education, Training, Research, Practice and Organizational Change for Psychologists." The Guidelines have been downloaded 64,153 times from the APA website from 2007 to 2013, and have been cited nearly 900 times. This suggests that the Guidelines have influenced education, training, research, and practice in psychology. However, it is unclear how the Guidelines have influenced these domains. We conducted a comprehensive literature review to examine how the Guidelines have influenced the field. Articles were coded for several criteria, including whether the Guidelines were cited, the type of research that was conducted, study findings, limitations, and future directions of research. The data for this study consisted of 895 empirical articles published since the 2003 publication of the Guidelines. A literature review using the keywords APA and multicultural guidelines were searched in PsycINFO and ERIC databases. Articles were then coded by the research team. Findings from the literature review suggested that although there were a total of 895 articles and books that cited the Guidelines, only 34 met our coding criteria. Our findings suggest that most of the articles that cited the Guidelines used the citation as a way to document that culture is important to consider. In some cases, other professions cited the Guidelines to argue that their discipline should also attend to culture. However, very few articles focused on framing an investigation around a specific guideline. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
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Strategy Guideline: Modeling Enclosure Design in Above-Grade Walls
Energy Technology Data Exchange (ETDEWEB)
Lstiburek, J. [Building Science Corporation, Westford, MA (United States); Ueno, K. [Building Science Corporation, Westford, MA (United States); Musunuru, S. [Building Science Corporation, Westford, MA (United States)
2016-02-24
The Strategy Guideline describes how to model and interpret results of models for above grade walls. The Measure Guideline analyzes the failure thresholds and criteria for above grade walls. A library of above-grade walls with historically successful performance was used to calibrate WUFI (Warme Und Feuchte Instationar) software models. The information is generalized for application to a broad population of houses within the limits of existing experience.
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Guidelines for rating Global Assessment of Functioning (GAF
Directory of Open Access Journals (Sweden)
Aas IH Monrad
2011-01-01
Full Text Available Abstract Background Global Assessment of Functioning (GAF is a scoring system for the severity of illness in psychiatry. It is used clinically in many countries, as well as in research, but studies have shown several problems with GAF, for example concerning its validity and reliability. Guidelines for rating are important. The present study aimed to identify the current status of guidelines for rating GAF, and relevant factors and gaps in knowledge for the development of improved guidelines. Methods A thorough literature search was conducted. Results Few studies of existing guidelines have been conducted; existing guidelines are short; and rating has a subjective element. Seven main categories were identified as being important in relation to further development of guidelines: (1 general points about guidelines for rating GAF; (2 introduction to guidelines, with ground rules; (3 starting scoring at the top, middle or bottom level of the scale; (4 scoring for different time periods and of different values (highest, lowest or average; (5 the finer grading of the scale; (6 different guidelines for different conditions; and (7 different languages and cultures. Little information is available about how rules for rating are understood by different raters: the final score may be affected by whether the rater starts at the top, middle or bottom of the scale; there is little data on which value/combination of GAF values to record; guidelines for scoring within 10-point intervals are limited; there is little empirical information concerning the suitability of existing guidelines for different conditions and patient characteristics; and little is known about the effects of translation into different languages or of different cultural understanding. Conclusions Few studies have dealt specifically with guidelines for rating GAF. Current guidelines for rating GAF are not comprehensive, and relevant points for new guidelines are presented. Theoretical and
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75 FR 4414 - Wind Turbine Guidelines Advisory Committee; Announcement of Public Meeting
2010-01-27
...] Wind Turbine Guidelines Advisory Committee; Announcement of Public Meeting AGENCY: Fish and Wildlife... (Service), will host a Wind Turbine Guidelines Advisory Committee (Committee) meeting March 2- 4, 2010. The.../wind_turbine_advisory_committee.html , by February 23, 2010. Seating is limited due to room capacity...
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Cancer related fatigue: implementing guidelines for optimal management.
Pearson, Elizabeth J M; Morris, Meg E; McKinstry, Carol E
2017-07-18
Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies. A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round. Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management. Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may
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Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven
2012-07-04
Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.
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Guideline of guidelines: asymptomatic microscopic haematuria.
Linder, Brian J; Bass, Edward J; Mostafid, Hugh; Boorjian, Stephen A
2018-02-01
The aim of the present study was to review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH). We reviewed the haematuria guidelines from: the American Urological Association; the consensus statement by the Canadian Urological Association, Canadian Urologic Oncology Group and Bladder Cancer Canada; the American College of Physicians; the Joint Consensus Statement of the Renal Association and British Association of Urological Surgeons; and the National Institute for Health and Care Excellence. All guidelines reviewed recommend evaluation for AMH in the absence of potential benign aetiologies, with the evaluation including cystoscopy and upper urinary tract imaging. Existing guidelines vary in their definition of AMH (role of urine dipstick vs urine microscopy), the age threshold for recommending evaluation, and the optimal imaging method (computed tomography vs ultrasonography). Of the reviewed guidelines, none recommended the use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow-up after a negative initial AMH evaluation. Significant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, AMH represents a valuable future research opportunity. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.
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Operational limits and disruptions in ITER
Energy Technology Data Exchange (ETDEWEB)
Tsunematsu, T; Mizoguchi, T; Yoshino, R [Japan Atomic Energy Research Inst., Tokyo (Japan); Borrass, K; Engelmann, F; Pacher, G; Pacher, H [Max-Planck-Institut fuer Plasmaphysik, Garching (Germany, F.R.). NET Design Team; Cohen, S; Post, D [Princeton Univ., NJ (USA). Plasma Physics Lab.; Hogan, J; Uckan, N A [Oak Ridge National Lab., TN (USA); Krasheninnikov, S; Mukhovatov, V; Parail, V
1990-12-15
Detailed knowledge of the operational limits for beta, q and the plasma density will be required for successful and flexible operation of ITER. In this paper, the present data base and guidelines on operational limits and disruptions in the ITER design are presented. 10 refs., 1 fig.
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Guidelines Gas Act. Information and Consultation Document 2001
International Nuclear Information System (INIS)
De Groene, P.; Teljeur, E.; Verdonkschot, I.R.
2001-06-01
This Information and Consultation Document has been drawn up for the consultation period that will be held prior to the approval of the new Guidelines, in accordance with sections 13 and 18 of the Dutch Gas Act. In determining the topics for discussion in the consultation document, DTe has based its decision on the scope and aim of these Guidelines. In doing so, DTe's objective is to achieve these aims in a responsible manner, with limited interventions in the market. The Guidelines focus firstly on gas transport companies, in so far as they transport gas to supply eligible customers. In the year 2002, customers with an annual off-take of 1 million m 3 or more will be eligible. Secondly, the Guidelines focus on gas storage companies that have a dominant position or are deemed to have a dominant position, in accordance with section 18(2) of the Gas Act. In determining the Guidelines, in accordance with section 13(1) of the Gas Act, the Director of DTe has to take into account the promotion of trade and the promotion of the efficient operation of gas transport companies and users of the gas network. In addition, it appears from the Parliamentary Proceedings that the Guidelines also have the aim of preventing abuse of a dominant position. This document indicates the way DTe intends to achieve the statutory aims referred to above. Partly on the basis of experience in other countries, DTe assumes that realising these aims and creating a 'level playing field' on the Dutch gas market is a gradual process that may take several years. It will not be possible to realise all the conditions for achieving the above-mentioned objectives, as outlined by DTe in the Information and Consultation Document, in 2002. DTe therefore intends to limit the Guidelines for the year 2002 to the conditions that have priority. The aim of the consultation process and the responses of the various markets players is partly to determine the conditions that have priority. For the purposes of
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Ansari, Shabnam; Rashidian, Arash
2012-01-01
Objectives We conducted a comparative review of clinical practice guideline development handbooks. We aimed to identify the main guideline development tasks, assign weights to the importance of each task using expert opinions and identify the handbooks that provided a comprehensive coverage of the tasks. Methods We systematically searched and included handbooks published (in English language) by national, international or professional bodies responsible for evidenced-based guideline development. We reviewed the handbooks to identify the main guideline development tasks and scored each handbook for each task from 0 (the handbook did not mention the task) to 2 (the task suitably addressed and explained), and calculated a weighted score for each handbook. The tasks included in over 75% of the handbooks were considered as ‘necessary’ tasks. Result Nineteen guideline development handbooks and twenty seven main tasks were identified. The guideline handbooks’ weighted scores ranged from 100 to 220. Four handbooks scored over 80% of the maximum possible score, developed by the National Institute for Health and Clinical Excellence, Swiss Centre for International Health, Scottish Intercollegiate Guidelines Network and World Health Organization. Necessary tasks were: selecting the guideline topic, determining the guideline scope, identifying relevant existing guidelines, involving the consumers, forming guideline development group,, developing clinical questions, systematic search for evidence, selecting relevant evidence, appraising identifies research evidence, making group decision, grading available evidence, creating recommendations, final stakeholder consultation, guideline implementation strategies, updating recommendations and correcting potential errors. Discussion Adequate details for evidence based development of guidelines were still lacking from many handbooks. The tasks relevant to ethical issues and piloting were missing in most handbooks. The findings
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Directory of Open Access Journals (Sweden)
J. Scott Weese
2011-01-01
Full Text Available Urinary tract disease is a common reason for use (and likely misuse, improper use, and overuse of antimicrobials in dogs and cats. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, guidelines for diagnosis and management of urinary tract infections were created by a Working Group of the International Society for Companion Animal Infectious Diseases. While objective data are currently limited, these guidelines provide information to assist in the diagnosis and management of upper and lower urinary tract infections in dogs and cats.
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Legal issues in the development and use of clinical practice guidelines.
Gevers, S
2001-01-01
Over the last ten years, the development and dissemination of practice guidelines has increased at a rapid pace. From a legal point of view, it should always be made clear whether a guideline has been developed to improve the quality of care and is based on medical evidence and professional experience, or whether other concerns and considerations (organisational, financial) did prevail. Guidelines should not simply be imposed on health professionals; that would result in a standardisation of care that does no justice to individual patient needs and preferences. Patients have the right to be informed about reasonable and realistic treatment alternatives, even if they are not included in the guideline. Using cost effectiveness analysis in guideline development can help to reduce care of dubious effectiveness. But if cost considerations are used as a reason to limit effective medical care, the guidelines in question need political legitimation.
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International Nuclear Information System (INIS)
Jarrett, B.M.; Kirby, R.G.
1978-07-01
To establish effluent limitation guidelines and standards of performance, the ore mining and dressing industry was divided into 41 separate categories and subcategories for which separate limitations were recommended. This report deals with the entire metal-ore mining and dressing industry and examines the industry by ten major categories: iron ore; copper ore; lead and zinc ores; gold ore; silver ore; bauxite ore; ferroalloy-metal ores; mercury ores; uranium, radium and vanadium ores; and metal ores, not elsewhere classified ((ores of antimony, beryllium, pltinum, rare earths, tin, titanium, and zirconium). The subcategorization of the ore categories is based primarily upon ore mineralogy and processing or extraction methods employed; however, other factors (such as size, climate or location, and method of mining) are used in some instances. With the best available technology economically achievable, facilities in 21 of the 41 subcategories can be operated with no discharge of process wastewater to navigable waters. No discharge of process wastewater is also achievable as a new source performance standard for facilities in 21 of the 41 subcategories
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Kunz, Regina; Fretheim, Atle; Cluzeau, Françoise; Wilt, Timothy J; Qaseem, Amir; Lelgemann, Monika; Kelson, Marcia; Guyatt, Gordon; Schünemann, Holger J
2012-12-01
Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the third of a series of 14 articles that were prepared to advise guideline developers in respiratory and other diseases on considerations for group compositions and group processes in guideline development, and how this can be effectively integrated in the context of respiratory disease guidelines on a national and international level. We updated a review of the literature addressing group composition and group process, focusing on the following questions: 1. How to compose a functioning and representative guideline group; Who should be included in a guideline panel?; How to select organizations, groups, and individuals; What expertise is needed?; Consultation with non-included groups. 2. How to assure a functioning group process; How to make the process constructive; Balancing participation and finding agreement; Administrative support; What constitutes sufficient resources? Our conclusions are based on available evidence from published literature, experience from guideline developers, and workshop discussions. Formal studies addressing optimal processes in developing guidelines are limited, and experience from guideline organizations supplement the formal studies. When resources are available, guideline development groups should aim for multidisciplinary groups, including patients. Prerequisites for a multidisciplinary group include: a strong chair experienced in group facilitation with broad acceptance in the group, training the group in guideline methodology, and professional technical support. Formal consensus developing methods have proved effective in reaching agreement on the final recommendations.
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GLASS MANUFACTURING POINT SOURCE CATEGORY Television Picture... applicable to the abrasive polishing and acid polishing waste water streams. Effluent characteristic Effluent...
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Knowledge-based verification of clinical guidelines by detection of anomalies.
Duftschmid, G; Miksch, S
2001-04-01
As shown in numerous studies, a significant part of published clinical guidelines is tainted with different types of semantical errors that interfere with their practical application. The adaptation of generic guidelines, necessitated by circumstances such as resource limitations within the applying organization or unexpected events arising in the course of patient care, further promotes the introduction of defects. Still, most current approaches for the automation of clinical guidelines are lacking mechanisms, which check the overall correctness of their output. In the domain of software engineering in general and in the domain of knowledge-based systems (KBS) in particular, a common strategy to examine a system for potential defects consists in its verification. The focus of this work is to present an approach, which helps to ensure the semantical correctness of clinical guidelines in a three-step process. We use a particular guideline specification language called Asbru to demonstrate our verification mechanism. A scenario-based evaluation of our method is provided based on a guideline for the artificial ventilation of newborn infants. The described approach is kept sufficiently general in order to allow its application to several other guideline representation formats.
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Energy Technology Data Exchange (ETDEWEB)
Boerner, A. J. [Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN (United States). Independent Environmental Assessment and Verification Program; Maldonado, D. G. [Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN (United States). Independent Environmental Assessment and Verification Program; Hansen, Tom [Ameriphysics, LLC (United States)
2012-09-01
Environmental assessments and remediation activities are being conducted by the U.S. Department of Energy (DOE) at the Paducah Gaseous Diffusion Plant (PGDP), Paducah, Kentucky. The Oak Ridge Institute for Science and Education (ORISE), a DOE prime contractor, was contracted by the DOE Portsmouth/Paducah Project Office (DOE-PPPO) to conduct radiation dose modeling analyses and derive single radionuclide soil guidelines (soil guidelines) in support of the derivation of Authorized Limits (ALs) for 'DOE-Owned Property Outside the Limited Area' ('Property') at the PGDP. The ORISE evaluation specifically included the area identified by DOE restricted area postings (public use access restrictions) and areas licensed by DOE to the West Kentucky Wildlife Management Area (WKWMA). The licensed areas are available without restriction to the general public for a variety of (primarily) recreational uses. Relevant receptors impacting current and reasonably anticipated future use activities were evaluated. In support of soil guideline derivation, a Conceptual Site Model (CSM) was developed. The CSM listed radiation and contamination sources, release mechanisms, transport media, representative exposure pathways from residual radioactivity, and a total of three receptors (under present and future use scenarios). Plausible receptors included a Resident Farmer, Recreational User, and Wildlife Worker. single radionuclide soil guidelines (outputs specified by the software modeling code) were generated for three receptors and thirteen targeted radionuclides. These soil guidelines were based on satisfying the project dose constraints. For comparison, soil guidelines applicable to the basic radiation public dose limit of 100 mrem/yr were generated. Single radionuclide soil guidelines from the most limiting (restrictive) receptor based on a target dose constraint of 25 mrem/yr were then rounded and identified as the derived soil guidelines. An additional evaluation using the derived soil
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International Nuclear Information System (INIS)
Boerner, A. J.
2012-01-01
Environmental assessments and remediation activities are being conducted by the U.S. Department of Energy (DOE) at the Paducah Gaseous Diffusion Plant (PGDP), Paducah, Kentucky. The Oak Ridge Institute for Science and Education (ORISE), a DOE prime contractor, was contracted by the DOE Portsmouth/Paducah Project Office (DOE-PPPO) to conduct radiation dose modeling analyses and derive single radionuclide soil guidelines (soil guidelines) in support of the derivation of Authorized Limits (ALs) for 'DOE-Owned Property Outside the Limited Area' ('Property') at the PGDP. The ORISE evaluation specifically included the area identified by DOE restricted area postings (public use access restrictions) and areas licensed by DOE to the West Kentucky Wildlife Management Area (WKWMA). The licensed areas are available without restriction to the general public for a variety of (primarily) recreational uses. Relevant receptors impacting current and reasonably anticipated future use activities were evaluated. In support of soil guideline derivation, a Conceptual Site Model (CSM) was developed. The CSM listed radiation and contamination sources, release mechanisms, transport media, representative exposure pathways from residual radioactivity, and a total of three receptors (under present and future use scenarios). Plausible receptors included a Resident Farmer, Recreational User, and Wildlife Worker. single radionuclide soil guidelines (outputs specified by the software modeling code) were generated for three receptors and thirteen targeted radionuclides. These soil guidelines were based on satisfying the project dose constraints. For comparison, soil guidelines applicable to the basic radiation public dose limit of 100 mrem/yr were generated. Single radionuclide soil guidelines from the most limiting (restrictive) receptor based on a target dose constraint of 25 mrem/yr were then rounded and identified as the derived soil guidelines. An additional evaluation using the derived soil
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Development of international guidelines for RAM shipment security
Energy Technology Data Exchange (ETDEWEB)
Luna, R.E.
2004-07-01
In October of 2003 a weeklong IAEA Technical Meeting developed a set of guidelines for providing security to consignments of radioactive materials in transport. These guidelines will be published shortly in an IAEA TECDOC. The guidelines produced reflect consideration of many influences and concerns that currently revolve around the potential for terrorist use of radioactive material for malevolent ends. The influences discussed here include: public perception of hazard and concern that new requirements will further limit global shipping capability, international efforts to control sealed sources, national efforts to increment protection on selected materials, the basis for exemption of materials, concern for cost impacts of overly broad requirements, questions on how to adjust requirements for a national threat assessment, and issues relating to consistency within the international community on security needs.
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Development of international guidelines for RAM shipment security
International Nuclear Information System (INIS)
Luna, R.E.
2004-01-01
In October of 2003 a weeklong IAEA Technical Meeting developed a set of guidelines for providing security to consignments of radioactive materials in transport. These guidelines will be published shortly in an IAEA TECDOC. The guidelines produced reflect consideration of many influences and concerns that currently revolve around the potential for terrorist use of radioactive material for malevolent ends. The influences discussed here include: public perception of hazard and concern that new requirements will further limit global shipping capability, international efforts to control sealed sources, national efforts to increment protection on selected materials, the basis for exemption of materials, concern for cost impacts of overly broad requirements, questions on how to adjust requirements for a national threat assessment, and issues relating to consistency within the international community on security needs
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Dietary recommendations: comparing dietary guidelines from Brazil and the United States.
Sichieri, Rosely; Chiuve, Stephanie E; Pereira, Rosângela Alves; Lopes, Aline Cristine Souza; Willett, Walter C
2010-11-01
The Brazilian dietary guidelines are based in part on mainstream United States' recommendations, in spite of the criticisms and shortcomings of the American guidelines. In this paper, Brazilian food guidelines are summarized and discussed in comparison with the USA recommendations. American and Brazilian dietary recommendations are quite similar in many aspects, particularly those related to variety in the diet, the importance of physical activity and weight management. Different to American guidelines, those from Brazil advise people to choose fresh foods, to prefer healthier types of fat, to limit trans fat intake and to eat good sources of protein, but does not recommend the consumption of whole grains. Besides the challenges related to their implementation, indicators for the evaluation of the effectiveness of these guidelines should be established from the beginning, particularly those related to changes in dietary habits and the prevalence of obesity.
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Understanding standard drinks and drinking guidelines.
Kerr, William C; Stockwell, Tim
2012-03-01
For consumers to follow drinking guidelines and limit their risk of negative consequences they need to track their ethanol consumption. This paper reviews published research on the ability of consumers to utilise information about the alcohol content of beverages when expressed in different forms, for example in standard drinks or units versus percentage alcohol content. A review of the literature on standard drink definitions and consumer understanding of these, actual drink pouring, use of standard drinks in guidelines and consumer understanding and use of these. Standard drink definitions vary across countries and typically contain less alcohol than actual drinks. Drinkers have difficulty defining and pouring standard drinks with over-pouring being the norm such that intake volume is typically underestimated. Drinkers have difficulty using percentage alcohol by volume and pour size information in calculating intake but can effectively utilise standard drink labelling to track intake. Standard drink labelling is an effective but little used strategy for enabling drinkers to track their alcohol intake and potentially conform to safe or low-risk drinking guidelines. © 2011 Australasian Professional Society on Alcohol and other Drugs.
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Brüggemann, S; Korsukéwitz, C
2004-10-01
Clinical practice guidelines - seen as an aggregation of scientific evidence - and evidence based medicine are of relevance and importance for everybody involved in health care. Nevertheless, the discussion of their pros and cons is controversial. Major criticisms concern methodological aspects, a disregard of the patients' perspective, potentially increasing costs and the limitation of doctors' autonomy possibly caused by streamlining therapy. Supporters emphasize the improvement of care that comes with using proven therapies, patients' empowerment, cost reduction and equity in the distribution of resources. Following medical practice guidelines the liability for medical malpractice may be limited, but non-adherence to guidelines does not entail liability per se. Clinical practice guidelines in the rehabilitative sector differ from those in curative medicine by being required to achieve more complex goals than maintenance, recovery and improvement of health. Activities in the rehabilitation sector address two main topics: The integration of rehabilitation into curative guidelines, e. g. by participating in the German clearing process for guidelines, and the development of guidelines specific to rehabilitation. There are a number of guideline initiatives, e. g. with the Association of the Scientific Medical Societies (AWMF), the Federation of German Pension Insurance Institutes (VDR) and the Federal Insurance Institute for Salaried Employees (BfA). The BfA project is the first to allow integration of evidence based medicine into the quality assurance programme of the German Pension Insurance complementing it with differentiated criteria for the assessment of therapeutic processes. Taking evidence based medicine increasingly into consideration and the continuous process of introducing rehabilitative clinical practice guidelines are going to improve health care for people with chronic diseases.
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46 CFR Appendix B to Subpart C to... - Substance Technical Guidelines, Benzene
2010-10-01
... 46 Shipping 7 2010-10-01 2010-10-01 false Substance Technical Guidelines, Benzene B Appendix B to... Subpart C to Part 197—Substance Technical Guidelines, Benzene I. Physical and Chemical Data (a) Substance... temperature: 580 °C (1076 °F). (3) Flammable limits in air, % by volume: Lower: 1.3%, Upper: 7.5%. (4...
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2012-05-16
... of drinking water sources (both surface and groundwater), creation of noxious odors and discolored... individual water bodies as the guidelines are developed; see Statement of Senator Muskie (October 4, 1972... biological process is contained in a sealed reactor, odors are eliminated. Based on EPA sampling results, the...
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Lack of international consensus in low-risk drinking guidelines.
Furtwaengler, Nina A F F; de Visser, Richard O
2013-01-01
To encourage moderate alcohol consumption, many governments have developed guidelines for alcohol intake, guidelines for alcohol consumption during pregnancy and legislation relating to blood alcohol limits when driving. The aim of this study was to determine the degree of international consensus within such guidelines. Official definitions of standard drinks and consumption guidelines were searched for on government websites, including all 27 European Union Member States and countries from all global geographic regions. There was a remarkable lack of agreement about what constitutes harmful or excessive alcohol consumption on a daily basis, a weekly basis and when driving, with no consensus about the ratios of consumption guidelines for men and women. International consensus in low-risk drinking guidelines is an important--and achievable--goal. Such agreement would facilitate consistent labelling of packaged products and could help to promote moderate alcohol consumption. However, there are some paradoxes related to alcohol content labelling and people's use of such information: although clearer information could increase people's capacity to monitor and regulate their alcohol consumption, not all drinkers are motivated to drink moderately or sensibly, and drinkers who intend to get drunk may use alcohol content labelling to select more alcoholic products. © 2012 Australasian Professional Society on Alcohol and other Drugs.
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Energy Technology Data Exchange (ETDEWEB)
Carter, R.J.
1997-07-01
This report documents the work conducted in four tasks of the Nuclear Regulatory Commission (NRC) project entitled Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation. The purpose of the first task was to integrate the applicable sections of NUREG-0700 into the advanced control room design review (ACRDR) guidelines to ensure that all applicable guidelines are together in one document and conveniently accessible to users. The primary objective of the second task was to formulate a strategy for the development of new ACRDR guidelines that have not otherwise been identified. The main focus of the third task was to modify the individual ACRDR guidelines generated to date to ensure that they are suitable for the intended nuclear power plant (NPP) control station system application. The goal of the fourth task was to develop human factors guidelines for two human-system interface categories that are missing from the current ACRDR guidelines document. During the first task those areas in NUREG-0700 that are not addressed by the ACRDR guidelines document were identified, the areas were subsequently reviewed against six recent industry human factors engineering review guidelines, and the NUREG-0700 guidelines were updated as necessary. In the second task 13 general categories of human-system interface guidelines that are either missing from or not adequately addressed by the ACRDR document were discovered. An approach was derived for the development of new ACRDR guidelines, a preliminary assessment of the available sources that may be useful in the creation of new guidelines and their applicability to the identified human-system interface categories was performed, and an estimate was made of the amount of time and level of effort required to complete the development of needed new ACRDR guidelines. During the third task those NPP control station systems to which the NUREG-0700 and ACRDR guidelines apply were identified, matrices of such
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International Nuclear Information System (INIS)
Carter, R.J.
1997-07-01
This report documents the work conducted in four tasks of the Nuclear Regulatory Commission (NRC) project entitled Review Criteria for Human Factors Aspects of Advanced Controls and Instrumentation. The purpose of the first task was to integrate the applicable sections of NUREG-0700 into the advanced control room design review (ACRDR) guidelines to ensure that all applicable guidelines are together in one document and conveniently accessible to users. The primary objective of the second task was to formulate a strategy for the development of new ACRDR guidelines that have not otherwise been identified. The main focus of the third task was to modify the individual ACRDR guidelines generated to date to ensure that they are suitable for the intended nuclear power plant (NPP) control station system application. The goal of the fourth task was to develop human factors guidelines for two human-system interface categories that are missing from the current ACRDR guidelines document. During the first task those areas in NUREG-0700 that are not addressed by the ACRDR guidelines document were identified, the areas were subsequently reviewed against six recent industry human factors engineering review guidelines, and the NUREG-0700 guidelines were updated as necessary. In the second task 13 general categories of human-system interface guidelines that are either missing from or not adequately addressed by the ACRDR document were discovered. An approach was derived for the development of new ACRDR guidelines, a preliminary assessment of the available sources that may be useful in the creation of new guidelines and their applicability to the identified human-system interface categories was performed, and an estimate was made of the amount of time and level of effort required to complete the development of needed new ACRDR guidelines. During the third task those NPP control station systems to which the NUREG-0700 and ACRDR guidelines apply were identified, matrices of such
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Analysis of Existing Guidelines for the Systematic Planning Process of Clinical Registries.
Löpprich, Martin; Knaup, Petra
2016-01-01
Clinical registries are a powerful method to observe the clinical practice and natural disease history. In contrast to clinical trials, where guidelines and standardized methods exist and are mandatory, only a few initiatives have published methodological guidelines for clinical registries. The objective of this paper was to review these guidelines and systematically assess their completeness, usability and feasibility according to a SWOT analysis. The results show that each guideline has its own strengths and weaknesses. While one supports the systematic planning process, the other discusses clinical registries in great detail. However, the feasibility was mostly limited and the special requirements of clinical registries, their flexible, expandable and adaptable technological structure was not addressed consistently.
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Approaches to radiation guidelines for space travel
International Nuclear Information System (INIS)
Fry, R.J.M.
1984-01-01
There are obvious risks in space travel that have loomed larger than any risk from radiation. Nevertheless, NASA has maintained a radiation program that has involved maintenance of records of radiation exposure, and planning so that the astronauts' exposures are kept as low as possible, and not just within the current guidelines. These guidelines are being reexamined currently by NCRP Committee 75 because new information is available, for example, risk estimates for radiation-induced cancer and about the effects of HZE particles. Furthermore, no estimates of risk or recommendations were made for women in 1970 and must now be considered. The current career limit is 400 rem. The appropriateness of this limit and its basis are being examined as well as the limits for specific organs. There is now considerably more information about age-dependency for radiation and this will be taken into account. Work has been carried out on the so-called microlesions caused by HZE particles and on the relative carcinogenic effect of heavy ions, including iron. A remaining question is whether the fluence of HZE particles could reach levels of concern in missions under consideration. Finally, it is the intention of the committee to indicate clearly the areas requiring further research. 21 references, 1 figure, 7 tables
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Screening for non-alcoholic fatty liver disease in children: do guidelines provide enough guidance?
Koot, B G P; Nobili, V
2017-09-01
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the industrialized world in children. Its high prevalence and important health risks make NAFLD highly suitable for screening. In practice, screening is widely, albeit not consistently, performed. To review the recommendations on screening for NAFLD in children. Recommendations on screening were reviewed from major paediatric obesity guidelines and NAFLD guidelines. A literature overview is provided on open questions and controversies. Screening for NAFLD is advocated in all obesity and most NAFLD guidelines. Guidelines are not uniform in whom to screen, and most guidelines do not specify how screening should be performed in practice. Screening for NAFLD remains controversial, due to lack of a highly accurate screening tool, limited knowledge to predict the natural course of NAFLD and limited data on its cost effectiveness. Guidelines provide little guidance on how screening should be performed. Screening for NAFLD remains controversial because not all conditions for screening are fully met. Consensus is needed on the optimal use of currently available screening tools. Research should focus on new accurate screening tool, the natural history of NAFLD and the cost effectiveness of different screening strategies in children. © 2017 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.
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Practice Guidelines for Primary Care of Acute Abdomen 2015.
Mayumi, Toshihiko; Yoshida, Masahiro; Tazuma, Susumu; Furukawa, Akira; Nishii, Osamu; Shigematsu, Kunihiro; Azuhata, Takeo; Itakura, Atsuo; Kamei, Seiji; Kondo, Hiroshi; Maeda, Shigenobu; Mihara, Hiroshi; Mizooka, Masafumi; Nishidate, Toshihiko; Obara, Hideaki; Sato, Norio; Takayama, Yuichi; Tsujikawa, Tomoyuki; Fujii, Tomoyuki; Miyata, Tetsuro; Maruyama, Izumi; Honda, Hiroshi; Hirata, Koichi
2016-01-01
Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine, in collaboration with four other medical societies, launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines (all clinical questions and recommendations were shown in supplementary information). A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on nine subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
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Effectiveness of the World Health Organization cancer pain relief guidelines: an integrative review
Carlson, Cathy L
2016-01-01
Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified patients treated with the guidelines, 2) evaluated self-reported pain, 3) identified instruments used, 4) provided data documenting pain relief, and 5) were written in English. Studies were coded for duration of treatment, definition of pain relief, instruments used, findings related to pain intensity or relief, and whether measures were used other than the WHO analgesic ladder. Twenty-five studies published since 1987 met the inclusion criteria. Evidence indicates 20%–100% of patients with cancer pain can be provided pain relief with the use of the WHO guidelines – while considering their status of treatment or end-of-life care. Due to multiple limitations in included studies, analysis was limited to descriptions. Future research to examine the effectiveness of the WHO guidelines needs to consider recommendations to facilitate study comparisons by standardizing outcome measures. Recent studies have reported that patients with cancer experience pain at moderate or greater levels. The WHO guidelines reflect the knowledge and effectual methods to relieve most cancer pain, but the guidelines are not being adequately employed. Part of the explanation for the lack of adoption of the WHO guidelines is that they may be considered outdated by many because they are not specific to the pharmacological and interventional options used in contemporary pain management practices. The conundrum of updating the WHO guidelines is to encompass the latest pharmacological and interventional innovations while maintaining its original simplicity. PMID:27524918
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[Guidelines for management of epilepsy--commentary on Scottish ("SIGN") guidelines].
Planjar-Prvan, Miljenka; Granić, Davorka
2005-01-01
The choice of AED (antiepileptic drug), worldwide and in Croatia, is been still based on the physician's subjective decision, personal experience, knowledge and marketing pressure made by big pharmaceutical industries. Therefore, according to some opinions, there is a need of treatment guidelines for epilepsy that would provide relevant information based on scientific evidence on the efficacy, tolerability and safety of AEDs. The guidelines, published by a competent source, should be designed as to allow for easy access to the information on the best practice in specific cases. An extensive background literature review was made to identify such a type of guidelines for the management of epilepsy. The literature review revealed a number of references with the recommendations for treating epilepsy in different groups of patients and from various, specific aspects of epilepsy treatment. However, only one comprehensive set of guidelines for the diagnosis and treatment of epilepsy treatment was found, i.e. the evidence-based guidelines published by the Scottish Intercollegiate Guidelines Network (SIGN). The development of this set of guidelines is quite extensively described in order to illustrate how rigorous and long-lasting the process was, including a great number of health professionals at the national level. Such a type of well designed guidelines facilitates access to highest educational standards for all professionals involved in the primary and secondary care of people with epilepsy. However, it is clear that guidelines can fully replace the standards of clinical practice based on critical evaluation and integration of all clinical data of each individual patient. No guidelines can replace the physician's obligation to keep informed of the novel achievements in the epileptology either.
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Carretta Zamborlini, Veruska; Da Silveira, Marcos; Pruski, Cedric; ten Teije, Annette; van Harmelen, Frank
2014-01-01
Computer-Interpretable Guidelines (CIGs) are representations of Clinical Guidelines (CGs) in computer interpretable languages. CIGs have been pointed as an alternative to deal with the various limitations of paper based CGs to support healthcare activities. Although the improvements offered by
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2012-01-01
Background Reducing the burden of disease relies on availability of evidence-based clinical practice guidelines (CPGs). There is limited data on availability, quality and content of guidelines within the Southern African Development Community (SADC). This evaluation aims to address this gap in knowledge and provide recommendations for regional guideline development. Methods We prioritised five diseases: HIV in adults, malaria in children and adults, pre-eclampsia, diarrhoea in children and hypertension in primary care. A comprehensive electronic search to locate guidelines was conducted between June and October 2010 and augmented with email contact with SADC Ministries of Health. Independent reviewers used the AGREE II tool to score six quality domains reporting the guideline development process. Alignment of the evidence-base of the guidelines was evaluated by comparing their content with key recommendations from accepted reference guidelines, identified with a content expert, and percentage scores were calculated. Findings We identified 30 guidelines from 13 countries, publication dates ranging from 2003-2010. Overall the 'scope and purpose' and 'clarity and presentation' domains of the AGREE II instrument scored highest, median 58%(range 19-92) and 83%(range 17-100) respectively. 'Stakeholder involvement' followed with median 39%(range 6-75). 'Applicability', 'rigour of development' and 'editorial independence' scored poorly, all below 25%. Alignment with evidence was variable across member states, the lowest scores occurring in older guidelines or where the guideline being evaluated was part of broader primary healthcare CPG rather than a disease-specific guideline. Conclusion This review identified quality gaps and variable alignment with best evidence in available guidelines within SADC for five priority diseases. Future guideline development processes within SADC should better adhere to global reporting norms requiring broader consultation of stakeholders
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How GPs value guidelines applied to patients with multimorbidity: a qualitative study.
Luijks, Hilde; Lucassen, Peter; van Weel, Chris; Loeffen, Maartje; Lagro-Janssen, Antoine; Schermer, Tjard
2015-10-26
To explore and describe the value general practitioner (GPs) attribute to medical guidelines when they are applied to patients with multimorbidity, and to describe which benefits GPs experience from guideline adherence in these patients. Also, we aimed to identify limitations from guideline adherence in patients with multimorbidity, as perceived by GPs, and to describe their empirical solutions to manage these obstacles. Focus group study with purposive sampling of participants. Focus groups were guided by an experienced moderator who used an interview guide. Interviews were transcribed verbatim. Data analysis was performed by two researchers using the constant comparison analysis technique and field notes were used in the analysis. Data collection proceeded until saturation was reached. Primary care, eastern part of The Netherlands. Dutch GPs, heterogeneous in age, sex and academic involvement. 25 GPs participated in five focus groups. GPs valued the guidance that guidelines provide, but experienced shortcomings when they were applied to patients with multimorbidity. Taking these patients' personal circumstances into account was regarded as important, but it was impeded by a consistent focus on guideline adherence. Preventative measures were considered less appropriate in (elderly) patients with multimorbidity. Moreover, the applicability of guidelines in patients with multimorbidity was questioned. GPs' extensive practical experience with managing multimorbidity resulted in several empirical solutions, for example, using their 'common sense' to respond to the perceived shortcomings. GPs applying guidelines for patients with multimorbidity integrate patient-specific factors in their medical decisions, aiming for patient-centred solutions. Such integration of clinical experience and best evidence is required to practise evidence-based medicine. More flexibility in pay-for-performance systems is needed to facilitate this integration. Several improvements in
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Computerizing clinical practice guidelines
DEFF Research Database (Denmark)
Lyng, Karen Marie
It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application and comp......It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application...... is comprised by fieldwork in three oncology departments and a case study of advanced life support. Although close to all patients within oncology are treated according to a CPG, I found limited application of physical CPGs and web-based CPG portals. However, I found comprehensive application of activity...... of the business strategic aims, and 3) analysis and formalization of CPGs. This will imply orchestration of design teams with competencies from a wide array of disciplines such as health practice, business management, knowledge management and information systems....
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Castration-resistant prostate cancer: AUA Guideline.
Cookson, Michael S; Roth, Bruce J; Dahm, Philipp; Engstrom, Christine; Freedland, Stephen J; Hussain, Maha; Lin, Daniel W; Lowrance, William T; Murad, Mohammad Hassan; Oh, William K; Penson, David F; Kibel, Adam S
2013-08-01
This Guideline is intended to provide a rational basis for the management of patients with castration-resistant prostate cancer based on currently available published data. A systematic review and meta-analysis of the published literature was conducted using controlled vocabulary supplemented with keywords relating to the relevant concepts of prostate cancer and castration resistance. The search strategy was developed and executed by reference librarians and methodologists to create an evidence report limited to English-language, published peer-reviewed literature. This review yielded 303 articles published from 1996 through 2013 that were used to form a majority of the guideline statements. Clinical Principles and Expert Opinions were used for guideline statements lacking sufficient evidence-based data. Guideline statements were created to inform clinicians on the appropriate use of observation, androgen-deprivation and antiandrogen therapy, androgen synthesis inhibitors, immunotherapy, radionuclide therapy, systemic chemotherapy, palliative care and bone health. These were based on six index patients developed to represent the most common scenarios encountered in clinical practice. As a direct result of the significant increase in FDA-approved therapeutic agents for use in patients with metastatic CRPC, clinicians are challenged with a multitude of treatment options and potential sequencing of these agents that, consequently, make clinical decision-making more complex. Given the rapidly evolving nature of this field, this guideline should be used in conjunction with recent systematic literature reviews and an understanding of the individual patient's treatment goals. In all cases, patients' preferences and personal goals should be considered when choosing management strategies. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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2010-07-01
... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS RUBBER MANUFACTURING POINT SOURCE CATEGORY Solution...) (1) English units (lb/1,000 lb of product) COD 5.91 3.94 BOD5 0.60 .40 TSS 0.98 .65 Oil and grease 0...
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Consensus on the guidelines for the dietary management of classical galactosemia.
Kerckhove, Kristel Vande; Diels, Marianne; Vanhaesebrouck, Sigrid; Luyten, Karin; Pyck, Nancy; De Meyer, An; Van Driessche, Marleen; Robert, Martine; Corthouts, Karen; Caris, Ariane; Duchateau, Emilie; Dassy, Martine; Bihet, Genevieve
2015-02-01
Worldwide there is scientific discussion about the dietary management of galactosemia. The dietary management is very different in several countries among Europe, the US and Canada. The main points of discussion are related to the fact that i) despite a strict diet some patients still have poor outcomes; ii) there is lack of scientific knowledge about the role of endogenous production of galactose on disease evolution, with or without diet. The aim of the current work was the creation of a Belgian consensus on dietary guidelines for the management of galactosemia. A step-wise approach was used to achieve a consensus, including: a workshop, a Delphi round, discussion groups and a round table of different Belgian experts. The consensus is an agreement between strict guidelines (strict limitation of fruits, vegetables and soybean products/French guidelines) and the more liberal guidelines (comparable with a diet free of lactose/guidelines of UK and the Netherlands). The consensus document consists of different modules, including the medical context, the theoretical background of dietary guidelines and the age-specific practical dietary guidelines. A Belgian consensus on the guidelines for the dietary management of classical galactosemia was developed despite the uncertainties of the efficacy and practical application of these guidelines. The final consensus is based on scientific knowledge and practical agreement among experts. In the future, regular revision of the guidelines is recommended and a uniform European guideline is desirable. Copyright © 2014 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
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International Nuclear Information System (INIS)
Chapman, T.E.
1993-11-01
Residual radioactive material guidelines were derived for the Laboratory for Energy-Related Health Research (LEHR) Environmental Restoration (ER) site in Davis, California. The guideline derivation was based on a dose limit of 100 mrem/yr. The US Department of Energy (DOE) residual radioactive material guideline computer code was used in this evaluation. This code implements the methodology described in the DOE manual for implementing residual radioactive material guidelines. Three potential site utilization scenarios were considered with the assumption that following ER action, the site will be used without radiological restrictions. The defined scenarios vary with regard to use of the site, time spent at the site, and sources of food consumed. The results of the evaluation indicate that the basic dose limit of 100 mrem/yr will not be exceeded, provided that the soil concentrations of these radionuclides at the LEHR site do not exceed the scenario-specific values calculated by this study. Except for the extent of the contaminated zone (which is very conservative), assumptions used are as site-specific as possible, given available information. The derived guidelines are single- radionuclide guidelines and are linearly proportional to the dose limit used in the calculations. In setting the actual residual soil contamination guides for the LEHR site, DOE will apply the as low as reasonably achievable policy to the decision-making process, along with other factors such as whether a particular scenario is reasonable and appropriate, as well as using site-specific inputs to computer models based on data not yet fully determined
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Proper management of rheumatoid arthritis in Latin America. What the guidelines say?
Brenol, Claiton V; Nava, Jorge Ivan Gamez; Soriano, Enrique R
2015-03-01
To analyze characteristics of clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) developed in Latin American (LA) countries and to describe the knowledge, use, and barriers for their implementation perceived among LA rheumatologists, a comprehensive literature search including Medline, PubMed, Cochrane Library, LILACS and Scielo was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was applied for evaluation. A survey was sent to PANLAR members containing questions related to knowledge about guidelines, application of the recommendations, and difficulties in implementing CPGs. Eight guidelines were identified. Most guidelines were evidence based (62 %), but in only 37 % a systematic literature search was done. None of the guidelines included patients' views and preferences, and only few of them stated an updating procedure. Funding body independence and disclosure of conflicts of interest were rarely reported. The survey was answered by 214 rheumatologists from all Latin American countries. Most rheumatologist reported knowledge and use of clinical guidelines, mainly international ones. In general, rheumatologist felt that guidelines apply to only a minority of patients seen in daily clinical practice. Limited access expensive drugs, suggested by the guidelines, was the most frequent barrier to guidelines implementation that was reported. A good number of guidelines on the treatment of rheumatoid arthritis have been developed in Latin America. Most of them are lacking some of the components recognized for high-quality clinical guidelines development. In spite that most rheumatologist know and apply guidelines, access to drugs is still a very important barrier to their implementation in Latin America.
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International Nuclear Information System (INIS)
Zaers, J.; Brix, G.; Woudenberg, S. van
1997-01-01
The Program 'Europe against Cancer' published the 2nd edition of quality assurance guidelines for breast cancer screening in June 1996. For the enforcement of these guidelines, a European network of reference centres (EUREF) is being established. Although the EUREF protocol contains guidelines for all disciplines involved in breast cancer screening, this article concentrates on the physical and technical aspect. The comparison with the German regulations (DIN Norms) demonstrates the high requirements requested by the EUREF guidelines with its tighter limits and more extensive and more frequent tests. (orig.) [de
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Alignment of Children's Food Advertising With Proposed Federal Guidelines.
Hingle, Melanie D; Castonguay, Jessica S; Ambuel, Danielle A; Smith, Rachel M; Kunkel, Dale
2015-06-01
It is well established that children are exposed to food marketing promoting calorically dense, low-nutrient products. Reducing exposure to obesogenic marketing presents an opportunity to improve children's health. The purpose of this study was to determine the extent to which televised food advertising practices targeting children (aged ≤12 years) were consistent with guidelines proposed by a coalition of federal authorities known as the Interagency Working Group on Foods Marketed to Children (IWG). A sample of children's TV programming aired on five national broadcast networks and two cable channels (N=103 shows) was recorded February to April 2013. The sample contained 354 food ads. Advertised products were identified and categorized using industry classification codes and nutrient data obtained from manufacturers. Product compliance with IWG saturated fat, trans fat, added sugar, and sodium guidelines was evaluated. Analyses conducted in 2013 revealed that nearly all food ads (94%) met guidelines for trans fats; 68% and 62% met guidelines for sodium and saturated fat, respectively; and 20% complied with added sugar guidelines. Overall, 1.4% of all child-targeted food ads met all aspects of IWG guidelines. Nearly all food advertisements exceeded guidelines for at least one recommended nutrient to limit. Individually, conformity was high for guidelines for trans fats, moderate for sodium and saturated fats, and poor for added sugar. These findings suggest that child-targeted food advertising remains strongly biased toward less healthy options. Policymakers wishing to regulate food marketing should understand the amount and types of advertisements that children view. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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2010-07-01
... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS PLASTICS MOLDING AND FORMING POINT SOURCE CATEGORY... currently available, which are calculated by multiplying the average process water usage flow rate for the... average process water usage flow rate for the cleaning water processes from the permittee. ...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS PLASTICS MOLDING AND FORMING POINT SOURCE CATEGORY Contact... technology, which are calculated by multiplying the average process water usage flow rate for the contact... usage flow rate for the contact cooling and heating water processes from the permittee. ...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS RUBBER MANUFACTURING POINT SOURCE CATEGORY Solution Crumb...) English units (lb/1,000 lb of product) COD 3.12 2.08 BOD5 0.12 .08 TSS 0.24 .16 Oil and grease 0.12 .08 pH...
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Terminology Guideline for Classifying Offshore Wind Energy Resources
Energy Technology Data Exchange (ETDEWEB)
Beiter, Philipp [National Renewable Energy Lab. (NREL), Golden, CO (United States); Musial, Walt [National Renewable Energy Lab. (NREL), Golden, CO (United States)
2016-09-01
The purpose of this guideline is to establish a clear and consistent vocabulary for conveying offshore wind resource potential and to interpret this vocabulary in terms that are familiar to the oil and gas (O&G) industry. This involves clarifying and refining existing definitions of offshore wind energy resource classes. The terminology developed in this guideline represents one of several possible sets of vocabulary that may differ with respect to their purpose, data availability, and comprehensiveness. It was customized to correspond with established offshore wind practices and existing renewable energy industry terminology (e.g. DOE 2013, Brown et al. 2015) while conforming to established fossil resource classification as best as possible. The developers of the guideline recognize the fundamental differences that exist between fossil and renewable energy resources with respect to availability, accessibility, lifetime, and quality. Any quantitative comparison between fossil and renewable energy resources, including offshore wind, is therefore limited. For instance, O&G resources are finite and there may be significant uncertainty associated with the amount of the resource. In contrast, aboveground renewable resources, such as offshore wind, do not generally deplete over time but can vary significantly subhourly, daily, seasonally, and annually. The intent of this guideline is to make these differences transparent and develop an offshore wind resource classification that conforms to established fossil resource classifications where possible. This guideline also provides methods to quantitatively compare certain offshore wind energy resources to O&G resource classes for specific applications. Finally, this guideline identifies areas where analogies to established O&G terminology may be inappropriate or subject to misinterpretation.
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[Current guidelines on carotid artery stenting. Critical evaluation].
Hein-Rothweiler, R; Mudra, H
2013-11-01
Scientific data underlying current guidelines on treatment of carotid artery stenosis is subject to interdisciplinary discussion. In particular selective weighting of the randomized European studies leads to conflicting levels of recommendation and levels of evidence, especially when directly comparing guidelines under surgical versus endovascular guidance. Surgical guidelines recommend a limitation of carotid artery stenting (CAS) to symptomatic patients with specific surgical/anatomical disadvantages and/or severe comorbidities. The European Society of Cardiology (ESC) guidelines recommend the use of CAS only in patients at increased surgical risk but at the same time requires morbidity and mortality rates comparable to those of surgical interventions. Even one step further, the American guidelines and specifically the associated comments of the German Society of Cardiology on the above mentioned ESC guidelines put CAS and carotid endarterectomy (CEA) on a par in terms of treatment alternatives, presupposing analogous CEA complication rates. Differential interpretation of the so far inadequate data is a common issue of current evidence-based medicine. The difficulty in conceptualization of new studies concerning the therapy of carotid stenosis lies in the funding these large projects and also on the high patient number required to achieve adequate statistical power. Furthermore, during the estimated long study period substantial changes of current techniques and devices can be anticipated which might render the study results in part outdated by the time of publication. However, as long as no new randomized study results comparing medical, surgical and interventional treatment of carotid stenosis are available, the question on the optimal therapy for patients with carotid artery disease remains unanswered.
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Birch, Stephen; Lee, Myeong Soo; Robinson, Nicola; Alraek, Terje
2017-04-01
Several systematic reviews suggest that acupuncture is effective for knee osteoarthritis (OA), and furthermore a safe and cost-effective treatment for this condition. A recent clinical practice guideline (CPG) from the National Institute for Health and Care Excellence (NICE), in the United Kingdom, recommended against the use of acupuncture on the grounds that the effect size (ES) in comparison with sham acupuncture is too small. Safety data were not considered in the review, in addition the levels of evidence for acupuncture against other recommended therapies were not compared. Consequently, it is argued that this NICE guideline has limitations that lead to several potential biases in its evaluation of acupuncture, which were not addressed correctly: (1) NICE's prior scoping process limited its review. (2) NICE introduced the method of developing recommendations based on the consideration of which interventions make "minimal important differences" of an ES of 0.5 or greater, rather than the statistical significance of the effect of an intervention when compared with an appropriate comparison. (3) Evidence that sham acupuncture is not physiologically inert and has some level of beneficial effect, hence artificially reducing the magnitude of the ES in comparison with sham. (4) The low adverse effects profile of acupuncture. (5) Evidence from trials comparing acupuncture with usual or standard care was not considered, nor was cost-effectiveness data. (6) Lack of the usual CPG "head-to-head" comparisons between interventions. If the same criteria and methods that have been applied to acupuncture were applied to other NICE-recommended therapies for knee OA, including patient centeredness, patient education, self-management and weight loss, nonsteroidal anti-inflammatory drug (NSAIDs), and cyclooxygenase-2 inhibitor (COX-2 inhibitors), these too would no longer be recommended and opiates would become the first line of drug prescription. Given the problems with sham
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Links, P.; Horsman, Peter; Kühnel, Karsten; Priddy, M.; Reijnhoudt, Linda; Merenmies, Mark
2013-01-01
The Guidelines follow the conceptual metadata model (deliverable 17.2). They include guidelines for description of collection-holding institutions, document collections, organisations, personalities, events, camps and ghettos. As much as possible the guidelines comply with the descriptive standards
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[Anemia: guidelines comparison].
Del Vecchio, Lucia
2009-01-01
The development of recombinant human erythropoietin and its introduction into the market in the late 1980s has significantly improved the quality of life of patients with chronic kidney disease (CKD) and reduced the need for blood transfusions. Starting from a cautious target, a progressive increase in the recommended hemoglobin levels has been observed over the years, in parallel with an increase in the obtained levels. This trend has gone together with the publication of findings of observational studies showing a relationship between the increase in hemoglobin levels and a reduction in the mortality risk, with the conduction of clinical trials testing the effects of complete anemia correction, and with the compilation of guidelines on anemia control in CKD patients by scientific societies and organizations. In the last two years, evidence of a possible increase in the mortality risk in those patients who were randomized to high hemoglobin levels has resulted in a decrease in the upper limit of the recommended Hb target to be obtained with erythropoietin stimulating agents (ESA), and consequently in a narrowing of the target range. Comparison of guidelines on anemia control in CKD patients is an interesting starting point to discuss single recommendations, strengthen their importance, or suggest new topics of research to fill up important gaps in knowledge.
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2010-07-01
... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS PLASTICS MOLDING AND FORMING POINT SOURCE CATEGORY... technology currently available, which are calculated by multiplying the average process water usage flow rate... process water usage flow rate for the contact cooling and heating water processes from the permittee. ...
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2010-07-01
... day Maximum for monthly average mg/kg (pounds per million pounds) of technical grade molybdenum plus... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS NONFERROUS METALS MANUFACTURING POINT SOURCE... technology currently available. Except as provided in 40 CFR 125.30 through 125.32, any existing point source...
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Air quality guidelines for arenas in Nova Scotia
Energy Technology Data Exchange (ETDEWEB)
NONE
1999-05-01
A series of guidelines have been prepared to address the quality of air in skating arena facilities in Nova Scotia. They are limited to carbon monoxide and nitrogen dioxide emissions. Average nitrogen dioxide levels should not exceed 1 part per million (ppm). Average carbon monoxide levels should not exceed 25 ppm. These guidelines do not address other contaminants such as ammonia or chlorofluorocarbons (CFCs). The guidelines are considered to be the minimum standards required for safe arena operations. These standards can be met by reducing emissions of the ice resurfacer and edger which is one of the major sources of poor air quality in arenas. Other ways to meet the standards are to ensure proper equipment operation, ventilation and monitoring of indoor air quality levels. Symptoms of exposure and potential consequences were also described. It was noted that owners and operators may be found libel for injury if a proper environment is not maintained. 6 appendices.
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Guideline for Bayesian Net based Software Fault Estimation Method for Reactor Protection System
International Nuclear Information System (INIS)
Eom, Heung Seop; Park, Gee Yong; Jang, Seung Cheol
2011-01-01
The purpose of this paper is to provide a preliminary guideline for the estimation of software faults in a safety-critical software, for example, reactor protection system's software. As the fault estimation method is based on Bayesian Net which intensively uses subjective probability and informal data, it is necessary to define formal procedure of the method to minimize the variability of the results. The guideline describes assumptions, limitations and uncertainties, and the product of the fault estimation method. The procedure for conducting a software fault-estimation method is then outlined, highlighting the major tasks involved. The contents of the guideline are based on our own experience and a review of research guidelines developed for a PSA
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Lord, J; Willis, S; Eatock, J; Tappenden, P; Trapero-Bertran, M; Miners, A; Crossan, C; Westby, M; Anagnostou, A; Taylor, S; Mavranezouli, I; Wonderling, D; Alderson, P; Ruiz, F
2013-12-01
priorities expressed in the stakeholder survey. We did not conduct systematic reviews to inform the model parameters, and so the results might not reflect all current evidence. Data limitations and time constraints restricted the number of analyses that we could conduct. We were also unable to obtain feedback from guideline stakeholders about the usefulness of the models within project time scales. Discrete event simulation can be used to model full guideline pathways for CEA, although this requires a substantial investment of clinical and analytic time and expertise. For some topics lack of data may limit the potential for modelling. There are also uncertainties over the accessibility and adaptability of full guideline models. However, full guideline modelling offers the potential to strengthen and extend the analytical basis of NICE's CGs. Further work is needed to extend the analysis of our case study models to estimate population-level budget and health impacts. The practical usefulness of our models to guideline developers and users should also be investigated, as should the feasibility and usefulness of whole guideline modelling alongside development of a new CG. This project was funded by the Medical Research Council and the National Institute for Health Research through the Methodology Research Programme [grant number G0901504] and will be published in full in Health Technology Assessment; Vol. 17, No. 58. See the NIHR Journals Library website for further project information.
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The Practice Guidelines for Primary Care of Acute Abdomen 2015.
Mayumi, Toshihiko; Yoshida, Masahiro; Tazuma, Susumu; Furukawa, Akira; Nishii, Osamu; Shigematsu, Kunihiro; Azuhata, Takeo; Itakura, Atsuo; Kamei, Seiji; Kondo, Hiroshi; Maeda, Shigenobu; Mihara, Hiroshi; Mizooka, Masafumi; Nishidate, Toshihiko; Obara, Hideaki; Sato, Norio; Takayama, Yuichi; Tsujikawa, Tomoyuki; Fujii, Tomoyuki; Miyata, Tetsuro; Maruyama, Izumi; Honda, Hiroshi; Hirata, Koichi
2016-01-01
Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the Japanese Society for Abdominal Emergency Medicine in collaboration with four other medical societies launched the Practice Guidelines for Primary Care of Acute Abdomen that were the first English guidelines in the world for the management of acute abdomen. Here we provide the highlights of these guidelines [all clinical questions (CQs) and recommendations are shown in supplementary information]. A systematic and comprehensive evaluation of the evidence for epidemiology, diagnosis, differential diagnosis, and primary treatment for acute abdomen was performed to develop the Practice Guidelines for Primary Care of Acute Abdomen 2015. Because many types of pathophysiological events underlie acute abdomen, these guidelines cover the primary care of adult patients with nontraumatic acute abdomen. A total of 108 questions based on 9 subject areas were used to compile 113 recommendations. The subject areas included definition, epidemiology, history taking, physical examination, laboratory test, imaging studies, differential diagnosis, initial treatment, and education. Japanese medical circumstances were considered for grading the recommendations to assure useful information. The two-step methods for the initial management of acute abdomen were proposed. Early use of transfusion and analgesia, particularly intravenous acetaminophen, were recommended. The Practice Guidelines for Primary Care of Acute Abdomen 2015 have been prepared as the first evidence-based guidelines for the management of acute abdomen. We hope that these guidelines contribute to clinical practice and improve the primary care and prognosis of patients with acute abdomen.
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DEFF Research Database (Denmark)
Ijäs, Jarja; Alanen, Seija; Kaila, Minna
2009-01-01
OBJECTIVE: To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. DESIGN: A cross...... Guideline. RESULTS: Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p ...: Hypertension Guideline recommendations that require joint agreements between professionals are less often adopted than simple, precise recommendations. More emphasis on effective multidisciplinary collaboration is needed....
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[Guidelines for wise utilization of knee imaging].
Finestone, Aharon S; Eshed, Iris; Freedman, Yehuda; Beer, Yiftah; Bar-Sever, Zvi; Kots, Yavvgeni; Adar, Eliyahu; Mann, Gideon
2012-02-01
The knee is a complex structure afflicted with diverse pathologies. Correct management of knee complaints demands wise utilization of imaging modalities, considering their accuracy in the specific clinical situation, the patient's safety and availability and financial issues. Some of these considerations are universal, while others are local, depending on medical and insurance systems. There is controversy and unclearness regarding the best imaging modality in different clinical situations. To develop clinical guidelines for utilizing knee imaging. Leading physicians in specialties associated with knee disease and imaging were invited to participate in a panel on the guidelines. Controversies were settled in the main panel or in sub-panels. The panel agreed on the principles in choosing from the various modalities, primarily medical accuracy, followed by patient safety, availability and cost. There was agreement that the physician is responsible to choose the most appropriate diagnostic tool, consulting, when necessary, on the advantages, limitations and risks of the various imaging modalities. A comprehensive table was compiled with the importance of the different imaging modalities in various clinical situations. For the first time, Israeli guidelines on wise utilization of knee imaging are presented. They take into consideration the clinical situations and also availability and financial issues specific to Israel. These guidelines will serve physicians of several disciplines and medical insurers to improve patient management efficiently.
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Yawn, Barbara P; Akl, Elie A; Qaseem, Amir; Black, Peter; Campos-Outcalt, Doug
2012-12-01
specialists may require guidelines with more details regarding complex COPD management. The purpose of the guidelines may determine the appropriate audience. Guidelines developed to improve care by enhancing education may have a very different audience than guidelines designed to improve care by limiting the scope of practice, punishing noncompliance, or saving money. The purpose will drive dissemination and implementation strategies, but should not influence the methods used to develop a guideline. Clinicians desire guidelines, but data suggest that the current development systems, content, format, and dissemination strategies may need to be altered to fit these audiences. After the purpose and audience are determined, the guideline committee must decide how to fairly address these audiences, which will usually require seeking their input.
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Cooper, Justin; Marx, Bernd; Buhl, Johannes; Hombach, Volker
2002-09-01
This paper investigates the minimum distance for a human body in the near field of a cellular telephone base station antenna for which there is compliance with the IEEE or ICNIRP threshold values for radio frequency electromagnetic energy absorption in the human body. First, local maximum specific absorption rates (SARs), measured and averaged over volumes equivalent to 1 and to 10 g tissue within the trunk region of a physical, liquid filled shell phantom facing and irradiated by a typical GSM 900 base station antenna, were compared to corresponding calculated SAR values. The calculation used a homogeneous Visible Human body model in front of a simulated base station antenna of the same type. Both real and simulated base station antennas operated at 935 MHz. Antenna-body distances were between 1 and 65 cm. The agreement between measurements and calculations was excellent. This gave confidence in the subsequent calculated SAR values for the heterogeneous Visible Human model, for which each tissue was assigned the currently accepted values for permittivity and conductivity at 935 MHz. Calculated SAR values within the trunk of the body were found to be about double those for the homogeneous case. When the IEEE standard and the ICNIRP guidelines are both to be complied with, the local SAR averaged over 1 g tissue was found to be the determining parameter. Emitted power values from the antenna that produced the maximum SAR value over 1 g specified in the IEEE standard at the base station are less than those needed to reach the ICNIRP threshold specified for the local SAR averaged over 10 g. For the GSM base station antenna investigated here operating at 935 MHz with 40 W emitted power, the model indicates that the human body should not be closer to the antenna than 18 cm for controlled environment exposure, or about 95 cm for uncontrolled environment exposure. These safe distance limits are for SARs averaged over 1 g tissue. The corresponding safety distance limits
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Radiological risk comparison guidelines
International Nuclear Information System (INIS)
Hallinan, E.J.; Muhlestein, L.D.; Brown, L.F.; Yoder, R.E.
1992-01-01
An important aspect of DOE safety analyses is estimating potential accident risk. The estimates are used to: determine if additional controls are needed, identify Safety Class Items, and demonstrate adequate risk reduction. Thus, guidelines are needed to measure comparative risks. The Westinghouse M ampersand O Nuclear Facility Safety Committee and the Safety Envelope Working Group have developed radiological risk guidelines for comparing the risks from individual accident analyses. These guidelines were prepared under contract with the US Department of Energy. These guidelines are based on historical DOE guidelines and current requirements, and satisfy DOE and technical community proposals. for goals that demonstrate acceptable risk. The guidelines consist of a frequency versus consequence curve for credible accidents. Offsite and onsite guidelines are presented. The offsite risk acceptance guidelines are presented in Figure 1. The guidelines are nearly isorisk for anticipated events where impacts are chronic, and provide additional reduction for unlikely events where impacts may be acute and risk uncertainties may be significant. The guidelines are applied to individual release accident scenarios where a discrete frequency and consequence has been estimated. The guideline curves are not to be used for total risk assessments. Common cause events are taken into consideration only for an individual facility. Frequencies outside the guideline range are considered to be local site option (analyst judgement) as far as assessments of risk acceptance are concerned. If the curve is exceeded, then options include either a more detailed analysis or imposing additional preventive or mitigative features. Another presentation discusses implementation in detail. Additional work is needed to provide risk comparison guidelines for releases from multiple facilities and for toxic releases
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2010-07-01
... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS PLASTICS MOLDING AND FORMING POINT SOURCE CATEGORY... currently available, which are calculated by multiplying the average process water usage flow rate for the... of 6.0 to 9.0 at all times. The permit authority will obtain the average process water usage flow...
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2010-07-01
... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS NONFERROUS METALS MANUFACTURING POINT SOURCE... contained in sodium antimonate product Antimony 44.840 20.000 Arsenic 32.650 14.530 Mercury 3.906 1.562... Maximum for any 1 day Maximum for monthly average mg/kg (pounds per million pounds) of antimony metal...
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... this page: https://medlineplus.gov/criteria.html MedlinePlus Quality Guidelines To use the sharing features on this ... materials must also meet our existing quality guidelines. Quality, authority and accuracy of health content The organization's ...
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Sadeghi-Demneh, Ebrahim; Forghany, Saeed; Onmanee, Pornsuree; Trinler, Ursula; Dillon, Michael P; Baker, Richard
2017-06-20
Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery.
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International Nuclear Information System (INIS)
Ewen, K.; Lauber, I.
2004-01-01
Two important guidelines for the application of X-rays in medicine became effective on 1 October 2003 and 1 December 2003. These are testing guidelines for experts and quality assurance guidelines. Both guidelines are very extensive and not always easy to interpret. In the present paper the authors try to explain in detail some chapters important for radiology and to make the necessary technical background transparent. Both authors took an essential part in forming the guidelines. (orig.) [de
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McCullough, Ricky W
2018-01-01
Aim To offer a practice insight for the management of chemoradiation toxic mucositis. Method Review chemoradiation toxic mucositis, its pathobiology and breadth of symptom presentation. Review mucositis guidelines and guideline-supported anti-mucositis therapies. Offer guidance on guidelines and an abbreviated review of high potency cross-linked sucralfate for management of chemoradiation toxic mucositis. Result There are six major mucositis guidelines but only one that is current and regularly updated. Guidelines from the Multinational Association Supportive Cancer Care suggest 14 interventions gleaned from controlled trials, 12 of which are off-label uses of therapies that offer statistically significant but incrementally beneficial outcomes. Several evidence-based limitations of guidelines are discussed. Data on high potency polymerized cross-linked sucralfate confirming complete prevention and rapid (2-3 days) elimination, sustained throughout cancer treatment is verified as high quality evidence in accordance to standards adopted by Agency for Healthcare Research and Quality. A 96-97% reduction in mucositis duration qualifies as a positive Glasziou treatment effect, which is discussed as an additional measure of evidence-based medicine. Conclusion Statistically significant but fractional treatment effects of guideline-supported interventions are not likely to substantially alter the course of mucositis when it occurs nor completely prevent its onset. Complete prevention and rapid sustained elimination should be the goal, therefore high potency polymerized cross-linked sucralfate may be useful. Where guidelines fail, institution-based protocols led by oncology pharmacists could succeed. In an effort to eliminate toxic mucositis, enhance compliance to chemoradiation regimens, and improve survival, such protocols for practice may verify pharmacoeconomic benefits, if any, in using high potency polymerized cross-linked sucralfate to manage toxic mucositis.
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DEFF Research Database (Denmark)
Petersen, Per Hyltoft; Jensen, Esther A; Brandslund, Ivan
2012-01-01
of the values of analytical components measured on reference samples from reference individuals. Decision limits are based on guidelines from national and international expert groups defining specific concentrations of certain components as limits for decision about diagnosis or well-defined specific actions....... Analytical quality specifications for reference intervals have been defined for bias since the 1990s, but in the recommendations specified in the clinical guidelines analytical quality specifications are only scarcely defined. The demands for negligible biases are, however, even more essential for decision...... limits, as the choice is no longer left to the clinician, but emerge directly from the concentration. Even a small bias will change the number of diseased individuals, so the demands for negligible biases are obvious. A view over the analytical quality as published gives a variable picture of bias...
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2010-07-01
... (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS NONFERROUS METALS MANUFACTURING POINT SOURCE CATEGORY Primary... sodium antimonate product Antimony 30.150 13.440 Arsenic 21.720 9.687 Mercury 2.344 0.937 (b) Fouled... any 1 day Maximum for monthly average mg/kg pounds per million pounds of antimony metal produced by...
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Developing clinical guidelines: how much rigour is required?
Haroon, Munib; Ranmal, Rita; McElroy, Helen; Dudley, Jan
2015-04-01
Clinical guidelines that are rigorously developed play a fundamental role in improving healthcare and reducing unnecessary variations in practice. National guidelines are increasingly used by healthcare professionals, patients and commissioners; however, national bodies are unable to meet the demand for guidance on all topics. There are fewer resources available for guidance produced locally or by specialty groups, and it is necessary to achieve a balance between pragmatism and rigour while conforming to the widely accepted norms of what constitutes a good guideline. This paper introduces the key concepts around this topic with suggestions for those interested in developing their own guideline. An example of challenges encountered in generating high-quality clinical guidance is given in box 1. Box 1 Challenges in guideline development Professor Johnson runs a local developmental paediatrics service with eight other colleagues. All have different ways of managing children with PAVING syndrome. This was difficult for patients and staff and has led to disagreements on how certain patients should be managed. As a result, Professor Johnson developed a Guideline Development Group to look at the management of PAVING syndrome. The group identified 12 clinical questions (including diagnosis, exclusion of comorbidities, treatment modalities), searched the PubMed database and found some useful evidence that they used to formulate key recommendations. For one question about behavioural therapy, PubMed did not suggest any evidence so they informally arrived at a consensus among themselves and wrote up their guideline. On the back of this success, they applied for the guideline to be endorsed or supported by the Royal College of Paediatrics and Child Health (RCPCH). To their frustration, it was turned down on methodological grounds. Professor Johnson wrote to the RCPCH saying that he was "pretty peeved that the PAVING syndrome guideline had been rejected" for the College
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Guidelines for responsible short-term global health activities: developing common principles.
Lasker, Judith N; Aldrink, Myron; Balasubramaniam, Ramaswami; Caldron, Paul; Compton, Bruce; Evert, Jessica; Loh, Lawrence C; Prasad, Shailendra; Siegel, Shira
2018-02-07
Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. Existing guidelines are almost entirely written by and addressed to educators and practitioners in the Global North. There is broad consensus on key principles for responsible, effective, and ethical programs--need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.
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Schünemann, Holger J.; Wiercioch, Wojtek; Etxeandia, Itziar; Falavigna, Maicon; Santesso, Nancy; Mustafa, Reem; Ventresca, Matthew; Brignardello-Petersen, Romina; Laisaar, Kaja-Triin; Kowalski, Sérgio; Baldeh, Tejan; Zhang, Yuan; Raid, Ulla; Neumann, Ignacio; Norris, Susan L.; Thornton, Judith; Harbour, Robin; Treweek, Shaun; Guyatt, Gordon; Alonso-Coello, Pablo; Reinap, Marge; Brožek, Jan; Oxman, Andrew; Akl, Elie A.
2014-01-01
Background: Although several tools to evaluate the credibility of health care guidelines exist, guidance on practical steps for developing guidelines is lacking. We systematically compiled a comprehensive checklist of items linked to relevant resources and tools that guideline developers could consider, without the expectation that every guideline would address each item. Methods: We searched data sources, including manuals of international guideline developers, literature on guidelines for guidelines (with a focus on methodology reports from international and national agencies, and professional societies) and recent articles providing systematic guidance. We reviewed these sources in duplicate, extracted items for the checklist using a sensitive approach and developed overarching topics relevant to guidelines. In an iterative process, we reviewed items for duplication and omissions and involved experts in guideline development for revisions and suggestions for items to be added. Results: We developed a checklist with 18 topics and 146 items and a webpage to facilitate its use by guideline developers. The topics and included items cover all stages of the guideline enterprise, from the planning and formulation of guidelines, to their implementation and evaluation. The final checklist includes links to training materials as well as resources with suggested methodology for applying the items. Interpretation: The checklist will serve as a resource for guideline developers. Consideration of items on the checklist will support the development, implementation and evaluation of guidelines. We will use crowdsourcing to revise the checklist and keep it up to date. PMID:24344144
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[Implementation of Study Results in Guidelines and Adherence to Guidelines in Clinical Practice].
Waldfahrer, F
2016-04-01
Guidelines were introduced in hospital and practice-based otorhinolaryngology in the 1990s, and have been undergoing further development ever since. There are currently 20 guidelines on file at the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. The Society has cooperated in a further 34 guidelines. The quality of the guidelines has been continually improved by concrete specifications put forward by the Association of the Scientific Medical Societies in Germany [Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.]. Since increasing digitalisation has made access to scientific publications quicker and more simple, relevant study results can be incorporated in guidelines more easily today than in the analogue world. S2e and S3 guidelines must be based on a formal literature search with subsequent evaluation of the evidence. The consensus procedure for S2k guidelines is also regulated. However, the implementation of guidelines in routine medical practice must still be considered inadequate, and there is still a considerable need for improvement in adherence to these guidelines. © Georg Thieme Verlag KG Stuttgart · New York.
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Energy Technology Data Exchange (ETDEWEB)
Stehfest, E; De Waal, L.
2010-09-15
This document describes the requirements and guidelines for the software of the IMAGE system. The motivation for this report was a substantial restructuring of the source code for IMAGE version 2.5. The requirements and guidelines relate to design considerations as well as to aspects of maintainability and portability. The design considerations determine guidelines about subjects, such as program structure, model hierarchy, the use of data modules, and the error message system. Maintainability and portability aspects determine the guidelines on, for example, the Fortran 90 standard, naming conventions, code lay-out, and internal documentation.
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Food Safety Authority of Ireland
2016-01-01
This document provides guideline microbiological limits for ready-to-eat foods placed on the market. These guideline limits can be used if legal microbiological criteria (Appendix 1) do not exist for a particular combination of food and microorganism. This Guidance Note is intended to be used by: • Food business operators • Enforcement officers, and • Laboratories performing microbiological testing on ready-to-eat foods Food business operators may also use the limits prese...
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Radon legislation and national guidelines
Energy Technology Data Exchange (ETDEWEB)
Aakerblom, G
1999-07-01
The International Commission on Radiological Protection (ICRP) and The Council of the European Union have recommended the Member States to take action against radon in homes and at workplaces. Within the EU project European Research into Radon in Construction Concerted Action, ERRICCA, the Topic Group on Legal and Building Code Impact was designated to study the current radon legislation and give advice regarding future enactment of laws and recommendations. On behalf of the Group, a questionnaire on radon legislation was sent out to nearly all European states and a selection of non-European states. Questions were asked regarding reference levels for dwellings, workplaces and drinking water, and about regulations or recommendations for building materials and city planning. All 15 EU Member States, 17 non-EU European countries and 10 non-European countries responded to the questionnaire. Their answers are considered current as of the end of 1998. Most European States and many non-European countries have recommended reference levels for dwellings and workplaces, and some have guidelines for measures against radon incorporated in their building codes and guidelines for construction techniques. However, only a few countries have enforced reference levels or regulations for planning and construction. The reference levels for indoor radon concentration in existing and new dwellings or workplaces are within the range 150-1000 Bq/m{sup 3}. Sweden is the only country (Out of 15 EU member states) which has enforced limits for existing dwellings. Sweden and the UK have both enforced levels for new dwellings. 7 non-European countries (Out of 17 responding countries) have enforced levels for existing dwellings and 9 have them for new dwellings. At the end of 1998, only Finland, Sweden, the Czech Republic, Romania, Russia and the Slovak Republic had limits for radon in water, although 8 countries were planning to introduce such limits. The present limits are within the range for
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Radon legislation and national guidelines
International Nuclear Information System (INIS)
Aakerblom, G.
1999-07-01
The International Commission on Radiological Protection (ICRP) and The Council of the European Union have recommended the Member States to take action against radon in homes and at workplaces. Within the EU project European Research into Radon in Construction Concerted Action, ERRICCA, the Topic Group on Legal and Building Code Impact was designated to study the current radon legislation and give advice regarding future enactment of laws and recommendations. On behalf of the Group, a questionnaire on radon legislation was sent out to nearly all European states and a selection of non-European states. Questions were asked regarding reference levels for dwellings, workplaces and drinking water, and about regulations or recommendations for building materials and city planning. All 15 EU Member States, 17 non-EU European countries and 10 non-European countries responded to the questionnaire. Their answers are considered current as of the end of 1998. Most European States and many non-European countries have recommended reference levels for dwellings and workplaces, and some have guidelines for measures against radon incorporated in their building codes and guidelines for construction techniques. However, only a few countries have enforced reference levels or regulations for planning and construction. The reference levels for indoor radon concentration in existing and new dwellings or workplaces are within the range 150-1000 Bq/m 3 . Sweden is the only country (Out of 15 EU member states) which has enforced limits for existing dwellings. Sweden and the UK have both enforced levels for new dwellings. 7 non-European countries (Out of 17 responding countries) have enforced levels for existing dwellings and 9 have them for new dwellings. At the end of 1998, only Finland, Sweden, the Czech Republic, Romania, Russia and the Slovak Republic had limits for radon in water, although 8 countries were planning to introduce such limits. The present limits are within the range for 50
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The new hypertension guidelines.
Stern, Ralph H
2013-10-01
The Canadian Hypertension Education Program (CHEP) has published guidelines annually since 2000. The CHEP guidelines are a model of concise, comprehensive, up-to-date, evidence-rated guidelines for physicians who diagnose and treat hypertension. The guidelines address measurement of blood pressure and the definition of hypertension, secondary hypertension evaluation and treatment, and blood pressure targets and medication choices in patients with and without compelling indications. This review describes CHEP's process for developing guidelines and provides an overview of the 2013 recommendations. ©2013 Wiley Periodicals, Inc.
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Approaches to radiation guidelines for space travel
International Nuclear Information System (INIS)
Fry, R.J.M.
1984-01-01
There are obvious risks in space travel that have loomed larger than any risk from radiation. Nevertheless, NASA has maintained a radiation program that has involved maintenance of records of radiation exposure, and planning so that the astronauts' exposures are kept as low as possible, and not just within the current guidelines. These guidelines are being reexamined currently by NCRP Committee 75 because new information is available, for example, risk estimates for radiation-induced cancer and about the effects of HZE particles. The current career limit is 400 rem to the blood forming organs. The appropriateness of this limit and its basis are being examined as well as the limits for specific organs. There is now considerably more information about age-dependency for radiation effects and this will be taken into account. In 1973 a committee of the National Research Council made a separate study of HZE particle effects and it was concluded that the attendant risks did not pose a hazard for low inclination near-earth orbit missions. Since that time work has been carried out on the so-called microlesions caused by HZE particles and on the relative carcinogenic effect of heavy ions, including iron. A remaining question is whether the fluence of HZE particles could reach levels of concern in missions under consideration. Finally, it is the intention of the committee to indicate clearly the areas requiring further research. 26 references, 1 figure, 7 tables
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Knowledge of and Adherence to Hygiene Guidelines among Medical Students in Austria
Directory of Open Access Journals (Sweden)
Verena G. Herbert
2013-01-01
Full Text Available Background. Adherence to hygiene guidelines is of utmost importance for healthcare professionals. The aim of this study was to evaluate the knowledge on and the adherence to hygiene guidelines among medical students in Austria. Additionally, a possible difference between female and male students was investigated. Methods. An open paper-based survey among third-year medical students at the Medical University of Graz was conducted. The questionnaire consisted of 20 single-choice questions covering compliance with basic hygiene standards, self-rated knowledge of hygiene guidelines, and satisfaction with current hygiene education, equipment, and quality standards. Results. Of 192 medical students, 70% judged their knowledge of hygiene standards as “excellent” or “good”; however, only 49% reported adherence to hygiene guidelines and only 43% performed hygienic hand disinfection according to WHO guidelines. Of the respondents, 79% voted for a mandatory course on hygiene standards in medical education. No significant gender differences were observed. Conclusion. While the knowledge on hygiene guidelines appears to be good among medical students, adherence is limited and requires improvement. The need for an optimum education in hygiene is high.
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Determinants of pregnant women's compliance with alcohol guidelines: a prospective cohort study
Directory of Open Access Journals (Sweden)
Anderson Amy E
2012-09-01
Full Text Available Abstract Background In 2009, Australian alcohol guidelines for pregnancy changed from low to no alcohol intake. Previous research found a high proportion of pregnant Australian women drank during pregnancy; however, there has been limited investigation of whether pregnant women comply with 2009 alcohol guidelines. The purpose of this study was to provide an assessment of pregnant women’s compliance with 2009 Australian alcohol guidelines and identify predictors of such compliance, including previous drinking behaviour. Methods Cross-sectional analysis of prospective data from the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health was conducted. Women aged 30–36 years who were pregnant at the 2009 survey and had data on alcohol use were included (n = 837. Compliance with 2009 alcohol guidelines for pregnancy was defined as no alcohol intake. Predictors of compliance were analysed using multivariate logistic regression, controlling for area of residence, in three separate models to account for multicollinearity between measures of previous alcohol intake (compliance with 2001 guidelines; frequency and quantity; bingeing. Private health insurance, household income, and illicit drug use were entered into all models and retained if significant. Results 72% of pregnant women did not comply with the 2009 alcohol guidelines and 82% of these women drank less than seven drinks per week, with no more than one or two drinks per drinking day. The odds of complying with abstinence increased by a factor of 3.48 (95% CI 2.39-5.05 for women who previously complied with the 2001 alcohol guidelines and decreased by a factor of 0.19 (95% CI 0.08-0.66 if household incomes were $36,400 or more. In other models the odds of complying were lower for women who consumed alcohol before pregnancy at least weekly (OR = 0.40, 95% CI 0.25-0.63 or binged (OR ≥ 0.18, 95% CI 0.10-0.31 and were higher for those who abstained (OR
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Guidelines for selection of radiological protective head covering
International Nuclear Information System (INIS)
Galloway, G.R. Jr.
1995-08-01
The hood is recognized throughout the nuclear industry as the standard radiological protective head covering for use in radioactively contaminated work environments. As of June 15, 1995, hoods were required for all activities performed in contaminated areas at the Y-12 Plant. The use of hoods had historically been limited to those radiological activities with a high potential for personnel contamination. Due to the large size of many posted contaminated areas at the Y-12 Plant, and compounding safety factors, requirements for the use of hoods are being reevaluated. The purpose of the evaluation is to develop technically sound guidelines for the selection of hoods when prescribing radiological protective head covering. This report presents the guidelines for selection of radiological protective hoods
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Do published guidelines for evaluation of Irritable Bowel Syndrome reflect practice?
Directory of Open Access Journals (Sweden)
Bertram Susan L
2001-10-01
Full Text Available Abstract Background The only US guidelines listed in the National Guideline Warehouse for the diagnosis of Irritable Bowel Syndrome (IBS are the expert opinion guidelines published by The American Gastroenterology Association. Although the listed target audience of these guidelines includes family physicians and general internists, the care recommended in the guidelines has not been compared to actual primary care practice. This study was designed to compare expert opinion guidelines with the actual primary care provided and to assess outcomes in the 3 years following the IBS diagnosis. Methods This is a retrospective medical record review study using a random sample of incident IBS cases from all Olmsted County, Minnesota providers diagnosed between January 1, 1993 and December 31, 1995. Data was collected on all care and testing provided to the subjects as well as 3-year outcomes related to the IBS diagnosis. Results Of the 149 IBS patients, 99 were women and the mean age was 47.6 years. No patient had all of the diagnostic tests recommended in the guidelines. 42% had the basic blood tests of CBC and a chemistry panel. Sedimentation rate (2% and serum thyroxine level (3% were uncommon. Colon imaging studies were done in 41% including 74% of those over the age of 50. In the 3 years following the diagnosis, only one person had a change in diagnosis and no diagnoses of gastro-intestinal malignancies were made in the cohort. Conclusions Primary care practice based diagnostic evaluations for IBS differ significantly from the specialty expert opinion-based guidelines. Implementation of the specialty guidelines in primary care practice would increase utilization with apparent limited improvement in diagnostic outcomes.
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Misleading guidelines for the diagnosis and management of hypertension
Directory of Open Access Journals (Sweden)
Flávio Danni Fuchs
2014-10-01
Full Text Available International guidelines for the diagnosis and management of hypertension were recently released [1,2]. A historical trend of lowering the blood pressure (BP thresholds to diagnose hypertension in high risk individuals was unexpectedly reversed. BP targets for the treatment were modified accordingly. Therefore some individuals who were hypertensive before are now normotensive. Other guidelines still recommend the previous diagnostic limits and goals of treatment [3-5], resulting that an individual may be hypertensive in some countries and normotensive in others. The guidelines are more homogeneous in the recommendations for treatment, particularly in regard to the liberal options of drugs to starting the treatment. Unfortunately, in my view, this liberal view includes drugs without unbiased evidences of effectiveness, such as Angiotensin Receptor Blockers (ARB. In this point of view, I discuss the reasons and misconceptions in the establishment of diagnostic thresholds and the shortcomings in the recommendations of antihypertensive drugs.
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Index-TB Guidelines: Guidelines on extrapulmonary tuberculosis for India
Sharma, Surendra K.; Ryan, H.; Khaparde, Sunil; Sachdeva, K. S.; Singh, Achintya D.; Mohan, Alladi; Sarin, Rohit; Paramasivan, C N; Kumar, Prahlad; Nischal, Neeraj; Khatiwada, Saurav; Garner, Paul; Tharyan, Prathap
2017-01-01
Extrapulmonary tuberculosis (EPTB) is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i) use of Xpert MTB/RIF in diagnosis, (ii) use of adjunct corticosteroids in treatment, and (iii) duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research. PMID:28862176
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Public informations guidelines
International Nuclear Information System (INIS)
1986-06-01
The purpose of these Public Information Guidelines is to provide principles for the implementation of the NWPA mandate and the Mission Plan requirements for the provision of public information. These Guidelines set forth the public information policy to be followed by all Office of Civilian Radioactive Waste Management (OCRWM) performance components. The OCRWM offices should observe these Guidelines in shaping and conducting public information activities
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Public informations guidelines
Energy Technology Data Exchange (ETDEWEB)
None
1986-06-01
The purpose of these Public Information Guidelines is to provide principles for the implementation of the NWPA mandate and the Mission Plan requirements for the provision of public information. These Guidelines set forth the public information policy to be followed by all Office of Civilian Radioactive Waste Management (OCRWM) performance components. The OCRWM offices should observe these Guidelines in shaping and conducting public information activities.
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An International Approach to Enhancing a National Guideline on Driving and Dementia.
Rapoport, Mark J; Chee, Justin N; Carr, David B; Molnar, Frank; Naglie, Gary; Dow, Jamie; Marottoli, Richard; Mitchell, Sara; Tant, Mark; Herrmann, Nathan; Lanctôt, Krista L; Taylor, John-Paul; Donaghy, Paul C; Classen, Sherrilene; O'Neill, Desmond
2018-03-12
The purpose of this study was to update a national guideline on assessing drivers with dementia, addressing limitations of previous versions which included a lack of developmental rigor and stakeholder involvement. An international multidisciplinary team reviewed 104 different recommendations from 12 previous guidelines on assessing drivers with dementia in light of a recent review of the literature. Revised guideline recommendations were drafted by consensus. A preliminary draft was sent to specialist physician and occupational therapy groups for feedback, using an a priori definition of 90% agreement as consensus. The research team drafted 23 guideline recommendations, and responses were received from 145 stakeholders. No recommendation was endorsed by less than 80% of respondents, and 14 (61%) of the recommendations were endorsed by more than 90%.The recommendations are presented in the manuscript. The revised guideline incorporates the perspectives of consensus of an expert group as well as front-line clinicians who regularly assess drivers with dementia. The majority of the recommendations were based on evidence at the level of expert opinion, revealing gaps in the evidence and future directions for research.
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The CARE guidelines: consensus-based clinical case report guideline development.
Gagnier, Joel J; Kienle, Gunver; Altman, Douglas G; Moher, David; Sox, Harold; Riley, David
2014-01-01
A case report is a narrative that describes, for medical, scientific, or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design. Develop, disseminate, and implement systematic reporting guidelines for case reports. We used a three-phase consensus process consisting of (1) pre-meeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines, and (3) post-meeting feedback, review, and pilot testing, followed by finalization of the case report guidelines. This consensus process involved 27 participants and resulted in a 13-item checklist-a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent. We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery. Copyright © 2014 Reproduced with permission of Global Advances in Health and Medicine. Published by Elsevier Inc. All rights reserved.
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Limits of Spalling of Fire-Exposed Concrete
DEFF Research Database (Denmark)
Hertz, Kristian Dahl
2003-01-01
on the nature of spalling, add the latest findings from the research of the author, and derives limits within which spalling should not take place. Some guidelines are formulated based on experience from research and practise for reducing the spalling risk for constructions beyond the safe design limits....... The limits provided are those, which can be stated at present, but further research is in progress, identifying more precisely the range of materials susceptible to spalling and contributing to the full understanding of the phenomenon....
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Directory of Open Access Journals (Sweden)
Anjni Patel
Full Text Available Traumatic brain injury (TBI is a leading cause of death worldwide and is increasing exponentially particularly in low and middle income countries (LMIC. To inform the development of a standard Clinical Practice Guideline (CPG for the acute management of TBI that can be implemented specifically for limited resource settings, we conducted a systematic review to identify and assess the quality of all currently available CPGs on acute TBI using the AGREE II instrument. In accordance with PRISMA guidelines, from April 2013 to December 2015 we searched MEDLINE, EMBASE, Google Scholar and the Duke University Medical Center Library Guidelines for peer-reviewed published Clinical Practice Guidelines on the acute management of TBI (less than 24 hours, for any level of traumatic brain injury in both high and low income settings. A comprehensive reference and citation analysis was performed. CPGs found were assessed using the AGREE II instrument by five independent reviewers and scores were aggregated and reported in percentage of total possible score. An initial 2742 articles were evaluated with an additional 98 articles from the citation and reference analysis, yielding 273 full texts examined. A total of 24 final CPGs were included, of which 23 were from high income countries (HIC and 1 from LMIC. Based on the AGREE II instrument, the best score on overall assessment was 100.0 for the CPG from the National Institute for Health and Clinical Excellence (NIHCE, 2007, followed by the New Zealand Guidelines Group (NZ, 2006 and the National Clinical Guideline (SIGN, 2009 both with a score of 96.7. The CPG from a LMIC had lower scores than CPGs from higher income settings. Our study identified and evaluated 24 CPGs with the highest scores in clarity and presentation, scope and purpose, and rigor of development. Most of these CPGs were developed in HICs, with limited applicability or utility for resource limited settings. Stakeholder involvement, Applicability
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DOE (Department of Energy) natural phenomena guidelines earthquake design and evaluation
International Nuclear Information System (INIS)
Short, S.A.; Murray, R.C.; Kennedy, R.P.
1989-01-01
Design and evaluation guidelines for DOE (Department of Energy) facilities subjected to earthquake, wind/tornado, and flood have been developed. This paper describes the philosophy and procedures fr the design or evaluation of facilities for earthquake ground shaking. The guidelines are intended to meet probabilistic-based performance goals expressed in terms of annual probability of exceedance of some level of structural damage. Meeting performance goals can be accomplished by specifying hazard probabilities of exceedance along with seismic behavior evaluation procedures in which the level of conservatism introduced is controlled such that desired performance can be achieved. Limited inelastic behavior is permitted by permitting demand determined from elastic response spectrum analyses to exceed capacity by an allowable inelastic demand-capacity ratio specified in the guidelines for different materials and construction
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The current state of epilepsy guidelines: A systematic review.
Sauro, Khara M; Wiebe, Samuel; Dunkley, Colin; Janszky, Jozsef; Kumlien, Eva; Moshé, Solomon; Nakasato, Nobukazu; Pedley, Timothy A; Perucca, Emilio; Senties, Horacio; Thomas, Sanjeev V; Wang, Yuping; Wilmshurst, Jo; Jetté, Nathalie
2016-01-01
The International League Against Epilepsy (ILAE) Epilepsy Guidelines Task Force, composed of 14 international members, was established in 2011 to identify, using systematic review methodology, international epilepsy clinical care guidelines, assess their quality, and determine gaps in areas of need of development. A systematic review of the literature (1985-2014) was performed in six electronic databases (e.g. Medline, Embase) using a broad search strategy without initial limits to language or study design. Six gray literature databases (e.g., American Academy of Neurology [AAN], ILAE) were also searched to minimize publication bias. Two independent reviewers screened abstracts, reviewed full text articles, and performed data abstraction. Descriptive statistics and a meta-analysis were generated. The search identified 10,926 abstracts. Of the 410 articles selected for full text review, 63 met our eligibility criteria for a guideline. Of those included, 54 were in English and 9 were in other languages (French, Spanish, and Italian). Of all guidelines, 29% did not specify the target age groups, 27% were focused on adults, 22% included only children, and 6% specifically addressed issues related to women with epilepsy. Guidelines included in the review were most often aimed at guiding clinical practice for status epilepticus (n = 7), first seizure (n = 6), drug-resistant epilepsy (n = 5), and febrile seizures (n = 4), among others. Most of the guidelines were therapeutic (n = 35) or diagnostic (n = 16) in nature. The quality of the guidelines using a 1-7 point scale (7 = highest) varied and was moderate overall (mean = 4.99 ± 1.05 [SD]). We identified substantial gaps in topics (e.g., epilepsy in the elderly) and there was considerable heterogeneity in methodologic quality. The findings should offer a valuable resource for health professionals caring for people with epilepsy, since they will help guide the prioritization, development, and dissemination of future
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Sun Exposure Guidelines and Serum Vitamin D Status in Denmark: The StatusD Study
DEFF Research Database (Denmark)
Hansen, Louise; Tjønneland, Anne; Køster, Brian
2016-01-01
Little is known on how vitamin D status is affected by adherence to UVB-limiting sun exposure guidelines. Our aim was to investigate the relationship between adherence to the Danish sun exposure guidelines and vitamin D status. In total, 3194 Danes (2625 adults, 569 children) were recruited among...... who did not had an OR (95% CI) of 1.68 (1.25-2.35) of having ≥50 nmol/L during both spring and autumn. No associations were found with wearing a sunhat, and there were no clear associations for children. In conclusion, adherence to the sun exposure guidelines on shade and protective clothing...
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Directory of Open Access Journals (Sweden)
Renata Monteiro
2006-05-01
Full Text Available The objective of this paper is to present and discuss Brazilian policy concerning actions to protect breastfeeding, especially the history, international and national background, limitations, and perspectives of the Brazilian Guidelines for the Marketing of Baby Food, Pacifiers and Bottles. The Brazilian Guidelines, which play a crucial role in protecting breastfeeding against industry marketing strategies, were based on the International Code of Marketing of Breastmilk Substitutes, proposed by the World Health Organization in 1981. The first version of the Brazilian Guidelines was released in 1988, and there were subsequent revisions in 1992 and 2001/2002. In 2006, the Guidelines became national law. However, the strides made over this period in terms of regulation have been few because the law is not always observed. Thus, it is essential that all actors involved, including government officials, manufacturers and sellers of baby food and other baby products, teaching and health professionals and their associations, international bodies, and non-governmental organizations make a commitment to enforce the current law.
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Index-TB guidelines: Guidelines on extrapulmonary tuberculosis for India
Directory of Open Access Journals (Sweden)
Surendra K Sharma
2017-01-01
Full Text Available Extrapulmonary tuberculosis (EPTB is frequently a diagnostic and therapeutic challenge. It is a common opportunistic infection in people living with HIV/AIDS and other immunocompromised states such as diabetes mellitus and malnutrition. There is a paucity of data from clinical trials in EPTB and most of the information regarding diagnosis and management is extrapolated from pulmonary TB. Further, there are no formal national or international guidelines on EPTB. To address these concerns, Indian EPTB guidelines were developed under the auspices of Central TB Division and Directorate of Health Services, Ministry of Health and Family Welfare, Government of India. The objective was to provide guidance on uniform, evidence-informed practices for suspecting, diagnosing and managing EPTB at all levels of healthcare delivery. The guidelines describe agreed principles relevant to 10 key areas of EPTB which are complementary to the existing country standards of TB care and technical operational guidelines for pulmonary TB. These guidelines provide recommendations on three priority areas for EPTB: (i use of Xpert MTB/RIF in diagnosis, (ii use of adjunct corticosteroids in treatment, and (iii duration of treatment. The guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE criteria, which were evidence based, and due consideration was given to various healthcare settings across India. Further, for those forms of EPTB in which evidence regarding best practice was lacking, clinical practice points were developed by consensus on accumulated knowledge and experience of specialists who participated in the working groups. This would also reflect the needs of healthcare providers and develop a platform for future research.
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Global Imaging referral guidelines
International Nuclear Information System (INIS)
Kawooya, M.; Perez, M.; Lau, L.; Reeed, M.
2010-01-01
The medical imaging specialists called for global referral guidelines which would be made available to referring doctors. These referral guidelines should be:- Applicable in different health care settings, including resource-poor settings; Inclusive in terms of the range of clinical conditions; User-friendly and accessible (format/media); Acceptable to stakeholders, in particular to the referrers as the main target audience. To conceive evidence-based medicine as an integration of best research evidence with clinical expertise and patient values. The Direct recipients of the Referral Guidelines would be:- Referrers: general practitioners / family doctors; paediatricians; emergency department doctors; other specialists and health workers. Providers (medical imaging practitioners): radiologists; nuclear medicine physicians; radiographers; other appropriately qualified practitioners providing diagnostic imaging services. For the Referral Guidelines to be effective there need to be: Credibility evidence-based Practicality end user involvement Context local resources, disease profiles Endorsement, opinion leaders Implementation- policy, education, CPOE - Monitoring of the use clinical audit, report feedback. The aim of the Referral Guidelines Project was to: Produce global referral guidelines that are evidence-based, cost effective and appropriate for the local setting, and include consideration of available equipment and expertise (RGWG; SIGs); Include supporting information about radiation doses, potential risks, protection of children and pregnant women (introductory chapter); Facilitate the implementation of the guidelines through guidance and tools (e.g. implementation guides, checklists, capacity building tools, guides on stakeholders engagement, audit support criteria); Conduct pilot testing in different clinical settings from each of the six WHO regions; Promote the inclusion of the referral guidelines in the curricula of medical schools; Develop and implement
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Management of achalasia in the UK, do we need new guidelines?
Directory of Open Access Journals (Sweden)
Jihene El Kafsi
2016-12-01
Conclusion: Diagnosis and management of achalasia within the UK is relatively standardised, although there remains limited access to HRM. Discussion at benign MDTs however is poor and follow-up differs widely. UK guidelines may help to make these more uniform.
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Impact of lens case hygiene guidelines on contact lens case contamination.
Wu, Yvonne T; Teng, Yuu Juan; Nicholas, Mary; Harmis, Najat; Zhu, Hua; Willcox, Mark D P; Stapleton, Fiona
2011-10-01
Lens case contamination is a risk factor for microbial keratitis. The effectiveness of manufacturers' lens case cleaning guidelines in limiting microbial contamination has not been evaluated in vivo. This study compared the effectiveness of manufacturers' guidelines and an alternative cleaning regimen. A randomized cross-over clinical trial with two phases (n = 40) was performed. Participants used the lens types of their choice in conjunction with the provided multipurpose solution (containing polyhexamethylene biguanide) for daily wear. In the manufacturers' guideline phase, cases were rinsed with multipurpose solution and air dried. In the alternative regimen phase, cases were rubbed, rinsed with solution, tissue wiped, and air-dried face down. The duration of each phase was 1 month. Lens cases were collected at the end of each phase for microbiological investigation. The levels of microbial contamination were compared, and compliance to both regimens was assessed. The case contamination rate was 82% (32/39) in the manufacturers' guideline group, compared with 72% (28/39) in the alternative regimen group. There were significantly fewer (p = 0.004) colony forming units (CFU) of bacteria from cases used by following the alternative regimen (CFU range of 0 to 10, and median of 12 CFU per well) compared with that of the manufacturer's guidelines (CFU range of 0 to 10, and median of 28 CFU per well). The compliance level between both guidelines was not significantly different (p > 0.05). The alternative guidelines are more effective in eliminating microbial contamination from lens cases than that of the current manufacturer's guideline. Simply incorporating rubbing and tissue-wiping steps in daily case hygiene reduces viable organism contamination.
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Effect of revised IOM weight gain guidelines on perinatal outcomes.
Halloran, Donna R; Wall, Terry C; Guild, Camelia; Caughey, Aaron B
2011-03-01
We sought to examine perinatal outcomes in women with a body mass index (BMI) of 25 kg/m(2) comparing those whose weight gain met 2009 IOM guidelines to women meeting 1990 IOM guidelines. This is a retrospective cohort study utilizing birth records linked to hospital discharge data for all term, singleton infants born to overweight, Missouri residents (2000-2006) with a BMI of 25 kg/m(2). We excluded congenital anomalies, mothers with diabetes, hypertension, or previous cesarean delivery. Fourteen thousand nine hundred fifty-five women gained 25-35 lbs (1990 guidelines); 1.6% delivered low birth weight (LBW) infants and 1.1% delivered macrosomic infants. Eight thousand three hundred fifty women gained 15-25 lbs (2009 guidelines); 3.4% delivered LBW infants and 0.6% delivered macrosomic infants. Women who gained 15-25 lbs were 1.99 (95% CI 1.67, 2.38) times more likely to have a LBW infant and 0.59 (95% CI 0.40, 0.76) times less likely to deliver a macrosomic infant. Limiting weight gain in women with a BMI of 25 kg/m(2), per the 2009 guidelines, increases the risk of LBW deliveries and decreases the risk of macrosomia but does not reduce associated adverse perinatal outcomes. Further studies should explore the optimal weight gain to reduce these outcomes.
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Uranium in Aquatic Sediments; Where are the Guidelines?
Energy Technology Data Exchange (ETDEWEB)
Iles, M., E-mail: michelle.iles@ewlsciences.com.au [Earth, Water and Life Sciences Pty Ltd, Darwin (Australia)
2014-05-15
Sediment data has been collected on and around the Ranger uranium mine for over 20 years. This included studies such as annual routine monitoring of metal concentrations, adsorption-desorption conditions, phase associations, transport mechanism, release potential, bioaccumulation and bioconcentration etc. Building on this, performance-based monitoring of the sediments from on-site water bodies was undertaken to ascertain the spatial and temporal distribution of contaminants as a basis to determine ecological risks associated with the sediments which in turn underpins closure planning. Highlights of these studies are interpreted using an ecological risk assessment approach. Ideally interpretation of aquatic sediment contamination in Australia is guided by the national guidelines for water quality and a weighted multiple lines of evidence approach whereby the chemistry of sediments is compared with reference and guideline values and predictions of bio-availability, and biological effects data allows cause and effect relationships to be derived. However, where uranium in aquatic sediments is concerned there is a lack of national (Australian) and international guidelines that are applicable to tropical sediments and the biological effects data available are limited or confounded by other variables. In the absence of clear uranium guidelines for sediments an internationally reported “Predicted No Effect Concentration” (PNEC) for uranium in temperate sediments was used as a “pseudo-guideline” value to identify sites with concentrations that might present an environmental risk and that should be further investigated. The applicability of the PNEC to the tropical Ranger site was understandably questioned by stakeholders and peers. The issues raised highlighted the need for international guidelines for uranium in aquatic sediments for tropical and temperate climates and an internationally accepted approach for deriving same. (author)
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Design patterns for modelling guidelines
Serban, Radu; Ten Teije, Annette; Marcos, Mar; Polo-Conde, Cristina; Rosenbrand, Kitty C J G M; Wittenberg, Jolanda; van Croonenborg, Joyce
2005-01-01
It is by now widely accepted that medical guidelines can help to significantly improve the quality of medical care. Unfortunately, constructing the required medical guidelines is a very labour intensive and costly process. The cost of guideline construction would decrease if guidelines could be
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2010-01-01
... 7 Agriculture 6 2010-01-01 2010-01-01 false Guidelines. 622.5 Section 622.5 Agriculture... AGRICULTURE WATER RESOURCES WATERSHED PROJECTS General § 622.5 Guidelines. Guidelines for carrying out... Environmental Principles and Guidelines for Water and Related Land Resources Implementation Studies issued by...
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Canadian clinical practice guidelines for acute and chronic rhinosinusitis
Directory of Open Access Journals (Sweden)
Desrosiers Martin
2011-02-01
Full Text Available Abstract This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis (ARS and chronic rhinosinusitis (CRS to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in guidelines development, and do not address the particulars of the Canadian healthcare environment. Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation, which have led to changes in therapeutic approaches (eg, increased use of corticosteroids. The role of bacteria in the persistence of chronic infections, and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused. Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on
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Hematology journals do not sufficiently adhere to reporting guidelines: a systematic review.
Wayant, C; Smith, C; Sims, M; Vassar, M
2017-04-01
Essentials Reporting guidelines and trial/review registration aim to limit bias in research. We systematically reviewed hematology journals to examine the use of these policies. Forty-eight percent of journals made no use of these policies. Improving the use of reporting guidelines will improve research for all stakeholders. Background Reporting guidelines and trial/review registration policies have been instituted in order to minimize bias and improve research practices. Objective The objective of this study was to investigate the policies of hematology journals concerning reporting guideline adoption and trial/review registration. Methods We performed a web-based data abstraction from the Instructions for Authors of 67 hematology journals catalogued in the Expanded Science Citation Index of the 2014 Journal Citation Reports to identify whether each journal required, recommended or made no mention of the following reporting guidelines: EQUATOR, ICMJE, CONSORT, MOOSE, QUOROM, PRISMA, STARD, STROBE, ARRIVE and CARE. We also extracted whether journals required or recommended trial or systematic review registration. We e-mailed editors three times to determine which types of studies their journal accepts. Results Forty-eight per cent (32/67) of hematology journals do not adhere to any reporting guidelines. For responding journals, the QUOROM statement, MOOSE, CARE and PROSPERO were the least often mentioned, whereas the ICMJE guidelines, CONSORT statement and general trial registration were most often mentioned. Discussion Reporting guidelines are infrequently required or recommended by hematology journals. Furthermore, few require clinical trial or systematic review database registration. A higher rate of adherence to reporting guidelines can prevent bias from entering the literature. Participation from all stakeholders, including authors and journal editors, to improve reporting guideline and policy practices is required. © 2017 International Society on Thrombosis
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Development of cancer treatment guidelines
African Journals Online (AJOL)
Krystyna Kiel
2011-05-26
May 26, 2011 ... KEYWORDS. Cancer;. Therapy;. Guidelines. Contents. 1. Why develop guidelines? ... Widely available guideline resources in cancer care. ... The use of guidelines in medicine has a long history. Many .... She has a negative family history. ... The patient has 1 cm grade 3 infiltrating ductal carcinoma.
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2010-07-01
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Guidelines. 42.306 Section 42.306... PROCEDURES Equal Employment Opportunity Program Guidelines § 42.306 Guidelines. (a) Recipient agencies are... guidelines under their equal employment opportunity program which will correct, in a timely manner, any...
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2010-07-01
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Guidelines. 42.404 Section 42.404... Guidelines. (a) Federal agencies shall publish title VI guidelines for each type of program to which they extend financial assistance, where such guidelines would be appropriate to provide detailed information...
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Guidelines for Quality Control of Equipment Used in Diagnostic Radiology in the Netherlands
International Nuclear Information System (INIS)
Berg, L. van den; Aarts, C.N.M.; Beentjes, L.B.; Dalen, A. van; Elsakkers, P.; Julius, H.W.; Kicken, P.J.H.; Meer, F. van der; Teeuwisse, W.; Thijssen, M.A.O.; Zoetelief, J.
1998-01-01
The Dutch working group on 'Quality Criteria for Equipment Used in Diagnostic Radiology' has formulated guidelines providing technical criteria for equipment used in conventional diagnostic radiology. These guidelines are applicable to the technical parameters having a major impact on image quality and patient dose and include methods for testing. The following parameters are included: tube voltage, automatic exposure control, film processing, film-screen combination, light tightness and illumination of the dark room, half-value layer and filtration, light field, grid, focal spot size, viewing boxes and geometrical indicators. Each guideline consists of the following chapters: (1) Scope and field of application, (2) Background information, (3) Test procedure, (4) Test frequency, (5) Registration of observations, (6) Evaluation and interpretation, (7) Test report. Chapter 3 includes both the principles of the test method and a step by step description of the procedures. The principles of the test procedure provide a basis for adaptation to local circumstances. The step by step test procedure allows a quality control measurement to be performed with limited physical knowledge of the equipment. Chapter 6 includes limiting values. Draft guidelines were evaluated in practice in 20 hospitals. The final document has been accepted by the professional societies in the Netherlands and the Dutch Minister of Health as a reference set of tools to perform Quality Control of equipment used for conventional diagnostic radiology. (author)
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Visitor's Computer Guidelines | CTIO
Visitor's Computer Guidelines Network Connection Request Instruments Instruments by Telescope IR Instruments Guidelines Library Facilities Outreach NOAO-S EPO Program team Art of Darkness Image Gallery EPO/CADIAS â¹âº You are here CTIO Home » Astronomers » Visitor's Computer Guidelines Visitor's Computer
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Nurses' experiences of guideline implementation
DEFF Research Database (Denmark)
Alanen, Seija; Välimäki, Marita; Kaila, Minna
2009-01-01
AIMS: The aim of the study was to address the following questions: What kind of experiences do primary care nurses have of guideline implementation? What do nurses think are the most important factors affecting the adoption of guidelines? BACKGROUND: The implementation of clinical guidelines seems...... to be dependent on multiple context-specific factors. This study sets out to explore the experiences of primary care nurses concerning guideline implementation. DESIGN: Qualitative interview. METHODS: Data were generated by four focus group interviews involving nurses working in out-patient services in primary...... to nurses, (iii) factors related to the anticipated consequences and (iv) factors related to the patient group. Nurses' awareness and acceptance of guidelines and the anticipated positive consequences facilitate the implementation of guidelines. Organisational support, especially the adapting of guidelines...
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International Nuclear Information System (INIS)
Lee, Y. H.; Lee, J. Y.
2003-01-01
Human factors have been well known as one of the key factors to the system effectiveness as well as the efficiency and safety of nuclear power plants(NPPs). Human factors engineering(HFE) are included in periodic safety review(PSR) on the existing NPPs and the formal safety assessment for the new ones. However, HFE for NPPs is still neither popular in practice nor concrete in methodology. Especially, the human factors guidelines, which are the most frequent form of human factors engineering in practice, reveal the limitations in their applications. We discuss the limitations and their casual factors found in human factors guidelines in order to lesson the workload of HFE practitioners and to improve the applicability of human factors guidelines. According to the purposes and the phases of HFE for NPPs, more selective items and specified criteria should be prepared carefully in the human factors guidelines for the each HFE applications in practice. These finding on the human factors guidelines can be transferred to the other HFE application field, such as military, aviation, telecommunication, HCI, and product safety
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2011-09-28
... Conference on Penalty Guidelines; Notice of Technical Conference on Penalty Guidelines The staff of the... the Penalty Guidelines, which the Commission issued on September 17, 2010.\\1\\ The conference will be... impact of the Penalty Guidelines on compliance and enforcement matters. More information on the topics to...
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... use this site. health.gov Physical Activity Guidelines Physical Activity Physical activity is key to improving the health of the Nation. Based on the latest science, the Physical Activity Guidelines for Americans is an essential resource for ...
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Directory of Open Access Journals (Sweden)
Lemieux-Charles Louise
2009-07-01
Full Text Available Abstract Background Practice guidelines can improve health care delivery and outcomes but several issues challenge guideline adoption, including their intrinsic attributes, and whether and how they are implemented. It appears that guideline format may influence accessibility and ease of use, which may overcome attitudinal barriers of guideline adoption, and appear to be important to all stakeholders. Guideline content may facilitate various forms of decision making about guideline adoption relevant to different stakeholders. Knowledge and attitudes about, and incentives and capacity for implementation on the part of guideline sponsors may influence whether and how they develop guidelines containing these features, and undertake implementation. Examination of these issues may yield opportunities to improve guideline adoption. Methods The attributes hypothesized to facilitate adoption will be expanded by thematic analysis, and quantitative and qualitative summary of the content of international guidelines for two primary care (diabetes, hypertension and institutional care (chronic ulcer, chronic heart failure topics. Factors that influence whether and how guidelines are implemented will be explored by qualitative analysis of interviews with individuals affiliated with guideline sponsoring agencies. Discussion Previous research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes, but this produced little insight on how the products themselves, or their implementation, could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization, such as recall, attitude toward, confidence in, and adoption intention. If successful, then long-term objective
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Testing post-editing guidelines
DEFF Research Database (Denmark)
Flanagan, Marian; Christensen, Tina Paulsen
2014-01-01
guidelines to use in translator training programmes. Recently, the first set of publicly available industry-focused PE guidelines (for ‘good enough’ and ‘publishable’ quality) were developed by Translation Automation User Society (TAUS) in partnership with the Centre for Global Intelligent Content (CNGL......), which can be used as a basis on which to instruct post-editors in professional environments. This paper reports on a qualitative study that investigates how trainee translators on an MA course, which is aimed at preparing the trainees for the translation industry, interpret these PE guidelines...... for publishable quality. The findings suggest trainees have difficulties interpreting the guidelines, primarily due to trainee competency gaps, but also due to the wording of the guidelines. Based on our findings we propose training measures to address these competency gaps. Furthermore, we provide post...
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Appraising and comparing pressure ulcer guidelines.
Wimpenny, Peter; van Zelm, Ruben
2007-01-01
Whilst considerable activity has been related to guideline development for nurses regarding pressure ulcer prevention and management, no attempt has been made to comparatively evaluate these guidelines against some form of quality indicators. To compare and contrast four national pressure ulcer guidelines, and identify similarities and differences in their quality and content. An international comparative appraisal method, using the AGREE (Appraisal of Guidelines Research and Evaluation) instrument, was undertaken to appraise four published pressure ulcer guidelines. Two further domains were added to the AGREE instrument to assess comparability of the guidelines and their perceived contribution to practice. An international group undertook the comparative appraisal. The domain scores for each guideline show some but not total agreement among reviewers. One particular set of guidelines was identified as scoring highest in a majority of AGREE domains. Overall, evidence of variability exists between pressure ulcer guidelines and common areas of development to consider for all guidelines. The results raise many questions concerning the "best" pressure ulcer guideline to use, particularly related to the AGREE scoring. Some notable shortcomings exist in all the pressure ulcer guidelines reviewed and these shortcomings need to be addressed from a quality perspective. However, other issues such as style of reporting and potential contribution to practice might more fully affect choice by practitioners as opposed to guideline developers. Notable differences exist among the four guidelines that are possibly explained by different approaches to development and also because of different cultural factors and intentions for use. Whilst the AGREE tool identifies the quality of the guideline development process it still requires local engagement with practitioners to determine which guideline should be implemented.
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Directory of Open Access Journals (Sweden)
Turner Tari J
2009-12-01
Full Text Available Abstract Background Evidence-based clinical practice guidelines support clinical decision-making by making recommendations to guide clinical practice. These recommendations are developed by integrating the expertise of a multidisciplinary group of clinicians with the perspectives of consumers and the best available research evidence. However studies have raised concerns about the quality of guideline development, and particularly the link between research and recommendations. The reasons why guideline developers are not following the established development methods are not clear. We aimed to explore the barriers to developing evidence-based guidelines in eleven hospitals in Australia, Indonesia, Malaysia, the Philippines and Thailand, so as to better understand how evidence-based guideline development could be facilitated in these settings. The research aimed to identify the value clinicians place on guidelines, what clinicians want in guidelines developed in hospital settings and what factors limit rigorous evidence-based guideline development in these settings. Methods Semi-structured, face-to-face interviews were undertaken with senior and junior healthcare providers (nurses, midwives, doctors, allied health from the maternal and neonatal services of the eleven participating hospitals. Interviews were audio-recorded, transcribed and a thematic analysis undertaken. Results Ninety-three individual, 25 pair and eleven group interviews were conducted. Participants were clear that they want guidelines that are based on evidence and updated regularly. They were also clear that there are major barriers to this. Most of the barriers were shared across countries, and included lack of time, lack of skills in finding, appraising and interpreting evidence, lack of access to relevant evidence and difficulty arranging meetings and achieving consensus. Barriers that were primarily identified in Australian hospitals include cumbersome organisational
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Sample preparation guidelines for two-dimensional electrophoresis.
Posch, Anton
2014-12-01
Sample preparation is one of the key technologies for successful two-dimensional electrophoresis (2DE). Due to the great diversity of protein sample types and sources, no single sample preparation method works with all proteins; for any sample the optimum procedure must be determined empirically. This review is meant to provide a broad overview of the most important principles in sample preparation in order to avoid a multitude of possible pitfalls. Sample preparation protocols from the expert in the field were screened and evaluated. On the basis of these protocols and my own comprehensive practical experience important guidelines are given in this review. The presented guidelines will facilitate straightforward protocol development for researchers new to gel-based proteomics. In addition the available choices are rationalized in order to successfully prepare a protein sample for 2DE separations. The strategies described here are not limited to 2DE and can also be applied to other protein separation techniques.
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Engineering design guidelines for nuclear criticality safety
International Nuclear Information System (INIS)
Waltz, W.R.
1988-08-01
This document provides general engineering design guidelines specific to nuclear criticality safety for a facility where the potential for a criticality accident exists. The guide is applicable to the design of new SRP/SRL facilities and to major modifications Of existing facilities. The document is intended an: A guide for persons actively engaged in the design process. A resource document for persons charged with design review for adequacy relative to criticality safety. A resource document for facility operating personnel. The guide defines six basic criticality safety design objectives and provides information to assist in accomplishing each objective. The guide in intended to supplement the design requirements relating to criticality safety contained in applicable Department of Energy (DOE) documents. The scope of the guide is limited to engineering design guidelines associated with criticality safety and does not include other areas of the design process, such as: criticality safety analytical methods and modeling, nor requirements for control of the design process
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Japanese Guideline for Atopic Dermatitis
Directory of Open Access Journals (Sweden)
Ichiro Katayama
2011-01-01
The basics of treatment discussed in this guideline are based on the “Guidelines for the Treatment of Atopic Dermatitis 2008” prepared by the Health and Labour Sciences Research and the “Guidelines for the Management of Atopic Dermatitis 2009 (ADGL2009” prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle.
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Guthrie, Joanne F; Smallwood, David M
2003-12-01
The Dietary Guidelines for Americans is the official nutrition policy statement for the United States. Government involvement in providing information on private behavior, such as food choice, is justified by the high cost of poor diets, as measured in medical expenses and lost productivity. The Guidelines are intended to provide an up-to-date, consistent information base for federal nutrition education and information efforts and food assistance program regulations. Through these policy mechanisms, the Guidelines are assumed to improve dietary behavior, and, ultimately, health. By law, the Dietary Guidelines for Americans must be updated every five years; however, there is no mandate for evaluation. Evaluation could provide useful information to assess the extent to which the Guidelines positively influence health and provide insights into reasons for their successes and limitations. However, evaluation would also present considerable challenges. This paper discusses the critical data and methodological needs for improving evaluation of the Dietary Guidelines for Americans.
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[Impact of low-molecular-weight heparin practice guidelines in a geriatric hospital].
d'Arailh, Lydie; Gaubert-Dahan, Marie-Line; Muller, Florence; Lechowski, Laurent; Teillet, Laurent
2011-06-01
The purpose of this study was to assess the impact of good use of anticoagulants guidelines implementation on low molecular weight heparin (LMWH) prescription in a french geriatric hospital. This interventional "before and after" study was conduced by the same geriatrician on a d-day in 2006 and 2009. Guidelines for anticoagulant's prescription based on selected references in the literature was established by an expert's consensus and implemented in 2008. Data were collected in all departments at the Sainte-Perine geriatric hospital for each patient with an LMWH prescription. Assessment was based on quality judgment criteria (indication, dosage, treatment duration, biological monitoring of LMWH). Data were collected for 72 prescriptions prior to the guidelines implementation and for 54 after. Sex-ratio, mean age and percentage of LMWH prescription did not differ significantly between the two periods. There was a better conformity for LMWH dosage prescription (p = 0.002) and biological monitoring prescription (p = 0.036) after the guidelines implementation. Conformity of LMWH indication and treatment duration were improved but the difference remained not significant (respectively p = 0.49 and p = 0.80). Implementing guidelines for LMWH use in geriatrics can improve quality of prescription. The impact was effective but limited. These guidelines are now in general use in the Sainte-Perine hospital.
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International Nuclear Information System (INIS)
Doering, Che; Bollhöfer, Andreas
2016-01-01
A soil guideline value for radiological protection of the environment was determined for the impending rehabilitation of Ranger uranium mine in the wet-dry tropics of northern Australia. The guideline value was 1000 Bq kg"−"1 of "2"2"6Ra in the proposed waste rock substrate of the rehabilitated landform and corresponded to an above-baseline dose rate of 100 μGy h"−"1 to the most highly exposed individuals of the limiting organism. The limiting organism was reptile based on an assessment using site-specific concentration ratio data. - Highlights: • A soil guideline value for wildlife was derived for a mine rehabilitation situation. • The value was 1000 Bq kg"−"1 of "2"2"6Ra in the rehabilitation substrate. • The value was back-calculated from a benchmark dose rate of 100 μGy h"−"1. • Exposures from "2"2"2Rn and progeny were considered and included. • Use of site-specific concentration ratio data gave lower results than generic data.
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10 CFR 960.3 - Implementation guidelines.
2010-01-01
... 10 Energy 4 2010-01-01 2010-01-01 false Implementation guidelines. 960.3 Section 960.3 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Implementation Guidelines § 960.3 Implementation guidelines. The guidelines of this subpart...
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[The German Program for Disease Management Guidelines: COPD Guideline 2006. Short review].
Ollenschläger, Günter; Kopp, Ina; Lelgemann, Monika
2007-01-15
In Germany, the first national consensus on evidence-based recommendations for COPD prevention and disease management was reached in spring 2006. After a development period of 9 months, the National Disease Management Guideline COPD was finalized by nominal group process under the authorship of the scientific societies for pneumology (DGP and Atemwegsliga), general internal medicine (DGIM), family medicine (DEGAM), and the Drug Commission of the German Medical Association (AKDAE). The recommendations' main sources are the NICE COPD Guideline 2004, the GOLD Recommendations as well as existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline COPD 2006 (www.copd.versorgungsleitlinien.de).
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[Vitamin D supplementation in the elderly: guidelines and practice].
Chel, V G M; Elders, P J M; Tuijp, M L M; van den Berg, H H; van Drongelen, K I; Siedenburg, R C; Ooms, M E; Lips, P T A
2013-01-01
In 2008, the Health Council of the Netherlands published an advice on vitamin D supplementation for the elderly. Nevertheless, suspicion arose at the Ministry of Health, Welfare and Sport and the Netherlands Nutrition Centre that vitamin D supplementation in the elderly is still insufficient. We aimed to determine the extent to which general practitioners and elderly care physicians actually followed the advice of the Health Council. Questionnaire study. Brief questionnaires were sent to all elderly care physicians in the Netherlands. Some questions were also posed to general practitioners at a network meeting of the Academic Network of GP Practices of the VU University Medical Center in Amsterdam. More than two-thirds of the respondents, both elderly care physicians and general practitioners, are familiar with the guidelines of the Health Council of the Netherlands on vitamin D supplementation in the elderly, but about half do not prescribe vitamin D when the guideline advises to do so. When supplementation is prescribed, about half of the elderly care physicians and a fifth of the general practitioners uses an insufficient dose. The guidelines of the Health Council of the Netherlands on vitamin D supplementation in the elderly are not sufficiently followed by elderly care physicians and general practitioners. Awareness of and support for the vitamin D supplementation guidelines among health care providers is still limited.
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Shin, Jeong Eun; Jung, Hye-Kyung; Lee, Tae Hee; Jo, Yunju; Lee, Hyuk; Song, Kyung Ho; Hong, Sung Noh; Lim, Hyun Chul; Lee, Soon Jin; Chung, Soon Sup; Lee, Joon Seong; Rhee, Poong-Lyul; Lee, Kwang Jae; Choi, Suck Chei; Shin, Ein Soon
2016-01-01
The Korean Society of Neurogastroenterology and Motility first published guidelines for chronic constipation in 2005 and was updated in 2011. Although the guidelines were updated using evidence-based process, they lacked multidisciplinary participation and did not include a diagnostic approach for chronic constipation. This article includes guidelines for diagnosis and treatment of chronic constipation to realistically fit the situation in Korea and to be applicable to clinical practice. The guideline development was based upon the adaptation method because research evidence was limited in Korea, and an organized multidisciplinary group carried out systematical literature review and series of evidence-based evaluations. Six guidelines were selected using the Appraisal of Guidelines for Research & Evaluation (AGREE) II process. A total 37 recommendations were adopted, including 4 concerning the definition and risk factors of chronic constipation, 8 regarding diagnoses, and 25 regarding treatments. The guidelines are intended to help primary physicians and general health professionals in clinical practice in Korea, to provide the principles of medical treatment to medical students, residents, and other healthcare professionals, and to help patients for choosing medical services based on the information. These guidelines will be updated and revised periodically to reflect new diagnostic and therapeutic methods. PMID:27226437
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Weidner, Theodore J.
2008-01-01
In 2002, APPA published "Maintenance Staffing Guidelines for Educational Facilities," the first building maintenance trades staffing guideline designed to assist educational facilities professionals with their staffing needs. addresses how facilities professionals can determine the appropriate size and mix of their organization. Contents…
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10 CFR 960.5 - Preclosure guidelines.
2010-01-01
... 10 Energy 4 2010-01-01 2010-01-01 false Preclosure guidelines. 960.5 Section 960.5 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5 Preclosure guidelines. The guidelines in this subpart specify the...
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10 CFR 960.4 - Postclosure guidelines.
2010-01-01
... 10 Energy 4 2010-01-01 2010-01-01 false Postclosure guidelines. 960.4 Section 960.4 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Postclosure Guidelines § 960.4 Postclosure guidelines. The guidelines in this subpart specify the...
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Tabbers, M.M.; Boluyt, N.; Offringa, M.
2010-01-01
There is little experience with the nationwide implementation of an evidence-based pediatric guideline on first-choice fluid for resuscitation in hypovolemia. We investigated fluid prescribing behavior at (1) guideline development, (2) after guideline development, and (3) after active implementation
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RSK-guidelines for PWR reactors
International Nuclear Information System (INIS)
1979-01-01
The RSK guidelines for PWA reactors of April 24, 1974, have been revised and amended in this edition. The RSK presents a summary of safety requirements to be observed in the design, construction, and operation of PWR reactors in the form of guidelines. From January 1979 onwards these guidelines will be the basis of siting and safety considerations for new PWR reactors, and newly built nuclear power plants will have to form these guidelines. They are not binding for existing nuclear power plants under construction or in operation. It will be a matter of individual discussion whether or not the guidelines will be applied in these plants. The main purpose of the guidelines is to facilitate discussion among RSK members and to give early information on necessary safety requirements. If the guidelines are observed by producers and operators, the RSK will make statements on individual projects at short notice. (orig./HP) [de
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International Nuclear Information System (INIS)
Strait, R.S.
1996-01-01
The first phase of the Depleted Uranium Hexafluoride Management Program (Program)--management strategy selection--consists of several program elements: Technology Assessment, Engineering Analysis, Cost Analysis, and preparation of an Environmental Impact Statement (EIS). Cost Analysis will estimate the life-cycle costs associated with each of the long-term management strategy alternatives for depleted uranium hexafluoride (UF6). The scope of Cost Analysis will include all major expenditures, from the planning and design stages through decontamination and decommissioning. The costs will be estimated at a scoping or preconceptual design level and are intended to assist decision makers in comparing alternatives for further consideration. They will not be absolute costs or bid-document costs. The purpose of the Cost Analysis Guidelines is to establish a consistent approach to analyzing of cost alternatives for managing Department of Energy's (DOE's) stocks of depleted uranium hexafluoride (DUF6). The component modules that make up the DUF6 management program differ substantially in operational maintenance, process-options, requirements for R and D, equipment, facilities, regulatory compliance, (O and M), and operations risk. To facilitate a consistent and equitable comparison of costs, the guidelines offer common definitions, assumptions or basis, and limitations integrated with a standard approach to the analysis. Further, the goal is to evaluate total net life-cycle costs and display them in a way that gives DOE the capability to evaluate a variety of overall DUF6 management strategies, including commercial potential. The cost estimates reflect the preconceptual level of the designs. They will be appropriate for distinguishing among management strategies
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Guidelines for the conduction of follow-up studies measuring injury-related disability
van Beeck, Ed F.; Larsen, Claus F.; Lyons, Ronan A.; Meerding, Willem-Jan; Mulder, Saakje; Essink-Bot, Marie-Louise
2007-01-01
BACKGROUND: Scientific knowledge on functional outcome after injury is limited. During the past decade, a variety of measures have been used at various moments in different study populations. Guidelines are needed to increase comparability between studies. METHODS: A working group of the European
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From Clinical Practice Guidelines to Computer-interpretable Guidelines. A Literature Overview
Latoszek-Berendsen, A.; Tange, H.; van den Herik, H. J.; Hasman, A.
2010-01-01
Background: Guidelines are among us for over 30 years. Initially they were used as algorithmic protocols by nurses and other ancillary personnel. Many physicians regarded the use of guidelines as cookbook medicine. However, quality and patient safety issues have changed the attitude towards
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Guidelines for radiological interventions
International Nuclear Information System (INIS)
Kauffmann, G.W.
1998-01-01
The German Radiological Society, in cooperation with other German professional bodies, set up draft Guidelines for Radiological Interventions and submitted them to the professional community for discussion. The Guidelines are meant to assess the potential of radiological interventions as treatment alternatives to surgery or aggressive therapy such as chemotherapy. In fact, technical practicability on its own is insufficient to warrant intervention. The Guidelines are systematically compiled notions and recommendations whose aim it is to provide support to physicians and patients in choosing suitable medical care provisions (prevention, diagnosis, therapy, aftertreatment) in specific circumstances. A complete Czech translation of the Guidelines is given. (P.A.)
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Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years).
Tremblay, Mark S; Leblanc, Allana G; Carson, Valerie; Choquette, Louise; Connor Gorber, Sarah; Dillman, Carrie; Duggan, Mary; Gordon, Mary Jane; Hicks, Audrey; Janssen, Ian; Kho, Michelle E; Latimer-Cheung, Amy E; Leblanc, Claire; Murumets, Kelly; Okely, Anthony D; Reilly, John J; Stearns, Jodie A; Timmons, Brian W; Spence, John C
2012-04-01
The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years). These national guidelines are in response to a call from health and health care professionals, child care providers, and fitness practitioners for guidance on sedentary behaviour in the early years. The guideline development process followed the Appraisal of Guidelines for Research Evaluation (AGREE) II framework. The recommendations are informed by evidence from a systematic review that examined the relationships between sedentary behaviour (predominantly screen time) and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged 900 domestic and international stakeholders, end-users, and key informants. The final guidelines state: for healthy growth and development, caregivers should minimize the time infants (aged spend being sedentary during waking hours. This includes prolonged sitting or being restrained (e.g., stroller, high chair) for more than 1 h at a time. For those under 2 years, screen time (e.g., TV, computer, electronic games) is not recommended. For children 2-4 years, screen time should be limited to under 1 h per day; less is better.
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Implementing guidelines in nursing homes: a systematic review.
Diehl, Heinz; Graverholt, Birgitte; Espehaug, Birgitte; Lund, Hans
2016-07-25
Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROSPERO 2014: CRD42014007664.
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Guidelines for wireless technology in nuclear power plants
International Nuclear Information System (INIS)
Shankar, Ramesh
2003-01-01
As a result of technological breakthroughs, increased demand for the use of wireless technology is common in all industries today, and the electric power industry is no exception. Already, wireless technology has many applications in our industry, including - but not limited to - cellular phone systems, paging systems, two-way radio communication systems, dose management and tracking systems, and operator logs. EPRI has prepared a comprehensive guidelines document to support evaluation of wireless technologies in power plants for integrated (voice/data/video) communication, remote equipment and system monitoring, and to complement an electronic procedures support system (EPSS). The guidelines effort focuses on the development of a rules structure to support the deployment of wireless devices in a plant without compromising continuous, safe, and reliable operation. The guidelines document consists of two volumes. The first volume is introductory in nature and lays out the business case for applying wireless technologies. The intended audience is senior plant management personnel and utility industry executives. This volume contains background information, templates, worksheets, processes, and presentations that will allow internal sponsors to create business cases for piloting wireless projects. The second volume includes guidance on implementation and regulatory issues relevant to plant implementation. It covers the following application areas: implementation of integrated communication capability, equipment monitoring, work quality control, time and knowledge management, and business process automation. It details regulatory issues relevant to the adoption of wireless technology within nuclear power plants and offers guidance on preparing for and executing pilot and implementations of wireless technologies. The paper will cover important aspects on the guidelines. (author)
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International Nuclear Information System (INIS)
Pfob, H.; Heinemann, G.
1992-01-01
Corresponding dose equivalent rate factors for various radionuclides are now available for determining the skin dose caused by skin contamination. These dose equivalent rate factors take into account all contributions from the types of radiation emitted. Any limits for skin decontamination measures are nowhere contained or determined yet. However, radiological protection does in practice require at least guideline values in order to prevent unsuitable or detrimental measures that can be noticed quite often. New calculations of dose equivalent rate factors for the skin now make the recommendation of guideline values possible. (author)
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Japanese Guideline for Atopic Dermatitis 2014
Directory of Open Access Journals (Sweden)
Ichiro Katayama
2014-01-01
The basics of treatment discussed in this guideline are based on the "Guidelines for the Treatment of Atopic Dermatitis 2008" prepared by the Health and Labour Sciences Research and the "Guidelines for the Management of Atopic Dermatitis 2012 (ADGL2012" prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle. The guidelines for the treatment of atopic dermatitis are summarized in the "Japanese Guideline for the Diagnosis and Treatment of Allergic Disease 2013" together with those for other allergic diseases.
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Directory of Open Access Journals (Sweden)
Burgers Jako S
2007-11-01
Full Text Available Abstract Background Dutch guideline-developing organizations do not focus systematically on differences between men and women when developing guidelines, even though there is increasing evidence that being male or female may have an effect on health and health outcomes. In collaboration with two prominent Dutch guideline-developing organizations, we designed a training course to encourage systematic attention to sex differences in guideline development procedures. Methods The course is targeted towards guideline developers. Its aims are to improve awareness concerning the relevance of considering sex differences in the guideline development process, as well as the competence and skills necessary for putting this into practice. The design and teaching methods of the course are based on adult learning styles and principles of changing provider behaviour. It was adjusted to the working methods of guideline organizations. The course was taught to, and evaluated by, a group of staff members from two guideline organizations in the Netherlands. Results The course consists of five modules, each of which corresponds to a key step in the guideline development process. The participants rated the training course positively on content, programme, and trainers. Their written comments suggest that the course met its objectives. Conclusion The training course is the first to address sex differences in guideline development. Results from the pilot test suggest that the course achieved its objectives. Because its modules and teaching methods of the course are widely transferable, the course could be useful for many organizations that are involved in developing guidelines. Follow-up studies are needed to assess the long-term effect of the course on the actions of guideline developers and its utility in other settings.
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[The German Program for Disease Management Guidelines: CHD Guideline 2006. Short review].
Ollenschläger, Günter; Lelgemann, Monika; Kopp, Ina
2006-12-15
In Germany, the first national consensus on evidence-based recommendations for disease management in patients with chronic coronary heart disease was reached in summer 2006. After a development period of 4 years, the National Disease Management Guideline Chronic Coronary Heart Disease was finalized by nominal group process under the authorship of the scientific associations for cardiac rehabilitation (DGPR), cardiac surgery (DGTHG), cardiology (DGK), general internal medicine (DGIM), family medicine (DEGAM), and the Drug Commission of the German Medical Association (AKDAE). The recommendations' main sources are the ACC/AHA guidelines 2002 updates as well as existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline Chronic Coronary Heart Disease 2006 (www.khk.versorgungsleitlinie.de).
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Japanese guidelines for atopic dermatitis 2017
Directory of Open Access Journals (Sweden)
Ichiro Katayama
2017-04-01
The basics of treatment discussed in this guideline are based on the “Guidelines for the Treatment of Atopic Dermatitis 2008” prepared by the Health and Labour Sciences Research and the “Guidelines for the Management of Atopic Dermatitis 2015 (ADGL2015” prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle. The guidelines for the treatment of atopic dermatitis are summarized in the “Japanese Guideline for the Diagnosis and Treatment of Allergic Disease 2016” together with those for other allergic diseases.
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Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).
Stachler, Robert J; Francis, David O; Schwartz, Seth R; Damask, Cecelia C; Digoy, German P; Krouse, Helene J; McCoy, Scott J; Ouellette, Daniel R; Patel, Rita R; Reavis, Charles Charlie W; Smith, Libby J; Smith, Marshall; Strode, Steven W; Woo, Peak; Nnacheta, Lorraine C
2018-03-01
Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include, but are not limited to, recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a
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International Nuclear Information System (INIS)
1988-02-01
The IAEA Operational Safety Review Team (OSART) programme provides advice and assistance to Member States to enhance the operational safety of nuclear power plants. These OSART Guidelines provide overall guidance for the experts to ensure the consistency and comprehensiveness of the operational safety review. Specific guidelines are provided as guide for the systematic review in the following areas important to operational safety: management, organization and administration, training and qualification, operations, maintenance, technical support, radiation protection, chemistry, emergency planning and preparedness
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Approach to DOE threshold guidance limits
International Nuclear Information System (INIS)
Shuman, R.D.; Wickham, L.E.
1984-01-01
The need for less restrictive criteria governing disposal of extremely low-level radioactive waste has long been recognized. The Low-Level Waste Management Program has been directed by the Department of Energy (DOE) to aid in the development of a threshold guidance limit for DOE low-level waste facilities. Project objectives are concernd with the definition of a threshold limit dose and pathway analysis of radionuclide transport within selected exposure scenarios at DOE sites. Results of the pathway analysis will be used to determine waste radionuclide concentration guidelines that meet the defined threshold limit dose. Methods of measurement and verification of concentration limits round out the project's goals. Work on defining a threshold limit dose is nearing completion. Pathway analysis of sanitary landfill operations at the Savannah River Plant and the Idaho National Engineering Laboratory is in progress using the DOSTOMAN computer code. Concentration limit calculations and determination of implementation procedures shall follow completion of the pathways work. 4 references
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Clinical practice guideline: Allergic rhinitis.
Seidman, Michael D; Gurgel, Richard K; Lin, Sandra Y; Schwartz, Seth R; Baroody, Fuad M; Bonner, James R; Dawson, Douglas E; Dykewicz, Mark S; Hackell, Jesse M; Han, Joseph K; Ishman, Stacey L; Krouse, Helene J; Malekzadeh, Sonya; Mims, James Whit W; Omole, Folashade S; Reddy, William D; Wallace, Dana V; Walsh, Sandra A; Warren, Barbara E; Wilson, Meghan N; Nnacheta, Lorraine C
2015-02-01
Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there is considerable variation in their use. This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options. The primary purpose of this guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to manage patients with AR as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with AR. Children under the age of 2 years were excluded from the clinical practice guideline because rhinitis in this population may be different than in older patients and is not informed by the same evidence base. The guideline is intended to focus on a limited number of quality improvement opportunities deemed most important by the working group and is not intended to be a comprehensive reference for diagnosing and managing AR. The recommendations outlined in the guideline are not intended to represent the standard of care for patient management, nor are the recommendations intended to limit treatment or care provided to individual patients. The development group made a strong
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36 CFR 1191.1 - Accessibility guidelines.
2010-07-01
... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Accessibility guidelines... COMPLIANCE BOARD AMERICANS WITH DISABILITIES ACT (ADA) ACCESSIBILITY GUIDELINES FOR BUILDINGS AND FACILITIES; ARCHITECTURAL BARRIERS ACT (ABA) ACCESSIBILITY GUIDELINES § 1191.1 Accessibility guidelines. (a) The...
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Poitras, Stéphane; Avouac, Jérôme; Rossignol, Michel; Avouac, Bernard; Cedraschi, Christine; Nordin, Margareta; Rousseaux, Chantal; Rozenberg, Sylvie; Savarieau, Bernard; Thoumie, Philippe; Valat, Jean-Pierre; Vignon, Éric; Hilliquin, Pascal
2007-01-01
Clinical practice guidelines have been elaborated to summarize evidence related to the management of knee osteoarthritis and to facilitate uptake of evidence-based knowledge by clinicians. The objectives of the present review were summarizing the recommendations of existing guidelines on knee osteoarthritis, and assessing the quality of the guidelines using a standardized and validated instrument – the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Internet medical literature databases from 2001 to 2006 were searched for guidelines, with six guidelines being identified. Thirteen clinician researchers participated in the review. Each reviewer was trained in the AGREE instrument. The guidelines were distributed to four groups of three or four reviewers, each group reviewing one guideline with the exception of one group that reviewed two guidelines. One independent evaluator reviewed all guidelines. All guidelines effectively addressed only a minority of AGREE domains. Clarity/presentation was effectively addressed in three out of six guidelines, scope/purpose and rigour of development in two guidelines, editorial independence in one guideline, and stakeholder involvement and applicability in none. The clinical management recommendation tended to be similar among guidelines, although interventions addressed varied. Acetaminophen was recommended for initial pain treatment, combined with exercise and education. Nonsteroidal anti-inflammatory drugs were recommended if acetaminophen failed to control pain, but cautiously because of gastrointestinal risks. Surgery was recommended in the presence of persistent pain and disability. Education and activity management interventions were superficially addressed in most guidelines. Guideline creators should use the AGREE criteria when developing guidelines. Innovative and effective methods of knowledge translation to health professionals are needed. PMID:18062805
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Abarshi, Ebun; Rietjens, Judith; Robijn, Lenzo; Caraceni, Augusto; Payne, Sheila; Deliens, Luc; Van den Block, Lieve
2017-09-01
Palliative sedation is a highly debated medical practice, particularly regarding its proper use in end-of-life care. Worldwide, guidelines are used to standardise care and regulate this practice. In this review, we identify and compare national/regional clinical practice guidelines on palliative sedation against the European Association for Palliative Care (EAPC) palliative sedation Framework and assess the developmental quality of these guidelines using the Appraisal Guideline Research and Evaluation (AGREE II) instrument. Using the PRISMA criteria, we searched multiple databases (PubMed, CancerLit, CINAHL, Cochrane Library, NHS Evidence and Google Scholar) for relevant guidelines, and selected those written in English, Dutch and Italian; published between January 2000 and March 2016. Of 264 hits, 13 guidelines-Belgium, Canada (3), Ireland, Italy, Japan, the Netherlands, Norway, Spain, Europe, and USA (2) were selected. 8 contained at least 9/10 recommendations published in the EAPC Framework; 9 recommended 'pre-emptive discussion of the potential role of sedation in end-of-life care'; 9 recommended 'nutrition/hydration while performing sedation' and 8 acknowledged the need to 'care for the medical team'. There were striking differences in terminologies used and in life expectancy preceding the practice. Selected guidelines were conceptually similar, comparing closely to the EAPC Framework recommendations, albeit with notable variations. Based on AGREE II, 3 guidelines achieved top scores and could therefore be recommended for use in this context. Also, domains 'scope and purpose' and 'editorial independence' ranked highest and lowest, respectively-underscoring the importance of good reportage at the developmental stage. 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/.
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International Nuclear Information System (INIS)
Yamaguchi-Sekino, Sachiko; Sekino, Masaki; Ueno, Shoogo
2011-01-01
Humans are exposed daily to artificial and naturally occurring magnetic fields that originate from many different sources. We review recent studies that examine the biological effects of and medical applications involving electromagnetic fields, review the properties of static and pulsed electromagnetic fields that affect biological systems, describe the use of a pulsed electromagnetic field in combination with an anticancer agent as an example of a medical application that incorporates an electromagnetic field, and discuss the recently updated safety guidelines for static electromagnetic fields. The most notable modifications to the 2009 International Commission on Non-Ionizing Radiation Protection guidelines are the increased exposure limits, especially for those who work with or near electromagnetic fields (occupational exposure limits). The recommended increases in exposure were determined using recent scientific evidence obtained from animal and human studies. Several studies since the 1994 publication of the guidelines have examined the effects on humans after exposure to high static electromagnetic fields (up to 9.4 tesla), but additional research is needed to ascertain further the safety of strong electromagnetic fields. (author)
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Guidelines on Building Regulations 2008
DEFF Research Database (Denmark)
Thse guidelines clarify and intepret the provisions of the Building Regulations of 2008 (BR08). The Guidelines, which match BR08 in terms of organisation into Parts, are accompanied by the full text of the regulations and the explanatory notes issued by the Danish Enterprise and Construction...... Authority. The Guidelines refer the reader to sources such as relevant standards, instructions and other background material which provides more detailed information. The Guidelines cover the same ground as BR08, including building control regulations, layout, fitting out, structures, fire safety, indoor...... climate, energy consumotion and services. The Guidelines are aimed at all professionals involved in building projects, particularly building design consultants, contractors and municipal application officers....
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Laidsaar-Powell, Rebekah; Butow, Phyllis; Boyle, Frances; Juraskova, Ilona
2018-06-01
Family caregivers can, at times, add complexity to clinical encounters. Difficult family caregivers and dynamics may: derail consultation communication, reduce patient autonomy, and compromise effective clinical care. A paucity of practical strategies guiding effective clinician-family communication exists. This study aimed to develop and evaluate the first comprehensive, evidence-based guidelines (the TRIO guidelines) for oncology physicians and nurses to better manage several complex/challenging situations involving family members. TRIO Guidelines were based on a comprehensive review of literature, relevant guidelines, and feedback from an expert advisory group (n = 10). Draft guidelines underwent two rounds of evaluation via an online Delphi consensus process involving international experts (n = 35). Guidelines incorporate topic areas, strategies, and sub-strategies on managing challenging family involvement (7 topics). Example wording, behaviours and level of evidence are provided. Challenging triadic interactions require skillful navigation, and the TRIO Guidelines provide clear, specific, and evidence-based strategies for clinicians to utilise in these potentially stressful encounters. Training based on these guidelines may improve both patient care and clinician confidence. Implementation of these guidelines into medical/nursing curricula and as a component of continuing professional development programs will likely be highly beneficial. Copyright © 2018 Elsevier B.V. All rights reserved.
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Energy Technology Data Exchange (ETDEWEB)
Hellman, Mats [Hellman Vatten AB, Haegersten (Sweden)
2006-02-15
The project summons a revision of the Swedish Cycle Chemistry Guidelines with the purpose to create guidelines that are more explicit and thereby easier to adapt to in daily operations. The objective in general has not been to tighten the limiting values; some are stricter but some others are less strict. The boilers of today are usually fed with demineralised water as make-up water which has been reflected in the guidelines. In this project consideration has been taken upon the fact that many boilers, mostly industrial, have been in operation for many years according to old guidelines, without problems. In these cases the boilers may very well continue to operate without any costly reinvestments due to the new guidelines. The most important revisions in the guidelines are: Action levels have been introduced for the core parameters in the water-steam cycle. With action levels the operators will have some guidance to correct deviations in the cycle chemistry. The action levels are progressive in the sense that the more serious deviation from the guidelines, the shorter time to correct the problem. Guidelines for boilers up to 6.0 MPa operating on softened make-up water have been adjusted slightly and introduced with action levels. New guidelines for boilers with demineralised make-up water have been compiled. Within the project group there is a consensus that demineralised make-up water is preferable even for low pressure boilers. Varying chemistry regimes are used in the industry today. This report gives guidelines for the three dominating in Sweden; All Volatile Treatment (AVT), Caustic Treatment and Phosphate Treatment. Cation conductivity is a core parameter for supervision of steam quality for turbine operation, and in all international guidelines cation conductivity is included. However, the cation conductivity can rise above limits if organic dosing agents are used. This may be accepted as long as the pH-value is within the specifications and it can be shown
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DEFF Research Database (Denmark)
Rovira, Àlex; Wattjes, Mike P; Tintoré, Mar
2015-01-01
diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal...
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Guidelines for reporting health economic research.
Haddad, F S; McLawhorn, A S
2016-02-01
Health economic evaluations potentially provide valuable information to clinicians, health care administrators, and policy makers regarding the financial implications of decisions about the care of patients. The highest quality research should be used to inform decisions that have direct impact on the access to care and the outcome of treatment. However, economic analyses are often complex and use research methods which are relatively unfamiliar to clinicians. Furthermore, health economic data have substantial national, regional, and institutional variability, which can limit the external validity of the results of a study. Therefore, minimum guidelines that aim to standardise the quality and transparency of reporting health economic research have been developed, and instruments are available to assist in the assessment of its quality and the interpretation of results. The purpose of this editorial is to discuss the principal types of health economic studies, to review the most common instruments for judging the quality of these studies and to describe current reporting guidelines. Recommendations for the submission of these types of studies to The Bone & Joint Journal are provided. Cite this article: Bone Joint J 2016;98-B:147-51. ©2016 The British Editorial Society of Bone & Joint Surgery.
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Adopting preoperative fasting guidelines.
Anderson, Megan; Comrie, Rhonda
2009-07-01
In 1999, the American Society of Anesthesiologists adopted preoperative fasting guidelines to enhance the quality and efficiency of patient care. Guidelines suggest that healthy, non-pregnant patients should fast six hours from solids and two hours from liquids. Although these guidelines are in place, studies suggest that providers are still using the blanket statement "NPO after midnight" without regard to patient characteristics, the procedure, or the time of the procedure. Using theory to help change provider's beliefs may help make change more successful. Rogers' Theory of Diffusion of Innovations can assist in changing long-time practice by laying the groundwork for an analysis of the benefits and disadvantages of proposed changes, such as changes to fasting orders, while helping initiate local protocols instead of additional national guidelines.
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Evidence based guidelines for complex regional pain syndrome type 1
Directory of Open Access Journals (Sweden)
Thomassen-Hilgersom Ilona L
2010-03-01
Full Text Available Abstract Background Treatment of complex regional pain syndrome type I (CRPS-I is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. Method A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment. Results For pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I. Conclusions Based on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines.
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Revised guidelines for good practice in IVF laboratories (2015).
De los Santos, Maria José; Apter, Susanna; Coticchio, Giovanni; Debrock, Sophie; Lundin, Kersti; Plancha, Carlos E; Prados, Fernando; Rienzi, Laura; Verheyen, Greta; Woodward, Bryan; Vermeulen, Nathalie
2016-04-01
Which recommendations can be provided by the European Society of Human Reproduction and Embryology Special Interest Group (ESHRE SIG) Embryology to support laboratory specialists in the organization and management of IVF laboratories and the optimization of IVF patient care? Structured in 13 sections, the guideline development group formulated recommendations for good practice in the organization and management of IVF laboratories, and for good practice of the specific procedures performed within the IVF laboratory. NA. The guideline was produced by a group of 10 embryologists representing different European countries, settings and levels of expertise. The group evaluated the document of 2008, and based on this assessment, each group member rewrote one or more sections. Two 2-day meetings were organized during which each of the recommendations was discussed and rewritten until consensus within the guideline group was reached. After finalizing the draft, the members of the ESHRE SIG embryology were invited to review the guideline. NA. The guideline provides recommendations on the general organization of an IVF laboratory (staffing and direction, quality management, laboratory safety), and on the specific aspects of the procedures performed in IVF laboratories (Identification of patients and traceability of their reproductive cells, consumables, handling of biological material, oocyte retrieval, sperm preparation, insemination of oocytes, scoring for fertilization, embryo culture and transfer, and cryopreservation). A last section provides recommendations regarding an Emergency plan for IVF laboratories. Evidence on most of the issues described is scarce, and therefore it was decided not to perform a formal search for and assessment of scientific evidence. However, recommendations published in the EUTCD and relevant and recent documents, manuals and consensus papers were taken into account when formulating the recommendations. Despite the limitations, the guideline
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South African Guidelines Excellence (SAGE): Adopt, adapt, or contextualise?
Dizon, J M; Grimmer, K; Louw, Q; Kredo, T; Young, T; Machingaidze, S
2016-01-01
Clinical practice guideline (CPG) activities must be planned carefully for efficient use of available resources and evidence-based implementation. De novo development of CPGs may sometimes 'recreate the wheel' and delay implementation. Three innovative alternatives to de novo CPG development (adopt, contextualise or adapt) are outlined, which have greater potential than de novo development to best use the limited available resources, personnel and time in settings such as South Africa.
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Evaluation of Industry Relationships Among Authors of Otolaryngology Clinical Practice Guidelines.
Horn, Jarryd; Checketts, Jake Xavier; Jawhar, Omar; Vassar, Matt
2018-03-01
Financial relationships between physicians and industry have influence on patient care. Therefore, organizations producing clinical practice guidelines (CPGs) must have policies limiting financial conflicts during guideline development. To evaluate payments received by physician authors of otolaryngology CPGs, compare disclosure statements for accuracy, and investigate the extent to which the American Academy of Otolaryngology-Head and Neck Surgery complied with standards for guideline development from the Institute of Medicine (IOM). This cross-sectional analysis retrieved CPGs from the American Academy of Otolaryngology-Head and Neck Surgery Foundation that were published or revised from January 1, 2013, through December 31, 2015, by 49 authors. Data were retrieved from December 1 through 31, 2016. Industry payments received by authors were extracted using the Centers for Medicare & Medicaid Services Open Payments database. The values and types of these payments were then evaluated and used to determine whether self-reported disclosure statements were accurate and whether guidelines adhered to applicable IOM standards. The monetary amounts and types of payments received by physicians who author otolaryngology guidelines and the accuracy of disclosure statements. Of the 49 physicians in this sample, 39 (80%) received an industry payment. Twenty-one authors (43%) accepted more than $1000; 12 (24%), more than $10 000; 7 (14%), more than $50 000; and 2 (4%), more than $100 000. Mean (SD) financial payments amounted to $18 431 ($53 459) per physician. Total reimbursement for all authors was $995 282. Disclosure statements disagreed with the Open Payments database for 3 authors, amounting to approximately $20 000 among them. Of the 3 IOM standards assessed, only 1 was consistently enforced. Some CPG authors failed to fully disclose all financial conflicts of interest, and most guideline development panels and chairpersons had conflicts. In addition
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Hoffmann-Eßer, Wiebke; Siering, Ulrich; Neugebauer, Edmund A M; Brockhaus, Anne Catharina; McGauran, Natalie; Eikermann, Michaela
2018-02-27
The AGREE II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within six domains. AGREE II also includes two overall assessments (overall guideline quality, recommendation for use). Our aim was to investigate how strongly the 23 AGREE II items influence the two overall assessments. An online survey of authors of publications on guideline appraisals with AGREE II and guideline users from a German scientific network was conducted between 10th February 2015 and 30th March 2015. Participants were asked to rate the influence of the AGREE II items on a Likert scale (0 = no influence to 5 = very strong influence). The frequencies of responses and their dispersion were presented descriptively. Fifty-eight of the 376 persons contacted (15.4%) participated in the survey and the data of the 51 respondents with prior knowledge of AGREE II were analysed. Items 7-12 of Domain 3 (rigour of development) and both items of Domain 6 (editorial independence) had the strongest influence on the two overall assessments. In addition, Items 15-17 (clarity of presentation) had a strong influence on the recommendation for use. Great variations were shown for the other items. The main limitation of the survey is the low response rate. In guideline appraisals using AGREE II, items representing rigour of guideline development and editorial independence seem to have the strongest influence on the two overall assessments. In order to ensure a transparent approach to reaching the overall assessments, we suggest the inclusion of a recommendation in the AGREE II user manual on how to consider item and domain scores. For instance, the manual could include an a-priori weighting of those items and domains that should have the strongest influence on the two overall assessments. The relevance of these assessments within AGREE II could thereby be further specified.
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2010-07-01
... 32 National Defense 2 2010-07-01 2010-07-01 false Guidelines. 231.11 Section 231.11 National... PROCEDURES GOVERNING BANKS, CREDIT UNIONS AND OTHER FINANCIAL INSTITUTIONS ON DOD INSTALLATIONS Guidelines for Application of the Privacy Act to Financial Institution Operations § 231.11 Guidelines. (a) The...
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Methodological quality of guidelines in gastroenterology.
Malheiro, Rui; de Monteiro-Soares, Matilde; Hassan, Cesare; Dinis-Ribeiro, Mário
2014-06-01
Clinical guidelines are a common feature in modern endoscopy practice and they are being produced faster than ever. However, their methodological quality is rarely assessed. This study evaluated the methodological quality of current clinical guidelines in the field of gastroenterology, with an emphasis on endoscopy. Practice guidelines published by the American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE), British Society of Gastroenterology (BSG), National Institute for Health and Care Excellence (NICE), and the Scottish Intercollegiate Guidelines Network (SIGN) were searched between September and October 2012 and evaluated using the AGREE II (Appraisal of Guidelines for Research and Evaluation) instrument (23 items, scores 1 - 7 for each item; higher scores mean better quality). A total of 100 guidelines were assessed. The mean number of items scoring 6 or 7 per guideline was 9.2 (out of 23 items). Overall, 99 % of guidelines failed to include the target population in the development process, and 96 % did not report facilitators and barriers to guideline application. In addition, 86 % did not include advice or tools, and 94 % did not present monitoring or auditing criteria. The global methodological quality of clinical guidelines in the field of gastroenterology is poor, particularly regarding involvement of the target population in the development of guidelines and in the provision of clear suggestions to practitioners. © Georg Thieme Verlag KG Stuttgart · New York.
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Interoperability Guidelines for Lithuanian E-Learning Management Systems
Directory of Open Access Journals (Sweden)
Eugenijus Kurilovas
2011-08-01
Full Text Available Purpose – the paper aims to analyse e-learning content and repositories along with the problems of learning organisation interoperability. The main objective of the paper is to analyse scientific research results and the newest international experience in the area and to provide interoperability guidelines and recommendations for the implementation of appropriate Lithuanian state programmes. The learning content and repositories recommendations are designed for the implementation of the Lithuanian education portal project as well as Lithuanian Virtual University (LVU programme’s information services’ (LABT / eLABa and e-learning services’ (LieDM sub-programmes. The whole education institution recommendations are designed for the maintenance and development of LVU programme’s management services’ (LieMSIS system.Design/methodology/approach – methods used for the general analysis of proposed interoperability guidelines (reccomendations were bibliographic research and comparative analysis of Lithuanian and foreign scientific works published in periodicals and large-scale EU-funded interoperability projects deliverables. System analysis and comparative analysis methods were used in order to formulate and analyse systems’ interoperability guidelines and recommendations. The author employed the experimental research method while working in the appropriate EU-funded interoperability projects to form the guidelines (recommendations. In order to summarize the results, the evaluative research method was used..Findings – the international guidelines and recommendations presented in the paper could be suitable for implementation while developing Lithuanian state education information systems such as the Lithuanian education portal, the Lithuanian academic libraries’ (eLABa system, the Lithuanian distance learning system (LieDM, and the Lithuanian universities’ management system (LieMSIS.Research limitations/implications – the paper
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Interoperability Guidelines for Lithuanian E-Learning Management Systems
Directory of Open Access Journals (Sweden)
Eugenijus Kurilovas
2013-08-01
Full Text Available Purpose – the paper aims to analyse e-learning content and repositories along with the problems of learning organisation interoperability. The main objective of the paper is to analyse scientific research results and the newest international experience in the area and to provide interoperability guidelines and recommendations for the implementation of appropriate Lithuanian state programmes. The learning content and repositories recommendations are designed for the implementation of the Lithuanian education portal project as well as Lithuanian Virtual University (LVU programme’s information services’ (LABT / eLABa and e-learning services’ (LieDM sub-programmes. The whole education institution recommendations are designed for the maintenance and development of LVU programme’s management services’ (LieMSIS system.Design/methodology/approach – methods used for the general analysis of proposed interoperability guidelines (reccomendations were bibliographic research and comparative analysis of Lithuanian and foreign scientific works published in periodicals and large-scale EU-funded interoperability projects deliverables. System analysis and comparative analysis methods were used in order to formulate and analyse systems’ interoperability guidelines and recommendations. The author employed the experimental research method while working in the appropriate EU-funded interoperability projects to form the guidelines (recommendations. In order to summarize the results, the evaluative research method was used.Findings – the international guidelines and recommendations presented in the paper could be suitable for implementation while developing Lithuanian state education information systems such as the Lithuanian education portal, the Lithuanian academic libraries’ (eLABa system, the Lithuanian distance learning system (LieDM, and the Lithuanian universities’ management system (LieMSIS.Research limitations/implications – the paper
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Guidelines for the medical treatment of idiopathic pulmonary fibrosis.
Xaubet, Antoni; Molina-Molina, María; Acosta, Orlando; Bollo, Elena; Castillo, Diego; Fernández-Fabrellas, Estrella; Rodríguez-Portal, José Antonio; Valenzuela, Claudia; Ancochea, Julio
2017-05-01
Idiopathic pulmonary fibrosis is defined as chronic fibrosing interstitial pneumonia limited to the lung, with poor prognosis. The incidence has been rising in recent years probably due to improved diagnostic methods and increased life expectancy. In 2013, the SEPAR guidelines for the diagnosis and treatment for idiopathic pulmonary fibrosis were published. Since then, clinical trials and meta-analyses have shown strong scientific evidence for the use of pirfenidone and nintedanib in the treatment of idiopathic pulmonary fibrosis. In 2015, the international consensus of 2011 was updated and new therapeutic recommendations were established, prompting us to update our recommendation for the medical treatment of idiopathic pulmonary fibrosis accordingly. Diagnostic aspects and non-pharmacological treatment will not be discussed as no relevant developments have emerged since the 2013 guidelines. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.
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2002-03-01
In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax. The study's aim was to determine the level of adherence to these guidelines at a London teaching hospital. A retrospective case note audit of 59 episodes was performed. In patients undergoing intervention, the initial procedure was simple aspiration in 32 (73 per cent) and chest tube insertion in 12 (27 per cent) cases, contrasting with the BTS recommendation that aspiration should be attempted first in all such patients. Simple aspiration was successful on 34 per cent of occasions. Successful aspiration was associated with a significantly shorter hospital stay (median 3, range 1-11 days) than either failed aspiration (7, 3-66 days) or chest tube insertion without aspiration (9, 3-16 days). Other areas where practice differed from the BTS guidelines were clamping of chest tubes and use of a pursestring suture for wound closure. A follow up questionnaire suggested a lack of familiarity with the guidelines. These findings indicate that current management of spontaneous pneumothorax deviates from the BTS guidelines in potentially important respects.
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Darzi, Andrea; Abou-Jaoude, Elias A; Agarwal, Arnav; Lakis, Chantal; Wiercioch, Wojtek; Santesso, Nancy; Brax, Hneine; El-Jardali, Fadi; Schünemann, Holger J; Akl, Elie A
2017-06-01
Our objective was to identify and describe published frameworks for adaptation of clinical, public health, and health services guidelines. We included reports describing methods of adaptation of guidelines in sufficient detail to allow its reproducibility. We searched Medline and EMBASE databases. We also searched personal files, as well manuals and handbooks of organizations and professional societies that proposed methods of adaptation and adoption of guidelines. We followed standard systematic review methodology. Our search captured 12,021 citations, out of which we identified eight proposed methods of guidelines adaptation: ADAPTE, Adapted ADAPTE, Alberta Ambassador Program adaptation phase, GRADE-ADOLOPMENT, MAGIC, RAPADAPTE, Royal College of Nursing (RCN), and Systematic Guideline Review (SGR). The ADAPTE framework consists of a 24-step process to adapt guidelines to a local context taking into consideration the needs, priorities, legislation, policies, and resources. The Alexandria Center for Evidence-Based Clinical Practice Guidelines updated one of ADAPTE's tools, modified three tools, and added three new ones. In addition, they proposed optionally using three other tools. The Alberta Ambassador Program adaptation phase consists of 11 steps and focused on adapting good-quality guidelines for nonspecific low back pain into local context. GRADE-ADOLOPMENT is an eight-step process based on the GRADE Working Group's Evidence to Decision frameworks and applied in 22 guidelines in the context of national guideline development program. The MAGIC research program developed a five-step adaptation process, informed by ADAPTE and the GRADE approach in the context of adapting thrombosis guidelines. The RAPADAPTE framework consists of 12 steps based on ADAPTE and using synthesized evidence databases, retrospectively derived from the experience of producing a high-quality guideline for the treatment of breast cancer with limited resources in Costa Rica. The RCN outlines
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Schmidt, Anders S; Lauridsen, Kasper G; Adelborg, Kasper; Løfgren, Bo
2016-06-01
This study aimed to investigate cardiopulmonary resuscitation (CPR) guideline implementation and CPR training in hospitals. This nationwide study included mandatory resuscitation protocols from each Danish hospital. Protocols were systematically reviewed for adherence to the European Resuscitation Council (ERC) 2010 guidelines and CPR training in each hospital. Data were included from 45 of 47 hospitals. Adherence to the ERC basic life support (BLS) algorithm was 49%, whereas 63 and 58% of hospitals adhered to the recommended chest compression depth and rate. Adherence to the ERC advanced life support (ALS) algorithm was 81%. Hospital BLS course duration was [median (interquartile range)] 2.3 (1.5-2.5) h, whereas ALS course duration was 4.0 (2.5-8.0) h. Implementation of ERC 2010 guidelines on BLS is limited in Danish hospitals 2 years after guideline publication, whereas the majority of hospitals adhere to the ALS algorithm. CPR training differs among hospitals.
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EAACI Food Allergy and Anaphylaxis Guidelines. Food allergy health-related quality of life measures.
Muraro, A; Dubois, A E J; DunnGalvin, A; Hourihane, J O'B; de Jong, N W; Meyer, R; Panesar, S S; Roberts, G; Salvilla, S; Sheikh, A; Worth, A; Flokstra-de Blok, B M J
2014-07-01
Instruments have been developed and validated for the measurement of health-related quality of life in patients with food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group. It draws on a systematic review of the literature on quality of life instruments for food allergy and the Appraisal of Guidelines for Research & Evaluation (AGREE II) guideline development process. Guidance is provided on the use of such instruments in research, and the current limitations of their use in clinical practice are described. Gaps in current knowledge as well as areas of future interest are also discussed. This document is relevant to healthcare workers dealing with food-allergic patients, scientists engaging in food allergy research and policy makers involved in regulatory aspects concerning food allergy and safety. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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36 CFR 910.67 - Square guidelines.
2010-07-01
... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Square guidelines. 910.67... GUIDELINES AND UNIFORM STANDARDS FOR URBAN PLANNING AND DESIGN OF DEVELOPMENT WITHIN THE PENNSYLVANIA AVENUE DEVELOPMENT AREA Glossary of Terms § 910.67 Square guidelines. Square Guidelines establish the Corporation's...
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28 CFR 2.36 - Rescission guidelines.
2010-07-01
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Rescission guidelines. 2.36 Section 2.36... guidelines. (a) The following guidelines shall apply to the sanctioning of disciplinary infractions or new... such period of confinement has resulted from initial parole to a detainer). These guidelines specify...
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Barrow, Paul
2016-09-01
SWOT analysis was used to gain insights and perspectives into the revision of the ICH S5(R2) guideline on detection of toxicity to reproduction for medicinal products. The current ICH guideline was rapidly adopted worldwide and has an excellent safety record for more than 20 years. The revised guideline should aim to further improve reproductive and developmental (DART) safety testing for new drugs. Alternative methods to animal experiments should be used whenever possible. Modern technology should be used to obtain high quality data from fewer animals. Additions to the guideline should include considerations on the following: limit dose setting, maternal toxicity, biopharmaceuticals, vaccines, testing strategies by indication, developmental immunotoxicity, and male-mediated developmental toxicity. Emerging issues, such as epigenetics and the microbiome, will most likely pose challenges to DART testing in the future. It is hoped that the new guideline will be adopted even outside the ICH regions. Copyright © 2016 Elsevier Inc. All rights reserved.
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Potential facilitators and barriers to adopting standard treatment guidelines in clinical practice.
Sharma, Sangeeta; Pandit, Ajay; Tabassum, Fauzia
2017-04-18
Purpose The purpose of this paper is to assess medicines information sources accessed by clinicians, if sources differed in theory and practice and to find out the barriers and facilitators to effective guideline adoption. Design/methodology/approach In all, 183 doctors were surveyed. Barriers and facilitators were classified as: communication; potential adopters; innovation; organization characteristics and environmental/social/economic context. Findings Most of the clinicians accessed multiple information sources including standard treatment guidelines, but also consulted seniors/colleagues in practice. The top three factors influencing clinical practice guideline adoption were innovation characteristics, environmental context and individual characteristics. The respondents differed in the following areas: concerns about flexibility offered by the guideline; denying patients' individuality; professional autonomy; insights into gaps in current practice and evidence-based practice; changing practices with little or no benefit. Barriers included negative staff attitudes/beliefs, guideline integration into organizational structures/processes, time/resource constraints. Fearing third parties (government and insurance companies) restricting medicines reimbursement and poor liability protection offered by the guidelines emerged as the barriers. Facilitators include aligning organizational structures/processes with the innovation; providing leadership support to guide diffusion; increasing awareness and enabling early innovation during pre/in-service training, with regular feedback on outcomes and use. Practical implications Guideline adoption in clinical practice is partly within doctors' control. There are other key prevailing factors in the local context such as environmental, social context, professional and organizational culture affecting its adoption. Organizational policy and accreditation standards necessitating adherence can serve as a driver. Originality
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2010-04-01
... 23 Highways 1 2010-04-01 2010-04-01 false Guidelines. 650.211 Section 650.211 Highways FEDERAL..., STRUCTURES, AND HYDRAULICS Erosion and Sediment Control on Highway Construction Projects § 650.211 Guidelines. (a) The FHWA adopts the AASHTO Highway Drainage Guidelines, Volume III, “Erosion and Sediment Control...
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2010-01-01
... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Guidelines. 1170.4 Section 1170.4... ADMINISTRATION, DEPARTMENT OF COMMERCE METRIC CONVERSION POLICY FOR FEDERAL AGENCIES § 1170.4 Guidelines. Each... agency actions, activities or programs undertaken in compliance with these guidelines or other laws or...
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ESUR prostate MR guidelines 2012
DEFF Research Database (Denmark)
Barentsz, Jelle O; Richenberg, Jonathan; Clements, Richard
2012-01-01
The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated......, but a compromise, reflected by "minimal" and "optimal" requirements has been made. The scope of these ESUR guidelines is to promulgate high quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines...... provides guidelines for magnetic resonance imaging (MRI) in prostate cancer. Clinical indications, and minimal and optimal imaging acquisition protocols are provided. A structured reporting system (PI-RADS) is described....
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Guidelines for Stretch Flanging Advanced High Strength Steels
International Nuclear Information System (INIS)
Sriram, S.; Chintamani, J.
2005-01-01
Advanced High Strength Steels (AHSS) are currently being considered for use in closure and structural panels in the automotive industry because of their high potential for affordable weight reduction and improved performance. AHSS such as dual phase steels are currently being used in some vehicle platforms. From a manufacturing perspective, stretch flanging during stamping is an important deformation mode requiring careful consideration of geometry and the die process. This paper presents some geometric and process guidelines for stretch flanging AHSS. Hole expansion experiments were conducted to determine the failure limit for a sheared edge condition. Effects of punching clearance, prestrain and prior strain path on hole expansion were explored in these experiments. In addition, dynamic explicit FE calculations using LS-DYNA were also conducted for a typical stretch flange by varying some key geometric parameters. The experimental and FEA results were then analyzed to yield process and geometric guidelines to enable successful stretch flanging of AHSS
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Guidelines for District Heating Substations
Energy Technology Data Exchange (ETDEWEB)
2009-07-15
The present guidelines contain a set of recommendations focusing on planning, installation, use and maintenance of district heating (DH) substations within district heating systems throughout Europe. The recommendations were developed in order to enable readers to develop well-functioning substations and an effective heat and domestic warm water delivery. These guidelines are intended to give the most effective overall solutions for various parts of the customer installation. The guidelines are not meant to specify the different components of the substation such as meters or heat exchangers. The guidelines deal with a wide variety of issues concerning both present systems of today and district heating systems of the future. Specific handling and maintenance recommendations are mainly focused on present modern systems but are also intended to cover the future situation as much as is feasible. For this reason, certain existing systems are not dealt with in these guidelines. For instance, these guidelines do not cover steam systems, systems with temperatures exceeding 110 deg C and pressure levels above 1.6 MPa. The guidelines include a chapter on the heat meter, as the meter and especially the meter installation is always installed simultaneously with the rest of the substation. These guidelines aim to provide best-practice and easy-to-handle recommendations for: - those who are responsible for relations between district heating utilities and customers; - those who own or maintain a building connected to the district heating network; - those who manufacture, plan, purchase, test and install substations. These guidelines do not deal with investment or cost aspects, but in general, Euroheat and Power recommends looking at the lifetime cost of all components of the substation, instead of investment costs alone. An example of this is provided in Chapter 7.8. The Guidelines were developed based on the most optimal operating principles of substations and meters
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Guidelines warfare over interventional techniques: is there a lack of discourse or straw man?
Manchikanti, Laxmaiah; Benyamin, Ramsin M; Falco, Frank J E; Caraway, David L; Datta, Sukdeb; Hirsch, Joshua A
2012-01-01
Guideline development seems to have lost some of its grounding as a medical science. At their best, guidelines should be a constructive response to assist practicing physicians in applying the exponentially expanding body of medical knowledge. In fact, guideline development seems to be evolving into a cottage industry with multiple, frequently discordant guidance on the same subject. Evidence Based Medicine does not always provide for conclusive opinions. With competing interests of payers, practitioners, health policy makers, and third parties benefiting from development of the guidelines as cost saving measures, guideline preparation has been described as based on pre-possession, vagary, rationalization, or congeniality of conclusion. Beyond legitimate differences in opinions regarding the evidence that could yield different guidelines there are potentials for conflicts of interest and various other issues play a major role in guideline development. As is always the case, conflicts of interest in guideline preparation must be evaluated and considered. Following the development of American Pain Society (APS) guidelines there has been an uproar in interventional pain management communities on various issues related to not only the evidence synthesis, but conflicts of interest. A recent manuscript published by Chou et al, in addition to previous publications, appears to have limited clinician involvement in the development of APS guidelines, and demonstrates some of these challenges clearly. This manuscript illustrates the deficiencies of Chou et al's criticisms, and demonstrates their significant conflicts of interest, and use a lack of appropriate evaluations in interventional pain management as a straw man to support their argument. Further, this review will attempt to demonstrate that excessive focus on this straw man has inhibited critique of what we believe to be flaws in the approach.
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2010-07-01
... 32 National Defense 1 2010-07-01 2010-07-01 false Guidelines. 143.8 Section 143.8 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN DOD POLICY ON... BARGAINING § 143.8 Guidelines. The guidelines for making certain factual determinations are as follows: (a...
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Did the American Academy of Orthopaedic Surgeons osteoarthritis guidelines miss the mark?
Bannuru, Raveendhara R; Vaysbrot, Elizaveta E; McIntyre, Louis F
2014-01-01
The American Academy of Orthopaedic Surgeons (AAOS) 2013 guidelines for knee osteoarthritis recommended against the use of viscosupplementation for failing to meet the criterion of minimum clinically important improvement (MCII). However, the AAOS's methodology contained numerous flaws in obtaining, displaying, and interpreting MCII-based results. The current state of research on MCII allows it to be used only as a supplementary instrument, not a basis for clinical decision making. The AAOS guidelines should reflect this consideration in their recommendations to avoid condemning potentially viable treatments in the context of limited available alternatives. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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Transparent Guideline Methodology Needed
DEFF Research Database (Denmark)
Lidal, Ingeborg; Norén, Camilla; Mäkelä, Marjukka
2013-01-01
As part of learning at the Nordic Workshop of Evidence-based Medicine, we have read with interest the practice guidelines for central venous access, published in your Journal in 2012.1 We appraised the quality of this guideline using the checklist developed by The Evidence-Based Medicine Working ...... are based on best currently available evidence. Our concerns are in two main categories: the rigor of development, including methodology of searching, evaluating, and combining the evidence; and editorial independence, including funding and possible conflicts of interest....... Group.2 Similar criteria for guideline quality have been suggested elsewhere.3 Our conclusion was that this much needed guideline is currently unclear about several aspects of the methodology used in developing the recommendations. This means potential users cannot be certain that the recommendations...
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Richter-Sundberg, Linda; Kardakis, Therese; Weinehall, Lars; Garvare, Rickard; Nyström, Monica E
2015-01-22
Many of the world's life threatening diseases (e.g. cancer, heart disease, stroke) could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines. Seven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework. The study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues. This case study
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International Nuclear Information System (INIS)
Cooper, M.B.
1998-01-01
Full text: The World Health Organisation has developed international guidelines for drinking water quality which define acceptable levels of contaminants including radionuclides. These guidelines were the basis for the recent Australian water quality guidelines developed by the National Health and Medical Research Council in conjunction with the Agriculture and Resource Management Council of Australia and New Zealand. This paper highlights some of the practical problems in applying the guidelines in the assessment of groundwater supplies in Australia where the radium content of the water may be significant and the presence of other dissolved minerals can create difficulties in the analytical procedures. Generally, screening methods are based on the determination of gross alpha and beta radioactivity and the limitations of these techniques are discussed. The issue is also addressed as to the appropriate actions in the event of guideline values for specific radionuclides being exceeded
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Guidelines for health technology assessment in Thailand (second edition)--the development process.
Chaikledkaew, Usa; Kittrongsiri, Kankamon
2014-05-01
The first Thai-specific HTA guidelines were completed in 2008 with the aim of ensuring that all HTA data was accurate, of high quality, and relevant for making decisions pertaining to healthcare resource allocation. Based on a quality assessment of 89 economic evaluation studies in the Thai context published in international academic journals between 1982 and 2012, the analysis revealed a significant increase in quality of data sources and result reporting in studies published after the dissemination of the first Thai HTA guidelines. As the first Thai HTA guidelines were developed in 2008, a number of areas for improvement have been identified. Therefore, the objective of this chapter is to describe the development process of this second edition of HTA guidelines for Thailand which builds on the success of the first edition, while attempting to address some of the identified limitations of the first edition and reflect the changes that the health care and policy contexts have undergone in the intervening years. It is hoped that this second edition will continue to build on these successes so that policy decision making becomes increasingly evidence-based.
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Interim guidelines on performance constraints for nuclear waste disposal in crystalline rock
International Nuclear Information System (INIS)
1984-01-01
Performance constraint guidelines have been developed for geologic disposal of nuclear waste in crystalline rock. The approach taken in defining these guidelines was to consider the thermal, thermomechanical, and thermochemical behavior for three regions (very-near field, near field, and far field) of the repository during three time periods (operational, containment, and isolation) associated with the disposal system. Limits are proposed to ensure compliance with the current repository criteria proposed by the United States Nuclear Regulatory Commission (NRC) concerning repository siting and performance assessment. These criteria are: Substantial containment of all radionuclides within the waste package for a period of time between 300 and 1000 years after emplacement. Release rate after loss of containment of one part in 100,000 annually per radionuclide based on the nuclides inventory when the waste package is breached, and in situ ground-water transit time of 1000 years from the repository horizon to the accessible environment, compliance with the performance constraint guidelines presented herein will be required to ensure that the final repository design is in compliance with NRC criteria. The constraint guidelines have also been developed to satisfy the requirement for technical conservatism. 40 refs., 14 figs., 4 tabs
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Sprague, Debra J; Vinson, Daniel C
2017-01-01
Effective intervention for risky drinking requires that clinicians and patients know low-risk daily and weekly guidelines and what constitutes a "standard drink." The authors hypothesized that most patients lack this knowledge, and that education is required. Following primary care visits, patients completed anonymous exit questionnaires that included the 3 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions, "How many drinks (containing alcohol) can you safely have in one day?" and questions about size, in ounces, of a standard drink of wine, beer, and liquor. Descriptive analyses were done in Stata. Of 1,331 respondents (60% female, mean age: 49.6, SD = 17.5), 21% screened positive on the AUDIT-C for risky drinking. Only 10% of those accurately estimated daily low-risk limits, with 9% accurate on weekly limits, and half estimated low-risk limits at or below guidelines. Fewer than half who checked "Yes" to "Do you know what a 'standard drink' is?" provided accurate answers for beer, wine, or liquor. Patients with a positive screen were twice as likely to say they knew what a standard drink is, but only a third gave accurate estimates. When asked about plans in the next month regarding change in drinking behavior, 23% with a positive AUDIT-C indicated they were at least considering a change. Most patients in primary care don't know specifics of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for low-risk drinking. Exploring patient perceptions of low-risk guidelines and current drinking behavior may reveal discrepancies worth discussing. For risky drinkers, most of whom don't know daily and weekly low-risk guidelines or standard drink sizes, education can be vital in intervening. Findings suggest the need for detailed and explicit social marketing and communication on exactly what low-risk drinking entails.
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Directory of Open Access Journals (Sweden)
Riccardo Crebelli
2012-12-01
Full Text Available Metal contaminants in drinking water represent a relevant health issue in several areas of the world. In Italy, because of the geological features of the territory, high arsenic and vanadium are frequently reported in ground waters in concentrations above current guideline values. The implications for public health of the presence of contaminants above their legal limit are directly related to the biological basis of the guideline value. In the case of arsenic there are still major uncertainties in the mechanism of carcinogenesis which prevent a precise evaluation of long-term risks. Thus, the guideline value endorsed in the European Community (10 µg/L has to be considered as a pragmatic tool rather than a quality objective, bearing in mind that "every effort should be made to keep concentrations as low as reasonably possible" (WHO, 2011. A reverse situation holds for vanadium, for which a strict national limit (50 µg/L was previously proposed in consideration of data gaps, and for which new evidence indicated a less stringent health-based limit.
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Reactions on Twitter to updated alcohol guidelines in the UK: a content analysis.
Stautz, Kaidy; Bignardi, Giacomo; Hollands, Gareth J; Marteau, Theresa M
2017-02-28
In January 2016, the 4 UK Chief Medical Officers released a public consultation regarding updated guidelines for low-risk alcohol consumption. This study aimed to assess responses to the updated guidelines using comments made on Twitter. Tweets containing the hashtag #alcoholguidelines made during 1 week following the announcement of the updated guidelines were retrieved using the Twitter Archiver tool. The source, sentiment and themes of the tweets were categorised using manual content analysis. A total of 3061 tweets was retrieved. 6 sources were identified, the most prominent being members of the public. Of 821 tweets expressing sentiment specifically towards the guidelines, 80% expressed a negative sentiment. 11 themes were identified, 3 of which were broadly supportive of the guidelines, 7 broadly unsupportive and 1 neutral. Overall, more tweets were unsupportive (49%) than supportive (44%). While the most common theme overall was sharing information, the most common in tweets from members of the public encouraged alcohol consumption (15%) or expressed disagreement with the guidelines (14%), reflecting reactance, resistance and misunderstanding. This descriptive analysis revealed a number of themes present in unsupportive comments towards the updated UK alcohol guidelines among a largely proalcohol community. An understanding of these may help to tailor effective communication of alcohol and health-related policies, and could inform a more dynamic approach to health communication via social media. 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/.
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Guideline for penetrant testing on welds by indirect visual test
International Nuclear Information System (INIS)
Tanaka, Isao; Taguchi, Tetsuo; Asano, Toshio; Sakai, Kaoru; Sato, Takemitsu; Takagi, Mikio
1999-01-01
A study of guidelines for penetrant testing on welds by indirect visual test using image processing is presented. Due to penetrant testing regulations by direct visual test, a porosity (a round defect) whose diameter is under 1.0 mm is allowed, but no crack (a line-shaped defect) is allowed, and the allowable defect size is not clear. It was found in the investigation that the smallest line-shaped indication which the inspectors could recognize was 0.15 mm in width and 0.5 mm in length. This means that the limit of line pair which all inspectors could discriminate was 3.3. A TV camera was used to take pictures of the NSIT (National Institute of Standards and Technology) (NBS: National Bureau of Standard) resolution chart and the smallest indication above, and the limit of line pair which all inspectors could discriminate was 3.6. Therefore, it is recommended as a guideline for penetrant testing through a TV camera by indirect visual test that the resolution of 3.6 line pair per mm is required and a reference test piece be defined to assure the resolution. (author)
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Guideline for penetrant testing on welds by indirect visual test
Energy Technology Data Exchange (ETDEWEB)
Tanaka, Isao; Taguchi, Tetsuo [Hitachi Ltd., Ibaraki (Japan). Hitachi Works; Asano, Toshio; Sakai, Kaoru; Sato, Takemitsu; Takagi, Mikio
1999-07-01
A study of guidelines for penetrant testing on welds by indirect visual test using image processing is presented. Due to penetrant testing regulations by direct visual test, a porosity (a round defect) whose diameter is under 1.0 mm is allowed, but no crack (a line-shaped defect) is allowed, and the allowable defect size is not clear. It was found in the investigation that the smallest line-shaped indication which the inspectors could recognize was 0.15 mm in width and 0.5 mm in length. This means that the limit of line pair which all inspectors could discriminate was 3.3. A TV camera was used to take pictures of the NSIT (National Institute of Standards and Technology) (NBS: National Bureau of Standard) resolution chart and the smallest indication above, and the limit of line pair which all inspectors could discriminate was 3.6. Therefore, it is recommended as a guideline for penetrant testing through a TV camera by indirect visual test that the resolution of 3.6 line pair per mm is required and a reference test piece be defined to assure the resolution. (author)
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Hoelzer, S; Schweiger, R K; Boettcher, H A; Tafazzoli, A G; Dudeck, J
2001-01-01
The purpose of guidelines in clinical practice is to improve the effectiveness and efficiency of clinical care. It is known that nationally or internationally produced guidelines which, in particular, do not involve medical processes at the time of consultation, do not take local factors into account, and have no consistent implementation strategy, have limited impact in changing either the behaviour of physicians, or patterns of care. The literature provides evidence for the effectiveness of computerization of CPGs for increasing compliance and improving patient outcomes. Probably the most effective concepts are knowledge-based functions for decision support or monitoring that are integrated in clinical information systems. This approach is mostly restricted by the effort required for development and maintenance of the information systems and the limited number of implemented medical rules. Most of the guidelines are text-based, and are primarily published in medical journals and posted on the internet. However, internet-published guidelines have little impact on the behaviour of physicians. It can be difficult and time-consuming to browse the internet to find (a) the correct guidelines to an existing diagnosis and (b) and adequate recommendation for a specific clinical problem. Our objective is to provide a web-based guideline service that takes as input clinical data on a particular patient and returns as output a customizable set of recommendations regarding diagnosis and treatment. Information in healthcare is to a very large extent transmitted and stored as unstructured or slightly structured text such as discharge letters, reports, forms, etc. The same applies for facilities containing medical information resources for clinical purposes and research such as text books, articles, guidelines, etc. Physicians are used to obtaining information from text-based sources. Since most guidelines are text-based, it would be practical to use a document-based solution
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Deriving guidelines for the design of plate evaporators in heat pumps using zeotropic mixtures
DEFF Research Database (Denmark)
Mancini, Roberta; Zühlsdorf, Benjamin; Jensen, Jonas Kjær
2018-01-01
This paper presents a derivation of design guidelines for plate heat exchangers used for evaporation of zeotropic mixtures in heat pumps. A mapping of combined heat exchanger and cycle calculations for different combinations of geometrical parameters and working fluids allowed estimating the trade....... It was found that the pressure drop limit leading to infeasible designs was dependent on the working fluid, thereby making it impossible to define a guideline based on maximum allowable pressure drops. It was found that economically feasible designs could be obtained by correlating the vapour Reynolds number...
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Gastrectomy with limited surgery for elderly patients with gastric cancer
Directory of Open Access Journals (Sweden)
Koji Mikami
2018-01-01
Conclusion: Gastrectomy according to the gastric treatment guidelines for elderly patients with gastric cancer is recommended. Elderly male patients with poor nutrition have poor prognosis; prognostic nutrition index <40. Limited surgery is a treatment option for such patients.
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10 CFR 960.4-2 - Technical guidelines.
2010-01-01
... 10 Energy 4 2010-01-01 2010-01-01 false Technical guidelines. 960.4-2 Section 960.4-2 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Postclosure Guidelines § 960.4-2 Technical guidelines. The technical guidelines in this subpart...
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International Variation in Asthma and Bronchiolitis Guidelines.
Bakel, Leigh Anne; Hamid, Jemila; Ewusie, Joycelyne; Liu, Kai; Mussa, Joseph; Straus, Sharon; Parkin, Patricia; Cohen, Eyal
2017-11-01
Guideline recommendations for the same clinical condition may vary. The purpose of this study was to determine the degree of agreement among comparable asthma and bronchiolitis treatment recommendations from guidelines. National and international guidelines were searched by using guideline databases (eg, National Guidelines Clearinghouse: December 16-17, 2014, and January 9, 2015). Guideline recommendations were categorized as (1) recommend, (2) optionally recommend, (3) abstain from recommending, (4) recommend against a treatment, and (5) not addressed by the guideline. The degree of agreement between recommendations was evaluated by using an unweighted and weighted κ score. Pairwise comparisons of the guidelines were evaluated similarly. There were 7 guidelines for asthma and 4 guidelines for bronchiolitis. For asthma, there were 166 recommendation topics, with 69 recommendation topics given in ≥2 guidelines. For bronchiolitis, there were 46 recommendation topics, with 21 recommendation topics provided in ≥2 guidelines. The overall κ for asthma was 0.03, both unweighted (95% confidence interval [CI]: -0.01 to 0.07) and weighted (95% CI: -0.01 to 0.10); for bronchiolitis, it was 0.32 unweighted (95% CI: 0.16 to 0.52) and 0.15 weighted (95% CI: -0.01 to 0.5). Less agreement was found in national and international guidelines for asthma than for bronchiolitis. Additional studies are needed to determine if differences are based on patient preferences and values and economic considerations or if other recommendation-level, guideline-level, and condition-level factors are driving these differences. Copyright © 2017 by the American Academy of Pediatrics.
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Garbayo, Luciana; Stahl, James
2017-03-01
Guidelines orient best practices in medicine, yet, in health care, many real world constraints limit their optimal realization. Since guideline implementation problems are not systematically anticipated, they will be discovered only post facto, in a learning curve period, while the already implemented guideline is tweaked, debugged and adapted. This learning process comes with costs to human health and quality of life. Despite such predictable hazard, the study and modeling of medical guideline implementation is still seldom pursued. In this article we argue that to systematically identify, predict and prevent medical guideline implementation errors is both an epistemic responsibility and an ethical imperative in health care, in order to properly provide beneficence, minimize or avoid harm, show respect for persons, and administer justice. Furthermore, we suggest that implementation knowledge is best achieved technically by providing simulation modeling studies to anticipate the realization of medical guidelines, in multiple contexts, with system and scenario analysis, in its alignment with the emerging field of implementation science and in recognition of learning health systems. It follows from both claims that it is an ethical imperative and an epistemic responsibility to simulate medical guidelines in context to minimize (avoidable) harm in health care, before guideline implementation.
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Surfing the best practice guidelines: national clinical guideline clearinghouse in development.
1997-08-01
The growth in development and usage of clinical guidelines during the last five years has been remarkable. Not only are health care practitioners reaching for what's deemed to be the best in protocols and practice, consumers, too, are looking toward standards and guidelines as they become more educated about the quality and quantity of health care services they should be receiving.
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International Nuclear Information System (INIS)
He Jia; Sun Sun; Bao Cunkuan; Chen Fan; Jiang Dahe
2011-01-01
This research was to evaluate the Technical Guideline (HJ/T130-2003) effectiveness based on data resource from a questionnaire survey and interviews on EIA experts. The result demonstrated that the guideline served mainly as a quality control measure for PEIA products, and only a small proportion of experts considered it effective due to its inconsistency with the newly released Chinese PEIA Regulation (2009) and poor practicability. Current status of SEA implementation in China was also studied in terms of application fields, effectiveness evaluation, and major issues to affect SEA, to conclude that SEA implementation in China is premature, and with limited effectiveness. The major problem was the lack of effective methodologies and technical tools. Recommendations for revising the PEIA Guideline and advices to improving SEA implementation in China were accordingly proposed.
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10 CFR 960.5-2 - Technical guidelines.
2010-01-01
... 10 Energy 4 2010-01-01 2010-01-01 false Technical guidelines. 960.5-2 Section 960.5-2 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5-2 Technical guidelines. The technical guidelines in this subpart set...
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Operability Guidelines For Product Tanker In Heavy Weather In The Adriatic Sea
Directory of Open Access Journals (Sweden)
Mudronja Luka
2014-06-01
Full Text Available This paper presents operability guidelines for seafarers on a product tanker which navigates in the Adriatic Sea during heavy weather. Tanker route starts from the Otranto strait in the south to the island Krk in the north of Adriatic Sea. Heavy weather is caused by south wind called jugo (blowing from E-SE to SS-E, sirocco family. Operability guidelines are given based on an operability criteria platform for presenting ship seakeeping characteristics. Operability criteria considered in this paper are propeller emergence, deck wetness and bow acceleration of a product tanker. Limiting values of mentioned criteria determine sustainable speed. Heavy weather is described by extreme sea state of 7.5 m wave height. Wave spectrum used in this paper is Tabain spectrum which is developed specifically for Adriatic Sea. Seafarer's approach of decisions making in extreme weather is also shown and servers as a guideline for further research of the authors.
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Metric Guidelines Inservice and/or Preservice
Granito, Dolores
1978-01-01
Guidelines are given for designing teacher training for going metric. The guidelines were developed from existing guidelines, journal articles, a survey of colleges, and the detailed reactions of a panel. (MN)
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The appraisal of clinical guidelines in dentistry.
Glenny, Anne-Marie; Worthington, Helen V; Clarkson, Jan E; Esposito, Marco
2009-01-01
To appraise the reported processes involved in the development of published dental guidelines. Electronic databases were searched to identify guidelines making recommendations for any health professional within dentistry. All included guidelines were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. A total of 105 guidelines met the inclusion criteria. The appraised guidelines showed lack of rigour in their development (median score 14.3%; range 0% to 100%). Only 10 (9.5%) were coded as 'strongly recommend' by at least two assessors. If recommendations within clinical guidelines are to be relied upon, the methods used in their development must be explicit and free from bias. When using the AGREE checklist to make decisions on whether or not to implement individual sets of guidelines, the findings of the present assessment reinforce the need for more than two assessors to be included in the appraisal of each set of guidelines.
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Van der Wees, Philip J; Hendriks, Erik J M; Custers, Jan W H; Burgers, Jako S; Dekker, Joost; de Bie, Rob A
2007-11-23
Clinical guidelines are considered important instruments to improve quality in health care. Since 1998 the Royal Dutch Society for Physical Therapy (KNGF) produced evidence-based clinical guidelines, based on a standardized program. New developments in the field of guideline research raised the need to evaluate and update the KNGF guideline program. Purpose of this study is to compare different guideline development programs and review the KNGF guideline program for physical therapy in the Netherlands, in order to update the program. Six international guideline development programs were selected, and the 23 criteria of the AGREE Instrument were used to evaluate the guideline programs. Information about the programs was retrieved from published handbooks of the organizations. Also, the Dutch program for guideline development in physical therapy was evaluated using the AGREE criteria. Further comparison the six guideline programs was carried out using the following elements of the guideline development processes: Structure and organization; Preparation and initiation; Development; Validation; Dissemination and implementation; Evaluation and update. Compliance with the AGREE criteria of the guideline programs was high. Four programs addressed 22 AGREE criteria, and two programs addressed 20 AGREE criteria. The previous Dutch program for guideline development in physical therapy lacked in compliance with the AGREE criteria, meeting only 13 criteria. Further comparison showed that all guideline programs perform systematic literature searches to identify the available evidence. Recommendations are formulated and graded, based on evidence and other relevant factors. It is not clear how decisions in the development process are made. In particular, the process of translating evidence into practice recommendations can be improved. As a result of international developments and consensus, the described processes for developing clinical practice guidelines have much in common
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Ovnat Tamir, Sharon; Shemesh, Shay; Oron, Yahav; Marom, Tal
2017-05-01
Acute otitis media (AOM) is a common childhood disease, with an enormous economic and healthcare-related burden. Guidelines and consensus papers for AOM diagnosis and management were published in many countries. Our objective was to study the differences and similarities between these protocols in developing and developed countries. The keywords: 'acute otitis media' AND 'children' AND ['treatment' or 'management'] AND ['guideline' or 'consensus'] were used in various electronic databases between 1 January 1989 through 31 December 2015. Overall, 99 sources from 62 countries were retrieved: 53 from 22 developed countries, and 46 from 40 developing countries. Representative guidelines from America (the USA, Argentina), Europe (Italy, Moldova), Africa (South Africa, Tanzania, Ethiopia), Asia (Japan, Afghanistan, Sri Lanka),and Oceania (South Australia, Fiji) were compared. Paediatric societies publish guidelines in most developed countries; in developing countries, the Ministry of Health usually initiates guideline formulation. Most guidelines use the same diagnostic criteria and offer watchful waiting in mild-moderate scenarios. Amoxicillin is the suggested first-line antibiotic, whereas options for second-line and third-line therapies vary. Duration of therapy varies and is usually age dependent: 5-7 days for children 2 years in developed countries, while duration and age groups vary greatly in developing countries. Reduction of AOM risk factors is encouraged in developed countries, but rarely in developing countries. Guidelines for AOM from developing and developed countries are similar in many aspects, with variation in specific recommendations, due to local epidemiology and healthcare accessibility. Formulation of regional guidelines may help reduce AOM burden. 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/.
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Guidelines on radiation exposure levels for emergency situations
International Nuclear Information System (INIS)
1992-07-01
This document provides guidelines for establishing occupational exposure levels for undertaking actions in emergency situations resulting from a nuclear accident. There are three categories of exposed persons identifiable in relation to the circumstances under which they receive exposures resulting from an accident: (i) emergency workers exposed while undertaking urgent corrective actions; (ii) workers exposed while undertaking subsequent remedial actions, including countermeasures to protect the public; (iii) persons living in an environment contaminated by a nuclear accident. Although no dose limit can be easily stated for the first category, doses should be kept below 0.5 Sv. For the second category, normal dose limits would apply with a maximum of 0.05 Sv in a given year; however, in some circumstances where a few key experts are required doses up to 0.1 Sv could be permitted. For the third category the approach to be taken is to apply the ICRP's concept of dose constraint - a fraction of the worker's dose limit, but above the public dose limit. (L.L.) (6 refs., tab.)
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Minges, Karl E; Chao, Ariana; Nam, Soohyun; Grey, Margaret; Whittemore, Robin
2015-04-01
Healthy behaviors including limited screen time (ST), high physical activity (PA), and adequate fruits and vegetables consumption (FV) are recommended for adolescents, but it is unclear how gender, race/ethnicity, and weight status relate to these public health guidelines in diverse urban adolescents. Participants (N = 384) were recruited from three public high schools in or near New Haven, Connecticut. Descriptive statistics and logistic regression analyses were conducted. Most adolescents exceeded recommended levels of ST (70.5%) and did not meet guidelines for PA (87.2%) and FV (72.6%). Only 3.5% of the sample met all three guidelines. Boys were more likely to meet guidelines for PA (p differences in meeting ST, PA, or FV guidelines by weight status for the overall sample or when stratified by gender or race/ethnicity. We found alarmingly low levels of healthy behaviors in normal weight and overweight/obese adolescents. © The Author(s) 2014.
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Heins, M.J.; Jong, J.D. de; Spronk, I.; Ho, V.K.; Brink, M.; Korevaar, J.C.
2017-01-01
Background: Guideline adherence remains a challenge in clinical practice, despite guidelines’ ascribed potential to improve patient outcomes. We studied the level of adherence to recommendations from Dutch national cancer treatment guidelines, and the influence of general and
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Weston, Eric B; Aurand, Alexander; Dufour, Jonathan S; Knapik, Gregory G; Marras, William S
2018-06-01
Though biomechanically determined guidelines exist for lifting, existing recommendations for pushing and pulling were developed using a psychophysical approach. The current study aimed to establish objective hand force limits based on the results of a biomechanical assessment of the forces on the lumbar spine during occupational pushing and pulling activities. Sixty-two subjects performed pushing and pulling tasks in a laboratory setting. An electromyography-assisted biomechanical model estimated spinal loads, while hand force and turning torque were measured via hand transducers. Mixed modelling techniques correlated spinal load with hand force or torque throughout a wide range of exposures in order to develop biomechanically determined hand force and torque limits. Exertion type, exertion direction, handle height and their interactions significantly influenced dependent measures of spinal load, hand force and turning torque. The biomechanically determined guidelines presented herein are up to 30% lower than comparable psychophysically derived limits and particularly more protective for straight pushing. Practitioner Summary: This study utilises a biomechanical model to develop objective biomechanically determined push/pull risk limits assessed via hand forces and turning torque. These limits can be up to 30% lower than existing psychophysically determined pushing and pulling recommendations. Practitioners should consider implementing these guidelines in both risk assessment and workplace design moving forward.
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DEFF Research Database (Denmark)
Burcharth, Hans F.; Lamberti, Alberto
The present guidelines are specifically dedicated to Low Crested Structures on attempt to provide methodological tools both for the engineering design of structures and for prediction of performance and environmental impacts. It is anticipated that the guidelines will provide valuable inputs to c...
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Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline
Directory of Open Access Journals (Sweden)
Seth Meyer
2017-11-01
Full Text Available Introduction: Cannabinoid hyperemesis syndrome (CHS is an entity associated with cannabinoid overuse. CHS typically presents with cyclical vomiting, diffuse abdominal pain, and relief with hot showers. Patients often present to the emergency department (ED repeatedly and undergo extensive evaluations including laboratory examination, advanced imaging, and in some cases unnecessary procedures. They are exposed to an array of pharmacologic interventions including opioids that not only lack evidence, but may also be harmful. This paper presents a novel treatment guideline that highlights the identification and diagnosis of CHS and summarizes treatment strategies aimed at resolution of symptoms, avoidance of unnecessary opioids, and ensuring patient safety. Methods: The San Diego Emergency Medicine Oversight Commission in collaboration with the County of San Diego Health and Human Services Agency and San Diego Kaiser Permanente Division of Medical Toxicology created an expert consensus panel to establish a guideline to unite the ED community in the treatment of CHS. Results: Per the consensus guideline, treatment should focus on symptom relief and education on the need for cannabis cessation. Capsaicin is a readily available topical preparation that is reasonable to use as first-line treatment. Antipsychotics including haloperidol and olanzapine have been reported to provide complete symptom relief in limited case studies. Conventional antiemetics including antihistamines, serotonin antagonists, dopamine antagonists and benzodiazepines may have limited effectiveness. Emergency physicians should avoid opioids if the diagnosis of CHS is certain and educate patients that cannabis cessation is the only intervention that will provide complete symptom relief. Conclusion: An expert consensus treatment guideline is provided to assist with diagnosis and appropriate treatment of CHS. Clinicians and public health officials should identity and treat CHS
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Public safety around dams guidelines
Energy Technology Data Exchange (ETDEWEB)
Bennett, T [Canadian Dam Association, Edmonton, AB (Canada)
2010-07-01
This presentation discussed Canadian and international initiatives for improving dam safety and described some of the drivers for the development of new Canadian Dam Association (CDA) public safety guidelines for dams. The CDA guidelines were divided into the following 3 principal sections: (1) managed system elements, (2) risk assessment and management, and (3) technical bulletins. Public and media responses to the drownings have called for improved safety guidelines. While the public remains unaware of the hazards of dams, public interaction with dams is increasing as a result of interest in extreme sports and perceived rights of access. Guidelines are needed for dam owners in order to provide due diligence. Various organizations in Canada are preparing technical and public safety dam guidelines. CDA guidelines have also been prepared for signage, booms and buoys, and audible and visual alerts bulletins. Working groups are also discussing recommended practices for spill procedures, spillways and the role of professional engineers in ensuring public safety. Methods of assessing risk were also reviewed. Managed system elements for risk assessment and public interactions were also discussed, and stepped control measures were presented. tabs., figs.
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Directory of Open Access Journals (Sweden)
Maria Cristina Peñaloza Ramos MA
2016-09-01
Full Text Available Background: Results of previous research have identified the need for further investigation into the compliance with good practice guidelines for current decision-analytic modeling (DAM. Objective: To identify the extent to which recent model-based economic evaluations of interventions focused on lowering the blood pressure (BP of patients with hypertension conform to published guidelines for DAM in health care using a five-dimension framework developed to assess compliance to DAM guidelines. Methods: A systematic review of English language articles was undertaken to identify published model-based economic evaluations that examined interventions aimed at lowering BP. The review covered the period January 2000 to March 2015 and included the following electronic bibliographic databases: EMBASE and Medline via Ovid interface and the Centre for Reviews and Dissemination’s (CRD NHS-EED. Data were extracted based on different components of good practice across five dimensions utilizing a framework to assess compliance to DAM guidelines. Results: Thirteen articles were included in this review. The review found limited compliance to good practice DAM guidelines, which was most frequently justified by the lack of data. Conclusions: The assessment of structural uncertainty cannot yet be considered common practice in primary prevention and management of hypertension, and researchers seem to face difficulties with identifying sources of structural uncertainty and then handling them correctly. Additional guidelines are needed to aid researchers in identifying and managing sources of potential structural uncertainty. Adherence to guidelines is not always possible and it does pose challenges, in particular when there are limitations due to data availability that restrict, for example, a validation process.
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Directory of Open Access Journals (Sweden)
Johnson Lorraine
2010-06-01
Full Text Available Abstract Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA. Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future.
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Joosen, Margot C W; Brouwers, Evelien P M; van Beurden, Karlijn M; Terluin, Berend; Ruotsalainen, Jani H; Woo, Jong-Min; Choi, Kyeong-Sook; Eguchi, Hisashi; Moriguchi, Jiro; van der Klink, Jac J L; van Weeghel, Jaap
2015-05-01
We compared available guidelines on the management of mental disorders and stress-related psychological symptoms in an occupational healthcare setting and determined their development and reporting quality. To identify eligible guidelines, we systematically searched National Guideline Clearinghouse, Guidelines International Network Library and PubMed. Members of the International Commission on Occupational Health (ICOH), were also consulted. Guidelines recommendations were compared and reporting quality was assessed using the AGREE II instrument. Of 2126 titles retrieved, 14 guidelines were included: 1 Japanese, 2 Finnish, 2 Korean, 2 British and 7 Dutch. Four guidelines were of high-reporting quality. Best described was the Scope and Purpose, and the poorest described were competing interests (Editorial independence) and barriers and facilitators for implementation (Applicability). Key recommendations were often difficult to identify. Most guidelines recommend employing an inventory of symptoms, diagnostic classification, performance problems and workplace factors. All guidelines recommend specific return-to-work interventions, and most agreed on psychological treatment and communication between involved stakeholders. Practice guidelines to address work disability due to mental disorders and stress-related symptoms are available in various countries around the world, however, these guidelines are difficult to find. To promote sharing, national guidelines should be accessible via established international databases. The quality of the guideline's developmental process varied considerably. To increase quality and applicability, guideline developers should adopt a common structure for the development and reporting of their guidelines, for example Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. Owing to differences in social systems, developers can learn from each other through reviews of this kind. Published by the BMJ Publishing Group Limited
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Computer-Based CPR Simulation Towards Validation of AHA/ERC Guidelines.
John, Alka Rachel; Manivannan, M; Ramakrishnan, T V
2017-06-01
As per the AHA 2015 and ERC 2015 guidelines for resuscitation, chest compression depth should be between 5 and 6 cm with a rate of 100-120 compressions per minute. Theoretical validation of these guidelines is still elusive. We developed a computer model of the cardiopulmonary resuscitation (CPR) system to validate these guidelines. A lumped element computer model of the cardiovascular system was developed to simulate cardiac arrest and CPR. Cardiac output was compared for a range of compression pressures and frequencies. It was observed from our investigation that there is an optimum compression pressure and rate. The maximum cardiac output occurred at 100 mmHg, which is approximately 5.7 cm, and in the range of 100 to 120 compressions per minute with an optimum value at 110 compressions per minute, validating the guidelines. Increasing the pressure or the depth of compression beyond the optimum, limits the blood flow by depleting the volume in the cardiac chambers and not allowing for an effective stroke volume. Similarly increasing the compression rate beyond the optimum degrades the ability of the chambers to pump blood. The results also bring out the importance of complete recoil of the chest after each compression with more than 400% increase in cardiac output from 90% recoil to 100% recoil. Our simulation predicts that the recommendation to compress harder and faster is not the best counsel as there is an optimum compression pressure and rate for high-quality CPR.
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Directory of Open Access Journals (Sweden)
Burgers Jako S
2007-11-01
Full Text Available Abstract Background Clinical guidelines are considered important instruments to improve quality in health care. Since 1998 the Royal Dutch Society for Physical Therapy (KNGF produced evidence-based clinical guidelines, based on a standardized program. New developments in the field of guideline research raised the need to evaluate and update the KNGF guideline program. Purpose of this study is to compare different guideline development programs and review the KNGF guideline program for physical therapy in the Netherlands, in order to update the program. Method Six international guideline development programs were selected, and the 23 criteria of the AGREE Instrument were used to evaluate the guideline programs. Information about the programs was retrieved from published handbooks of the organizations. Also, the Dutch program for guideline development in physical therapy was evaluated using the AGREE criteria. Further comparison the six guideline programs was carried out using the following elements of the guideline development processes: Structure and organization; Preparation and initiation; Development; Validation; Dissemination and implementation; Evaluation and update. Results Compliance with the AGREE criteria of the guideline programs was high. Four programs addressed 22 AGREE criteria, and two programs addressed 20 AGREE criteria. The previous Dutch program for guideline development in physical therapy lacked in compliance with the AGREE criteria, meeting only 13 criteria. Further comparison showed that all guideline programs perform systematic literature searches to identify the available evidence. Recommendations are formulated and graded, based on evidence and other relevant factors. It is not clear how decisions in the development process are made. In particular, the process of translating evidence into practice recommendations can be improved. Conclusion As a result of international developments and consensus, the described processes
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D'Aurizio, F; Metus, P; Ferrari, A; Caruso, B; Castello, R; Villalta, D; Steffan, A; Gaspardo, K; Pesente, F; Bizzaro, N; Tonutti, E; Valverde, S; Cosma, C; Plebani, M; Tozzoli, R
2017-12-01
In the last two decades, thyroglobulin autoantibodies (TgAb) measurement has progressively switched from marker of thyroid autoimmunity to test associated with thyroglobulin (Tg) to verify the presence or absence of TgAb interference in the follow-up of patients with differentiated thyroid cancer. Of note, TgAb measurement is cumbersome: despite standardization against the International Reference Preparation MRC 65/93, several studies demonstrated high inter-method variability and wide variation in limits of detection and in reference intervals. Taking into account the above considerations, the main aim of the present study was the determination of TgAb upper reference limit (URL), according to the National Academy of Clinical Biochemistry guidelines, through the comparison of eleven commercial automated immunoassay platforms. The sera of 120 healthy males, selected from a population survey in the province of Verona, Italy, were tested for TgAb concentration using eleven IMA applied on as many automated analyzers: AIA-2000 (AIA) and AIA-CL2400 (CL2), Tosoh Bioscience; Architect (ARC), Abbott Diagnostics; Advia Centaur XP (CEN) and Immulite 2000 XPi (IMM), Siemens Healthineers; Cobas 6000 (COB), Roche Diagnostics; Kryptor (KRY), Thermo Fisher Scientific BRAHMS, Liaison XL (LIA), Diasorin; Lumipulse G (LUM), Fujirebio; Maglumi 2000 Plus (MAG), Snibe and Phadia 250 (PHA), Phadia AB, Thermo Fisher Scientific. All assays were performed according to manufacturers' instructions in six different laboratories in Friuli-Venezia Giulia and Veneto regions of Italy [Lab 1 (AIA), Lab 2 (CL2), Lab 3 (ARC, COB and LUM), Lab 4 (CEN, IMM, KRY and MAG), Lab 5 (LIA) and Lab 6 (PHA)]. Since TgAb values were not normally distributed, the experimental URL (e-URL) was established at 97.5 percentile according to the non-parametric method. TgAb e-URLs showed a significant inter-method variability. Considering the same method, e-URL was much lower than that suggested by manufacturers (m
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Parreira, Patrícia C S; Maher, Chris G; Megale, Rodrigo Z; March, Lyn; Ferreira, Manuela L
2017-12-01
of presentation, and applicability. The use of plain radiography or dual-energy X-ray absorptiometry for diagnosis was recommended in two of the four guidelines. Vertebroplasty or kyphoplasty was recommended in three of the four guidelines. The recommendation for bed rest, trunk orthoses, electrical stimulation, and supervised or unsupervised exercise was inconsistent across the included guidelines. The comparison of clinical guidelines for the management of VCF showed that diagnostic and therapeutic recommendations were generally inconsistent. The evidence available to guideline developers was limited in quantity and quality. Greater efforts are needed to improve the quality of the majority of guidelines. Copyright © 2017 Elsevier Inc. All rights reserved.
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MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy
Lalla, Rajesh V.; Bowen, Joanne; Barasch, Andrei; Elting, Linda; Epstein, Joel; Keefe, Dorothy M.; McGuire, Deborah B.; Migliorati, Cesar; Nicolatou-Galitis, Ourania; Peterson, Douglas E.; Raber-Durlacher, Judith E.; Sonis, Stephen T.; Elad, Sharon; Al-Dasooqi, Noor; Brennan, Michael; Gibson, Rachel; Fulton, Janet; Hewson, Ian; Jensen, Siri B.; Logan, Richard; Öhrn, Kerstin E. O.; Sarri, Triantafyllia; Saunders, Deborah; von Bültzingslöwen, Inger; Yarom, Noam
2014-01-01
Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for mucositis.
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MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy
DEFF Research Database (Denmark)
Lalla, Rajesh V; Bowen, Joanne; Barasch, Andrei
2014-01-01
BACKGROUND: Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines ...
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MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy
Lalla, R.V.; Bowen, J.; Barasch, A.; Elting, L.; Epstein, J.; Keefe, D.M.; McGuire, D.B.; Migliorati, C.; Nicolatou-Galitis, O.; Peterson, D.E.; Raber-Durlacher, J.E.; Sonis, S.T.; Elad, S.
2014-01-01
BACKGROUND Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for
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Berger, R
1986-04-30
The Sun article, "Employers finding that AIDS in the workplace is a managerial nightmare" (April 3), did not accurately portray the status of AIDS in the workplace. The AIDS virus, HTLV III, is transmitted by body fluids, primarily semen and blood, and there is no known risk of transmitting the virus by casual contact in the workplace. The Center for Disease Control (CDC) released guidelines for child care workers last August. Guidelines on preventing transmission of AIDS in the workplace were issued by CDC in November 1985. These guidelines specifically discussed health care, personal service, and food service workers. The recommendations were against routine screening. Furthermore, employment should not be restricted on the basis of a positive HTLV III antibody test. A person with HTLV III infection should be exempt from the workplace only if there are circumstances interfering with job performance. In Maryland, the Governor's Task Force on AIDS has gone on record as endorsing CDC guidelines related to employment. Furthermore, the task force condemns discrimination based on the disease AIDS, AIDS Related Complex (ARC), or HTLV III infection. Increasingly AIDS patients are being considered legally disabled and therefore are protected by federal and state laws prohibiting discrimination on the basis of a handicap. Marylanders who are subjected to mandatory HTLV III screening in the workplace, or if discriminated against on the basis of HTLV III inefction, should contact the Maryland Commission on Human Relations, the Maryland Department of Health and Mental Hygiene, or the Health Education Resource Organization (HERO). All 3 of these resources guarantee confidentiality. It is only by employees reporting incidents that a nightmare in the workplace can be avoided in Maryland. full text
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Guidelines for nuclear reactor equipments safety-analysis
International Nuclear Information System (INIS)
1978-01-01
The safety analysis in approving the applications for nuclear reactor constructions (or alterations) is performed by the Committee on Examination of Reactor Safety in accordance with various guidelines prescribed by the Atomic Energy Commission. In addition, the above Committee set forth its own regulations for the safety analysis on common problems among various types of nuclear reactors. This book has collected and edited those guidelines and regulations. It has two parts: Part I includes the guidelines issued to date by the Atomic Energy Commission: and Part II - regulations of the Committee. Part I has collected 8 categories of guidelines which relate to following matters: nuclear reactor sites analysis guidelines and standards for their applications; standard exposure dose of plutonium; nuclear ship operation guidelines; safety design analysis guidelines for light-water type, electricity generating nuclear reactor equipments; safety evaluation guidelines for emergency reactor core cooling system of light-water type power reactors; guidelines for exposure dose target values around light-water type electricity generating nuclear reactor equipments, and guidelines for evaluation of above target values; and meteorological guidelines for the safety analysis of electricity generating nuclear reactor equipments. Part II includes regulations of the Committee concerning - the fuel assembly used in boiling-water type and in pressurized-water type reactors; techniques of reactor core heat designs, etc. in boiling-water reactors; and others
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Technical basis for the CANDU steam generator tube fitness-for-service guidelines
International Nuclear Information System (INIS)
Kozluk, M.J.; Scarth, D.A.; Graham, D.B.
2002-01-01
Active degradation mechanisms in steam generators and preheaters in Canadian CANDU T M generating stations are managed through Steam Generator Programs that incorporate tube inspection, maintenance (cleaning), fitness-for-service assessment, and preventative plugging as part of the overall steam generator management strategy. Steam generator and preheater tubes are inspected in accordance with the CSA Standard CAN/CSA-N285.4-94[l]. When a detected flaw indication does not satisfy the criteria of acceptance by examination, CSA-N285.4-94 permits a fitness-for-service assessment to determine acceptability. In 1999 Ontario Power Generation issued, for trial use, fitness-for-service guidelines for steam generator and preheater tubes in CANDU nuclear power plants. The main objectives of the Fitness-for-Service Guidelines are to provide reasonable assurance that tube structural integrity is maintained, and to provide reasonable assurance that there are adequate margins between estimated accumulated dose and applicable site dose limits. The Fitness-for-Service Guidelines are intended to provide industry-standard acceptance criteria and evaluation procedures for assessing the condition of steam generator and preheater tubes in terms of tube structural integrity, operational leak rate, and consequential leakage during an upset or abnormal event. This paper describes the technical basis for the minimum required safety factors specified in Table IC-1 of the Fitness-for-Service Guidelines and for the flaw models used to develop the flaw stability requirements in the nonmandatory, Appendix C of the Fitness-for-Service Guidelines. (author)
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Directory of Open Access Journals (Sweden)
Silvina Arrossi
2017-10-01
Full Text Available Purpose: To provide resource-stratified (four tiers, evidence-based recommendations on the primary prevention of cervical cancer globally. Methods: The American Society of Clinical Oncology convened a multidisciplinary, multinational panel of oncology, obstetrics/gynecology, public health, cancer control, epidemiology/biostatistics, health economics, behavioral/implementation science, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (consensus ratings group for one round of formal ratings. Results: Existing sets of guidelines from five guideline developers were identified and reviewed; adapted recommendations formed the evidence base. Five systematic reviews, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75%. Recommendations: In all resource settings, two doses of human papillomavirus vaccine are recommended for girls age 9 to 14 years, with an interval of at least 6 months and possibly up to 12 to 15 months. Individuals with HIV positivity should receive three doses. Maximal and enhanced settings: if girls are age ≥ 15 years and received their first dose before age 15 years, they may complete the series; if no doses were received before age 15 years, three doses should be administered; in both scenarios, vaccination may be through age 26 years. Limited and basic settings: if sufficient resources remain after vaccinating girls age 9 to 14 years, girls who received one dose may receive additional doses between age 15 and 26 years. Maximal, enhanced, and limited settings: if ≥ 50% coverage in the priority female target population, sufficient resources, and cost effectiveness, boys may be vaccinated to prevent other noncervical human papillomavirus–related cancers and diseases. Basic settings: vaccinating boys is not recommended
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Arrossi, Silvina; Temin, Sarah; Garland, Suzanne; Eckert, Linda O'Neal; Bhatla, Neerja; Castellsagué, Xavier; Alkaff, Sharifa Ezat; Felder, Tamika; Hammouda, Doudja; Konno, Ryo; Lopes, Gilberto; Mugisha, Emmanuel; Murillo, Rául; Scarinci, Isabel C; Stanley, Margaret; Tsu, Vivien; Wheeler, Cosette M; Adewole, Isaac Folorunso; de Sanjosé, Silvia
2017-10-01
To provide resource-stratified (four tiers), evidence-based recommendations on the primary prevention of cervical cancer globally. The American Society of Clinical Oncology convened a multidisciplinary, multinational panel of oncology, obstetrics/gynecology, public health, cancer control, epidemiology/biostatistics, health economics, behavioral/implementation science, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (consensus ratings group) for one round of formal ratings. Existing sets of guidelines from five guideline developers were identified and reviewed; adapted recommendations formed the evidence base. Five systematic reviews, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75%. In all resource settings, two doses of human papillomavirus vaccine are recommended for girls age 9 to 14 years, with an interval of at least 6 months and possibly up to 12 to 15 months. Individuals with HIV positivity should receive three doses. Maximal and enhanced settings: if girls are age ≥ 15 years and received their first dose before age 15 years, they may complete the series; if no doses were received before age 15 years, three doses should be administered; in both scenarios, vaccination may be through age 26 years. Limited and basic settings: if sufficient resources remain after vaccinating girls age 9 to 14 years, girls who received one dose may receive additional doses between age 15 and 26 years. Maximal, enhanced, and limited settings: if ≥ 50% coverage in the priority female target population, sufficient resources, and cost effectiveness, boys may be vaccinated to prevent other noncervical human papillomavirus-related cancers and diseases. Basic settings: vaccinating boys is not recommended. It is the view of the American Society of Clinical Oncology that
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Incremental guideline formalization with tool support
Serban, Radu; Puig-Centelles, Anna; ten Teije, Annette
2006-01-01
Guideline formalization is recognized as an important component in improving computerized guidelines, which in turn leads to better informedness, lower inter-practician variability and, ultimately, to higher quality healthcare. By means of a modeling exercise, we investigate the role of guideline
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Quality of evidence-based pediatric guidelines
Boluyt, Nicole; Lincke, Carsten R.; Offringa, Martin
2005-01-01
Objective. To identify evidence-based pediatric guidelines and to assess their quality. Methods. We searched Medline, Embase, and relevant Web sites of guideline development programs and national pediatric societies to identify evidence-based pediatric guidelines. A list with titles of identified
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Colour Size Illusion on Liquid Crystal Displays and Design Guidelines for Bioinformatics Tools
Yoo, Hyun Seung; Smith-Jackson, Tonya L.
2011-01-01
Although the influence of colour on size perception has been known for a century, there is only limited research on interventions that can reduce this effect. This study was therefore undertaken in order to identify appropriate interventions and propose design guidelines for information visualisation, especially in applications where size…
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Okely, Anthony D; Ghersi, Davina; Hesketh, Kylie D; Santos, Rute; Loughran, Sarah P; Cliff, Dylan P; Shilton, Trevor; Grant, David; Jones, Rachel A; Stanley, Rebecca M; Sherring, Julie; Hinkley, Trina; Trost, Stewart G; McHugh, Clare; Eckermann, Simon; Thorpe, Karen; Waters, Karen; Olds, Timothy S; Mackey, Tracy; Livingstone, Rhonda; Christian, Hayley; Carr, Harriette; Verrender, Adam; Pereira, João R; Zhang, Zhiguang; Downing, Katherine L; Tremblay, Mark S
2017-11-20
the draft guidelines. Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants (Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.
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Lin, Ching-Heng; Lo, Ying-Chih; Hung, Pei-Yuan; Liou, Der-Ming
2016-12-07
As a result of the disease's high prevalence, chronic kidney disease (CKD) has become a global public health problem. A clinical decision support system that integrates with computer-interpretable guidelines (CIGs) should improve clinical outcomes and help to ensure patient safety. The openEHR guideline definition language (GDL) is a formal language used to represent CIGs. This study explores the feasibility of using a GDL approach for CKD; it also attempts to identify any potential gaps between the ideal concept and reality. Using the Kidney Disease Improving Global Outcomes (KDIGO) anemia guideline as material, we designed a development workflow in order to establish a series of GDL guidelines. Focus group discussions were conducted in order to identify important issues related to GDL implementation. Ten GDL guidelines and 37 archetypes were established using the KDIGO guideline document. For the focus group discussions, 16 clinicians and 22 IT experts were recruited and their perceptions, opinions and attitudes towards the GDL approach were explored. Both groups provided positive feedback regarding the GDL approach, but raised various concerns about GDL implementation. Based on the findings of this study, we identified some potential gaps that might exist during implementation between the GDL concept and reality. Three directions remain to be investigated in the future. Two of them are related to the openEHR GDL approach. Firstly, there is a need for the editing tool to be made more sophisticated. Secondly, there needs to be integration of the present approach into non openEHR-based hospital information systems. The last direction focuses on the applicability of guidelines and involves developing a method to resolve any conflicts that occur with insurance payment regulations.
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Hobin, Erin; Vallance, Kate; Zuo, Fei; Stockwell, Tim; Rosella, Laura; Simniceanu, Alice; White, Christine; Hammond, David
2018-01-01
Despite the introduction of national drinking guidelines in Canada, there is limited public knowledge of them and low understanding of 'standard drinks (SDs)' which limits the likelihood of guidelines affecting drinking behaviour. This study tests the efficacy of alcohol labels with SD information and Canada's Low-Risk Drinking Guidelines (LRDGs) as compared to %ABV labels on consumers' ability to estimate alcohol intake. It also examines the label size and format that best supports adults' ability to make informed drinking choices. This research consisted of a between-groups experiment (n = 2016) in which participants each viewed one of six labels. Using an online survey, participants viewed an alcohol label and were asked to estimate: (a) the amount in a SD; (b) the number of SDs in an alcohol container and (c) the number of SDs to consume to reach the recommended daily limit in Canada's LRDG. Results indicated that labels with SD and LRDG information facilitated more accurate estimates of alcohol consumption and awareness of safer drinking limits across different beverage types (12.6% to 58.9% increase in accuracy), and labels were strongly supported among the majority (66.2%) of participants. Labels with SD and LRDG information constitute a more efficacious means of supporting accurate estimates of alcohol consumption than %ABV labels, and provide evidence to inform potential changes to alcohol labelling regulations. Further research testing labels in real-world settings is needed. Results indicate that the introduction of enhanced alcohol labels combining standard drink information and national drinking guidelines may be an effective way to improve drinkers' ability to accurately assess alcohol consumption and monitor intake relative to guidelines. Overall support for enhanced labels suggests probable acceptability of introduction at a population level. © The Author 2017. Medical Council on Alcohol and Oxford University Press. All rights reserved.
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nestor Guideline for Preservation Planning – a Process Model
Directory of Open Access Journals (Sweden)
Sabine Schrimpf
2014-02-01
Full Text Available The nestor guideline for preservation planning is the latest in a series of nestor publications. nestor is the German competence network for digital preservation and it offers all interested parties from the private and public domains the possibility to participate in working groups. The guideline for preservation planning is the result of such a working group, which discussed the conceptual and practical issues of implementing the OAIS Functional Entity “Preservation Planning”.The guideline describes a process model and offers some guidance on potential implementations. It integrates and builds on recognized community concepts like Significant Properties, the OAIS Designated Community, the National Archives of Australia’s Performance Model, the PREMIS concept of Intellectual Entities and Representations, and the PLANET’s approach to preservation planning. Furthermore, it introduces the concepts “intended use” (Nutzungsziele, “information type” (Informationstyp and “preservation group” (Erhaltungsgruppe. The purpose of these new categories is that information objects shall be grouped by information type (e.g., audio, video, text… and intended use (e.g., reading for pleasure, search for specific information… to preservation groups for automatic processing. Significant properties can then be derived for whole preservation groups. The file format alone is considered as not completely sufficient for such categorisation. Some exemplary implementation solutions of the new concepts are presented in an annex.The guideline takes into account that resources for preservation planning and preservation actions are limited and has therefore adopted 4 premises: adequacy, financial viability, automation, and authenticity of archived objects. Its pragmatic approach becomes apparent in the definition and explanation of these dimensions. The guideline is written from the point of view of representatives of memory institutions, i
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Needs and availability of snake antivenoms: relevance and application of international guidelines.
Scheske, Laura; Ruitenberg, Joost; Bissumbhar, Balram
2015-04-04
Snakebite has recently been declared a global public health emergency. Empirical data showing the true burden of snakebite is lacking. Treatment with specific antivenoms is considered the only cure. However, several factors have led to an ongoing antivenom crisis. This study offers recommendations concerning the improvement of antivenom access and control, by providing an overview of the factors limiting the successful implementation of international guidelines within the international industry and state institutions. It further investigates the reasons for the epidemiological knowledge gap regarding snakebites. Data for this study was collected using surveys with closed- and open-ended questions, which allowed for descriptive and thematic analysis, respectively. Participants for this study were selected as follows: 46 manufacturers were contacted from the open-access World Health Organization (WHO) Database for antivenom producers; 23 National Health Authorities (NHAs) of high-burden countries were contacted; and 11 poison centers or experts were randomly contacted. In total, responses from 6/46 (13%) manufacturers, 10/23 (43%) NHAs, and 3/11 (27%) poison centers were received. The low response rates had a limiting effect on the coverage of this study, allowing only exploratory conclusions to be drawn. Based on the gathered information, a probable reason for the epidemiological knowledge gap is the low priority given to snakebites on public health agendas, driving interest and funding away from research in this field. As a consequence, the ensuing lack in funding is preventing state institutions and manufacturers from implementing international guidelines to the highest standards. Furthermore, manufacturers indicated that international guidelines were often not applicable in the field, lacking technical information and protocols. Snakebite ranks low on international public health agendas, and partially due to this low priority, NHAs have shown limited efforts in
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Needs and Availability of Snake Antivenoms: Relevance and Application of International Guidelines
Directory of Open Access Journals (Sweden)
Laura Scheske
2015-07-01
Full Text Available Background Snakebite has recently been declared a global public health emergency. Empirical data showing the true burden of snakebite is lacking. Treatment with specific antivenoms is considered the only cure. However, several factors have led to an ongoing antivenom crisis. This study offers recommendations concerning the improvement of antivenom access and control, by providing an overview of the factors limiting the successful implementation of international guidelines within the international industry and state institutions. It further investigates the reasons for the epidemiological knowledge gap regarding snakebites. Methods Data for this study was collected using surveys with closed- and open-ended questions, which allowed for descriptive and thematic analysis, respectively. Participants for this study were selected as follows: 46 manufacturers were contacted from the open-access World Health Organization (WHO Database for antivenom producers; 23 National Health Authorities (NHAs of high-burden countries were contacted; and 11 poison centers or experts were randomly contacted. Results In total, responses from 6/46 (13% manufacturers, 10/23 (43% NHAs, and 3/11 (27% poison centers were received. The low response rates had a limiting effect on the coverage of this study, allowing only exploratory conclusions to be drawn. Based on the gathered information, a probable reason for the epidemiological knowledge gap is the low priority given to snakebites on public health agendas, driving interest and funding away from research in this field. As a consequence, the ensuing lack in funding is preventing state institutions and manufacturers from implementing international guidelines to the highest standards. Furthermore, manufacturers indicated that international guidelines were often not applicable in the field, lacking technical information and protocols. Conclusion Snakebite ranks low on international public health agendas, and partially due to
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Whitebark pine planting guidelines
Ward McCaughey; Glenda L. Scott; Kay L. Izlar
2009-01-01
This article incorporates new information into previous whitebark pine guidelines for planting prescriptions. Earlier 2006 guidelines were developed based on review of general literature, research studies, field observations, and standard US Forest Service survival surveys of high-elevation whitebark pine plantations. A recent study of biotic and abiotic factors...
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Measure Guideline: Ventilation Cooling
Energy Technology Data Exchange (ETDEWEB)
Springer, D. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); Dakin, B. [Alliance for Residential Building Innovation (ARBI), David, CA (United States); German, A. [Alliance for Residential Building Innovation (ARBI), David, CA (United States)
2012-04-01
The purpose of this measure guideline is to provide information on a cost-effective solution for reducing cooling system energy and demand in homes located in hot-dry and cold-dry climates. This guideline provides a prescriptive approach that outlines qualification criteria, selection considerations, and design and installation procedures.
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Enhancing usability of augmented-reality-based mobile escape guidelines for radioactive accidents
International Nuclear Information System (INIS)
Tsai, Ming-Kuan; Yau, Nie-Jia
2013-01-01
When radioactive accidents occur, modern tools in information technology for emergency response are good solutions to reduce the impact. Since few information-technology-based applications were developed for people during radioactive accidents, a previous study (Tsai et al., 2012) proposed augmented-reality-based mobile escape guidelines. However, because of the lack of transparent escape routes and indoor escape guidelines, the usability of the guidelines is limited. Therefore, this study introduces route planning and mobile three-dimensional (3D) graphics techniques to address the identified problems. The proposed approach could correctly present the geographical relationship from user locations to the anticipated shelters, and quickly show the floor-plan drawings as users are in the buildings. Based on the testing results, in contrast to the previous study, this study offered better escape routes, when the participants performed self-evacuation in outdoor and indoor environments. Overall, this study is not only a useful reference for similar studies, but also a beneficial tool for emergency response during radioactive accidents. -- Highlights: ► Enhancing the efficiency when people escape from radioactive accidents. ► The spatial relationship is transparently displayed in real time. ► In contrast to a previous study, this study offers better escape guidelines
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Postma, Douwe F; van Werkhoven, Cornelis H; Oosterheert, Jan Jelrik
2017-05-01
This review focuses on the evidence base for guideline recommendations on the diagnosis, the optimal choice, timing and duration of empirical antibiotic therapy, and the use of microbiological tests for patients hospitalized with community-acquired pneumonia (CAP): issues for which guidelines are frequently used as a quick reference. Furthermore, we will discuss possibilities for future research in these topics. Many national and international guideline recommendations, even on critical elements of CAP management, are based on low-to-moderate quality evidence. The diagnosis and management of CAP has hardly changed for decades. The recommendation to cover atypical pathogens in all hospitalized CAP patients is based on observational studies only and is challenged by two recent trials. The following years, improved diagnostic testing, radiologically by low-dose Computed Tomography or ultrasound and/or microbiologically by point-of-care multiplex PCR, has the potential to largely influence the choice and start of antibiotic therapy in hospitalized CAP patients. Rapid microbiological testing will hopefully improve antibiotic de-escalation or early pathogen-directed therapy, both potent ways of reducing broad-spectrum antibiotic use. Current guideline recommendations on the timing and duration of antibiotic therapy are based on limited evidence, but will be hard to improve.
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Standards and Guidelines in Telemedicine and Telehealth
Krupinski, Elizabeth A.; Bernard, Jordana
2014-01-01
The development of guidelines and standards for telemedicine is an important and valuable process to help insure effective and safe delivery of quality healthcare. Some organizations, such as the American Telemedicine Association (ATA), have made the development of standards and guidelines a priority. The practice guidelines developed so far have been well received by the telemedicine community and are being adopted in numerous practices, as well as being used in research to support the practice and growth of telemedicine. Studies that utilize published guidelines not only help bring them into greater public awareness, but they also provide evidence needed to validate existing guidelines and guide the revision of future versions. Telemedicine will continue to grow and be adopted by more healthcare practitioners and patients in a wide variety of forms not just in the traditional clinical environments, and practice guidelines will be a key factor in fostering this growth. Creation of guidelines is important to payers and regulators as well as increasingly they are adopting and integrating them into regulations and policies. This paper will review some of the recent ATA efforts in developing telemedicine practice guidelines, review the role of research in guidelines development, review data regarding their use, and discuss some of areas where guidelines are still needed. PMID:27429261
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Effect of new ICRP guidelines on radiological protection
International Nuclear Information System (INIS)
Anon.
1992-01-01
The new limits proposed by ICRP and under consideration (at the time of writing) by AECB (Atomic Energy Control Board of Canada) reduce the maximum exposure of atomic radiation workers from 50 to 20 mSv per year, and that of the general public from 5 to 1 mSv. The new guidelines will have three main effects: first, some licensees may have difficulty in complying; secondly, many workers may have to be reclassified as atomic radiation workers; thirdly, extensive retraining will be needed. Activities affected include reactor retubing and underground uranium mining
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Raising the Bar with Trades Staffing Guidelines.
Weidner, Theodore J.
2000-01-01
Examines the APPA's Trades Staffing Guidelines Task Force for college campus building maintenance and presents descriptions of the proposed guideline levels and a matrix of indicators for the Trades Staffing Guidelines. The levels and matrix are intended to mimic features of the custodial staffing guidelines. (GR)
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78 FR 38102 - Passenger Vessels Accessibility Guidelines
2013-06-25
... Costs and Benefits The primary estimates of the costs and benefits of the proposed guidelines are shown... quantify the benefits of the proposed guidelines due to the nature of the benefits. The proposed guidelines..., transportation, public accommodation, and leisure. The proposed guidelines would enable these individuals to...
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International Nuclear Information System (INIS)
Nimmagadda, M.; Yu, C.
1993-04-01
Residual radioactive material guidelines for strontium-90 and cesium-137 were derived for the Laboratory for Energy-Related Health Research (LEHR) site in Davis, California. The guideline derivation was based on a dose limit of 100 mrem/yr. The US Department of Energy (DOE) residual radioactive material guideline computer code, RESRAD, was used in this evaluation; this code implements the methodology described in the DOE manual for implementing residual radioactive material guidelines. Three potential site utilization scenarios were considered with the assumption that, for a period of 1,000 years following remedial action, the site will be utilized without radiological restrictions. The defined scenarios vary with regard to use of the site, time spent at the site, and sources of food consumed. The results of the evaluation indicate that the basic dose limit of 100 mrem/yr will not be exceeded within 1,000 years for either strontium-90 or cesium-137, provided that the soil concentrations of these radionuclides at the LEHR site do not exceed the following levels: 71,000 pCi/g for strontium-90 and 91 pCi/g for cesium-137 for Scenario A (researcher: the expected scenario); 160,000 pCi/g for strontium-90 and 220 pCi/g for cesium-137 for Scenario B (recreationist: a plausible scenario); and 37 pCi/g for strontium-90 and 32 pCi/g for cesium-137 for Scenario C (resident farmer ingesting food produced in the contaminated area: a plausible scenario). The derived guidelines are single-radionuclide guidelines and are linearly proportional to the dose limit used in the calculations. In setting the actual strontium-90 and cesium-137 guidelines for the LEHR site, DOE will apply the as low as reasonably achievable (ALARA) policy to the decision-making process, along with other factors such as whether a particular scenario is reasonable and appropriate
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Canadian Clinical Practice Guidelines for Invasive Candidiasis in Adults
Directory of Open Access Journals (Sweden)
Eric J Bow
2010-01-01
Full Text Available Candidemia and invasive candidiasis (C/IC are life-threatening opportunistic infections that add excess morbidity, mortality and cost to the management of patients with a range of potentially curable underlying conditions. The Association of Medical Microbiology and Infectious Disease Canada developed evidence-based guidelines for the approach to the diagnosis and management of these infections in the ever-increasing population of at-risk adult patients in the health care system. Over the past few years, a new and broader understanding of the epidemiology and pathogenesis of C/IC has emerged and has been coupled with the availability of new antifungal agents and defined strategies for targeting groups at risk including, but not limited to, acute leukemia patients, hematopoietic stem cell transplants and solid organ transplants, and critical care unit patients. Accordingly, these guidelines have focused on patients at risk for C/IC, and on approaches of prevention, early therapy for suspected but unproven infection, and targeted therapy for probable and proven infection.
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28 CFR 23.30 - Funding guidelines.
2010-07-01
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Funding guidelines. 23.30 Section 23.30 Judicial Administration DEPARTMENT OF JUSTICE CRIMINAL INTELLIGENCE SYSTEMS OPERATING POLICIES § 23.30 Funding guidelines. The following funding guidelines shall apply to all Crime Control Act funded...
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5 CFR 724.403 - Advisory guidelines.
2010-01-01
... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Advisory guidelines. 724.403 Section 724.403 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS... RETALIATION ACT OF 2002 Best Practices § 724.403 Advisory guidelines. OPM will issue advisory guidelines to...
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Energy Technology Data Exchange (ETDEWEB)
1993-09-01
The Electrical Safety Guidelines prescribes the DOE safety standards for DOE field offices or facilities involved in the use of electrical energy. It has been prepared to provide a uniform set of electrical safety standards and guidance for DOE installations in order to affect a reduction or elimination of risks associated with the use of electrical energy. The objectives of these guidelines are to enhance electrical safety awareness and mitigate electrical hazards to employees, the public, and the environment.
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Brigl, B; Ammenwerth, E; Dujat, C; Gräber, S; Grosse, A; Häber, A; Jostes, C; Winter, A
2005-01-01
Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. The guideline recommends a detailed structure of a SIM plan and gives advice about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which -- in the sense of enterprise architecture planning -- represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.
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Ivanovska, V.; Hek, K.; Mantel-Teeuwisse, A.K.; Leufkens, H.G.M.; Dijk, L. van
2018-01-01
Background: Most antibiotics in children are used to treat viral and self-limiting conditions. This study aims to compare physicians' adherence to guidelines on antibiotic prescribing in fever and in ear and respiratory infections to children in different age groups in the Netherlands. Methods: Data
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Kakeeto, Mikael; Lundmark, Robert; Hasson, Henna; von Thiele Schwarz, Ulrica
2017-08-01
In the evidence-to-practice pathway, guidelines are developed to provide a practical summary of evidence and stimulate change. However, when guidelines are used in practice, adherence to the recommendations in guidelines is limited, and adaptations are common. Thus, we need more detailed knowledge about adherence and adaptations when guidelines are used in practice to understand the end of the evidence-to-practice pathway. Subsequently, the aim is to examine adherence to and adaptations of recommendations in the Swedish National Guidelines for Methods of Preventing Disease. A questionnaire was sent to healthcare professionals and managers in Stockholm between January and March 2014. Adherence to the recommendations was compared between practice settings, and the frequency of different adaptations and reasons for adaptations was analysed. Partial adherence to the guidelines was found. The adherence was significantly greater within primary care than at the hospitals (P guidelines are used in practice. Work with lifestyle habits was partially done in accordance with the guidelines. Lack of time and lack of resources were not the most common reasons for adaptations. Rather, the findings suggest that when patient needs and capabilities contrast with guideline recommendations, patient needs trump adherence to guidelines. © 2017 John Wiley & Sons, Ltd.
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Inspector qualification guidelines
International Nuclear Information System (INIS)
Batty, A.C.; Van Binnebeek, J.J.; Ericsson, P.O.; Fisher, J.C.; Geiger, P.; Grandame, M.; Grimes, B.K.; Joode, A. de; Kaufer, B.; Kinoshita, M.; Klonk, H.; Koizumi, H.; Maeda, N.; Maqua, M.; Perez del Moral, C.; Roselli, F.; Warren, T.; Zimmerman, R.
1994-07-01
The OECD Nuclear Energy Agency Committee on Nuclear Regulatory Activities (CNRA) has a Working Group on Inspection Practices (WGIP). The WGIP provides a forum for the exchange of Information and experience on the safety Inspection practices of regulatory authorities In the CNRA member countries. A consistent qualification process and well defined level of training for all Inspectors who participate In the safety Inspections are needed to provide consistent Inspections and reliable Inspection results. The WGIP organized in 1992 a workshop on the conduct of inspections, inspector qualification and training, and shutdown inspections at the Technical Training Center of the US NRC in Chattanooga, Tennessee. In the connection of workshop the WGIP identified a need to develop guidance for inspector qualification which could be used as a model by those who are developing their qualification practices. The inspector qualification journals of US NRC provided a good basis for the work. The following inspector qualification guideline has been developed for guidance of qualification of a new inspector recruited to the regulatory body. This guideline has been developed for helping the supervisors and training officers to give the initial training and familiarization to the duties of a new inspector in a controlled manner. US NRC inspector qualification journals have been used to define the areas of attention. This guideline provides large flexibility for application in different type organizations. Large organizations can develop separate qualification journals for each inspector positions. Small regulatory bodies can develop individual training programmes by defining the necessary training topics on case by case basis. E.g. the guideline can be used to define the qualifications of contracted inspectors used in some countries. The appropriate part would apply. Annex 1 gives two examples how this guideline could be applied
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Inspector qualification guidelines
Energy Technology Data Exchange (ETDEWEB)
Batty, A. C.; Van Binnebeek, J. J.; Ericsson, P. O.; Fisher, J. C.; Geiger, P.; Grandame, M.; Grimes, B. K.; Joode, A. de; Kaufer, B.; Kinoshita, M.; Klonk, H.; Koizumi, H.; Maeda, N.; Maqua, M.; Perez del Moral, C.; Roselli, F.; Warren, T.; Zimmerman, R.
1994-07-15
The OECD Nuclear Energy Agency Committee on Nuclear Regulatory Activities (CNRA) has a Working Group on Inspection Practices (WGIP). The WGIP provides a forum for the exchange of Information and experience on the safety Inspection practices of regulatory authorities In the CNRA member countries. A consistent qualification process and well defined level of training for all Inspectors who participate In the safety Inspections are needed to provide consistent Inspections and reliable Inspection results. The WGIP organized in 1992 a workshop on the conduct of inspections, inspector qualification and training, and shutdown inspections at the Technical Training Center of the US NRC in Chattanooga, Tennessee. In the connection of workshop the WGIP identified a need to develop guidance for inspector qualification which could be used as a model by those who are developing their qualification practices. The inspector qualification journals of US NRC provided a good basis for the work. The following inspector qualification guideline has been developed for guidance of qualification of a new inspector recruited to the regulatory body. This guideline has been developed for helping the supervisors and training officers to give the initial training and familiarization to the duties of a new inspector in a controlled manner. US NRC inspector qualification journals have been used to define the areas of attention. This guideline provides large flexibility for application in different type organizations. Large organizations can develop separate qualification journals for each inspector positions. Small regulatory bodies can develop individual training programmes by defining the necessary training topics on case by case basis. E.g. the guideline can be used to define the qualifications of contracted inspectors used in some countries. The appropriate part would apply. Annex 1 gives two examples how this guideline could be applied.
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Guidelines for nuclear plant response to an earthquake
International Nuclear Information System (INIS)
1989-12-01
Guidelines have been developed to assist nuclear plant personnel in the preparation of earthquake response procedures for nuclear power plants. The objectives of the earthquake response procedures are to determine (1) the immediate effects of an earthquake on the physical condition of the nuclear power plant, (2) if shutdown of the plant is appropriate based on the observed damage to the plant or because the OBE has been exceeded, and (3) the readiness of the plant to resume operation following shutdown due to an earthquake. Readiness of a nuclear power plant to restart is determined on the basis of visual inspections of nuclear plant equipment and structures, and the successful completion of surveillance tests which demonstrate that the limiting conditions for operation as defined in the plant Technical Specifications are met. The guidelines are based on information obtained from a review of earthquake response procedures from numerous US and foreign nuclear power plants, interviews with nuclear plant operations personnel, and a review of reports of damage to industrial equipment and structures in actual earthquakes. 7 refs., 4 figs., 4 tabs
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Guidelines for Posting Soil Contamination Areas
Energy Technology Data Exchange (ETDEWEB)
Mcnaughton, Michael [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Eisele, William [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)
2016-02-01
All soil guidelines were determined using RESRAD, version 6.1. All offsite guidelines are based on 15 mrem/year. This dose rate is sufficiently low to protect human health and is in accordance with DOE guidance and the proposed EPA 40-CFR-196 regulations for members of the public (never promulgated). For those onsite areas where general employees (non-radiological workers) could have routine access, soil concentrations should be based on a dose rate of 30 mrem/year (approximately one-third of the onsite LANL non-radiological worker dose of 100 mrem/year). In this case, soil concentration guidelines may be obtained by doubling the 15 mrem/year guidelines. Several scenarios were developed to provide maximum flexibility for application of the guidelines. The offsite guidelines were developed using: residential scenarios for both adults and children; a construction worker scenario; a resource user (e.g., a hunter) scenario; a child playing within canyon reaches scenario, a trail using jogger within canyon reaches scenario, and a trail using hiker within canyon reaches scenario. The residential guidelines represent the lowest values from both the adult residential scenario and the child residential scenario.
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Energy Technology Data Exchange (ETDEWEB)
Shields, Nora [School of Physiotherapy, La Trobe University, Victoria 3086 (Australia); O' Hare, Neil [Department of Medical Physics and Bioengineering, St James' s Hospital, Dublin 8 (Ireland); Gormley, John [School of Physiotherapy, Trinity College Dublin, Trinity Centre for Health Sciences, St James' s Hospital, Dublin 8 (Ireland)
2004-07-07
Short-wave diathermy (SWD), a form of radiofrequency radiation used therapeutically by physiotherapists, may be applied in continuous (CSWD) or pulsed (PSWD) mode using either capacitive or inductive methods. Stray radiation emitted by these units may exceed exposure guidelines close to the equipment. Discrepant guidelines exist on a safe distance from an operating unit for operators and other personnel. Stray electric (E-field) and magnetic (H-field) field strengths from 10 SWD units in six departments were examined using a PMM 8053 meter and two isotropic probes (EP-330, HP-032). A 5 l saline phantom completed the patient circuit. Measurements were recorded in eight directions between 0.5 m and 2 m at hip and eye levels while the units operated at maximum output and data compared to current guidelines. Results found stray fields from capacitive CSWD fell below operator limits at 2 m (E-field 4.8-39.8 V/m; H-field 0.015-0.072 A/m) and at 1 m for inductive CSWD (E-field 0-36 V/m; H-field 0.01-0.065 A/m). Capacitive PSWD fields fell below the limits at 1.5 m (E-field 1.2-19.9 V/m; H-field 0.002-0.045 A/m) and at 1m for inductive PSWD (E-field 0.7-4.0 V/m; H-field 0.009-0.03 A/m). An extra 0.5 m was required before fields fell below the guidelines for other personnel. These results demonstrate, under a worst case scenario, emissions from SWD exceed the guidelines for operators at distances currently recommended as safe. Future guidelines should include recommendations for personnel other than physiotherapists.
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International Nuclear Information System (INIS)
Shields, Nora; O'Hare, Neil; Gormley, John
2004-01-01
Short-wave diathermy (SWD), a form of radiofrequency radiation used therapeutically by physiotherapists, may be applied in continuous (CSWD) or pulsed (PSWD) mode using either capacitive or inductive methods. Stray radiation emitted by these units may exceed exposure guidelines close to the equipment. Discrepant guidelines exist on a safe distance from an operating unit for operators and other personnel. Stray electric (E-field) and magnetic (H-field) field strengths from 10 SWD units in six departments were examined using a PMM 8053 meter and two isotropic probes (EP-330, HP-032). A 5 l saline phantom completed the patient circuit. Measurements were recorded in eight directions between 0.5 m and 2 m at hip and eye levels while the units operated at maximum output and data compared to current guidelines. Results found stray fields from capacitive CSWD fell below operator limits at 2 m (E-field 4.8-39.8 V/m; H-field 0.015-0.072 A/m) and at 1 m for inductive CSWD (E-field 0-36 V/m; H-field 0.01-0.065 A/m). Capacitive PSWD fields fell below the limits at 1.5 m (E-field 1.2-19.9 V/m; H-field 0.002-0.045 A/m) and at 1m for inductive PSWD (E-field 0.7-4.0 V/m; H-field 0.009-0.03 A/m). An extra 0.5 m was required before fields fell below the guidelines for other personnel. These results demonstrate, under a worst case scenario, emissions from SWD exceed the guidelines for operators at distances currently recommended as safe. Future guidelines should include recommendations for personnel other than physiotherapists
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Young, K L; Koppel, S; Charlton, J L
2017-09-01
Older adults are the fastest growing segment of the driving population. While there is a strong emphasis for older people to maintain their mobility, the safety of older drivers is a serious community concern. Frailty and declines in a range of age-related sensory, cognitive, and physical impairments can place older drivers at an increased risk of crash-related injuries and death. A number of studies have indicated that in-vehicle technologies such as Advanced Driver Assistance Systems (ADAS) and In-Vehicle Information Systems (IVIS) may provide assistance to older drivers. However, these technologies will only benefit older drivers if their design is congruent with the complex needs and diverse abilities of this driving cohort. The design of ADAS and IVIS is largely informed by automotive Human Machine Interface (HMI) guidelines. However, it is unclear to what extent the declining sensory, cognitive and physical capabilities of older drivers are addressed in the current guidelines. This paper provides a review of key current design guidelines for IVIS and ADAS with respect to the extent they address age-related changes in functional capacities. The review revealed that most of the HMI guidelines do not address design issues related to older driver impairments. In fact, in many guidelines driver age and sensory cognitive and physical impairments are not mentioned at all and where reference is made, it is typically very broad. Prescriptive advice on how to actually design a system so that it addresses the needs and limitations of older drivers is not provided. In order for older drivers to reap the full benefits that in-vehicle technology can afford, it is critical that further work establish how older driver limitations and capabilities can be supported by the system design process, including their inclusion into HMI design guidelines. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Below regulatory concern standards: The limits of state and local authority
International Nuclear Information System (INIS)
Silverman, D.J.
1990-01-01
The paper discusses: (1) the scope of the Nuclear Regulatory Commission's authority to develop and implement below regulatory concern or BRC standards; and (2) the limitations on the legal authority of states and local governments to create impediments to full implementation of such standards. The paper demonstrates that the NRC is acting well within its statutory authority in developing BRC regulations and guidelines, and that the ability of state and local governments to impede generators' use of those regulations and guidelines on the basis of legal or regulatory initiatives is substantially circumscribed. While some generators may be reluctant, as a result of political factors, to utilize BRC standards, the decision whether or not to use such standards should not be made without careful consideration of the applicable legal and regulatory limitations on state and local authority
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Thompson, J P
2014-04-01
Several bodies produce broadly concurring and updated guidelines for the evaluation and treatment of cardiovascular disease in both surgical and non-surgical patients. Recent developments include revised recommendations on preoperative stress testing, referral for possible coronary revascularization and medical management. It is recognized that non-invasive cardiac tests are relatively poor at predicting perioperative risk, and "prophylactic" coronary revascularization has a limited role. The planned aortic intervention (open or endovascular repair) also influences preoperative management. Patients presenting for elective abdominal aortic aneurysm (AAA) repair should only be referred for cardiological testing if they have active symptoms of coronary artery disease (CAD), known CAD and poor functional exercise capacity, or multiple risk factors for CAD. Coronary revascularization before AAA surgery should be limited to patients with established indications, so cardiac stress testing should only be performed if it would change management i.e. the patient is a candidate for and would benefit from coronary revascularization. When endovascular aortic repair is planned, it is reasonable to proceed to surgery without further cardiac stress testing or evaluation unless otherwise indicated. All non-emergency patients require medical optimization, but perioperative beta blockade benefits only certain patients. Some of the data informing recent guidelines have been questioned and some guidelines are being revised. Current guidelines do not specifically address the management of patients with known or suspected carotid artery disease who may require aortic surgery. For these patients, an individualized approach is required. This review considers recent guidelines. Algorithms for investigation and management based on their recommendations are included.
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40 CFR 766.12 - Testing guidelines.
2010-07-01
... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Testing guidelines. 766.12 Section 766... DIBENZO-PARA-DIOXINS/DIBENZOFURANS General Provisions § 766.12 Testing guidelines. Analytical test methods must be developed using methods equivalent to those described or reviewed in Guidelines for the...
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5 CFR 720.206 - Selection guidelines.
2010-01-01
... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Selection guidelines. 720.206 Section 720... guidelines. This subpart sets forth requirements for a recruitment program, not a selection program... procedures and criteria must be consistent with the Uniform Guidelines on Employee Selection Procedures (43...
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76 FR 63565 - Event Reporting Guidelines
2011-10-13
...-2011-0237] Event Reporting Guidelines AGENCY: Nuclear Regulatory Commission. ACTION: Draft NUREG... comments on Draft NUREG-1022, Revision 3, ``Event Reporting Guidelines: 10 CFR 50.72 and 50.73''. The NUREG-1022 contains guidelines that the NRC staff considers acceptable for use in meeting the event reporting...
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Review of standards and guidelines pertinent to DOE's Remedial Action programs
International Nuclear Information System (INIS)
Soldat, J.K.; Denham, D.H.
1985-01-01
A number of radiological standards, guidelines, and dose criteria have been promulgated that may be relevant to the Department of Energy's (DOE) Remedial Action programs. Some of these are being applied to remedial actions undertaken by DOE to ensure that health and safety aspects are adequately addressed. Pacific Northwest Laboratory staff reviewed existing and proposed environmental radiological standards and criteria for their applicability to DOE's Remedial Action Programs. National and international environmental standards and criteria, and studies conducted by other DOE contractors were reviewed. The review indicated that there is a lack of uniformity between the dose guidelines developed by the various agencies. A uniform dose standard is needed for DandD, at least as an upper limit with application of the ALARA philosophy. 33 references, 5 tables
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Guidelines for identifying suspect/counterfeit material
Energy Technology Data Exchange (ETDEWEB)
NONE
1995-09-01
These guidelines are intended to assist users of products in identifying: substandard, misrepresented, or fraudulently marked items. The guidelines provide information about such topics as: precautions, inspection and testing, dispositioning identified items, installed inspection and reporting suspect/counterfeit materials. These guidelines apply to users who are developing procurement documents, product acceptance/verification methods, company procedures, work instructions, etc. The intent of these SM guidelines in relation to the Quality Assurance Program Description (QAPD) and implementing company Management Control Procedures is not to substitute or replace existing requirements, as defined in either the QAPD or company implementing instructions (Management Control Procedures). Instead, the guidelines are intended to provide a consolidated source of information addressing the issue of Suspect/Counterfeit materials. These guidelines provide an extensive suspect component listing and suspect indications listing. Users can quickly check their suspect items against the list of manufacturers products (i.e., type, LD. number, and nameplate information) by consulting either of these listings.
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Strengthening the Enforcement of CSR Guidelines
DEFF Research Database (Denmark)
Olsen, Birgitte Egelund; Sørensen, Karsten Engsig
2014-01-01
the extensive right to refer complaints to them, the broad scope of the recommendations in the Guidelines and especially the use of naming and shaming in cases of breaches of the Guidelines, has changed the original character of the Guidelines as a purely soft law instrument. Furthermore, it is shown...... that the use of very broad and vague terminology in the Guidelines makes it very difficult for enterprises to comply with them. This is further complicated by the fact that many of the terms, which lay down when the NCPs have jurisdiction, are not clearly defined or explained. The three NCPs examined have...... implemented the Guidelines very differently. In particular the Danish NCP stands out. It has a jurisdiction which in many respects goes far beyond that envisioned in the Guidelines. This may put in question the legitimacy and effectiveness of the Danish NCP, but at the same time it can also be viewed...
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10 CFR 960.5-1 - System guidelines.
2010-01-01
... 10 Energy 4 2010-01-01 2010-01-01 false System guidelines. 960.5-1 Section 960.5-1 Energy DEPARTMENT OF ENERGY GENERAL GUIDELINES FOR THE PRELIMINARY SCREENING OF POTENTIAL SITES FOR A NUCLEAR WASTE REPOSITORY Preclosure Guidelines § 960.5-1 System guidelines. (a) Qualifying conditions—(1) Preclosure...
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32 CFR 310.36 - OMB training guidelines.
2010-07-01
... 32 National Defense 2 2010-07-01 2010-07-01 false OMB training guidelines. 310.36 Section 310.36... PROGRAM DOD PRIVACY PROGRAM Training Requirements § 310.36 OMB training guidelines. The OMB guidelines (OMB Privacy Guidelines, 40 FR 28948 (July 9, 1975) require all agencies additionally to: (a) Instruct...
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LENUS (Irish Health Repository)
Flynn, E
2012-03-01
ABPM is an invaluable clinical tool, as it has been shown to improve blood pressure control in primary care. Many clinical guidelines for hypertension advocate ambulatory blood pressure monitoring. This study aims to quantify the use of clinical guidelines for hypertension and to explore the role of ABPM in Primary Care. A questionnaire survey was sent to GPs working in the West of Ireland. 88% (n=139) of GPs use clinical guidelines that recommend the use of ABPM. 82% (n=130) of GPs find use of clinic blood pressure monitoring insufficient for the diagnosis and monitoring of hypertension. Despite good access to ABPM, GPs report lack of remuneration, 72% (n=116), cost 68% (n=108), and lack of time, 51% (n=83) as the main limiting factors to use of ABPM. GPs recognise the clinical value of ABPM, but this study identifies definite barriers to the use of ABPM in Primary Care.
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[Preoperative fasting guidelines: an update].
López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J
2015-03-01
Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.
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Thole, Henning
2011-01-01
While methods for the production of guidelines (evidence analysis, assessment, adaptation) have been continually refined throughout the past years, there is a lack of instruments for the production of easily understandable synopses. Definition of a methodological approach to encompass synopses by Spidernet diagrams. Tables of synopses can be generated with distinct information to bring down the main results in one Spidernet diagram. This is possible for both the entire synopsis and parts of it. Guideline comparisons require detailed analyses on the one hand and easily understandable presentations of their results on the other. Guideline synopses can be substantially supported by graphic presentation of the results of synopsis. Graphic synopsis is also helpful in other cases; it may be used, for example, to summarise HTA reports, systematic reviews or guidelines. Copyright © 2011. Published by Elsevier GmbH.
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Potential low-level waste disposal limits for activation products from fusion
International Nuclear Information System (INIS)
Kennedy, W.E. Jr.; Peloquin, R.A.
1983-09-01
Hanford Engineering Development Laboratory (HEDL) scientists are involved in studies considering alternative construction materials for the first wall of commercial fusion reactors. To permit a comparison of radioactivity levels, both the level of activation and an acceptable limit for the radionuclides present must be known. Generic material composition guidelines can be developed using the US Nuclear Regulatory Commission (NRC) regulations governing the near-surface disposal of low-level radioactive wastes. These regulations consider wastes defined as containing source, special nuclear, or by-product materials arising from research, industrial, medical, and nuclear fuel-cycle activities. However, not all of the activation products produced in low-level wastes from fusion reactors are considered by the NRC in their regulations. The purpose of this report is to present potential low-level waste-disposal limits for ten radionuclides resulting from fusion reactor operations that are not considered in the NRC low-level waste regulations. These potential limits will be used by HEDL scientists to complete their generic material composition guidelines for the first wall of commercial fusion reactors
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LENUS (Irish Health Repository)
Burgunder, J-M
2011-02-01
These EFNS guidelines on the molecular diagnosis of motoneuron disorders, neuropathies and myopathies are designed to summarize the possibilities and limitations of molecular genetic techniques and to provide diagnostic criteria for deciding when a molecular diagnostic work-up is indicated.
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Water chemistry guidelines for BWRs
International Nuclear Information System (INIS)
Bilanin, W.J.; Jones, R.L.; Welty, C.S.
1984-01-01
Guidelines for BWR water chemistry control have been prepared by a committee of experienced utility industry personnel sponsored by the BWR Owners Group on IGSCC Research and coordinated by the Electric Power Research Institute. The guidelines are based on extensive plant operational experience and laboratory research data. The purpose of the guidelines is to provide guidance to the electric utility industry on water chemistry control to help reduce corrosion, especially stress corrosion cracking, in boiling water reactors
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Olympic emblem guidelines: London 2012
2013-01-01
These guidelines issued by the London Organising Committee of the Olympic Games and Paralympic Games Ltd (“LOCOG”) provide standards, requirements and guidelines for use of the London 2012 Olympic Games Emblem (the “Emblem”) by LOCOG and the International Olympic Committee (IOC) creative, marketing and communications personnel, agencies and consultants only who are authorised to use the London 2012 marks. The purpose of these guidelines is to preserve and enhance the value of the Emblem for t...
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5 CFR 1310.1 - Policy guidelines.
2010-01-01
... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Policy guidelines. 1310.1 Section 1310.1 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES OMB CIRCULARS § 1310.1 Policy guidelines. In carrying out its responsibilities, the Office of Management and Budget issues policy guidelines to...
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Methodological Quality of Consensus Guidelines in Implant Dentistry.
Faggion, Clovis Mariano; Apaza, Karol; Ariza-Fritas, Tania; Málaga, Lilian; Giannakopoulos, Nikolaos Nikitas; Alarcón, Marco Antonio
2017-01-01
Consensus guidelines are useful to improve clinical decision making. Therefore, the methodological evaluation of these guidelines is of paramount importance. Low quality information may guide to inadequate or harmful clinical decisions. To evaluate the methodological quality of consensus guidelines published in implant dentistry using a validated methodological instrument. The six implant dentistry journals with impact factors were scrutinised for consensus guidelines related to implant dentistry. Two assessors independently selected consensus guidelines, and four assessors independently evaluated their methodological quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Disagreements in the selection and evaluation of guidelines were resolved by consensus. First, the consensus guidelines were analysed alone. Then, systematic reviews conducted to support the guidelines were included in the analysis. Non-parametric statistics for dependent variables (Wilcoxon signed rank test) was used to compare both groups. Of 258 initially retrieved articles, 27 consensus guidelines were selected. Median scores in four domains (applicability, rigour of development, stakeholder involvement, and editorial independence), expressed as percentages of maximum possible domain scores, were below 50% (median, 26%, 30.70%, 41.70%, and 41.70%, respectively). The consensus guidelines and consensus guidelines + systematic reviews data sets could be compared for 19 guidelines, and the results showed significant improvements in all domain scores (p dentistry journals is needed. The findings of the present study may help researchers to better develop consensus guidelines in implant dentistry, which will improve the quality and trust of information needed to make proper clinical decisions.
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Clinical practice guidelines in breast cancer
Tyagi, N. Kumar; Dhesy-Thind, S.
2018-01-01
Background A number of clinical practice guidelines (cpgs) concerning breast cancer (bca) screening and management are available. Here, we review the strengths and weaknesses of cpgs from various professional organizations and consensus groups with respect to their methodologic quality, recommendations, and implementability. Methods Guidelines from four groups were reviewed with respect to two clinical scenarios: adjuvant ovarian function suppression (ofs) in premenopausal women with early-stage estrogen receptor–positive bca, and use of sentinel lymph node biopsy (slnb) after neoadjuvant chemotherapy (nac) for locally advanced bca. Guidelines from the American Society of Clinical Oncology (asco); Cancer Care Ontario’s Program in Evidence Based Care (cco’s pebc); the U.S. National Comprehensive Cancer Network (nccn); and the St. Gallen International Breast Cancer Consensus Conference were reviewed by two independent assessors. Guideline methodology and applicability were evaluated using the agree ii tool. Results The quality of the cpgs was greatest for the guidelines developed by asco and cco’s pebc. The nccn and St. Gallen guidelines were found to have lower scores for methodologic rigour. All guidelines scored poorly for applicability. The recommendations for ofs were similar in three guidelines. Recommendations by the various organizations for the use of slnb after nac were contradictory. Conclusions Our review demonstrated that cpgs can be heterogeneous in methodologic quality. Low-quality cpg implementation strategies contribute to low uptake of, and adherence to, bca cpgs. Further research examining the barriers to recommendations—such as intrinsic guideline characteristics and the needs of end users—is required. The use of bca cpgs can improve the knowledge-to-practice gap and patient outcomes.
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Guidelines on radiation protection for work with open radioactive sources
International Nuclear Information System (INIS)
1995-01-01
The Danish National Institute of Radiation Protection (SIS) has published this, fourth edition of guidelines on radiation protection for work with open radiation sources. There are few changes compared to the previous edition, film doses are updated and preparation of the Danish legislation with respect to the 1991 ICRP recommendations (ICRP publication 60) is discussed. In this future recommendation the new dose limits will be proposed and new risk factors enlightened. (EG)
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Ferraris, Victor A; Brown, Jeremiah R; Despotis, George J; Hammon, John W; Reece, T Brett; Saha, Sibu P; Song, Howard K; Clough, Ellen R; Shore-Lesserson, Linda J; Goodnough, Lawrence T; Mazer, C David; Shander, Aryeh; Stafford-Smith, Mark; Waters, Jonathan; Baker, Robert A; Dickinson, Timothy A; FitzGerald, Daniel J; Likosky, Donald S; Shann, Kenneth G
2011-03-01
Practice guidelines reflect published literature. Because of the ever changing literature base, it is necessary to update and revise guideline recommendations from time to time. The Society of Thoracic Surgeons recommends review and possible update of previously published guidelines at least every three years. This summary is an update of the blood conservation guideline published in 2007. The search methods used in the current version differ compared to the previously published guideline. Literature searches were conducted using standardized MeSH terms from the National Library of Medicine PUBMED database list of search terms. The following terms comprised the standard baseline search terms for all topics and were connected with the logical 'OR' connector--Extracorporeal circulation (MeSH number E04.292), cardiovascular surgical procedures (MeSH number E04.100), and vascular diseases (MeSH number C14.907). Use of these broad search terms allowed specific topics to be added to the search with the logical 'AND' connector. In this 2011 guideline update, areas of major revision include: 1) management of dual anti-platelet therapy before operation, 2) use of drugs that augment red blood cell volume or limit blood loss, 3) use of blood derivatives including fresh frozen plasma, Factor XIII, leukoreduced red blood cells, platelet plasmapheresis, recombinant Factor VII, antithrombin III, and Factor IX concentrates, 4) changes in management of blood salvage, 5) use of minimally invasive procedures to limit perioperative bleeding and blood transfusion, 6) recommendations for blood conservation related to extracorporeal membrane oxygenation and cardiopulmonary perfusion, 7) use of topical hemostatic agents, and 8) new insights into the value of team interventions in blood management. Much has changed since the previously published 2007 STS blood management guidelines and this document contains new and revised recommendations. Copyright © 2011 The Society of Thoracic
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Nachamkin, Irving; Kirn, Thomas J; Westblade, Lars F; Humphries, Romney
2017-11-01
As part of the American Society for Microbiology (ASM) Evidence-Based Laboratory Medicine Practice Guidelines Committee of the Professional Practice Committee, an ad hoc committee was formed in 2014 to assess guidelines published by the committee using an assessment tool, Appraisal of Guidelines for Research Evaluation II (AGREE II). The AGREE II assessment helps reviewers determine whether published guidelines are robust, transparent, and clear in presenting practice recommendations in a standardized manner. Identifying strengths and weaknesses of practice guidelines by ad hoc assessments helps with improving future guidelines through the participation of key stakeholders. This minireview describes the development of the ad hoc committee and results from their review of several ASM best practices guidelines and a non-ASM practice guideline from the Emergency Nurses Association. Copyright © 2017 American Society for Microbiology.
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International Nuclear Information System (INIS)
Edwards, T.B.; Shine, E.P.
1992-01-01
Data Qualification (DQ) is a formal, technical process whose objective is to affirm that experimental data are suitable for their intended use. Although it is not possible to develop a fixed recipe for the DQ process to cover all test situations, these general guidelines have been developed for the Nuclear Engineering Section to establish a framework for qualifying data from steady-state processing. These guidelines outline the role of the DQ team providing insight into the planning and conducting of the DQ process
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Guidelines for Learning Stations.
Fehrle, Carl C.; Schulz, Jolene
Guidelines for designing and planning learning stations for pupils at the elementary grade level include suggestions on how to develop a station that will be successful in meeting the learners' needs. Instructions for the use of tapes at a station and matching pupils with stations are given, as are guidelines on classroom arrangement and record…
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42 CFR 438.236 - Practice guidelines.
2010-10-01
... 42 Public Health 4 2010-10-01 2010-10-01 false Practice guidelines. 438.236 Section 438.236 Public... Improvement Standards § 438.236 Practice guidelines. (a) Basic rule: The State must ensure, through its...) Adoption of practice guidelines. Each MCO and, when applicable, each PIHP and PAHP adopts practice...
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22 CFR 214.42 - Uniform pay guidelines.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Uniform pay guidelines. 214.42 Section 214.42... Advisory Committees § 214.42 Uniform pay guidelines. (a) A.I.D. follows OMB/CSC guidelines in section 11 of... experts, their compensation shall be fixed in accordance with CSC guidelines and regulations, and the...
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Mexican Asthma Guidelines: GUIMA 2017
Directory of Open Access Journals (Sweden)
Désirée Larenas-Linnemann
2017-04-01
Full Text Available Background: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. Methods: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. Results: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included. After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. Conclusion: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.
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Tier 2 guidelines and remediation of Tebuthiuron on a native prairie site
Energy Technology Data Exchange (ETDEWEB)
Bessie, K.; Harckham, N.; Dance, T. [EBA Engineering Consultants Ltd., Calgary, AB (Canada); Burk, A. [EnCana Corp., Calgary, AB (Canada); Stephenson, G. [Stantec Consulting, Guelph, ON (Canada); Corbet, B. [Access Analytical Laboratories Inc., Calgary, AB (Canada)
2009-10-01
Tebuthiuron is a sterilant used to control vegetation at upstream and midstream petroleum sites. This article discussed the remediation processes used to reclaim a native prairie site contaminated with tebuthiuron. The site was located within a dry mixed grass natural area. A literature review was conducted to establish soil eco-contact guidelines specific to tebuthiuron. A site-specific ecotoxicity assessment was then conducted using a liquid chromatograph to detect tebuthiuron limits in the contaminated soils. A soil sampling technique was used to delineate the affected areas at the site. Site soils were spiked with various concentrations of tebuthiuron ranging from 0.00003 mg/kg to 3000 mg/kg. Test species included a Folsomia candida, an earthworm, and 4 plant species. The study showed that the invertebrate species were less sensitive to tebuthiuron than the plant species. A groundwater assessment showed that tebuthiuron levels exceeded Tier 1 groundwater remediation guidelines. A multilayer hydro-geological model showed that remediation guidelines were orders of magnitude greater than Tier 1 groundwater remediation. A thermal desorption technique was used to remediate the site. 7 refs., 8 figs.
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SU-E-P-43: A Knowledge Based Approach to Guidelines for Software Safety
International Nuclear Information System (INIS)
Salomons, G; Kelly, D
2015-01-01
Purpose: In the fall of 2012, a survey was distributed to medical physicists across Canada. The survey asked the respondents to comment on various aspects of software development and use in their clinic. The survey revealed that most centers employ locally produced (in-house) software of some kind. The respondents also indicated an interest in having software guidelines, but cautioned that the realities of cancer clinics include variations, that preclude a simple solution. Traditional guidelines typically involve periodically repeating a set of prescribed tests with defined tolerance limits. However, applying a similar formula to software is problematic since it assumes that the users have a perfect knowledge of how and when to apply the software and that if the software operates correctly under one set of conditions it will operate correctly under all conditions Methods: In the approach presented here the personnel involved with the software are included as an integral part of the system. Activities performed to improve the safety of the software are done with both software and people in mind. A learning oriented approach is taken, following the premise that the best approach to safety is increasing the understanding of those associated with the use or development of the software. Results: The software guidance document is organized by areas of knowledge related to use and development of software. The categories include: knowledge of the underlying algorithm and its limitations; knowledge of the operation of the software, such as input values, parameters, error messages, and interpretation of output; and knowledge of the environment for the software including both data and users. Conclusion: We propose a new approach to developing guidelines which is based on acquiring knowledge-rather than performing tests. The ultimate goal is to provide robust software guidelines which will be practical and effective
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SU-E-P-43: A Knowledge Based Approach to Guidelines for Software Safety
Energy Technology Data Exchange (ETDEWEB)
Salomons, G [Cancer Center of Southeastern Ontario & Queen’s University, Kingston, ON (Canada); Kelly, D [Royal Military College of Canada, Kingston, ON, CA (Canada)
2015-06-15
Purpose: In the fall of 2012, a survey was distributed to medical physicists across Canada. The survey asked the respondents to comment on various aspects of software development and use in their clinic. The survey revealed that most centers employ locally produced (in-house) software of some kind. The respondents also indicated an interest in having software guidelines, but cautioned that the realities of cancer clinics include variations, that preclude a simple solution. Traditional guidelines typically involve periodically repeating a set of prescribed tests with defined tolerance limits. However, applying a similar formula to software is problematic since it assumes that the users have a perfect knowledge of how and when to apply the software and that if the software operates correctly under one set of conditions it will operate correctly under all conditions Methods: In the approach presented here the personnel involved with the software are included as an integral part of the system. Activities performed to improve the safety of the software are done with both software and people in mind. A learning oriented approach is taken, following the premise that the best approach to safety is increasing the understanding of those associated with the use or development of the software. Results: The software guidance document is organized by areas of knowledge related to use and development of software. The categories include: knowledge of the underlying algorithm and its limitations; knowledge of the operation of the software, such as input values, parameters, error messages, and interpretation of output; and knowledge of the environment for the software including both data and users. Conclusion: We propose a new approach to developing guidelines which is based on acquiring knowledge-rather than performing tests. The ultimate goal is to provide robust software guidelines which will be practical and effective.
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Guidelines in lower-middle income countries.
Olayemi, Edeghonghon; Asare, Eugenia V; Benneh-Akwasi Kuma, Amma A
2017-06-01
Guidelines include recommendations intended to optimize patient care; used appropriately, they make healthcare consistent and efficient. In most lower-middle income countries (LMICs), there is a paucity of well-designed guidelines; as a result, healthcare workers depend on guidelines developed in Higher Income Countries (HICs). However, local guidelines are more likely to be implemented because they are applicable to the specific environment; and consider factors such as availability of resources, specialized skills and local culture. If guidelines developed in HICs are to be implemented in LMICs, developers need to incorporate local experts in their development. Involvement of local stakeholders may improve the rates of implementation by identifying and removing barriers to implementation in LMICs. Another option is to encourage local experts to adapt them for use in LMICs; these guidelines may recommend strategies different from those used in HICs, but will be aimed at achieving the best practicable standard of care. Infrastructural deficits in LMICs could be improved by learning from and building on the successful response to the human immunodeficiency virus/acquired immunodeficiency syndrome pandemic through interactions between HICs and LMICs. Similarly, collaborations between postgraduate medical colleges in both HICs and LMICs may help specialist doctors training in LMICs develop skills required for guideline development and implementation. © 2017 John Wiley & Sons Ltd.
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Energy Technology Data Exchange (ETDEWEB)
Kawamura, Hirotaka, E-mail: kawamuh@criepi.denken.or.jp [Central Research Institute of Electric Power Industry (Japan); Hirano, Hideo [Central Research Institute of Electric Power Industry (Japan); Katsumura, Yousuke [University of Tokyo (Japan); Uchida, Shunsuke [Tohoku University (Japan); Mizuno, Takayuki [Mie University (Japan); Kitajima, Hideaki; Tsuzuki, Yasuo [Japan Nuclear Safety Institute (Japan); Terachi, Takumi [Institute of Nuclear Safety System, Inc. (Japan); Nagase, Makoto; Usui, Naoshi [Hitachi-GE Nuclear Energy, Ltd. (Japan); Takagi, Junichi; Urata, Hidehiro [Toshiba Corporation (Japan); Shoda, Yasuhiko; Nishimura, Takao [Mitsubishi Heavy Industry, Ltd. (Japan)
2016-12-01
Highlights: • Framework of BWR/PWR water chemistry Guidelines in Japan are presented. • Guideline necessity, definitions, philosophy and technical background are mentioned. • Some guideline settings for control parameters and recommendations are explaines. • Chemistry strategy is also mentioned. - Abstract: After 40 years of light water reactor (LWR) operations in Japan, the sustainable development of water chemistry technologies has aimed to ensure the highest coolant system component integrity and fuel reliability performance for maintaining LWRs in the world; additionally, it aimed to achieve an excellent dose rate reduction. Although reasonable control and diagnostic parameters are utilized by each boiling water reactor (BWR) and pressurized water reactor (PWR) owner, it is recognized that specific values are not shared among everyone involved. To ensure the reliability of BWR and PWR operation and maintenance, relevant members of the Atomic Energy Society of Japan (AESJ) decided to establish guidelines for water chemistry. The Japanese BWR and PWR water chemistry guidelines provide strategies to improve material and fuel reliability performance as well as to reduce dosing rates. The guidelines also provide reasonable “control values”, “diagnostic values” and “action levels” for multiple parameters, and they stipulate responses when these levels are exceeded. Specifically, “conditioning parameters” are adopted in the Japanese PWR primary water chemistry guidelines. Good practices for operational conditions are also discussed with reference to long-term experience. This paper presents the purpose, technical background and framework of the preliminary water chemistry guidelines for Japanese BWRs and PWRs. It is expected that the guidelines will be helpful as an introduction to achieve safety and reliability during operations.
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Guidelines for Better Heart Health
Skip Navigation Bar Home Current Issue Past Issues Guidelines for Better Heart Health Past Issues / Winter 2007 ... women either had or did not have CVD. Guidelines at a Glance: Prevention should be tailored to ...
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2012 Guidelines for Water Reuse
This manual is a revision of the "2004 Water Reuse Guidelines." This document is a summary of reuse guidelines, with supporting information, for the benefit of utilities of utilities and regulatory agencies, particularly EPA.
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Burgers, Jako S.; Bailey, Julia V.; Klazinga, Niek S.; van der Bij, Akke K.; Grol, Richard; Feder, Gene
2002-01-01
OBJECTIVE: To compare guidelines on diabetes from different countries in order to examine whether differences in recommendations could be explained by use of different research evidence. RESEARCH DESIGN AND METHODS: We analyzed 15 clinical guidelines on type 2 diabetes from 13 countries using
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ASSET guidelines. Revised 1991 Edition
International Nuclear Information System (INIS)
1991-12-01
The present publication is an updated version of the IAEA Assessment of Safety Significant Events Team (ASSET) Guidelines, IAEA-TECDOC-573, published in 1990. Sections 5 and 6 include revised definitions and investigation guidelines for identification of both direct and root causes. These revisions were recommended by a Consultants Meeting held in Vienna on 3-7 December 1990. This guidance is not intended to infringe an expert's prerogative to investigate additional items. Its main purpose is to provide a basic structure and ensure consistency in the assessments. Use of the ASSET guidelines should also facilitate comparison between the observations made in different nuclear power plants and harmonize the reporting of generic ASSET results. The guidelines should always be used with a critical attitude and a view to possible improvements
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Total quality management implementation guidelines
Energy Technology Data Exchange (ETDEWEB)
1993-12-01
These Guidelines were designed by the Energy Quality Council to help managers and supervisors in the Department of Energy Complex bring Total Quality Management to their organizations. Because the Department is composed of a rich mixture of diverse organizations, each with its own distinctive culture and quality history, these Guidelines are intended to be adapted by users to meet the particular needs of their organizations. For example, for organizations that are well along on their quality journeys and may already have achieved quality results, these Guidelines will provide a consistent methodology and terminology reference to foster their alignment with the overall Energy quality initiative. For organizations that are just beginning their quality journeys, these Guidelines will serve as a startup manual on quality principles applied in the Energy context.
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Why the Canadian sedentary behaviour guidelines should reflect sex and gender.
Liwander, Anna; Pederson, Ann; Boyle, Ellexis
2013-10-31
The world's first evidence-based sedentary behaviour guidelines were released in Canada in 2011. Based on evidence that time spent in sedentary pursuits poses important health risks, the guidelines recommend limits on the time that children and youth are sedentary throughout the day. Although the guidelines reflect differences in age, they do not include recommendations for adults, nor engage with other important determinants of health such as sex and gender, despite research suggesting that girls and boys, women and men, engage in different sedentary behaviours. For example, it has been suggested that girls spend considerable time in communication-based sedentary behaviours such as talking on the phone, texting and instant messaging, while boys are more likely to watch television and videos, or play computer games. There is also evidence suggesting that the health outcomes associated with sedentary behaviour differ for females and males, and there are gendered social and economic barriers that may influence sedentary behaviour. It is therefore time to consider sex and gender in research and policy on sedentary behaviour in order to effectively reduce time spent sedentary and to improve the health of women and men in Canada.
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Derivation of uranium residual radioactive material guidelines for the Elza Gate Site
International Nuclear Information System (INIS)
Cheng, J.J.; Yu, C.; Devgun, J.S.
1991-02-01
Residual radioactive material guidelines for uranium were derived for a large, homogeneously contaminated area at the Elza Gate Site in Oak Ridge, Tennessee. The derivation of the single-nuclide and total uranium guidelines was based on the requirement that the 50-year committed effective dose equivalent to hypothetical individual who lives or works in the immediate vicinity of the Elza Gate Site should not exceed a dose of 100 mrem/yr following decontamination. The DOE residual radioactive guideline computer code RESRAD was used in this evaluation. Four potential scenarios were considered for the site; the scenarios vary with regard to time spent at the site, sources of water used, and sources of food consumed. The results of the evaluation indicate that the basic dose limit of 100 mrem/yr will not be exceeded for uranium within 1000 years, provided that the soil concentration of uranium at the Elza Gate Site does not exceed the following levels: 1800 pCi/g for Scenario A (industrial worker: the expected scenario); 4000 pCi/g for Scenario B (recreationist: a plausible scenario); 470 pCi/g for Scenario C (resident farmer using pond water as the only water source: a possible but unlikely scenario); and 120 pCi/g for Scenario D (resident farmer using well water as the only water source: a possible but unlikely scenario). The uranium guideline applies to the total activity concentration of uranium isotopes in their natural activity concentration ratio of 1:1: 0.046. These guidelines are calculated on the basis of a dose of 100 mrem/yr. In setting the actual uranium guideline for the Elza Gate Site, the DOE will apply the as low as reasonably achievable (ALARA) policy to the decision-making process, along with other factors, such as determining whether a particular scenario is reasonable and appropriate. 10 refs., 3 figs., 7 tabs
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Fever without source: evaluation of a guideline.
Machado, Beatriz Marcondes; Cardoso, Débora Morais; de Paulis, Milena; Escobar, Ana Maria de Ulhôa; Gilio, Alfredo Elias
2009-01-01
To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 degrees C. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection.
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Best-practices guidelines for L2PSA development and applications. Volume 1 - General
International Nuclear Information System (INIS)
Raimond, E.; Pichereau, F.; Durin, T.; Rahni, N.; Loeffler, H.; Roesch, O.; Lajtha, G.; Santamaria, C.S.; Dienstbier, J.; Rydl, A.; Holmberg, J.E.; Lindholm, I.; Maennistoe, I.; Pauli, E.M.; Dirksen, G.; Grindon, L.; Peers, K.; Bassi, C.; Hulqvist, G.; Parozzi, F.; Polidoro, F.; Cazzoli, E.; Vitazkova, J.; Burgazzi, L.; Brinkman, H.; Seidel, A.; Schubert, B.; Wohlstein, R.; Guentay, S.; Oury, L.; Ngatchou, C.; Siltanen, S.; Niemela, I.; Routamo, T.; Vincon, L.; Helstroem, P.
2010-01-01
The objective of this coordinated action was to develop best practice guidelines for the performance and application of Level 2 PSA with a view to achieve harmonisation at EU level and to allow a meaningful and practical uncertainty evaluation in a Level 2 PSA. Specific relationships with communities in charge of nuclear reactor safety (utilities, safety authorities, vendors, and research or services companies) have been established in order to define the current needs in terms of guidelines for Level 2 PSA development and application. An international workshop was organised in Hamburg, with the support of VATTENFALL, in November 2008. The Level 2 PSA experts from ASAMPSA2 project partners have proposed some guidelines for the development and application of L2PSA based on their experience, open literature, and on information available from international cooperation (EC Severe Accident network of Excellence - SARNET, IAEA standards, OECD-NEA publications and workshop). There are a large number of technical issues addressed in the guideline which are not all covered with the same level of detail in the first version of the guideline. This version was submitted for external review in November 2010 by severe accident and PSA experts (especially from SARNET and OECD-NEA members). The feedback of the external review will be dis cussed during an international open works hop planned for March 2011 and all outcomes will be taken into consideration in the final version of this guideline (June 2011). The guideline includes 3 volumes: - Volume 1 - General considerations on L2PSA. - Volume 2 - Technical recommendations for Gen II and III reactors. - Volume 3 - Specific considerations for future reactors (Gen IV). The recommendations formulated in the guideline should not be considered as 'mandatory' but should help Level 2 PSA developers to achieve high quality studies with limited time and resources. It may also help Level 2 PSA reviewers by positioning one specific study in
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A Critical Review of Low Back Pain Guidelines.
Chetty, Laran
2017-09-01
Low back pain (LBP) remains one of the most common and challenging musculoskeletal conditions encountered by health care professionals and is a leading cause of absenteeism. Clinical guidelines are often considered best evidence in health care. The aim of this critical review was to assess the quality and recommendations of LBP guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Electronic databases were used to identify LBP guidelines published between 2000 and 2015. Nine guidelines were selected for review from a total of 17. Only five guidelines effectively addressed the AGREE scoring. On the basis of the appraisal and domain scores, only four guidelines were strongly recommended. Improved translation of research evidence from guidelines to clinical practice is needed.
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Librarian contributions to clinical practice guidelines.
Cruse, Peggy; Protzko, Shandra
2014-01-01
Librarians have become more involved in developing high quality systematic reviews. Evidence-based practice guidelines are an extension of systematic reviews and offer another significant area for librarian involvement. This column highlights opportunities and challenges for the librarian working on guideline panels and provides practical considerations for meaningful contributions to the guideline creation process.
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Main-coolant-pump shaft-seal guidelines. Volume 2. Operational guidelines. Final report
International Nuclear Information System (INIS)
Fair, C.E.; Greer, A.O.
1983-03-01
This report presents a set of guidelines and criteria for improving main coolant pump shaft seal operational reliability. The noted guidelines are developed from EPRI sponsored nuclear power plant seal operating experience studies. Usage procedures/practices and operational environment influence on seal life and reliability from the most recent such survey are summarized. The shaft seal and its auxiliary supporting systems are discussed both from technical and operational related viewpoints
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Singapore Paediatric Resuscitation Guidelines 2016.
Ong, Gene Yong Kwang; Chan, Irene Lai Yeen; Ng, Agnes Suah Bwee; Chew, Su Yah; Mok, Yee Hui; Chan, Yoke Hwee; Ong, Jacqueline Soo May; Ganapathy, Sashikumar; Ng, Kee Chong
2017-07-01
We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice. Copyright: © Singapore Medical Association.
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Ament, Stephanie M C; de Groot, Jeanny J A; Maessen, José M C; Dirksen, Carmen D; van der Weijden, Trudy; Kleijnen, Jos
2015-12-29
To evaluate (1) the state of the art in sustainability research and (2) the outcomes of professionals' adherence to guideline recommendations in medical practice. Systematic review. Searches were conducted until August 2015 in MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the Guidelines International Network (GIN) library. A snowball strategy, in which reference sections of other reviews and of included papers were searched, was used to identify additional papers. Studies needed to be focused on sustainability and on professionals' adherence to clinical practice guidelines in medical care. Studies had to include at least 2 measurements: 1 before (PRE) or immediately after implementation (EARLY POST) and 1 measurement longer than 1 year after active implementation (LATE POST). The search retrieved 4219 items, of which 14 studies met the inclusion criteria, involving 18 sustainability evaluations. The mean timeframe between the end of active implementation and the sustainability evaluation was 2.6 years (minimum 1.5-maximum 7.0). The studies were heterogeneous with respect to their methodology. Sustainability was considered to be successful if performance in terms of professionals' adherence was fully maintained in the late postimplementation phase. Long-term sustainability of professionals' adherence was reported in 7 out of 18 evaluations, adherence was not sustained in 6 evaluations, 4 evaluations showed mixed sustainability results and in 1 evaluation it was unclear whether the professional adherence was sustained. (2) Professionals' adherence to a clinical practice guideline in medical care decreased after more than 1 year after implementation in about half of the cases. (1) Owing to the limited number of studies, the absence of a uniform definition, the high risk of bias, and the mixed results of studies, no firm conclusion about the sustainability of professionals' adherence to guidelines in medical practice can be drawn
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Strategy Guideline. Modeling Enclosure Design in Above-Grade Walls
Energy Technology Data Exchange (ETDEWEB)
Lstiburek, J. [Building Science Corporation, Westford, MA (United States); Ueno, K. [Building Science Corporation, Westford, MA (United States); Musunuru, S. [Building Science Corporation, Westford, MA (United States)
2016-02-01
The Strategy Guideline, written by the U.S. Department of Energy's research team Building Science Corporation, 1) describes how to model and interpret results of models for above-grade walls, and 2) analyzes the failure thresholds and criteria for above-grade walls. A library of above-grade walls with historically successful performance was used to calibrate WUFI (Wärme und Feuchte instationär) software models. The information is generalized for application to a broad population of houses within the limits of existing experience.
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Foods, Nutrients, and Dietary Patterns: Interconnections and Implications for Dietary Guidelines12
Satija, Ambika; Hu, Frank B
2016-01-01
Dietary guidelines provide evidence-based statements on food choices to meet nutritional requirements and reduce the risk of prevailing chronic disease. They involve a substantial amount of research translation, and their implementation has important health consequences. Foods, however, are complex combinations of nutrients and other compounds that act synergistically within the food and across food combinations. In addition, the evidence base underpinning dietary guidelines accesses research that reflects different study designs, with inherent strengths and limitations. We propose a systematic approach for the review of evidence that begins with research on dietary patterns. This research will identify the combinations of foods that best protect, or appear deleterious to, health. Next, we suggest that evidence be sought from research that focuses on the effects of individual foods. Finally, nutrient-based research should be considered to explain the mechanisms by which these foods and dietary patterns exert their effects, take into account the effects of ingredients added to the food supply, and enable assessments of dietary sufficiency. The consideration of individual nutrients and food components (e.g., upper limits for saturated fat, added sugar, and sodium) provides important benchmarks for evaluating overall diet quality. The concepts of core and discretionary foods (nutrient-rich and nutrient-poor foods, respectively) enable distinctions between foods, and this has implications for the relation between food policy and food manufacturing. In summary, evidence supporting healthy dietary patterns provides the foundation for the development of dietary guidelines. Further reference to individual foods and nutrients follows from the foundation of healthy dietary patterns. PMID:27184272
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Guidelines for Building Science Education
Energy Technology Data Exchange (ETDEWEB)
Metzger, Cheryn E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rashkin, Samuel [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Huelman, Pat [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)
2015-11-01
The U.S. Department of Energy’s (DOE) residential research and demonstration program, Building America, has triumphed through 20 years of innovation. Partnering with researchers, builders, remodelers, and manufacturers to develop innovative processes like advanced framing and ventilation standards, Building America has proven an energy efficient design can be more cost effective, healthy, and durable than a standard house. As Building America partners continue to achieve their stretch goals, they have found that the barrier to true market transformation for high performance homes is the limited knowledge-base of the professionals working in the building industry. With dozens of professionals taking part in the design and execution of building and selling homes, each person should have basic building science knowledge relevant to their role, and an understanding of how various home components interface with each other. Instead, our industry typically experiences a fragmented approach to home building and design. After obtaining important input from stakeholders at the Building Science Education Kick-Off Meeting, DOE created a building science education strategy addressing education issues preventing the widespread adoption of high performance homes. This strategy targets the next generation and provides valuable guidance for the current workforce. The initiative includes: • Race to Zero Student Design Competition: Engages universities and provides students who will be the next generation of architects, engineers, construction managers and entrepreneurs with the necessary skills and experience they need to begin careers in clean energy and generate creative solutions to real world problems. • Building Science to Sales Translator: Simplifies building science into compelling sales language and tools to sell high performance homes to their customers. • Building Science Education Guidance: Brings together industry and academia to solve problems related to
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The complete European guidelines on phenylketonuria
DEFF Research Database (Denmark)
van Wegberg, A M J; MacDonald, A; Ahring, K
2017-01-01
severe intellectual disability, epilepsy and behavioural problems. PKU management differs widely across Europe and therefore these guidelines have been developed aiming to optimize and standardize PKU care. Professionals from 10 different European countries developed the guidelines according to the AGREE...... (Appraisal of Guidelines for Research and Evaluation) method. Literature search, critical appraisal and evidence grading were conducted according to the SIGN (Scottish Intercollegiate Guidelines Network) method. The Delphi-method was used when there was no or little evidence available. External consultants....... In addition, knowledge gaps are identified which require further research in order to direct better care for the future....
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Lamarche, Dallon T; Meade, Robert D; D'Souza, Andrew W; Flouris, Andreas D; Hardcastle, Stephen G; Sigal, Ronald J; Boulay, Pierre; Kenny, Glen P
2017-09-01
The American Conference of Governmental and Industrial Hygienists (ACGIH®) Threshold Limit Values (TLV® guidelines) for work in the heat consist of work-rest (WR) allocations designed to ensure a stable core temperature that does not exceed 38°C. However, the TLV® guidelines have not been validated in older workers. This is an important shortcoming given that adults as young as 40 years demonstrate impairments in their ability to dissipate heat. We therefore evaluated body temperature responses in older adults during work performed in accordance to the TLV® recommended guidelines. On three occasions, 9 healthy older (58 ± 5 years) males performed a 120-min work-simulated protocol in accordance with the TLV® guidelines for moderate-to-heavy intensity work (360 W fixed rate of heat production) in different wet-bulb globe temperatures (WBGT). The first was 120 min of continuous (CON) cycling at 28.0°C WBGT (CON[28°C]). The other two protocols were 15-min intermittent work bouts performed with different WR cycles and WBGT: (i) WR of 3:1 at 29.0°C (WR3:1[29°C]) and (ii) WR of 1:1 at 30.0°C (WR1:1[30°C]). Rectal temperature was measured continuously. The rate of change in mean body temperature was determined via thermometry (weighting coefficients: rectal, 0.9; mean skin temperature, 0.1) and direct calorimetry. Rectal temperature exceeded 38°C in all participants in CON[28°C] and WR3:1[29°C] whereas a statistically similar proportion of workers exceeded 38°C in WR1:1[30°C] (χ 2 ; P = 0.32). The average time for rectal temperature to reach 38°C was: CON[28°C], 53 ± 7; WR3:1[29°C], 79 ± 11; and WR1:1[30°C], 100 ± 29 min. Finally, while a stable mean body temperature was not achieved in any work condition as measured by thermometry (i.e., >0°C·min -1 ; all Pheat balance as determined by direct calorimetry was achieved in WR3:1[29°C] and WR1:1[30°C] (both P ≥ 0.08). Our findings indicate that the TLV® guidelines do not prevent body core
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Misguided guidelines for managing labor.
Cohen, Wayne R; Friedman, Emanuel A
2015-06-01
In a recent review we expressed concerns about new guidelines for the assessment and management of labor recommended jointly by the American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). These guidelines are based heavily on a new concept of how cervical dilatation and fetal descent progress, derived from the work of Zhang et al. In their Viewpoint article they have addressed, but not allayed, the concerns we described in our review. We assert that the dilatation curve promulgated by Zhang et al cannot be reconciled with direct clinical observation. Even if they were correct, however, it still does not follow that the ACOG/SMFM guidelines should recommend replacing the coherent system of identifying and managing labor aberrations described by Friedman. That system is grounded in well-established clinical principles based on decades of use and the objectively documented association of some labor abnormalities with poor fetal and maternal outcomes. Recommendations for new clinical management protocols should require the demonstration of superior outcomes through extensive, preferably prospective, assessment. Using untested guidelines for the management of labor may adversely affect women and children. Even if those guidelines were to reduce the currently excessive cesarean delivery rate, the price of that benefit is likely to be a trade-off in harm to parturients and their offspring. The nature and degree of that harm needs to be documented before considering adoption of the guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.
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Paralympic emblem guidelines: London 2012
2015-01-01
The purpose of these guidelines is to preserve and enhance the value of the Emblem for the benefit of all authorised users. These guidelines apply to LOCOG and IPC creative, marketing and communications personnel, agencies and consultants only.
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Reporting guidelines and journal quality in otolaryngology.
Henderson, A H; Upile, T; Pilavakis, Y; Patel, N N
2016-10-01
Journals increasingly use reporting guidelines to standardise research papers, partly to improve quality. Although defining journal quality is difficult, various calculated metrics are used. This study investigates guideline adoption by otolaryngology journals and whether a relationship exists between this and journal quality. Retrospective MEDLINE database review for English language, Index Medicus, journals of interest to otolaryngologists (October 2013). The resulting journals were examined for the number of guidelines endorsed and then tabulated against surrogate measures of journal quality (Impact factor, Eigenfactor, SCImago, Source-Normalised rank). The primary outcome measure was the number of recognised reporting guidelines endorsed per journal. This was then correlated against journal quality scores. For comparison, a further small sample correlation was performed with 6 randomly selected and 6 high-profile clinical non-otolaryngology journals. 37 otolaryngology journals were identified. Number of guidelines used and quality scores were not normally distributed. Mean guideline usage was 1.0 for otolaryngology journals, 1.5 for randomly selected, and 5.5 for the high-profile journals. Only 18/37 (49%) otolaryngology journals endorsed any guidelines, compared with 11/12 non-otolaryngology journals. Within otolaryngology, Eigenfactor positively correlated with guideline use (r = 0.4, n = 44, p otolaryngology journals is low. Although it might be expected that use of reporting guidelines improved quality, this is not reflected in the derived quality scores in otolaryngology. This may reflect low levels of use/enforcement, that quality indicators are inherently flawed, or that generalised guidelines are not always appropriate or valued by editors. © 2015 John Wiley & Sons Ltd.
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How do SAGES members rate its guidelines?
Hope, William W; Richardson, William; Fanelli, Robert; Stefanidis, Dimitrios
2014-04-01
The development of practice guidelines should take into consideration the opinions of end users. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has implemented several changes in its guideline development and dissemination process based on previous end-user input. An anonymous electronic survey was conducted via e-mail solicitation in September 2011. Respondents were asked to submit their feedback on the 26 guidelines produced by our society using a 32-item questionnaire and to suggest topics for new guideline development and areas of improvement. Responses from the survey were received by 494 people, of whom 474 (96 %) were clinicians; 373 (75 %) were general, laparoscopic, or bariatric surgeons; and 324 (65 %) held leadership roles within their institution. Most respondents were 35-44 years old (36 %), male (83 %), and had been in practice for over 10 years (54 %). A total of 383 (81 %) had used our guidelines, and, of those, 96 % agreed with their content. Guideline quality was rated 4.34; value 4.27; and ease of access 3.97 on a five-point Likert scale. The most commonly referenced guideline in the survey regarded surgical treatment of reflux (67 %), followed by laparoscopy during pregnancy (51 %). The three most common reasons guidelines were accessed were to update knowledge (68 %), to maximize patient care through evidence-based treatment (51 %), and to obtain a critical literature review. The majority of respondents indicated they greatly value and agree with our guidelines. These results indicate that recent efforts to improve our guidelines have succeeded.
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The Interconnection Guidelines provide general guidance on the steps involved with connecting biogas recovery systems to the utility electrical power grid. Interconnection best practices including time and cost estimates are discussed.
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Epidemiology of cancer due to radiations and development of guidelines
International Nuclear Information System (INIS)
Okuno, Emico
2009-01-01
This review article describes the ionizing and non-ionizing radiation protection commissions and the development processes of the guidelines for limiting exposure to these radiations. We briefly describe the history of these commissions and the types of epidemiological studies from which the risk factors are evaluated. Some recent results obtained from epidemiological studies of atomic bomb survivors in Japan and the inherent difficulties will be presented. At last the current international recommendations will be presented. (author)
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Derivation of uranium residual radioactive material guidelines for the Shpack site
International Nuclear Information System (INIS)
Cheng, J.J.; Yu, C.; Monette, F.; Jones, L.
1991-08-01
Residual radioactive material guidelines for uranium were derived for the Shpack site in Norton, Massachusetts. This site has been identified for remedial action under the Formerly Utilized Sites Remedial Action Program (FUSRAP) of the US Department of Energy (DOE). The uranium guidelines were derived on the basis of the requirement that the 50-year committed effective dose equivalent to a hypothetical individual who lives or works in the immediate vicinity of the Shpack site should not exceed a dose of 100 mrem/yr following decontamination. The DOE residual radioactive material guideline computer code, RESRAD, which implements the methodology described in the DOE manual for implementing residual radioactive material guidelines, was used in this evaluation. Three potential scenarios were considered for the site; the scenarios vary with regard to time spent at the site, sources of water used, and sources of food consumed. The results of the evaluation indicate that the basic dose limit of 100 mrem/yr will not be exceeded for uranium (including uranium-234, uranium-235, and uranium-238) within 1000 years, provided that the soil concentration of combined uranium (uranium-234 and uranium-238) at the Shpack site does not exceed the following levels: 2500 pCi/g for Scenario A (recreationist: the expected scenario); 1100 pCi/g for Scenario B (industrial worker: a plausible scenario); and 53 pCi/g for Scenario C (resident farmer using a well water as the only water source: a possible but unlikely scenario). The uranium guidelines derived in this report apply to the combined activity concentration of uranium-234 and uranium-238 and were calculated on the basis of a dose of 100 mrem/yr. In setting the actual uranium guidelines for the Shpack site, DOE will apply the as low as reasonably achievable (ALARA) policy to the decision-making process, along with other factors, such as whether a particular scenario is reasonable and appropriate. 8 refs., 2 figs., 8 tabs
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NCCN Guidelines® Insights Bladder Cancer, Version 2.2016 Featured Updates to the NCCN Guidelines
Clark, Peter E.; Spiess, Philippe E.; Agarwal, Neeraj; Bangs, Rick; Boorjian, Stephen A.; Buyyounouski, Mark K.; Efstathiou, Jason A.; Flaig, Thomas W.; Friedlander, Terence; Greenberg, Richard E.; Guru, Khurshid A.; Hahn, Noah; Herr, Harry W.; Hoimes, Christopher; Inman, Brant A.; Kader, A. Karim; Kibel, Adam S.; Kuzel, Timothy M.; Lele, Subodh M.; Meeks, Joshua J.; Michalski, Jeff; Montgomery, Jeffrey S.; Pagliaro, Lance C.; Pal, Sumanta K.; Patterson, Anthony; Petrylak, Daniel; Plimack, Elizabeth R.; Pohar, Kamal S.; Porter, Michael P.; Sexton, Wade J.; Siefker-Radtke, Arlene O.; Sonpavde, Guru; Tward, Jonathan; Wile, Geoffrey; Dwyer, Mary A.; Smith, Courtney
2017-01-01
These NCCN Guidelines Insights discuss the major recent updates to the NCCN Guidelines for Bladder Cancer based on the review of the evidence in conjunction with the expert opinion of the panel. Recent updates include (1) refining the recommendation of intravesical bacillus Calmette-Guérin, (2) strengthening the recommendations for perioperative systemic chemotherapy, and (3) incorporating immunotherapy into second-line therapy for locally advanced or metastatic disease. These NCCN Guidelines Insights further discuss factors that affect integration of these recommendations into clinical practice. PMID:27697976
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Main-coolant-pump shaft-seal guidelines. Volume 3. Specification guidelines. Final report
International Nuclear Information System (INIS)
Fair, C.E.; Greer, A.O.
1983-03-01
This report presents a set of guidelines and criteria to aid in the generation of procurement specifications for Main Coolant Pump Shaft Seals. The noted guidelines are developed from EPRI sponsored nuclear power plant seal operating experience studies, a review of pump and shaft seal literature and discussions with pump and seal designers. This report is preliminary in nature and could be expanded and finalized subsequent to completion of further design, test and evaluation efforts
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Effluent guidelines are national standards for wastewater discharges to surface waters and municipal sewage treatment plants. We issue the regulations for industrial categories based on the performance of treatment and control technologies.
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IT governance guidelines for directors
Calder, Alan
2005-01-01
This important new book – 'IT Governance: Guidelines for Directors' provides directors, executives, managers and professional advisers with clear, pragmatic guidelines for ensuring that IT and the business work together for the same strategic objectives.
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Canadian consensus practice guidelines for bisphosphonate associated osteonecrosis of the jaw.
Khan, Aliya A; Sándor, George K B; Dore, Edward; Morrison, Archibald D; Alsahli, Mazen; Amin, Faizan; Peters, Edmund; Hanley, David A; Chaudry, Sultan R; Dempster, David W; Glorieux, Francis H; Neville, Alan J; Talwar, Reena M; Clokie, Cameron M; Al Mardini, Majd; Paul, Terri; Khosla, Sundeep; Josse, Robert G; Sutherland, Susan; Lam, David K; Carmichael, Robert P; Blanas, Nick; Kendler, David; Petak, Steven; St-Marie, Louis Georges; Brown, Jacques; Evans, A Wayne; Rios, Lorena; Compston, Juliet E
2008-07-01
Following publication of the first reports of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates in 2003, a call for national multidisciplinary guidelines based upon a systematic review of the current evidence was made by the Canadian Association of Oral and Maxillofacial Surgeons (CAOMS) in association with national and international societies concerned with ONJ. The purpose of the guidelines is to provide recommendations regarding diagnosis, identification of at-risk patients, and prevention and management strategies, based on current evidence and consensus. These guidelines were developed for medical and dental practitioners as well as for oral pathologists and related specialists. The multidisciplinary task force established by the CAOMS reviewed all relevant areas of research relating to ONJ associated with bisphosphonate use and completed a systematic review of current literature. These evidence-based guidelines were developed utilizing a structured development methodology. A modified Delphi consensus process enabled consensus among the multidisciplinary task force members. These guidelines have since been reviewed by external experts and endorsed by national and international medical, dental, oral surgery, and oral pathology societies. RECOMMENDATIONS regarding diagnosis, prevention, and management of ONJ were made following analysis of all current data pertaining to this condition. ONJ has many etiologic factors including head and neck irradiation, trauma, periodontal disease, local malignancy, chemotherapy, and glucocorticoid therapy. High-dose intravenous bisphosphonates have been identified as a risk factor for ONJ in the oncology patient population. Low-dose bisphosphonate use in patients with osteoporosis or other metabolic bone disease has not been causally linked to the development of ONJ. Prevention, staging, and treatment recommendations are based upon collective expert opinion and current data, which has been limited to case
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Exploiting thesauri knowledge in medical guideline formalization
Serban, R.C.; ten Teije, A.C.M.
2009-01-01
Objectives: As in software product lifecycle, the effort spent in maintaining medical knowl edge in guidelines can be reduced, if modularization, formalization and tracking of domain knowledge are employed across the guideline development phases. Methods: We propose to exploit and combine knowledge templates with medical background knowledge from existing thesauri in order to produce reusable building blocks used in guideline development. These tem- plates enable easier guideline formalizatio...
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Directory of Open Access Journals (Sweden)
Eli Feiring
2017-11-01
Full Text Available Abstract Background As effective antibiotics are becoming a scarce resource, governmental regulation is needed to promote responsible use. Implementation of antibiotic stewardship and practice guidelines in health care facilities seems to be crucial to this effort. Empirical studies suggest, however, that guidelines have limited influence on health professionals’ behavior and practice. Barriers and facilitators to guideline implementability are much studied, but little attention has been given to health professionals’ perceptions of normative acceptability of guidelines as a condition for compliance. The aim of the present study was first, to examine if and how aspects potentially promoting acceptability and compliance among clinical target users were addressed during development of Norwegian national guidelines for antibiotic use in hospitals and second, to identify procedural characteristics of the development process that were perceived by target users to yield legitimate guidelines. Methods Qualitative deductive thematic analysis was used. A theoretical framework inspired by the AGREE II Instrument and the Accountability for reasonableness framework assisted data gathering and interpretation. Archival data was collected and used to detail the guideline development process. Semi-structured, in-depth interviews with eight clinicians with extensive knowledge of the guidelines were carried out. Results Guideline development was characterized by i broad agreement about scope and purpose, ii broad involvement of stakeholders in the development process, iii use of systematic methods to search for and apply evidence, iv easily identifiable and specific recommendations, v provision of tools on how to put recommendations into practice, and vi editorial independence. Several procedural characteristics were perceived by the interviewees as promoting guideline legitimacy; i diverse perspectives systematically involved in the process, ii accessibility
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Feiring, Eli; Walter, Anne Berit
2017-11-21
As effective antibiotics are becoming a scarce resource, governmental regulation is needed to promote responsible use. Implementation of antibiotic stewardship and practice guidelines in health care facilities seems to be crucial to this effort. Empirical studies suggest, however, that guidelines have limited influence on health professionals' behavior and practice. Barriers and facilitators to guideline implementability are much studied, but little attention has been given to health professionals' perceptions of normative acceptability of guidelines as a condition for compliance. The aim of the present study was first, to examine if and how aspects potentially promoting acceptability and compliance among clinical target users were addressed during development of Norwegian national guidelines for antibiotic use in hospitals and second, to identify procedural characteristics of the development process that were perceived by target users to yield legitimate guidelines. Qualitative deductive thematic analysis was used. A theoretical framework inspired by the AGREE II Instrument and the Accountability for reasonableness framework assisted data gathering and interpretation. Archival data was collected and used to detail the guideline development process. Semi-structured, in-depth interviews with eight clinicians with extensive knowledge of the guidelines were carried out. Guideline development was characterized by i) broad agreement about scope and purpose, ii) broad involvement of stakeholders in the development process, iii) use of systematic methods to search for and apply evidence, iv) easily identifiable and specific recommendations, v) provision of tools on how to put recommendations into practice, and vi) editorial independence. Several procedural characteristics were perceived by the interviewees as promoting guideline legitimacy; i) diverse perspectives systematically involved in the process, ii) accessibility and transparency of the rationales for decision
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Manual for implementing residual radioactivity guidelines
International Nuclear Information System (INIS)
Gilbert, T.L.; Eckerman, K.F.; Hansen, W.R.; Healy, J.W.; Kennedy, W.E.; Napier, B.A.; Solday, J.K.
1986-01-01
The US Department of Energy (DOE) has recently issued guidelines for residual radioactivity at Formerly Utilized Sites Remedial Action Program (FUSRAP) and remote Surplus Facilities Management Program (SFMP) sites. A manual for implementing these guidelines has been prepared jointly by four DOE laboratories (ANL, LANL, ORNL, and PNL) and is being issued as a supplement to the guidelines. The manual presents procedures and tables for deriving site-specific guidelines for levels of residual radionuclide concentrations in soil that must not be exceeded if a site is to be released for unrestricted use. Guidance for implementing DOE ALARA policy for remedial actions is also included. The concentration factor method is used in the pathway analysis for deriving soil guidelines. The analysis has been structured in a manner that explicitly identifies all of the factors involved. Tables are provided for dose-conversion factors and pathway factors from which environmental transport factors for each radionuclide and pathway may be calculated. The scenarios used for deriving the environmental transport factors and dose conversion factors, and the manner in which the information provided in the manual is used to derive site-specific soil guidelines will be presented
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EuroFIR Guideline on calculation of nutrient content of foods for food business operators.
Machackova, Marie; Giertlova, Anna; Porubska, Janka; Roe, Mark; Ramos, Carlos; Finglas, Paul
2018-01-01
This paper presents a Guideline for calculating nutrient content of foods by calculation methods for food business operators and presents data on compliance between calculated values and analytically determined values. In the EU, calculation methods are legally valid to determine the nutrient values of foods for nutrition labelling (Regulation (EU) No 1169/2011). However, neither a specific calculation method nor rules for use of retention factors are defined. EuroFIR AISBL (European Food Information Resource) has introduced a Recipe Calculation Guideline based on the EuroFIR harmonized procedure for recipe calculation. The aim is to provide food businesses with a step-by-step tool for calculating nutrient content of foods for the purpose of nutrition declaration. The development of this Guideline and use in the Czech Republic is described and future application to other Member States is discussed. Limitations of calculation methods and the importance of high quality food composition data are discussed. Copyright © 2017. Published by Elsevier Ltd.
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[Guideline 'Organ donation following euthanasia"
Mulder, H.; Olthuis, G.J.; Siebelink, M.; Gerritsen, R; Heurn, E. van
2017-01-01
- The multidisciplinary guideline 'Organ donation following euthanasia' was published in March 2017 at request of the Minister of Health, Welfare and Sport.- This guideline provides recommendations for the organisation and implementation of a request to donate organs expressed by a patient who asks
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Medical Malpractice Implications of Clinical Practice Guidelines.
Ruhl, Douglas S; Siegal, Gil
2017-08-01
Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.
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Lupus nephritis management guidelines compared.
Wilhelmus, Suzanne; Bajema, Ingeborg M; Bertsias, George K; Boumpas, Dimitrios T; Gordon, Caroline; Lightstone, Liz; Tesar, Vladimir; Jayne, David R
2016-06-01
In the past years, many (randomized) trials have been performed comparing the treatment strategies for lupus nephritis. In 2012, these data were incorporated in six different guidelines for treating lupus nephritis. These guidelines are European, American and internationally based, with one separate guideline for children. They offer information on different aspects of the management of lupus nephritis including induction and maintenance treatment of the different histological classes, adjunctive treatment, monitoring of the patient, definitions of response and relapse, indications for (repeat) renal biopsy, and additional challenges such as the presence of vascular complications, the pregnant SLE patient, treatment in children and adolescents and considerations about end-stage renal disease and transplantation. In this review, we summarize the guidelines, determine the common ground between them, highlight the differences and discuss recent literature. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
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Energy Technology Data Exchange (ETDEWEB)
Schwibach, J; Huber, O
1975-08-01
In licensing the operation of nuclear power plants in the FRG and USA, particular limitations of the release of radioactive materials in the air and water are layed down to correspond to the protective laws of radiation and environmental protection. The first limiting recommendations for the removal of radioactive waste waters were worked out in 1965 in the FRG and in 1968/69 for the removal of radioactive exhaust air of nuclear power plants. Based on this, in 1975 these relevant regulations were included in the draft of the new radiation protection specification. In 1971, these type of guidelines were put to discussion in the USA and were dismissed in 1975 in a licensing regulation of the NRC. These regulations or guidelines differ in their various dose limits. For example, the German dose limits of 30 mrem/a whole body dose for radioactive materials in the exhaust air of nuclear power plants and of 90 mrem/a for the thyroid dose through radioiodine via the exposure exhaust air-pasture-cow-milk-infant are often compared to the American dose limits of 5 mrem/a whole body dose and 15 mrem/a skin dose as well as 15 mrem/a thyroid dose. Such a numerical comparison is, howewer, wrong. The dose limits used in the FRG are, e.g., not to be exceeded. Furthermore, in the FRG, all contributions to be calculated on one site are to be considered. In the USA, the corresponding values are only valid for actual exposure paths due to the emission of a power reactor. They can be multiply exceeded. Thus the German licensing practise is clearly more restrictive.
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2011-11-28
..., the State shall submit NO X RACT SIPs for electrical generating units (EGUs) no later than the date by.... 2 Lime Kiln require Lowest Achievable Emissions Rate (LAER) standards and for these units LAER meets...
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Directory of Open Access Journals (Sweden)
Anthony D. Okely
2017-11-01
= 5 to obtain feedback from stakeholders on the draft guidelines. Results Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h, integrating physical activity, sedentary behaviour (including limits to screen time, and sleep for infants (<1 year, toddlers (1–2 years and preschoolers (3–5 years. Conclusions To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.
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EPA`s program for risk assessment guidelines: Quantification issues
Energy Technology Data Exchange (ETDEWEB)
Dourson, M.L. [Environmental Protection Agency, Washington, DC (United States)
1990-12-31
The quantitative procedures associated with noncancer risk assessment include reference dose (RfD), benchmark dose, and severity modeling. The RfD, which is part of the EPA risk assessment guidelines, is an estimation of a level that is likely to be without any health risk to sensitive individuals. The RfD requires two major judgments: the first is choice of a critical effect(s) and its No Observed Adverse Effect Level (NOAEL); the second judgment is choice of an uncertainty factor. This paper discusses major assumptions and limitations of the RfD model.
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Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary.
Stachler, Robert J; Francis, David O; Schwartz, Seth R; Damask, Cecelia C; Digoy, German P; Krouse, Helene J; McCoy, Scott J; Ouellette, Daniel R; Patel, Rita R; Reavis, Charles Charlie W; Smith, Libby J; Smith, Marshall; Strode, Steven W; Woo, Peak; Nnacheta, Lorraine C
2018-03-01
Objective This guideline provides evidence-based recommendations on treating patients presenting with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology-head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to recent surgical procedures involving the head, neck, or chest; recent endotracheal intubation; presence of concomitant neck mass; respiratory distress or stridor; history of tobacco abuse; and whether the patient is a professional voice user. (2) Clinicians should advocate voice therapy for patients with dysphonia from a
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Guidelines for Reporting Medical Research
DEFF Research Database (Denmark)
Johansen, Mathilde; Thomsen, Simon Francis
2016-01-01
As a response to a low quality of reporting of medical research, guidelines for several different types of study design have been developed to secure accurate reporting and transparency for reviewers and readers from the scientific community. Herein, we review and discuss the six most widely...... accepted and used guidelines: PRISMA, CONSORT, STROBE, MOOSE, STARD, and SPIRIT. It is concluded that the implementation of these guidelines has led to only a moderate improvement in the quality of the reporting of medical research. There is still much work to be done to achieve accurate and transparent...... reporting of medical research findings....
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[A new update of the SIMLII Guidelines on carcinogens].
Pira, Enrico; Giachino, Gian Mario; Discalzi, Gianluigi
2011-01-01
The second update of the Italian Society of Occupational Medicine and Industrial Hygiene (SIMLII) guidelines on Cancerogens and Mutagens, first published in 2003 and reviewed in 2007, is presented. The general setting of the guidelines remaines unmodified. In this new release some important developments on regulatory system, risk assessment, and health surveillance are discussed. The relevant evolution of the regulatory rules is illustrated in detail, with particular reference to the recent implementation in European Union and in Italy of the Regulation (EC) 1272/2008 on Classification, Labelling and Packaging of substances and mixtures. The recent tendencies of the European Scientific Committee on Occupational Exposure Limits in risk assessment, are presented. Some remarks on the use of new biomarkers in health surveillance, with reference to lung and bladder cancer, are discussed. The more recent results on the effectiveness of the use of LDTC scan on screening in asymptomatic persons at high risk for lung cancer, are presented. The use of this imaging technique in health surveillance of special group of workers (i.e., subjects with relevant past asbestos exposure and smokers) could be adopted.
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Weight gain in pregnancy and application of the 2009 IOM guidelines: toward a uniform approach.
Gilmore, L Anne; Redman, Leanne M
2015-03-01
There is an urgent need to adopt standardized nomenclature as it relates to gestational weight gain (GWG), a more uniform approach to calculate it, and hence quantifying adherence to the 2009 Institute of Medicine (IOM) guidelines. This perspective highlights the varying methods used to estimate GWG and discuss the advantages and limitations of each. While these calculations could be argued to have a minimal impact on data at the population level, on the patient level, incorrectly estimating weight at conception can result in misclassification of preconception body mass index (BMI) and assignment of the IOM guidelines which inherently affect the prospective management of weight gain (and potential outcomes) during the current pregnancy. This study recommends that preconception BMI and total GWG be determined objectively and total GWG be adjusted for length of gestation before assessing adherence to the IOM GWG guidelines. © 2014 The Obesity Society.
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Maintaining formal models of living guidelines efficiently
Seyfang, Andreas; Martínez-Salvador, Begoña; Serban, Radu; Wittenberg, Jolanda; Miksch, Silvia; Marcos, Mar; Ten Teije, Annette; Rosenbrand, Kitty C J G M
2007-01-01
Translating clinical guidelines into formal models is beneficial in many ways, but expensive. The progress in medical knowledge requires clinical guidelines to be updated at relatively short intervals, leading to the term living guideline. This causes potentially expensive, frequent updates of the
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Compliance with practice guidelines: clinical autonomy revisited
Klazinga, N.
1994-01-01
The development of practice guidelines is gaining popularity in both North America and Europe. This review article explores the different reasons behind guideline development, the methodologies used and the effects assessed so far. Experience since 1982 with a guideline development programme at CBO
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European guidelines for workplace drug testing in urine.
Taskinen, Sanna; Beck, Olof; Bosch, Tessa; Brcak, Michaela; Carmichael, Duncan; Fucci, Nadia; George, Claire; Piper, Mark; Salomone, Alberto; Schielen, Wim; Steinmeyer, Stefan; Weinmann, Wolfgang
2017-06-01
These European Guidelines for Workplace Drug Testing in Urine have been prepared and updated by the European Workplace Drug Testing Society (EWDTS). The first version of these urine guidelines was published in 2002. Since then, the guidelines have been followed by many laboratories in different European countries and their role has been essential particularly in countries lacking legislation for workplace drug testing. In 2014, the EWDTS started a guidelines updating project and published a new version of the urine guidelines in 2015. Here we represent this updated version of the urine guidelines. The European Guidelines are designed to establish best practice procedures whilst allowing individual countries to operate within the requirements of national customs and legislation. The EWDTS recommends that all European laboratories that undertake legally defensible workplace drug testing should use these guidelines as a template for accreditation. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
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Campsall, Paul; Colizza, Kate; Straus, Sharon; Stelfox, Henry T
2016-05-01
): guidelines produced by organizations reporting more comprehensive conflict of interest policies (per additional procedure, range 5-17) included fewer positive (rate ratio [RR] 0.91, 95% CI 0.86-0.95) and more negative (RR 1.32, 95% CI 1.09-1.60) recommendations regarding patented biomedical products. The clinical practice guidelines produced by organizations reporting more comprehensive conflict of interest policies were also more likely to include disclosure statements for direct funding sources (odds ratio [OR] 1.31, 95% CI 1.10-1.56) and financial relationships of guideline committee members (OR 1.36, 95% CI 1.09-1.79), but not financial relationships of the organizations (0 disclosures). Limitations of the study include the use of the National Guideline Clearinghouse as the single source of clinical practice guidelines and the self-report of survey responses and organizations' website postings. Financial relationships between organizations that produce clinical practice guidelines and biomedical companies are common and infrequently disclosed in guidelines. Our study highlights the need for an effective policy to manage organizational conflicts of interest and disclosure of financial relationships.
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[Elaboration and critical evaluation of clinical guidelines].
García Villar, C
2015-11-01
Clinical guidelines are documents to help professionals and patients select the best diagnostic or therapeutic option. Elaborating guidelines requires an efficient literature search and a critical evaluation of the articles found to select the most appropriate ones. After that, the recommendations are formulated and then must be externally evaluated before they can be disseminated. Even when the guidelines are very thorough and rigorous, it is important to know whether they fulfill all the methodological requisites before applying them. With this aim, various scales have been developed to critically appraise guidelines. Of these, the AGREE II instrument is currently the most widely used. This article explains the main steps in elaborating clinical guidelines and the main aspects that should be analyzed to know whether the guidelines are well written. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.
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World Health Organization guideline development: an evaluation.
Directory of Open Access Journals (Sweden)
David Sinclair
Full Text Available BACKGROUND: Research in 2007 showed that World Health Organization (WHO recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization's own "Guidelines for Guidelines". In response, the WHO established a "Guidelines Review Committee" (GRC to implement and oversee internationally recognized standards. We examined the impact of these changes on WHO guideline documents and explored senior staff's perceptions of the new procedures. METHODS AND FINDINGS: We used the AGREE II guideline appraisal tool to appraise ten GRC-approved guidelines from nine WHO departments, and ten pre-GRC guidelines matched by department and topic. We interviewed 20 senior staff across 16 departments and analyzed the transcripts using the framework approach. Average AGREE II scores for GRC-approved guidelines were higher across all six AGREE domains compared with pre-GRC guidelines. The biggest changes were noted for "Rigour of Development" (up 37.6%, from 30.7% to 68.3% and "Editorial Independence" (up 52.7%, from 20.9% to 73.6%. Four main themes emerged from the interviews: (1 high standards were widely recognized as essential for WHO credibility, particularly with regard to conflicts of interest; (2 views were mixed on whether WHO needed a single quality assurance mechanism, with some departments purposefully bypassing the procedures; (3 staff expressed some uncertainties in applying the GRADE approach, with departmental staff concentrating on technicalities while the GRC remained concerned the underlying principles were not fully institutionalized; (4 the capacity to implement the new standards varied widely, with many departments looking to an overstretched GRC for technical support. CONCLUSIONS: Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance
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PIAAC Technical Standards and Guidelines
OECD Publishing, 2014
2014-01-01
The Programme for International Assessment of Adult Competencies (PIAAC) will establish technical standards and guidelines to ensure that the survey design and implementation processes of PIAAC yield high-quality and internationally comparable data. This document provides a revised version of the technical standards and guidelines originally…
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Specialty Guidelines for Forensic Psychology
American Psychologist, 2013
2013-01-01
In the past 50 years forensic psychological practice has expanded dramatically. Because the practice of forensic psychology differs in important ways from more traditional practice areas (Monahan, 1980) the "Specialty Guidelines for Forensic Psychologists" were developed and published in 1991 (Committee on Ethical Guidelines for Forensic…
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ESUR prostate MR guidelines 2012
Energy Technology Data Exchange (ETDEWEB)
Barentsz, Jelle O.; Fuetterer, Jurgen J. [Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen (Netherlands); Richenberg, Jonathan [Brighton and Sussex University Hospital Trust, Brighton (United Kingdom); Clements, Richard [Royal Gwent Hospital, Department of Clinical Radiology, Newport, South Wales (United Kingdom); Choyke, Peter [National Cancer Institute, Molecular Imaging Program, Bethesda, MD (United States); Verma, Sadhna [University Of Cincinnati Medical Center, Cincinnati, OH (United States); Villeirs, Geert [Ghent University Hospital, Division of Genitourinary Radiology, Ghent (Belgium); Rouviere, Olivier [Hopital Edouard Herriot, Hospices Civils de Lyon, Department of Urinary and Vascular Imaging, Lyon (France); Universite de Lyon, Lyon (France); Universite Lyon 1, Faculte de Medecine Lyon Est, Lyon (France); Logager, Vibeke [Copenhagen University, Hospital Herlev, Herlev (Denmark)
2012-04-15
The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated, but a compromise, reflected by ''minimal'' and ''optimal'' requirements has been made. The scope of these ESUR guidelines is to promulgate high quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines for the optimal technique and three protocols for ''detection'', ''staging'' and ''node and bone'' are presented. The use of endorectal coil vs. pelvic phased array coil and 1.5 vs. 3 T is discussed. Clinical indications and a PI-RADS classification for structured reporting are presented. (orig.)
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41 CFR 109-39.301 - Utilization guidelines.
2010-07-01
... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Utilization guidelines... Management System Vehicles § 109-39.301 Utilization guidelines. DOE activities utilizing GSA IFMS motor... meeting DOE utilization guidelines or established local use objectives, as appropriate. Those vehicles not...
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28 CFR 2.21 - Reparole consideration guidelines.
2010-07-01
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Reparole consideration guidelines. 2.21....21 Reparole consideration guidelines. (a)(1) If revocation is based upon administrative violation(s... analogy with listed federal offense behaviors. (b) The guidelines for parole consideration specified at 28...
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Dutch physiotherapy guidelines for low back pain
Bekkering, Geertruida E; Hendriks, H.J.M.; Koes, Bart W; Oostendorp, R. A B; Ostelo, R. W J G; Thomassen, J. M C; van Tulder, M. W.
2003-01-01
Many guidelines for the management of low back pain in primary care have been published during recent years, but guidelines for physiotherapy do not yet exist. Therefore, physiotherapy guidelines have been developed, reflecting the consequences of the current state of knowledge of effective and
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40 CFR 799.11 - Availability of test guidelines.
2010-07-01
... 40 Protection of Environment 31 2010-07-01 2010-07-01 true Availability of test guidelines. 799.11... General Provisions § 799.11 Availability of test guidelines. (a) The TSCA and FIFRA guidelines for the...-487-4650). (b) The OECD guidelines for the various study plans are available from the following...
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International Nuclear Information System (INIS)
Gilbert, T.L.
1985-01-01
The need for a definitive basis for radiological guidelines and criteria for FUSRAP became apparent by 1981 and led ORO to sponsor a joint ANL/BNI/LANL/ORO effort under the chairmanship of Wayne Hansen (LANL) that resulted in a final FUSRAP radiological guidelines document in March 1983. A separate effort to develop guidelines for remedial action criteria for SFMP was in progress at PNL. The need to coordinate both efforts with impending revisions of DOE Radiological Protection Standards and impending new developments in EPA and NRC Radiological Protection Standards led to convening of the first DOE Workshop on Remedial Action Criteria in Gaithersburg, Maryland, in February 1984, followed by a second workshop in June 1984 at ANL. The major decisions were to base the criteria on dosimetry models and basic limits currently recommended by the International Commission on Radiological Protection, to emphasize the development and use of site-specific rather than generic guidelines and criteria for residual radionuclide concentrations in the ground, and to prepare a manual to accompany the guidelines that would present procedures and tables for deriving site-specific soil guidelines and criteria for the remedial action programs. A joint ANL/LANL/ORNL/PNL effort to prepare a definitive set of guidelines and a manual has been initiated. The scope, status, and current plans for this effort, and some of the key issues, are presented. 10 references, 1 table
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International Nuclear Information System (INIS)
Gilbert, T.L.
1984-01-01
The need for a definitive basis for radiological guidelines and criteria for FUSRAP became apparent by 1981 and led ORO to sponsor a joint ANL/BNI/LANL/ORO effort under the chairmanship of Wayne Hansen (LANL) that resulted in a final FUSRAP radiological guidelines document in March 1983. A separate effort to develop guidelines for remedial action criteria for SFMP was in progress at PNL. The need to coordinate both efforts with impending revisions of DOE Radiological Protection Standards and impending new developments in EPA and NRC Radiological Protection Standards led to convening of the first DOE Workshop on Remedial Action Criteria in Gaithersburg, Maryland, in February 1984, followed by a second workshop in June 1984 at ANL. The major decisions were to base the criteria on dosimetry models and basic limits currently recommended by the International Commission on Radiological Protection, to emphasize the development and use of site-specific rather than generic guidelines and criteria for residual radionuclide concentrations in the ground, and to prepare a manual to accompany the guidelines that would present procedures and tables for deriving site-specific soil guidelines and criteria for the remedial action programs. A joint ANL/LANL/ORNL/PNL effort to prepare a definitive set of guidelines and a manual has been initiated. The scope, status, and current plans for this effort, and some of the key issues, are presented. 10 references, 1 table
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Pfaller, M A; Jones, R N; Walter, D H
2001-01-01
Quality control guidelines for standardized antimicrobial susceptibility test methods are critical for the continuing accuracy of these clinical tests. In this report, quality control limits were proposed for the veterinary antimicrobial agent tiamulin with minimum inhibitory concentration (MIC) ranges of three or four log(2) dilution steps in two different medium formulations. Disk diffusion zone diameter ranges were proposed for tiamulin tested against Actinobacillus pleuropneumoniae ATCC 27090 (12-18 mm) and Staphylococcus aureus ATCC 25923 (25-32 mm). The data from eight participating laboratories produced 100% of results within proposed MIC limits (8-32 microg/mL), and 95.8-97.0% of zones were found within suggested zone diameter QC guidelines. These proposed QC ranges should be validated by in-use results from veterinary clinical laboratories.
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The nuclear codes and guidelines
International Nuclear Information System (INIS)
Sonter, M.
1984-01-01
This paper considers problems faced by the mining industry when implementing the nuclear codes of practice. Errors of interpretation are likely. A major criticism is that the guidelines to the codes must be seen as recommendations only. They are not regulations. Specific clauses in the guidelines are criticised
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5 CFR 1312.10 - Systematic review guidelines.
2010-01-01
... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Systematic review guidelines. 1312.10... Declassification of National Security Information § 1312.10 Systematic review guidelines. The EOP Security Officer will prepare and keep current such guidelines as are required by Executive Order 12958 for the...
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50 CFR 253.18 - Program operating guidelines.
2010-10-01
... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Program operating guidelines. 253.18 Section 253.18 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC... Guarantee Program § 253.18 Program operating guidelines. The Division may issue Program operating guidelines...
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Retinopathy of prematurity: applicability and compliance of guidelines in Hong Kong.
Luk, Abbie S W; Yip, Wilson W K; Lok, Julie Y C; Lau, Henry H W; Young, Alvin L
2017-04-01
To analyse the incidence, application and compliance to Royal College of Ophthalmologists retinopathy of prematurity (ROP) screening recommendations and subsequent treatment of ROP in a neonatal intensive care unit of a large tertiary referral centre in Hong Kong. A retrospective review was performed for all eligible premature neonates screened for ROP over a 7-year period from June 2008 to December 2015 in our local tertiary neonatal intensive care unit in Prince of Wales Hospital, Hong Kong, using the Royal College of Ophthalmologists ROP screening guideline (2008). Comparison between established UK and American screening guidelines were analysed for their applicability in our locality. A total of 602 infants were screened, with the incidence of ROP in 28.2% and type 1 ROP in 3.8%, and indirect diode laser performed in all type 1 ROP cases. Overall, adherence for screening criteria was 99.7%, with the average time to commence first screening at 4 weeks postnatal age. Of the 602 cases, 94 (15.6%) were early and 35 (5.8%) were later than the guidelines, of which only 5 (0.8%) of late-screened cases developed ROP requiring treatment. Subsequent treatment of ROP for all the late-screened cases was not delayed. Current ROP screening using the UK guidelines (2008) is applicable, effective and safe to our predominantly Asian population in Hong Kong, with a low rate of delayed screening. 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/.
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Osteoarthritis guidelines: Barriers to implementation and solutions.
Ferreira de Meneses, Sarah; Rannou, Francois; Hunter, David J
2016-06-01
Osteoarthritis (OA) is a leading cause of disability worldwide. Clinical practice guidelines (CPGs) have been developed to facilitate improved OA management. Scientific communities worldwide have proposed CPGs for OA treatment. Despite the number of highly prominent guidelines available and their remarkable consistency, their uptake has been suboptimal. Possibly because of the multitude of barriers related to the implementation of CPGs. For example, different guidelines show contradictions, some lack evidence, and they lack a hierarchy or tools to facilitate their translation and application. Also, the guidelines do not acknowledge the effect of comorbidities on choosing the treatments. Finally, poor integration of multidisciplinary services within and across healthcare settings is a major barrier to the effective implementation of management guidelines. Here we describe the main problems related to the OA guidelines and some solutions so as to offer some guidance on the elaboration of future CPGs and their implementation in primary care. Copyright © 2016 Elsevier Masson SAS. All rights reserved.