WorldWideScience

Sample records for statement acute management

  1. International, Expert-Based, Consensus Statement Regarding the Management of Acute Diverticulitis.

    Science.gov (United States)

    O'Leary, D Peter; Lynch, Noel; Clancy, Cillian; Winter, Desmond C; Myers, Eddie

    2015-09-01

    This Delphi study provides consensus related to many aspects of acute diverticulitis and identifies other areas in need of research. To generate an international, expert-based, consensus statement to address controversies in the management of acute diverticulitis. This study was conducted using the Delphi technique from April 3 through October 21, 2014. A survey website was used and a panel of acute diverticulitis experts was formed via the snowball method. The top 5 acute diverticulitis experts in 5 international geographic regions were identified based on their number of publications related to acute diverticulitis. The Delphi study used 3 rounds of questions, after which the consensus statement was collated. A consensus statement related to the management of acute diverticulitis. Twenty items were selected for inclusion in the consensus statement following 3 rounds of questioning. A clear definition of uncomplicated and complicated diverticulitis is provided. In uncomplicated diverticulitis, consensus was reached regarding appropriate laboratory and radiological evaluation of patients as well as nonsurgical, surgical, and follow-up strategies. A number of important topics, including antibiotic treatment, failed to reach consensus. In addition, consensus was reached regarding many nonsurgical and surgical treatment strategies in complicated diverticulitis. Controversy continues internationally regarding the management of acute diverticulitis. This study demonstrates that there is more nonconsensus among experts than consensus regarding most issues, even in the same region. It also provides insight into the status quo regarding the treatment of acute diverticulitis and provides important direction for future research.

  2. Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team.

    Science.gov (United States)

    Kakou-Guikahue, Maurice; N'Guetta, Roland; Anzouan-Kacou, Jean-Baptiste; Kramoh, Euloge; N'Dori, Raymond; Ba, Serigne Abdou; Diao, Maboury; Sarr, Moustapha; Kane, Abdoul; Kane, Adama; Damorou, Findide; Balde, Dadhi; Diarra, Mamadou Bocary; Djiddou, Mohamed; Kimbally-Kaki, Gisèle; Zabsonre, Patrice; Toure, Ibrahim Ali; Houénassi, Martin; Gamra, Habib; Chajai, Bachir; Gerardin, Benoit; Pillière, Rémy; Aubry, Pierre; Iliou, Marie-Christine; Isnard, Richard; Leprince, Pascal; Cottin, Yves; Bertrand, Edmond; Juillière, Yves; Monsuez, Jean-Jacques

    2016-01-01

    Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities. The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories. Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple

  3. Corporate Information Management Financial Statements

    National Research Council Canada - National Science Library

    Gimble, Thomas

    1995-01-01

    The audit objective was to determine whether the OASD(C31) methods for preparing FY 1996 CIM, general purpose financial statements will result in auditable and complete general purpose financial statements...

  4. Acute management of stones

    DEFF Research Database (Denmark)

    Jung, Helene; Osther, Palle J S

    2015-01-01

    INTRODUCTION: Stone management is often conservative due to a high spontaneous stone passage rate or non-symptomatic calyceal stones that do not necessarily require active treatment. However, stone disease may cause symptoms and complications requiring urgent intervention. MATERIAL AND METHODS: I...... with careful consideration of stone size and location, symptoms, patient comorbidity and radiation dose. CONCLUSION: In case of infective hydronephrosis, compromised renal function or persistent pain despite adequate analgesic treatment acute intervention is indicated....

  5. ANDRA - Management report and financial statements 2011

    International Nuclear Information System (INIS)

    2012-07-01

    The first part of this ANDRA report (French National Agency for radioactive waste management) comments the global financial balance and the evolution of the personnel. It briefly presents the CIGEO project, the FA-VL project (low activity and long life). It presents the various industrial activities such as surface storage centres, nuclear activities outside the electronuclear sector (waste collection, polluted sites, national inventory of radioactive wastes). It evokes public subsidies, investments, and the international activity. It discusses the securing of the future nuclear burden financing. It briefly indicates the main objectives for 2012. The second part contains the different tables of the financial statements. These accounts are discussed and commented in appendix

  6. MANAGEMENT OF ACUTE MUSCULOSKELETAL PAIN ...

    African Journals Online (AJOL)

    of multimodal and multi-agent approach to acute pain management for better patient care. Data Source:The material ..... in the management of pain and stiffness arising ..... include immediate, direct psychologic feedback to the motivated ...

  7. 78 FR 79658 - Environmental Impact Statement; Animal Carcass Management

    Science.gov (United States)

    2013-12-31

    ...] Environmental Impact Statement; Animal Carcass Management AGENCY: Animal and Plant Health Inspection Service... prepare an environmental impact statement to examine the potential environmental effects of animal carcass... of animal carcass management options used throughout the United States. The EIS will analyze and...

  8. Management of severe acute malnutrition

    African Journals Online (AJOL)

    age are attributed to undernutrition, especially in developing countries. ... General principles for inpatient management of acute malnutrition can be divided into two phases, i.e. the .... malnourished child: Perspective from developing countries.

  9. Management of Acute Skin Trauma

    Institute of Scientific and Technical Information of China (English)

    Joel W. Beam

    2010-01-01

    @@ Acute skin trauma (ie, abrasions, avulsions, blisters, incisions, lacerations, and punctures) is common among individuals involved in work, recreational, and athletic activities. Appropriate management of these wounds is important to promote healing and lessen the risk of cross-contamination and infection. Wound management techniques have undergone significant changes in the past 40 years but many clinicians continue to manage acute skin trauma with long-established, traditional techniques (ie, use of hydrogen peroxide, adhesive strips/patches, sterile gauze, or no dressing) that can delay healing and increase the risk of infection. The purpose of this review is to discuss evidence-based cleansing, debridement, and dressing techniques for the management of acute skin trauma.

  10. NIH consensus development statement on management of hepatitis B.

    Science.gov (United States)

    Belongia, E A; Costa, J; Gareen, I F; Grem, J L; Inadomi, J M; Kern, E R; McHugh, J A; Petersen, G M; Rein, M F; Sorrell, M F; Strader, D B; Trotter, H T

    To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the management of hepatitis B. A non-DHHS, nonadvocate 12-member panel representing the fields of hepatology and liver transplantation, gastroenterology, public health and epidemiology, infectious diseases, pathology, oncology, family practice, internal medicine, and a public representative. In addition, 22 experts from pertinent fields presented data to the panel and conference audience. Presentations by experts and a systematic review of the literature prepared by the Minnesota Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience. The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. The most important predictors of cirrhosis or hepatocellular carcinoma in persons who have chronic HBV are persistently elevated HBV DNA and ALT levels in blood. Other risk factors include HBV genotype C infection, male sex, older age, family history of hepatocellular carcinoma, and co-infection with HCV or HIV. The major goals of anti-HBV therapy are to prevent the development of progressive disease, specifically cirrhosis and liver failure, as well as hepatocellular carcinoma development and subsequent death. To date, no RCTs of anti-HBV therapies have demonstrated a beneficial impact on overall mortality, liver-specific mortality, or development of hepatocellular carcinoma. Most published reports of hepatitis therapy use changes in short-term virologic, biochemical, and

  11. 78 FR 63959 - Environmental Impact Statement; Animal Carcass Management

    Science.gov (United States)

    2013-10-25

    ...] Environmental Impact Statement; Animal Carcass Management AGENCY: Animal and Plant Health Inspection Service... pests or diseases. Large numbers of animals and carcasses may need to be disposed of or otherwise... management of large numbers of carcasses during an animal health emergency must be timely, safe, biosecure...

  12. Rational management of acute keratoconus

    Directory of Open Access Journals (Sweden)

    Yu. B. Slonimskiy

    2014-01-01

    Full Text Available Acute keratoconus is a common and severe complication of advanced progressive keratoconus that occurs in more than 30 % of cases. Acute corneal edema in advanced progressive keratectasia is reffered to as acute corneal hydrops (hydrops corneae. It has been also reported in other ectatic disorders such as pellucid marginal degeneration. The most common misdiagnosis in hydrops is HSV disciform keratitis or acute bacterial keratitis. 126 corneal hydrops patients (79 men, 47 women aged 16‑63 (129 eyes were observed and treated over the last five years. 124 patients were diagnosed with acute keratoconus and 2 patients were diagnosed with pellucid marginal degeneration. Acute kereatoconus patientsrepresented a special and compromised cohort with systemic allergic diseases (neurodermatitis and various atopic disorders, n = 48, Down’s syndrome (n = 16 or mental disorders (n = 19. In many of these patients who vigorously rubbed their eyes, keratectasia progressed more rapidly. In 7 cases, acute keratoconus developed during pregnancy. 3 cases of recurrent keratoconus were reported — in a woman with Down’s syndrome (recurrence in 3 years, in a man with severe neurodermatitis (recurrence in 5 years, and in a man with anamnestic acute keratoconus (recurrence in 20 years. 3 patients experienced bilateral acute keratoconus. Acute keratoconus can be subdivided by the area of corneal edema into three categories, i.e., partial (6 mm or less, 52 eyes, subtotal (7‑10 mm, 56 eyes, and total (more than 10 mm, 21 eyes. Corneal edema ultimately disappeared, however, acute keratoconus resulted in a deep local scarring through the corneal layers. Slit lamp exam revealed Descemet’s membrane ruptures (so-called fish mouth. 73 eyes were referred to refractive penetrating keratoplasty (PKP. Corneal perforation was unusual even in severe corneal thinning (4 cases. In one case, descemetocele with a high risk of perforation was observed. 4 eyes

  13. Rational management of acute keratoconus

    Directory of Open Access Journals (Sweden)

    Yu. B. Slonimskiy

    2015-01-01

    Full Text Available Acute keratoconus is a common and severe complication of advanced progressive keratoconus that occurs in more than 30 % of cases. Acute corneal edema in advanced progressive keratectasia is reffered to as acute corneal hydrops (hydrops corneae. It has been also reported in other ectatic disorders such as pellucid marginal degeneration. The most common misdiagnosis in hydrops is HSV disciform keratitis or acute bacterial keratitis. 126 corneal hydrops patients (79 men, 47 women aged 16‑63 (129 eyes were observed and treated over the last five years. 124 patients were diagnosed with acute keratoconus and 2 patients were diagnosed with pellucid marginal degeneration. Acute kereatoconus patientsrepresented a special and compromised cohort with systemic allergic diseases (neurodermatitis and various atopic disorders, n = 48, Down’s syndrome (n = 16 or mental disorders (n = 19. In many of these patients who vigorously rubbed their eyes, keratectasia progressed more rapidly. In 7 cases, acute keratoconus developed during pregnancy. 3 cases of recurrent keratoconus were reported — in a woman with Down’s syndrome (recurrence in 3 years, in a man with severe neurodermatitis (recurrence in 5 years, and in a man with anamnestic acute keratoconus (recurrence in 20 years. 3 patients experienced bilateral acute keratoconus. Acute keratoconus can be subdivided by the area of corneal edema into three categories, i.e., partial (6 mm or less, 52 eyes, subtotal (7‑10 mm, 56 eyes, and total (more than 10 mm, 21 eyes. Corneal edema ultimately disappeared, however, acute keratoconus resulted in a deep local scarring through the corneal layers. Slit lamp exam revealed Descemet’s membrane ruptures (so-called fish mouth. 73 eyes were referred to refractive penetrating keratoplasty (PKP. Corneal perforation was unusual even in severe corneal thinning (4 cases. In one case, descemetocele with a high risk of perforation was observed. 4 eyes

  14. Generic impact statement for commercial radioactive waste management

    International Nuclear Information System (INIS)

    Unruh, C.M.

    1976-01-01

    ERDA is preparing a generic environmental impact statement on the treatment and disposal of waste resulting from commercial reactors and post fission operations in the light water reactor (LWR) fuel cycle. Expert contributions will be provided by many of the ERDA national laboratories and contractors. The waste management aspects of the statement will be based on available technology as presented in the recently issued ''Alternatives for Managing Waste from Reactors and Post Fission Operations in the LWR Fuel Cycle,'' ERDA-76-43 Document. This 1500 page, five volume Technical Alternative Document (TAD) describes the status of technology (to September, 1975) for handling post fission radioactive waste generated by the production of electricity by nuclear power light water reactor-generator systems. The statement will be generic in nature discussing typical or hypothetical facilities in typical or hypothetical environments. It is not intended to replace environmental statements required in support of specific projects nor for Nuclear Regulatory Commission licensing procedures. A major purpose of the generic statement is to inform the public and to solicit comments on the ERDA program for: (1) the final disposition of commercial radioactive waste, (2) waste treatment, (3) waste interim storage, and (4) transportation of waste. The statement will discuss the ERDA contingency program to provide retrievable storage of such waste if they should be transferred to Federal custody prior to the availability of the geologic isolation facilities for terminal disposal. The generic statement will not address radioactive waste resulting from U.S. Defense Programs, the mining or milling of uranium, the management of waste from the breeder reactor program, waste from other nations, nor will it include an evaluation of the impact of waste resulting from power sources other than light water reactors

  15. Environmental impact statement on management of commercially generated radioactive wastes

    International Nuclear Information System (INIS)

    Shupe, M.W.; Kreiter, M.R.

    1979-01-01

    This report describes the generic environmental impact statement on the management of generated high-level and transuranic radioactive wastes. The contents of the statement are summarized. The alternatives considered include: geologic disposal; chemical resynthesis; very deep hole disposal; rock melting concept; island disposal; subseabed disposal; icesheet disposal; reverse well disposal; transmutation treatment; and space disposal concepts. The types and quantities of wastes considered are from 3 different fuel cycles for the LWR reactor: once through; uranium-only recycle; and uranium and platinum recycle

  16. 78 FR 73559 - Moose-Wilson Corridor Comprehensive Management Plan, Environmental Impact Statement, Grand Teton...

    Science.gov (United States)

    2013-12-06

    ...-Wilson Corridor Comprehensive Management Plan, Environmental Impact Statement, Grand Teton National Park... is preparing a Comprehensive Management Plan and Environmental Impact Statement (EIS) for the Moose...; (2) distinguish the corridor's fundamental and other important resources and values; (3) clearly...

  17. Fundamentals of financial statement analysis for academic physician managers.

    Science.gov (United States)

    Danzi, J T; Boom, M L

    1998-04-01

    Academic medical centers (i.e., teaching hospitals) and academic medical practices are under pressure to control costs to compete with for-profit health care institutions. The authors explain how academic physician managers who want to control costs wisely must first understand the cost structure of the medical center or practice and compare that structure with those of for-profit institutions. Doing this requires a firm understanding of how to use a valuable tool, financial statement analysis, to assess an institution's health and performance. Such analysis consists of calculating a variety of financial ratios (e.g., operating income divided by revenues; net income divided by total assets) and then comparing them with the corresponding ratios that are considered industry norms. Three types of financial statements (defined in detail) lend themselves to this approach: the balance sheet, income statement, and statement of cash flows. The authors define standard financial ratios, point out their uses and limitations, and emphasize that a ratio's meaning derives from comparing it with the corresponding benchmark ratio in the industry as a whole. Ratios should be used not as the end point of assessing financial status, but as ways to identify possible problems that require further investigation. Analysis of trends of ratios over time within an institution is a complementary approach. The authors then discuss the use of ratios in three standard types of institutional evaluation: of performance, of liquidity and leverage, and of strategic planning. In addition, they present the financial statement of a fictitious academic medical center as an example of how to use ratios for financial statement analysis. The authors emphasize that the key to using the ratios they discuss and hundreds of others is first to decide what question needs answering and then to choose the relevant ratios to provide a basis for finding the answer.

  18. Final Programmatic Environmental Impact Statement for stockpile stewardship and management

    International Nuclear Information System (INIS)

    1996-09-01

    The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed a Stockpile Stewardship and Management Program to provide a single highly integrated technical program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management Programmatic Environmental Impact Statement (PEIS) describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program. This document contains Volume II which consists of Appendices A through H

  19. Canadian Association of Emergency Physicians position statement on acute ischemic stroke.

    Science.gov (United States)

    Harris, Devin; Hall, Christopher; Lobay, Kevin; McRae, Andrew; Monroe, Tanya; Perry, Jeffrey J; Shearing, Anthony; Wollam, Gabe; Goddard, Tom; Lang, Eddy

    2015-03-01

    The CAEP Stroke Practice Committee was convened in the spring of 2013 to revisit the 2001 policy statement on the use of thrombolytic therapy in acute ischemic stroke. The terms of reference of the panel were developed to include national representation from urban academic centres as well as community and rural centres from all regions of the country. Membership was determined by attracting recognized stroke leaders from across the country who agreed to volunteer their time towards the development of revised guidance on the topic. The guideline panel elected to adopt the GRADE language to communicate guidance after review of existing systematic reviews and international clinical practice guidelines. Stroke neurologists from across Canada were engaged to work alongside panel members to develop guidance as a dyad-based consensus when possible. There was no unique systematic review performed to support this guidance, rather existing efficacy data was relied upon. After a series of teleconferences and face to face meetings, a draft guideline was developed and presented to the CAEP board in June of 2014. The panel noted the development of significant new evidence to inform a number of clinical questions related to acute stroke management. In general terms the recommendations issued by the CAEP Stroke Practice Committee are supportive of the use of thrombolytic therapy when treatment can be administered within 3 hours of symptom onset. The committee is also supportive of system-level changes including pre-hospital interventions, the transport of patients to dedicated stroke centers when possible and tele-health measures to support thrombolytic therapy in a timely window. Of note, after careful deliberation, the panel elected to issue a conditional recommendation against the use of thrombolytic therapy in the 3–4.5 hour window. The view of the committee was that as a result of a narrow risk benefit balance, one that is considerably narrower than the same considerations

  20. American Society for Pain Management Nursing Position Statement: Pain Management in Patients with Substance Use Disorders

    OpenAIRE

    Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St. Marie, Barbara; Strobbe, Stephen; Turner, Helen N.

    2012-01-01

    The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high qu...

  1. Management of acute pancreatitis in children.

    Science.gov (United States)

    Abu-El-Haija, Maisam; Lin, Tom K; Nathan, Jaimie D

    2017-10-01

    Pediatric acute pancreatitis has been on the rise in the last decades, with an incidence close to adult pancreatitis. In the majority of cases acute pancreatitis resolves spontaneously, but in a subset of children the disease progresses to severe acute pancreatitis with attendant morbidity and mortality. Pediatric acute pancreatitis in this era is recognized as a separate entity from adult acute pancreatitis given that the causes and disease outcomes are different. There are slow but important advances made in understanding the best management for acute pancreatitis in children from medical, interventional, and surgical aspects. Supportive care with fluids, pain medications, and nutrition remain the mainstay for acute pancreatitis management. For complicated or severe pancreatitis, specialized interventions may be required with endoscopic or drainage procedures. Surgery has an important but limited role in pediatric acute pancreatitis.

  2. Income statement management in a turbulent health care environment.

    Science.gov (United States)

    Covaleski, M A

    2001-03-01

    This article considers the role of accounting information embedded in the income statement of health care providers in their increasingly difficult economic environment. This turbulent economic environment has resulted from the dramatic shift in power from the seller to the buyer of health care services, with a consequential shift of risks that will mandate that health care providers obtain access to better cost and utilization information. This article looks at the 2 critical components of the income statement--the revenue function and the cost structure-in terms of their importance in the management of enhanced economic performance in both the fee-for-service and the prepaid provision of health care services. Copyright 2001 by W.B. Saunders Company

  3. Financial statements in the function of management decision

    Directory of Open Access Journals (Sweden)

    Mrvaljević Mirjana

    2014-01-01

    Full Text Available In this paper discuss on the role and importance of information which are provided by financial statements in business decision-making is considered. Basically, financial reports represent information basis for making economic / financial decisions for a wide range of users because they represent the key source of information about the financial position of a company at the end of a period, about the achieved results of the company for the period, about the cash flow within the company etc. In accordance with the process of globalisation, international frameworks have regulated the accounting standards which have been created and introduced in order to achieve transparency and uniformity of financial reports of any company, regardless its scope of work and the country where it does its business. The management of a company is aimed at the perception of future events and the flow of values within a company as a result of present decisions, while the accounting is ex post oriented. Nevertheless, the connections between accounting and management of a company are important and multiple because it is the effects of management decisions that are evaluated through financial statements, which are the product of company accounting in which all the business decisions are processed.

  4. Rational management of acute keratoconus

    OpenAIRE

    Yu. B. Slonimskiy; A. Yu. Slonimskiy; E. A. Korchuganova

    2015-01-01

    Acute keratoconus is a common and severe complication of advanced progressive keratoconus that occurs in more than 30 % of cases. Acute corneal edema in advanced progressive keratectasia is reffered to as acute corneal hydrops (hydrops corneae). It has been also reported in other ectatic disorders such as pellucid marginal degeneration. The most common misdiagnosis in hydrops is HSV disciform keratitis or acute bacterial keratitis. 126 corneal hydrops patients (79 men, 47 women) aged 16‑63 (1...

  5. 77 FR 33237 - Saline Valley Warm Springs Management Plan/Environmental Impact Statement, Death Valley National...

    Science.gov (United States)

    2012-06-05

    ... Valley Warm Springs Management Plan/Environmental Impact Statement, Death Valley National Park, Inyo... an Environmental Impact Statement for the Saline Valley Warm Springs Management Plan, Death Valley... analysis process for the Saline Valley Warm Springs Management Plan for Death Valley [[Page 33238...

  6. 76 FR 27344 - Water Resources Management Plan/Environmental Impact Statement, Mojave National Preserve, San...

    Science.gov (United States)

    2011-05-11

    ... and resource management activities must be guided by general principles that can be applied to... Resources Management Plan/Environmental Impact Statement, Mojave National Preserve, San Bernardino County... Management Plan/ Environmental Impact Statement for Mojave National Preserve. SUMMARY: In accordance with Sec...

  7. 75 FR 13656 - Interagency Policy Statement on Funding and Liquidity Risk Management

    Science.gov (United States)

    2010-03-22

    ... Interagency Policy Statement on Funding and Liquidity Risk Management AGENCY: Office of the Comptroller of the... policy statement summarizes the principles of sound liquidity risk management that the agencies have.... Ray Diggs, Group Leader: Balance Sheet Management, Credit and Market Risk Division, (202) 874-5670...

  8. 75 FR 22680 - Financial Management Service; Proposed Collection of Information: Annual Financial Statement of...

    Science.gov (United States)

    2010-04-29

    ... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Annual Financial Statement of Surety Companies--Schedule F AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and Request for comments. SUMMARY: The Financial Management...

  9. Savannah River Site waste management. Final environmental impact statement - addendum

    International Nuclear Information System (INIS)

    1995-07-01

    The purpose of this environmental impact statement is to help DOE decide how to manage over the next 30 years liquid high-level radioactive, low-level radioactive, mixed, hazardous, and transuranic wastes generated during 40 years of past operations and on-going activities (including management of wastes received from offsite) at Savannah River Site (SRS) in southwestern South Carolina. The wastes are currently stored at SRS. DOE seeks to dispose of the wastes in a cost-effective manner that protects human health and the environment. In this document, DOE assesses the cumulative environmental impacts of storing, treating, and disposing of the wastes, examines the impacts of alternatives, and identifies measures available to reduce adverse impacts. Evaluations of impacts on water quality, air quality, ecological systems, land use, geologic resources, cultural resources, socio-economics, and the health and safety of onsite workers and the public are included in the assessment

  10. Savannah River Site Waste Management Final Environmental Impact Statement Addendum

    International Nuclear Information System (INIS)

    1995-07-01

    The purpose of this environmental impact statement is to help DOE decide how to manage over the next 30 years liquid high-level radioactive, low-level radioactive, mixed, hazardous, and transuranic wastes generated during 40 years of past operations and on-going activities (including management of wastes received from offsite) at Savannah River Site (SRS) in southwestern South Carolina. The wastes are currently stored at SRS. DOE seeks to dispose of the wastes in a cost-effective manner that protects human health and the environment. In this document, DOE assesses the cumulative environmental impacts of storing, treating, and disposing of the wastes, examines the impacts of alternatives, and identifies measures available to reduce adverse impacts. Evaluations of impacts on water quality, air quality, ecological systems, land use, geologic resources, cultural resources, socio-economic, and the health and safety of onsite workers and the public are included in the assessment

  11. ERS statement on the multidisciplinary respiratory management of ataxia telangiectasia

    Directory of Open Access Journals (Sweden)

    Jayesh M. Bhatt

    2015-12-01

    Full Text Available Ataxia telangiectasia (A-T is a rare, progressive, multisystem disease that has a large number of complex and diverse manifestations which vary with age. Patients with A-T die prematurely with the leading causes of death being respiratory diseases and cancer. Respiratory manifestations include immune dysfunction leading to recurrent upper and lower respiratory infections; aspiration resulting from dysfunctional swallowing due to neurodegenerative deficits; inefficient cough; and interstitial lung disease/pulmonary fibrosis. Malnutrition is a significant comorbidity. The increased radiosensitivity and increased risk of cancer should be borne in mind when requesting radiological investigations. Aggressive proactive monitoring and treatment of these various aspects of lung disease under multidisciplinary expertise in the experience of national multidisciplinary clinics internationally forms the basis of this statement on the management of lung disease in A-T. Neurological management is outwith the scope of this document.

  12. Acute surgical management in idiopathic intracranial hypertension.

    LENUS (Irish Health Repository)

    Zakaria, Zaitun

    2012-01-01

    Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.

  13. American Society for Pain Management nursing position statement: pain management in patients with substance use disorders.

    Science.gov (United States)

    Oliver, June; Coggins, Candace; Compton, Peggy; Hagan, Susan; Matteliano, Deborah; Stanton, Marsha; St Marie, Barbara; Strobbe, Stephen; Turner, Helen N

    2012-10-01

    The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.

  14. 17 CFR 274.13 - Form N-8B-3, registration statement of unincorporated management investment companies currently...

    Science.gov (United States)

    2010-04-01

    ... statement of unincorporated management investment companies currently issuing periodic payment plan...-8B-3, registration statement of unincorporated management investment companies currently issuing..., pursuant to section 8(b) of the Investment Company Act of 1940, by unincorporated management investment...

  15. An EASO Position Statement on Multidisciplinary Obesity Management in Adults

    Directory of Open Access Journals (Sweden)

    Volkan Yumuk

    2014-03-01

    Full Text Available Obesity has proven to be a gateway to ill health. It has already reached epidemic proportions becoming one of the leading causes of death and disability in Europe and world-wide. Obesity plays a central role in the development of a number of risk factors and chronic diseases like hypertension, dyslipidaemia and type 2 diabetes mellitus inducing cardiovascular morbidity and mortality. Therefore weight management plays a central role in controlling the respective risk factors and their consequences. Obesity is a complex condition of multifactorial origin. Biological but also psychological and social factors interfere to lead to excess body weight and its deleterious outcomes. Obesity management cannot focus any more only on weight (and BMI reduction. More attention is to be paid to waist circumference (or waist-to-hip ratio, especially in females, the improvement in body composition (measured with body composition tracking systems like BOD POD, dual energy X-ray absorptiometry or bioelectrical impedance analysis which is focusing on ameliorating or maintaining fat-free mass and decreasing fat mass. Management of co-morbidities, improving quality of life and well-being of obese patients are also included in treatment aims. This statement emphasises the importance of a comprehensive approach to obesity management.

  16. 76 FR 22917 - Dog Management Plan/Draft Environmental Impact Statement, Golden Gate National Recreation Area...

    Science.gov (United States)

    2011-04-25

    ... DEPARTMENT OF THE INTERIOR National Park Service [NPS-PWR-PWRO--0315-696; 8145-8B90-SZM] Dog... Impact Statement/Dog Management Plan, Golden Gate National Recreation Area. SUMMARY: The National Park Service has prepared a Draft Dog Management Plan and Environmental Impact Statement (Plan/DEIS). The Plan...

  17. 77 FR 16558 - General Management Plan/Final Environmental Impact Statement, Hampton National Historic Site...

    Science.gov (United States)

    2012-03-21

    ... Management Plan/Final Environmental Impact Statement, Hampton National Historic Site, Maryland AGENCY...) announces the availability of the Final Environmental Impact Statement for the General Management Plan.../Baltimore County Library, 320 York Avenue, Towson, Maryland 21204. Baltimore County Tourism Office and...

  18. Consensus statement on management of chronic heart failure in India

    Directory of Open Access Journals (Sweden)

    Sandeep Seth

    2015-01-01

    Full Text Available Summary of the Consensus Statement: This statement has been prepared keeping Indian heart failure patients in mind. Optimal management of CHF improves quality of life, reduces hospitalization rates and prolongs survival for people with this condition. Echocardiography is the single most useful test in the evaluation of heart failure, and is necessary to confirm the diagnosis. Plasma B-natriuretic peptide (BNP measurements may be useful in excluding CHF but not mandatory in India. Educate people with CHF about lifestyle changes (e.g., increase physical activity levels, reduce salt intake and manage weight. Educate people with CHF about CHF symptoms and how to manage fluid load. Avoid prescribing drugs that exacerbate CHF. Prescribe angiotensin-converting enzyme inhibitors (ACEI at effective doses for people with all grades of systolic heart failure, and titrate to the highest recommended dose tolerated. Angiotensin II receptor antagonists (ARA may be used as alternatives in people who cannot tolerate ACEIs. Mineralocorticoid receptor antagonists (MRAs should also be used. For people with stabilised systolic heart failure, prescribe beta-blockers that have been shown to improve outcome in heart failure (e.g., bisoprolol, carvedilol, extended release metoprolol or nebivolol. Titrate to the highest recommended dose tolerated. Prescribe diuretics, digoxin and nitrates for people already using ACEIs and beta-blockers to manage symptoms as indicated. For people who have systolic heart failure (New York Heart Association (NYHA Class II-IV despite appropriate doses of ACEIs and diuretics, consider prescribing spironolactone. Eplerenone can be considered in certain setting especially post myocardial infarction though it is more expensive. Consider direct sinus node inhibition with ivabradine for people with CHF who have impaired systolic function, have had a recent heart failure hospitalisation and are in sinus rhythm with a heart rate >70 bpm despite

  19. APPLICATION OF INTERNAL FINANCIAL STATEMENTS IN BUDGETARY USER MANAGEMENT IN CROATIA

    OpenAIRE

    Vesna Vašiček; Verica Budimir; Mirjana Hladika

    2011-01-01

    The subject of this paper is to investigate the level of use of the internal financial statements of budgetary users in their management process. The main objective of this paper is to determine the importance of internal financial statements prepared according to the specific requirements of managers in decision making and budgetary user management. Another goal of this paper is to assess the implications of using a wide range of accounting information on efficiency of budgetary users manag...

  20. ANDRA's Management report and financial statement December 2008

    International Nuclear Information System (INIS)

    2008-01-01

    This management report indicates the main operation events in the activity of the ANDRA (the French national Agency for radioactive waste management) during 2008, and of its waste storage centres. It comments the evolution of the various characteristic figures (production, personnel, financial result, certification), and reports the evolution of two projects (the HA-MAVL project for the creation of a storage centre for high- and intermediate-level long-life wastes, and the FA-VL project for the creation of a storage centre for low-level long-life wastes). It reviews ANDRA's industrial activity evolution, that is the operation of several storage centres and the activities related to small waste producers and polluted sites. It comments the level and the evolution of the public subside, briefly describes other activities (national inventory of radioactive materials and wastes, activity at the international level), the financing of future nuclear loads, the action for a sustainable development, the prospective evolution for 2009. In a second part, after the financial statement tables, the report comments these financial results. The different authorities are presented and the official auditor's report concludes this document

  1. American Society for Pain Management Nursing position statement: pain management at the end of life.

    Science.gov (United States)

    Reynolds, Janice; Drew, Debra; Dunwoody, Colleen

    2013-09-01

    Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. While nurses have an ethical obligation to reduce suffering at the end of life, barriers remain regarding appropriate and adequate pain management at the end of life. This position statement from the American Society for Pain Management Nursing contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  2. NIH Consensus Statement on Management of Hepatitis C: 2002.

    Science.gov (United States)

    To provide health care providers, patients, and the general public with a responsible assessment of currently available data regarding the management and treatment of hepatitis C. A non-Federal, nonadvocate, 12-member panel representing the fields of infectious diseases, gastroenterology, medical oncology, molecular genetics, geriatrics, internal medicine, and the public. In addition, experts in these same fields presented data to the panel and to a conference audience of approximately 300. Presentations by experts; a systematic review of the medical literature provided by the Agency for Healthcare Research and Quality; and an extensive bibliography of hepatitis C research papers, prepared by the National Library of Medicine. Scientific evidence was given precedence over clinical anecdotal experience. Answering predefined questions, the panel drafted a statement based on the scientific evidence presented in open forum and the scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the experts and the audience for comment. The panel then met in executive session to consider these comments and released a revised statement at the end of the conference. The statement was made available on the World Wide Web at http://consensus.nih.gov immediately after the conference. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. The incidence of newly acquired hepatitis C infection has diminished in the United States. This decline is largely due to a decrease in cases among IDUs for reasons that are unclear and, to a lesser extent, to testing of blood donors for HCV. The virus is transmitted by blood and such transmission now occurs primarily through injection drug use, sex with an infected partner or multiple partners, and occupational exposure. The majority of infections become chronic, and therefore the prevalence of HCV infections is high

  3. 17 CFR 239.15A - Form N-1A, registration statement of open-end management investment companies.

    Science.gov (United States)

    2010-04-01

    ... statement of open-end management investment companies. 239.15A Section 239.15A Commodity and Securities... Registration Statements § 239.15A Form N-1A, registration statement of open-end management investment companies... management investment companies other than separate accounts of insurance companies registered under the...

  4. [The acute management of agitation].

    Science.gov (United States)

    Bakay, S; Iweins, A; Scantamburlo, G; Ansseau, M; Pitchot, W

    2013-11-01

    Agitation in psychiatry is defined as "a request to which an answer cannot be deferred". If some types of controllable agitation can be solved by human means or psychotropic drugs, others may require the intervention of intensivists who will contribute to the onset of crisis resolution. In addition, an organic aetiology must be carefully excluded a before considering a psychiatric origin of agitation, especially in patients with no psychiatric history and in the elderly. Indeed, acute agitation can hide serious somatic traps and be life threatening.

  5. Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach.

    Science.gov (United States)

    Vickers, A; Bali, S; Baxter, A; Bruce, G; England, J; Heafield, R; Langford, R; Makin, R; Power, I; Trim, J

    2009-10-01

    There has been considerable investment in efforts to improve postoperative pain management, including the introduction of acute pain teams. There have also been a number of guidelines published on postoperative pain management and there is widespread agreement on how pain should be practically managed. Despite these advances, there is no apparent improvement in the number of patients experiencing moderately severe or extreme pain after surgery. This highlights significant scope for improvement in acute postoperative pain management. In January 2009, a multidisciplinary UK expert panel met to define and agree a practical framework to encourage implementation of the numerous guidelines and fundamentals of pain management at a local level. The panel recognised that to do this, there was a need to organise the information and guidelines into a simplified, accessible and easy-to-implement system based on their practical clinical experience. Given the volume of literature in this area, the Chair recommended that key international guidelines from professional bodies should be distributed and then reviewed during the meeting to form the basis of the framework. Consensus was reached by unanimous agreement of all ten participants. This report provides a framework for the key themes, including consensus recommendations based upon practical experience agreed during the meeting, with the aim of consolidating the key guidelines to provide a fundamental framework which is simple to teach and implement in all areas. Key priorities that emerged were: Responsibility, Anticipation, Discussion, Assessment and Response. This formed the basis of RADAR, a novel framework to help pain specialists educate the wider care team on understanding and prioritising the management of acute pain. Acute postoperative pain can be more effectively managed if it is prioritised and anticipated by a well-informed care team who are educated with regard to appropriate analgesic options and understand what

  6. Acute and chronic pancreatitis: surgical management.

    Science.gov (United States)

    Dzakovic, Alexander; Superina, Riccardo

    2012-08-01

    Pancreatitis is becoming increasingly prevalent in children, posing new challenges to pediatric health care providers. Although some general adult treatment paradigms are applicable in the pediatric population, diagnostic workup and surgical management of acute and chronic pancreatitis have to be tailored to anatomic and pathophysiological entities peculiar to children. Nonbiliary causes of acute pancreatitis in children are generally managed nonoperatively with hydration, close biochemical and clinical observation, and early initiation of enteral feeds. Surgical intervention including cholecystectomy or endoscopic retrograde cholangiopancreatography is often required in acute biliary pancreatitis, whereas infected pancreatic necrosis remains a rare absolute indication for pancreatic debridement and drainage via open, laparoscopic, or interventional radiologic procedure. Chronic pancreatitis is characterized by painful irreversible changes of the parenchyma and ducts, which may result in or be caused by inadequate ductal drainage. A variety of surgical procedures providing drainage, denervation, resection, or a combination thereof are well established to relieve pain and preserve pancreatic function. Copyright © 2012. Published by Elsevier Inc.

  7. The management of acute heart failure

    NARCIS (Netherlands)

    Milo-Cotter, O.; Bettari, L.; Kleijn, L.; Bugatti, S.; Lombardi, C.; Rund, M.; Metra, M.; Voors, A. A.; Cotter, G.; Kaluski, E.; Weatherley, B. D.

    Hospitalization for acute heart failure (AHF) is one of the burdensome aspects of 21(st) century medicine, leading to significant debilitating symptoms, high morbidity and mortality and consuming significant portion of the health care budget. Management of AHF is thought-provoking given the

  8. Acute management of hyperlipaemic pancreatitis: a successful ...

    African Journals Online (AJOL)

    Acute management of hyperlipaemic pancreatitis: a successful reduction in triglyceride levels with simultaneous insulin infusion and plasma exchange. A Korba*, PH Sonnekusa and JD Bothaa. aSpecialist Physician in Private Practice, Roodepoort, South Africa. *Corresponding author, email: anneli@drkorb.com. We report ...

  9. Management of Acute Bleeding Per Rectum

    Directory of Open Access Journals (Sweden)

    Benita K.T. Tan

    2004-01-01

    Conclusion: Perianal conditions contributed to the majority of acute patient admissions. Colonic causes of bleeding were less common and were most stable. There were differences in the frequencies of aetiologies in our population compared to Western populations. Understanding the common pathologies and outcomes guides the management of our patients.

  10. Financial Management: Misstatement of NASA's Statement of Budgetary Resources

    National Research Council Canada - National Science Library

    2001-01-01

    .... The Committee's inquiry into this discrepancy resulted in NASA s Chief Financial Officer (CFO) subsequently determining that the information in the audited financial statements was in error by about $644 million...

  11. Implementation Plan. Environmental Restoration and Waste Management Programmatic Environmental Impact Statement

    Energy Technology Data Exchange (ETDEWEB)

    1994-01-01

    In accordance with the Department of Energy`s National Environmental Policy Act implementing procedures in Volume 10 of the Code of Federal Regulations, Section 1021,312, the Environmental Restoration and Waste Management Programmatic Environmental Impact Statement Implementation Plan has two primary purposes: to provide guidance for the preparation of the Programmatic Environmental Impact Statement and to record the issues resulting from the scoping and the extended public participation process. The Implementation Plan identifies and discusses the following: background of Environmental Restoration and Waste Management activities, the purpose of the Programmatic Environmental Impact Statement, and the relationship of the Programmatic Environmental Impact Statement to other Departmental initiatives (Chapter 1); need and purposes for action (Chapter 2); scoping process and results of the public participation program in defining the scope of the Programmatic Environmental Impact Statement, including a summary of the comments received and their disposition (Chapter 3); planned scope and content of the Programmatic Environmental Impact Statement (Chapter 4); consultations with other agencies and the role of cooperating agencies (Chapter 5); planned schedule of major Programmatic Environmental Impact Statement milestones (Chapter 6); and responsibilities for preparation of the Programmatic Environmental Impact Statement (Chapter 7).

  12. Contemporary Management of Acute Type B Dissection.

    Science.gov (United States)

    Scott, A J; Bicknell, C D

    2016-03-01

    Growing confidence in thoracic endovascular aortic repair (TEVAR) for the management of acute type B aortic dissection has resulted in controversies regarding optimum patient selection and the timing of intervention. In this review a clinical vignette to present a practical perspective on the contemporary management of acute type B dissection (ABAD) in a specialist vascular centre with particular focus on areas of debate is used. This is a narrative clinical review. Aggressive anti-impulse therapy is the cornerstone of management of all patients with ABAD. However, 20-30% of patients develop complicated ABAD defined by the presence of malperfusion syndromes, acute aortic dilatation, dissection extension, or persistent pain and hypotension. These complicated patients typically require intervention, and non-randomised series suggest TEVAR to be an effective alternative to open repair with a lower morbidity. There is considerable interest and controversy surrounding the use of TEVAR in uncomplicated ABAD patients for whom the intervention-free survival at 6 years is less than 50% for patients managed with anti-impulse therapy. Data regarding this question are sparse, but two randomised trials (ADSORB and INSTEAD) both demonstrated a higher rate of favourable aortic remodelling in patients managed with TEVAR than medical therapy alone. However, it is unclear whether this positive remodelling translates into a reduction in long-term mortality sufficient to balance the early perioperative hazards of endografting. Despite increasing adeptness at endovascular stenting, the long-term outcomes of patients with ABAD leave significant room for improvement. In particular, the optimum management of patients with uncomplicated disease is unclear and guidance from trials powered for long-term mortality is awaited. Until then, the principals of management of ABAD remain aggressive medical therapy for all patients, with TEVAR primarily reserved for those who develop complications

  13. Clinical practice guideline: management of acute pancreatitis

    Science.gov (United States)

    Greenberg, Joshua A.; Hsu, Jonathan; Bawazeer, Mohammad; Marshall, John; Friedrich, Jan O.; Nathens, Avery; Coburn, Natalie; May, Gary R.; Pearsall, Emily; McLeod, Robin S.

    2016-01-01

    There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone–induced pancreatitis. Une hausse de l’incidence de pancréatite aiguë a été constatée à l’échelle mondiale. Malgré l’amélioration de l’accès aux soins et aux techniques d’imagerie et d’intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu’il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l’importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu’elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire. PMID:27007094

  14. 76 FR 58543 - Draft Policy Statement on Volume Reduction and Low-Level Radioactive Waste Management

    Science.gov (United States)

    2011-09-21

    ...-Level Radioactive Waste Management AGENCY: Nuclear Regulatory Commission. ACTION: Reopening of comment... for public comment a draft Policy Statement on Volume Reduction and Low-Level Radioactive Waste...-based approaches to managing waste are also needed to safely manage Low-Level Radioactive Waste. The...

  15. 75 FR 10308 - Fire Management Plan, Final Environmental Impact Statement, Record of Decision, Grand Canyon...

    Science.gov (United States)

    2010-03-05

    ... DEPARTMENT OF THE INTERIOR National Park Service Fire Management Plan, Final Environmental Impact... Statement for the Fire Management Plan, Grand Canyon National Park. SUMMARY: Pursuant to the National... the Record of Decision for the Fire Management Plan, Grand Canyon National Park, Arizona. On January...

  16. 75 FR 19989 - Final Environmental Impact Statement for Drought Management Planning at the Kerr Hydroelectric...

    Science.gov (United States)

    2010-04-16

    ... Drought Management Planning at the Kerr Hydroelectric Project, Flathead Lake, MT AGENCY: Bureau of Indian... Impact Statement (FEIS) for Drought Management Planning at the Kerr Hydroelectric Project, Flathead Lake... drought management planning at the Kerr Hydroelectric Project no sooner than 30 days following the...

  17. 78 FR 26067 - General Management Plan, Draft Environmental Impact Statement, Big Thicket National Preserve, Texas

    Science.gov (United States)

    2013-05-03

    .... Alternative 2, the NPS preferred alternative, would support a broad ecosystem approach for preserve management... management of cross-boundary resource issues and the importance of encouraging partnerships to address and... Management Plan, Draft Environmental Impact Statement, Big Thicket National Preserve, Texas AGENCY: National...

  18. 76 FR 3652 - Dog Management Plan/Environmental Impact Statement, Golden Gate National Recreation Area, California

    Science.gov (United States)

    2011-01-20

    ... DEPARTMENT OF THE INTERIOR National Park Service [8145-8B90-SZM] Dog Management Plan/Environmental...: Notice of Availability of a Draft Environmental Impact Statement for the Dog Management Plan, Golden Gate... the Dog Management Plan (Draft Plan/EIS), Golden Gate National Recreation Area (GGNRA), California...

  19. 78 FR 55093 - Dog Management Plan, Supplemental Environmental Impact Statement, Golden Gate National Recreation...

    Science.gov (United States)

    2013-09-09

    ....YP0000] Dog Management Plan, Supplemental Environmental Impact Statement, Golden Gate National Recreation... the Dog Management Plan (Plan/SEIS), Golden Gate National Recreation Area (GGNRA), California. Current dog management in the park is based on a number of factors. Areas included in the GGNRA Citizens...

  20. 78 FR 13081 - Draft Environmental Impact Statement for General Management Plan, Everglades National Park, Florida

    Science.gov (United States)

    2013-02-26

    ... visitor use in the Park. The GMP will provide updated management direction for the entire park. The EEWS....YP0000] Draft Environmental Impact Statement for General Management Plan, Everglades National Park... the General Management Plan (GMP) and East Everglades Wilderness Study (EEWS) for Everglades National...

  1. Therapeutic management of acute pulmonary embolism.

    Science.gov (United States)

    Tromeur, Cécile; Van Der Pol, Liselotte M; Couturaud, Francis; Klok, Frederikus A; Huisman, Menno V

    2017-08-01

    Acute pulmonary embolism (PE) is a potentially fatal manifestation of venous thromboembolism. Prompt anticoagulant treatment is crucial for PE patients, which can decrease morbidity and mortality. Risk assessment is the cornerstone of the therapeutic management of PE. It guides physicians to the most appropriate treatment and selects patients for early discharge or home treatment. Areas covered: Here, we review the current treatments of acute PE according to contemporary risk stratification strategies, highlighting each step of PE therapeutic management. Expert commentary: Currently, direct oral anticoagulants (DOACs) represent the first-line therapy of patients presenting with non-high risk PE with a better risk-benefit ratios than vitamin K antagonists (VKAs) due to lower risk of major bleeding. Only high-risk patients with PE who present in shock should be treated with systematic thrombolysis, while surgical thrombectomy or catheter direct thrombolysis (CDT) should only be considered when thrombolysis is contraindicated because of too high bleeding risk.

  2. Endovascular Management of Acute Limb Ischemia.

    LENUS (Irish Health Repository)

    Hynes, Brian G

    2011-09-14

    Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series. This review will address the contemporary endovascular management of ALI encompassing pharmacologic and percutaneous interventional treatment strategies.

  3. Transmission System Vegetation Management Program. Draft Environmental Impact Statement - Appendices

    International Nuclear Information System (INIS)

    1999-01-01

    The appendices covered in this Draft Environmental Impact Statement are: Appendix A--Public involvement; Appendix B--Biological weed control agents; Appendix C--BPA herbicide licensing plan; Appendix D--Sample educational information; Appendix E--Clearance criteria; Appendix F--USFS mitigation measures and background; Appendix G--BLM mitigation measures and background and Appendix H--Pesticide fact sheets

  4. Emergency management of acute abdomen in children.

    Science.gov (United States)

    Balachandran, Binesh; Singhi, Sunit; Lal, Sadhna

    2013-03-01

    Acute abdomen can be defined as a medical emergency in which there is sudden and severe pain in abdomen with accompanying signs and symptoms that focus on an abdominal involvement. It accounts for about 8 % of all children attending the emergency department. The goal of emergency management is to identify and treat any life-threatening medical or surgical disease condition and relief from pain. In mild cases often the cause is gastritis or gastroenteritis, colic, constipation, pharyngo-tonsilitis, viral syndromes or acute febrile illnesses. The common surgical causes are malrotation and Volvulus (in early infancy), intussusception, acute appendicitis, and typhoid and ischemic enteritis with perforation. Lower lobe pneumonia, diabetic ketoacidosis and acute porphyria should be considered in patients with moderate-severe pain with little localizing findings in abdomen. The approach to management in ED should include, in order of priority, a rapid cardiopulmonary assessment to ensure hemodynamic stability, focused history and examination, surgical consult and radiologic examination to exclude life threatening surgical conditions, pain relief and specific diagnosis. In a sick patient the initial steps include rapid IV access and normal saline 20 ml/kg (in the presence of shock/hypovolemia), adequate analgesia, nothing per oral/IV fluids, Ryle's tube aspiration and surgical consultation. An ultrasound abdomen is the first investigation in almost all cases with moderate and severe pain with localizing abdominal findings. In patients with significant abdominal trauma or features of pancreatitis, a Contrast enhanced computerized tomography (CECT) abdomen will be a better initial modality. Continuous monitoring and repeated physical examinations should be done in all cases. Specific management varies according to the specific etiology.

  5. Outpatient management of pediatric acute mastoiditis.

    Science.gov (United States)

    Alkhateeb, Ahmed; Morin, Francis; Aziz, Haya; Manogaran, Mayuri; Guertin, William; Duval, Melanie

    2017-11-01

    Evaluate the Montreal Children's Hospital experience with outpatient management of uncomplicated acute mastoiditis with parenteral antibiotic therapy alone and determine if it is a safe alternative to inpatient management. A retrospective review of pediatric patients diagnosed with acute mastoiditis at a tertiary care pediatric hospital between 2013 and 2015 was performed. Patients with syndromes, immunodeficiency, cholesteatoma, chronic otitis media, cochlear implant in the affected ear, or incidental mastoid opacity were excluded. 56 children age 6 months to 15 years old were treated for acute mastoiditis, including 29 hospitalizations and 27 outpatients. Patients managed as outpatient with daily intravenous ceftriaxone had a 93% cure rate. Eighteen hospitalized and one outpatient had complications of acute mastoiditis. Children with complications were more likely to be febrile (p = 0.045). Two patients failed outpatient therapy and were admitted; one for myringotomy and piperacillin-tazobactam treatment and one required a mastoidectomy. 4/27 children treated as outpatient underwent myringotomy and tube insertion, 2 underwent myringotomy and tube along with admission and 21 did not require tube insertion. The average total duration of intravenous antibiotic therapy was respectively 4.9 and 18.9 days in the outpatient and hospitalized group. The average duration of admission was 5.9 days. Outpatient medical therapy of uncomplicated pediatric mastoiditis is safe, successful, and efficient. Benefits include efficient use of surgical beds, cost savings and patient and family convenience. Careful patient selection and close monitoring are keys for successful outcome. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Management of acute gastric varices bleeding

    Directory of Open Access Journals (Sweden)

    Chen-Jung Chang

    2013-10-01

    Full Text Available Gastroesophageal varices bleeding is a major complication in patients with cirrhosis. Gastric varices (GVs occur in approximately 20% of patients with portal hypertension. However, GV bleeding develops in only 25% of patients with GV and requires more transfusion and has higher mortality than esophageal variceal (EV bleeding. The best strategy for managing acute GV bleeding is similar to that of acute EV bleeding, which involves airway protection, hemodynamic stabilization, and intensive care. Blood transfusion should be cautiously administered in order to avoid rebleeding. Vasoactive agents such as terlipressin or somatostatin should be used when GV bleeding is suspected. Routine use of prophylactic antibiotics reduces bacterial infection and lowers rebleeding rates. By administering endoscopic cyanoacrylate injection, the initial hemostasis rate achieved is at least 90% in most cases; the average mortality rate of GV bleeding is approximately 10–30% and the rebleeding rate is between 22% and 37%. Although endoscopic injection of cyanoacrylate is superior to sclerotherapy and band ligation, and has remained the treatment of choice for treating acute GV bleeding, the outcome of this treatment is still unsatisfactory. New treatment options, such as thrombin injection, transjugular intrahepatic portosystemic shunts, or balloon-occluded retrograde transvenous obliteration, have shown promising results for acute GV bleeding. However, randomized controlled trials are needed to compare the efficacy of these therapies with cyanoacrylate.

  7. Acute pancreatitis: current perspectives on diagnosis and management

    Science.gov (United States)

    Shah, Adarsh P; Mourad, Moustafa M; Bramhall, Simon R

    2018-01-01

    The last two decades have seen the emergence of significant evidence that has altered certain aspects of the management of acute pancreatitis. While most cases of acute pancreatitis are mild, the challenge remains in managing the severe cases and the complications associated with acute pancreatitis. Gallstones are still the most common cause with epidemiological trends indicating a rising incidence. The surgical management of acute gallstone pancreatitis has evolved. In this article, we revisit and review the methods in diagnosing acute pancreatitis. We present the evidence for the supportive management of the condition, and then discuss the management of acute gallstone pancreatitis. Based on the evidence, our local institutional pathways, and clinical experience, we have produced an outline to guide clinicians in the management of acute gallstone pancreatitis. PMID:29563826

  8. 78 FR 13376 - Chronic Wasting Disease Management Plan/Environmental Impact Statement, Shenandoah National Park

    Science.gov (United States)

    2013-02-27

    ... and experience from management actions; and minimize the potential for health and safety issues for...] Chronic Wasting Disease Management Plan/Environmental Impact Statement, Shenandoah National Park AGENCY... National Environmental Policy Act of 1969 and the Council on Environmental Quality regulations, the...

  9. 76 FR 75557 - Draft Environmental Impact Statement for General Management Plan/Wilderness Study, Hawaii...

    Science.gov (United States)

    2011-12-02

    ... Environmental Impact Statement for General Management Plan/ Wilderness Study, Hawaii Volcanoes National Park, Hawaii AGENCY: National Park Service, Interior. ACTION: Notice of intent. SUMMARY: The National Park... updating the General Management Plan (GMP) for Hawaii Volcanoes National Park. As part of this conservation...

  10. 78 FR 70354 - Conceptual Example of a Proposed Risk Management Regulatory Framework Policy Statement

    Science.gov (United States)

    2013-11-25

    ... NUCLEAR REGULATORY COMMISSION [NRC-2013-0254] Conceptual Example of a Proposed Risk Management Regulatory Framework Policy Statement AGENCY: Nuclear Regulatory Commission. ACTION: Conceptual example of a... ``openness,'' a white paper on a Conceptual Example of a Proposed Risk Management Regulatory Framework (RMRF...

  11. 76 FR 70483 - Environmental Impact Statement and General Management Plan, Paterson Great Falls National...

    Science.gov (United States)

    2011-11-14

    ... planning process and will remain actively involved throughout the development of the plan. Prepared by... the long-term management of Paterson Great Falls NHP early in the process through public meetings and... Impact Statement and General Management Plan, Paterson Great Falls National Historical Park, NJ AGENCY...

  12. 76 FR 57760 - Notice of Availability of Draft Resource Management Plan and Draft Environmental Impact Statement...

    Science.gov (United States)

    2011-09-16

    ... approximately 707,000 subsurface acres of Federal mineral estate. Decisions in the Colorado River Valley RMP... Availability of Draft Resource Management Plan and Draft Environmental Impact Statement for the Colorado River Valley Field Office, Colorado AGENCY: Bureau of Land Management, Interior. ACTION: Notice of availability...

  13. Acute pain management in children with sickle cell anaemia during ...

    African Journals Online (AJOL)

    inpatient system for debilitating events such as crises or acute pain. ... and pharmacological treatments documented in the patients' case files. ... this study. Therefore, our objective was to evaluate acute pain management in SCA children on ...

  14. Impression management and self-presentation dissimulation in Portuguese chairman's statements

    OpenAIRE

    Oliveira, J.; Azevedo, G.; Borges, F.

    2016-01-01

    WOS:000381979800008 (Nº de Acesso Web of Science) Drawn on social psychology theory of impression management, the present study tries to assess the way Portuguese managers build their narratives in Chairman’s Statement to manage stakeholders’ perceptions on corporate image, in a period of time of scarce resources. The paper’s theoretical framework draws on elements of social psychology theory of impression management developed by Leary and Kowalski (1990). Through the use of the two-compon...

  15. 17 CFR 274.11b - Form N-3, registration statement of separate accounts organized as management investment companies.

    Science.gov (United States)

    2010-04-01

    ... statement of separate accounts organized as management investment companies. 274.11b Section 274.11b... accounts organized as management investment companies. Form N-3 shall be used as the registration statement... offer variable annuity contracts to register as management investment companies. This form shall also be...

  16. 17 CFR 274.11a-1 - Form N-2, registration statement of closed end management investment companies.

    Science.gov (United States)

    2010-04-01

    ... statement of closed end management investment companies. 274.11a-1 Section 274.11a-1 Commodity and... management investment companies. This form shall be used as the registration statement to be filed pursuant to section 8(b) of the Investment Company Act of 1940 by closed end management investment companies...

  17. Management of acute unstable acromioclavicular joint injuries.

    Science.gov (United States)

    Cisneros, Luis Natera; Reiriz, Juan Sarasquete

    2016-12-01

    Surgical management of acute unstable acromioclavicular joint injuries should be focused on realigning the torn ends of the ligaments to allow for healing potential. The most widely utilized treatment methods incorporate the use of metal hardware, which can alter the biomechanics of the acromioclavicular joint. This leads to a second surgical procedure for hardware removal once the ligaments have healed. Patients with unstable acromioclavicular joint injuries managed with arthroscopy-assisted procedures have shown good and excellent clinical outcomes, without the need for a second operation. These procedures incorporate a coracoclavicular suspension device aimed to function as an internal brace, narrowing the coracoclavicular space thus allowing for healing of the torn coracoclavicular ligaments. The lesser morbidity of a minimally invasive approach and the possibility to diagnose and treat concomitant intraarticular injuries; no obligatory implant removal, and the possibility of having a straight visualization of the inferior aspect of the base of the coracoid (convenient when placing coracoclavicular fixation systems) are the main advantages of the arthroscopic approach over classic open procedures. This article consists on a narrative review of the literature in regard to the management of acute acromioclavicular joint instability.

  18. Safety of Nonoperative Management After Acute Diverticulitis

    Science.gov (United States)

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

    2014-01-01

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

  19. Evaluation and management of acute radiation dermatitis

    International Nuclear Information System (INIS)

    Modesto, A.; Faivre, J.C.; Granel-Brocard, F.; Tao, Y.G.; Pointreau, Y.

    2012-01-01

    Acute radiation dermatitis remains one of the most commonly observed side effect during radiation therapy leading to complication such as superinfection or treatment disruption. Its management is characterized by a great heterogeneity. Few strategies have demonstrated a benefit in preventing radiation dermatitis, which relies mostly on decreasing dose delivered to the skin and skin care practices. Simple emollients and use of topical steroids can be useful in early stages. The singularity of the skin toxicity seen with cetuximab and radiotherapy warrants a specific grading system and distinctive clinical treatment with use of antibiotics. (authors)

  20. Acute pain management in burn patients

    DEFF Research Database (Denmark)

    Gamst-Jensen, Hejdi; Vedel, Pernille Nygaard; Lindberg-Larsen, Viktoria Oline

    2014-01-01

    OBJECTIVE: Burn patients suffer excruciating pain due to their injuries and procedures related to surgery, wound care, and mobilization. Acute Stress Disorder, Post-Traumatic Stress Disorder, chronic pain and depression are highly prevalent among survivors of severe burns. Evidence-based pain...... patients. The most highly recommended guidelines provided clear and accurate recommendations for the nursing and medical staff on pain management in burn patients. We recommend the use of a validated appraisal tool such as the AGREE instrument to provide more consistent and evidence-based care to burn...

  1. The management of acute and chronic pancreatitis.

    Science.gov (United States)

    Banks, Peter A; Conwell, Darwin L; Toskes, Phillip P

    2010-02-01

    Pancreatitis, which is most generally described as any inflammation of the pancreas, is a serious condition that manifests in either acute or chronic forms. Chronic pancreatitis results from irreversible scarring of the pancreas, resulting from prolonged inflammation. Six major etiologies for chronic pancreatitis have been identified: toxic/ metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, and obstruction. The most common symptom associated with chronic pancreatitis is pain localized to the upper-to-middle abdomen, along with food malabsorption, and eventual development of diabetes. Treatment strategies for acute pancreatitis include fasting and short-term intravenous feeding, fluid therapy, and pain management with narcotics for severe pain or nonsteroidal anti-inflammatories for milder cases. Patients with chronic disease and symptoms require further care to address digestive issues and the possible development of diabetes. Dietary restrictions are recommended, along with enzyme replacement and vitamin supplementation. More definitive outcomes may be achieved with surgical or endoscopic methods, depending on the role of the pancreatic ducts in the manifestation of disease.

  2. Critical care management of acute ischemic stroke.

    Science.gov (United States)

    Coplin, William M

    2012-06-01

    Acute ischemic stroke (AIS) can have profound and devastating effects on the CNS and several other organs. Approximately 15% to 20% of patients with AIS are admitted to an intensive care unit and cared for by a multidisciplinary team. This article discusses the critical care management of patients with AIS. Patients with AIS require attention to airway, pulmonary status, blood pressure, glucose, temperature, cardiac function, and, sometimes, life-threatening cerebral edema. The lack of disease-specific data has led to numerous management approaches and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of bleeding but provide little discussion of the complex critical care issues involved in caring for patients with AIS.

  3. Acute respiratory distress syndrome: evaluation and management.

    Science.gov (United States)

    Cortés, I; Peñuelas, O; Esteban, A

    2012-03-01

    Acute respiratory distress syndrome (ARDS) is a life-threatening condition that affects patients admitted in the Intensive Care Units (ICUs) under mechanical ventilation. ARDS is a process of non-hydrostatic pulmonary edema and hypoxemia associated with a variety of conditions, resulting in a direct (e.g., pneumonia) or indirect (e.g., sepsis) lung injury and is associated with a significant morbidity and mortality. A large body of clinical and basic research has focused in ventilatory strategies and novel pharmacological therapies but, nowadays, treatment is mainly supportive. Mechanical ventilation is the hallmark of the management of these patients. In the last decades, the recognition that mechanical ventilation can contribute to harming the lung has changed the goals of this therapy and has driven research to focus in ventilatory strategies that mitigate lung injury. This review emphasizes clinical aspects in the evaluation and management of ARDS in the ICUs and updates the latest advances in these therapies.

  4. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed....... All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

  5. Time Management in Acute Vertebrobasilar Occlusion

    International Nuclear Information System (INIS)

    Kamper, Lars; Rybacki, Konrad; Mansour, Michael; Winkler, Sven B.; Kempkes, Udo; Haage, Patrick

    2009-01-01

    Acute vertebrobasilar occlusion (VBO) is associated with a high risk of stroke and death. Although local thrombolysis may achieve recanalization and improve outcome, mortality is still between 35% and 75%. However, without recanalization the chance of a good outcome is extremely poor, with mortality rates of 80-90%. Early treatment is a fundamental factor, but detailed studies of the exact time management of the diagnostic and interventional workflow are still lacking. Data on 18 patients were retrospectively evaluated. Time periods between symptom onset, admission to hospital, time of diagnosis, and beginning of intervention were correlated with postinterventional neurological status. The Glasgow Coma Scale and National Institute of Health Stroke Scale (NIHSS) were used to examine patients before and after local thrombolysis. Additionally, multivariate statistics were applied to reveal similarities between patients with neurological improvement. Primary recanalization was achieved in 77% of patients. The overall mortality was 55%. Major complications were intracranial hemorrhage and peripheral embolism. The time period from symptom onset to intervention showed a strong correlation with the postinterventional NIHSS as well as the patient's age, with the best results in a 4-h interval. Multivariate statistics revealed similarities among the patients. Evaluation of time management in acute VBO by multivariate statistics is a helpful tool for definition of similarities in this patient group. Similarly to the door-to-balloon time for acute coronary interventions, the chances for a good outcome depend on a short time interval between symptom onset and intervention. While the only manipulable time period starts with hospital admission, our results emphasize the necessity of efficient intrahospital workflow.

  6. Time management in acute vertebrobasilar occlusion.

    Science.gov (United States)

    Kamper, Lars; Rybacki, Konrad; Mansour, Michael; Winkler, Sven B; Kempkes, Udo; Haage, Patrick

    2009-03-01

    Acute vertebrobasilar occlusion (VBO) is associated with a high risk of stroke and death. Although local thrombolysis may achieve recanalization and improve outcome, mortality is still between 35% and 75%. However, without recanalization the chance of a good outcome is extremely poor, with mortality rates of 80-90%. Early treatment is a fundamental factor, but detailed studies of the exact time management of the diagnostic and interventional workflow are still lacking. Data on 18 patients were retrospectively evaluated. Time periods between symptom onset, admission to hospital, time of diagnosis, and beginning of intervention were correlated with postinterventional neurological status. The Glasgow Coma Scale and National Institute of Health Stroke Scale (NIHSS) were used to examine patients before and after local thrombolysis. Additionally, multivariate statistics were applied to reveal similarities between patients with neurological improvement. Primary recanalization was achieved in 77% of patients. The overall mortality was 55%. Major complications were intracranial hemorrhage and peripheral embolism. The time period from symptom onset to intervention showed a strong correlation with the postinterventional NIHSS as well as the patient's age, with the best results in a 4-h interval. Multivariate statistics revealed similarities among the patients. Evaluation of time management in acute VBO by multivariate statistics is a helpful tool for definition of similarities in this patient group. Similarly to the door-to-balloon time for acute coronary interventions, the chances for a good outcome depend on a short time interval between symptom onset and intervention. While the only manipulable time period starts with hospital admission, our results emphasize the necessity of efficient intrahospital workflow.

  7. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposl of radioactive and hazardous waste. Volume II

    International Nuclear Information System (INIS)

    1997-01-01

    The Final Waste Management Programmatic Environmental Impact Statement (WM PEIS) examines the potential environmental and cost impacts of strategic management alternatives for managing five types of radioactive and hazardous wastes that have resulted and will continue to result from nuclear defense and research activities at a variety of sites around the United States. The five waste types are low-level mixed waste, low-level waste, transuranic waste, high-level waste, and hazardous waste. The WM PEIS provides information on the impacts of various siting alternatives which the Department of Energy (DOE) will use to decide at which sites to locate additional treatment, storage, and disposal capacity for each waste type.Volume II is an integral part of the Office of Environmental Management''s (EM''s) Waste Management Programmatic Environmental Impact Statement (WM PEIS), which portrays the impacts of EM''s waste management activities at each of the 17 major DOE sites evaluated in the WM PEIS

  8. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Konstam, Marvin A; Kiernan, Michael S; Bernstein, Daniel; Bozkurt, Biykem; Jacob, Miriam; Kapur, Navin K; Kociol, Robb D; Lewis, Eldrin F; Mehra, Mandeep R; Pagani, Francis D; Raval, Amish N; Ward, Carey

    2018-05-15

    The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF. The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations. Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output and progressive end-organ damage (caused by a combination of end-organ venous congestion and underperfusion), and cachexia resulting from poor absorption of nutrients, as well as a systemic proinflammatory state. It is the principal cause of death in patients with pulmonary arterial hypertension. Similarly, acute RHF is associated with hemodynamic instability and is the primary cause of death in patients presenting with massive pulmonary embolism, RV myocardial infarction, and postcardiotomy shock associated with cardiac surgery. Functional assessment of the right side of the heart can be hindered by its complex geometry. Multiple

  9. Diagnosis and management of acute movement disorders.

    Science.gov (United States)

    Dressler, D; Benecke, R

    2005-11-01

    Most movement disorders, reflecting degenerative disorders, develop in a slowly progressive fashion. Some movement disorders, however, manifest with an acute onset. We wish to give an overview of the management and therapy of those acute-onset movement disorders.Drug-induced movement disorders are mainly caused by dopamine-receptor blockers (DRB) as used as antipsychotics (neuroleptics) and antiemetics. Acute dystonic reactions usually occur within the first four days of treatment. Typically, cranial pharyngeal and cervical muscles are affected. Anticholinergics produce a prompt relief. Akathisia is characterized by an often exceedingly bothersome feeling of restlessness and the inability to remain still. It is a common side effect of DRB and occurs within few days after their initiation. It subsides when DRB are ceased. Neuroleptic Malignant Syndrome is a rare, but life-threatening adverse reaction to DRB which may occur at any time during DRB application. It is characterised by hyperthermia, rigidity, reduced consciousness and autonomic failure. Therapeutically immediate DRB withdrawal is crucial. Additional dantrolene or bromocriptine application together with symptomatic treatment may be necessary. Paroxysmal dyskinesias are childhood onset disorders characterised by dystonic postures, chorea, athetosis and ballism occurring at irregular intervals. In Paroxysmal Kinesigenic Dyskinesia they are triggered by rapid movements, startle reactions or hyperventilation. They last up to 5 minutes, occur up to 100 times per day and are highly sensitive to anticonvulsants. In Paroxysmal Non-Kinesiogenic Dyskinesia they cannot be triggered, occur less frequently and last longer. Other paroxysmal dyskinesias include hypnogenic paroxysmal dyskinesias, paroxysmal exertional dyskinesia, infantile paroxysmal dystonias, Sandifer's syndrome and symptomatic paroxysmal dyskinesias. In Hereditary Episodic Ataxia Type 1 attacks of ataxia last for up to two minutes, may be accompanied

  10. Management and Communication of the Companies' Knowledge; Guidelines for Intellectual Capital Statement

    Directory of Open Access Journals (Sweden)

    Justyna Fijalkowska

    2008-04-01

    Full Text Available This paper aims at analyzing the development of guidelines on Intellectual Capital Statement, providing a comparison of them and presenting their importance within the knowledge management process of the today's companies. We entered the Knowledge Era in which the basic economic resources are no longer financial capital, physical resources, or labor, but knowledge, called also intellectual capital (IC. Many analysts and investors demand for more information and they highlight the gap that exists between the information found in companies' annual reports and the financial information regarding intangible part of the company requested by the market. Knowledge of the company should be measured and the effects should be communicated, as measurement without any further action has no sense. Intellectual capital statement seems an appropriate tool for that and becomes an integral part of the knowledge management of the modern enterprise. This kind of statement emphasizes the role of IC in relation to the value creation and communicates how knowledge resources are managed in the firms within a strategic objectives. This paper compares different approaches to IC statement preparation: underlines similarities and differences concerning the scope, methodology and terminology used and ensuing consequences. It raises significant implications for managers of the companies, researches and policy makers.

  11. 78 FR 5494 - Off-Road Vehicle Management Plan, Draft Environmental Impact Statement, Lake Meredith National...

    Science.gov (United States)

    2013-01-25

    ... DEPARTMENT OF THE INTERIOR National Park Service [NPS-IMR-LAMR-10224; 2310-0091-422] Off-Road... Service (NPS) is releasing a Draft Environmental Impact Statement (DEIS) for the Off- Road Vehicle... impacts of four alternatives that address off-road vehicle (ORV) management in the national recreation...

  12. 78 FR 5492 - Draft Environmental Impact Statement for Merced Wild and Scenic River Comprehensive Management...

    Science.gov (United States)

    2013-01-25

    ... DEPARTMENT OF THE INTERIOR National Park Service [NPS-PWR-PWRO-11522; PX.P0131800B.00.1] Draft Environmental Impact Statement for Merced Wild and Scenic River Comprehensive Management Plan, Yosemite National Park, Madera and Mariposa Counties, CA AGENCY: National Park Service, Interior. ACTION: Notice of...

  13. Evaluation of Increasing Antecedent Specificity in Goal Statements on Adherence to Positive Behavior-Management Strategies

    Science.gov (United States)

    Cohrs, Corey M.; Shriver, Mark D.; Burke, Raymond V.; Allen, Keith D.

    2016-01-01

    We evaluated the impact of antecedent specificity in goal statements on adherence to positive behavior-management strategies. Teaching staff were recruited from 2 different school settings where there were routine expectations to use behavior-specific praise in the classroom, but adherence was poor. In a concurrent multiple baseline design, the…

  14. [Primary emergencies: management of acute ischemic stroke].

    Science.gov (United States)

    Leys, Didier; Goldstein, Patrick

    2012-01-01

    The emergency diagnostic strategy for acute ischemic stroke consists of:--identification of stroke, based on clinical examination (sudden onset of a focal neurological deficit);--identification of the ischemic or hemorrhagic nature by MRI or CT;--determination of the early time-course (clinical examination) and the cause. In all strokes (ischemic or hemorrhagic), treatment consists of:--the same general management (treatment of a life-threatening emergency, ensuring normal biological parameters except for blood pressure, and prevention of complications);--decompressive surgery in the rare cases of intracranial hypertension. For proven ischemic stroke, other therapies consist of: rt-PA for patients admitted with 4.5 hours of stroke onset who have no contraindications, and aspirin (160 to 300 mg) for patients who are not eligible for rt-PA. These treatments should be administered within a few hours. A centralized emergency call system (phone number 15 in France) is the most effective way of achieving this objective.

  15. [EDRP public local inquiry] radioactive waste management statement

    International Nuclear Information System (INIS)

    1986-03-01

    The statutory arrangements which will apply to the proposed EDRP at Dounreay in relation to radioactive waste management matters, and the principles against which it will be assessed, are described. Also included are some preliminary, provisional comments on the waste management implications of the outline application. (U.K.)

  16. Public comments on the draft generic environmental impact statement for management of commercially generated radioactive waste

    International Nuclear Information System (INIS)

    Kreiter, M.R.; Unruh, C.M.; McCallum, R.F.

    1980-01-01

    The US Department of Energy has the responsibility for developing the technology required for managing commercial radioactive wastes in an environmentally acceptable manner. As part of this responsibility, DOE has prepared a draft environmental impact statement on the management of commercially generated radioactive waste. The draft was issued for public comment in April of 1979; five public hearings were held. The draft GEIS is intended to provide environmental input for the selection of an appropriate program strategy for the permanent isolation of commercially generated high-level and transuranic wastes. The scope of such a strategy includes research and development into alternative treatment processes and emplacement media, site investigations into candidate media, and the examination of advanced waste management technologies. The draft statement describes the commercial radioactive wastes that would have to be managed for very long periods of time from an assumed nuclear generation scenario of 10,000 GWe-yr of power over a 65-year period ending in 2040

  17. UTILITY OF ANNUAL FINANCIAL STATEMENTS IN THE MANAGEMENT PROCESS

    Directory of Open Access Journals (Sweden)

    PUICAN LILIANA

    2015-07-01

    Full Text Available Process knowledge of the financial situation of the economic entity presupposes the use of analysis and synthesis, as indispensable tools of investigation. Financial management of the economic entity have to belong to the basic role in strategic financial decisions that would solve the problem of effective management of the process optimal growth, balanced and proportionate entity. That is why it becomes necessary and imperative objective analysis of the implications of the current financial management in economic entities familiarize managers with the basic tools with which they operate, acquiring knowledge about planning and financial control, evaluation techniques of investment projects, about how to conduct financial and economic diagnosis and management control of the entity, the key issues in its orientation towards performance.

  18. The paediatric acute scrotum: are we still managing correctly?

    African Journals Online (AJOL)

    Objective The objective of this study was to investigate current investigation and management practice in a general district hospital in the UK of the paediatric acute scrotum. Summary background Diagnosis and management of the paediatric acute scrotum remains an elusive and often challenging area of urology.

  19. Managing an Acute and Chronic Periprosthetic Infection

    Directory of Open Access Journals (Sweden)

    Cristian Barrientos

    2017-01-01

    Full Text Available A case report of a 65-year-old female with a history of right total hip arthroplasty (THA in 2007 and left THA in 2009 was presented. She consulted with our institution for the first time, on December 2013, for right hip pain and fistula on the THA incision. It was managed as a chronic infection, so a two-stage revision was performed. First-time intraoperative cultures were positive for Staphylococcus aureus (3/5 and Proteus mirabilis (2/5. Three weeks after the second half of the review, it evolved with acute fever and pain in relation to right hip. No antibiotics were used, arthrocentesis was performed, and a coagulase-negative staphylococci multisensible was isolated at the 5th day. Since the germ was different from the first revision, it was decided to perform a one-stage revision. One year after the first review, the patient has no local signs of infection and presents ESV and RPC in normal limits. The indication and management of periprosthetic infections are discussed.

  20. Management of pemphigus vulgaris during acute phase

    Directory of Open Access Journals (Sweden)

    Kar P

    2003-03-01

    Full Text Available We present our experience with 21 patients of pemphigus vulgaris seen over a period of 10 years managed in service hospitals during acute phase of the disease. Age groups of patients ranged from 25-45 years. Eighteen (85.7% were young adults, 30-40 years of age. Fifteen (71.4% were men and 6(28.6% were women. All the cases were hospitalized in ICU, till the acute phase of the disease subsided. Complete hematological profile, urinalysis, serum biochemistry and repeated bacterial cultures from the skin were carried out in all patients at the time of admission and thereafter weekly. The treatment comprised of potassium permanganate lotion bath (1:10000 and 1 framycetin gauze dressing of the denuded areas, maintenance of fluid and electrolyte balance. All suspected infections and septicemia were treated with appropriate antibiotics. The corticosteroids were usually administered as a single dose of prednisolone 1 mg/kg/day. Cyclophosphamide was given at an initial dose of 50mg/day and the dose was escalated to 100mg/day. Once the bulk of the lesions were healed, the dose of corticosteroids was gradually lowered by approximately 50% every two weeks and cyclophosphamide was continued till patients were symptomfree. Out of 21 patients receiving corticosteroids, cyclophosphamide and other supportive therapy, 20(95% had undergone clinical resolution of the disease. During follow up study 15(71.4% patients remained symptom-free and undergone clinical remission. Five patients (23.8% had relapse, out of which 4(19% remained symptom free, after subsequent treatment. There was one death (4.7% in our study.

  1. Final programmatic environmental impact statement for stockpile stewardship and management

    International Nuclear Information System (INIS)

    1996-09-01

    In response to the end of the Cold War and changes in the world's political regimes, the United States is not producing new-design nuclear weapons. Instead, the emphasis of the U.S. nuclear weapons program is on reducing the size of the Nation's nuclear stockpile by dismantling existing nuclear weapons. The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed a Stockpile Stewardship and Management Program to provide a single highly integrated technical program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management PEIS describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program

  2. Acute diarrhea: evidence-based management

    Directory of Open Access Journals (Sweden)

    Kátia Galeão Brandt

    2015-11-01

    Full Text Available Objectives: To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. Data source: PubMed, Scopus, Google Scholar. Data summary: There has been little progress in the use of oral rehydration salts (ORS in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. Conclusions: Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea. Resumo: Objetivos: descrever as recomendações atuais sobre a melhor maneira de conduzir o paciente pediátrico com doença diarreica aguda. Fonte dos dados: PubMed, Scopus, Scholar Google. Síntese dos dados: Houve pouco avanço na utilização dos sais de reidratação oral (SRO nas últimas décadas apesar de ser amplamente divulgado através de diretrizes internacionais. Vários estudos vêm sendo realizados na tentativa de melhorar a eficácia do SRO. Hidratação venosa com solução salina isotônica, infundida de forma rápida, deve ser indicada em casos de desidratação grave. A nutrição deve ser assegurada logo após a resolução da desidratação, sendo primordial para a saúde intestinal e imunológica. Restrições alimentares usualmente não são benéficas e podem ser prejudiciais. As medicações sintomáticas têm indicação restrita e antibióticos são indicados em casos específicos, cólera e shiguelose moderada a grave. Conclusões: a hidratação e a nutri

  3. National Athletic Trainers' Association Position Statement: Management of Sport Concussion

    Science.gov (United States)

    Broglio, Steven P.; Cantu, Robert C.; Gioia, Gerard A.; Guskiewicz, Kevin M.; Kutcher, Jeffrey; Palm, Michael; McLeod, Tamara C. Valovich

    2014-01-01

    Objective: To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions. Background: An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical providers available onsite to identify and evaluate these injuries. Recommendations: The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations. PMID:24601910

  4. Exercise management in type 1 diabetes: a consensus statement.

    Science.gov (United States)

    Riddell, Michael C; Gallen, Ian W; Smart, Carmel E; Taplin, Craig E; Adolfsson, Peter; Lumb, Alistair N; Kowalski, Aaron; Rabasa-Lhoret, Remi; McCrimmon, Rory J; Hume, Carin; Annan, Francesca; Fournier, Paul A; Graham, Claudia; Bode, Bruce; Galassetti, Pietro; Jones, Timothy W; Millán, Iñigo San; Heise, Tim; Peters, Anne L; Petz, Andreas; Laffel, Lori M

    2017-05-01

    Type 1 diabetes is a challenging condition to manage for various physiological and behavioural reasons. Regular exercise is important, but management of different forms of physical activity is particularly difficult for both the individual with type 1 diabetes and the health-care provider. People with type 1 diabetes tend to be at least as inactive as the general population, with a large percentage of individuals not maintaining a healthy body mass nor achieving the minimum amount of moderate to vigorous aerobic activity per week. Regular exercise can improve health and wellbeing, and can help individuals to achieve their target lipid profile, body composition, and fitness and glycaemic goals. However, several additional barriers to exercise can exist for a person with diabetes, including fear of hypoglycaemia, loss of glycaemic control, and inadequate knowledge around exercise management. This Review provides an up-to-date consensus on exercise management for individuals with type 1 diabetes who exercise regularly, including glucose targets for safe and effective exercise, and nutritional and insulin dose adjustments to protect against exercise-related glucose excursions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Diabetes Management in the School Setting. Position Statement. Revised

    Science.gov (United States)

    Wright, Janet B.; Easterling, Traci; Hardy, Alicen

    2017-01-01

    It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) is the school staff member who has the knowledge, skills, and statutory authority to fully meet the healthcare needs of students with diabetes in the school setting. Diabetes management in…

  6. Survey of the management of acute asthma in children.

    LENUS (Irish Health Repository)

    Widger, J

    2009-12-01

    Acute asthma is one of the most common reasons for children presenting to the emergency department. International guidelines for the management of acute paediatric asthma are widely available. In this study we examined how acute asthma in children is managed across hospitals in Ireland and compared Irish practice with standard international guidelines. We surveyed 54 paediatricians across 18 centres in Ireland. A total of 30 (55.5%) individual paediatricians across 17 (94%) centres replied. The majority of centres had a written protocol for the management of acute asthma. A large number of centres use MDI and spacer devices in acute management although doses used varied widely. Only 29% of centres had written asthma action plans available from the emergency department and 53% had plans available from the ward. Irish practice is largely inline with established guidelines. A national asthma strategy could further help to improve asthma care.

  7. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Summary

    International Nuclear Information System (INIS)

    1997-05-01

    This Waste Management Programmatic Environmental Impact Statement (WM PEIS) is a nationwide study examining the environmental impacts of managing five types of radioactive and hazardous wastes generated by past and future nuclear defense and research activities at a variety of sites located around the United States. The five waste types are low-level mixed waste (LLMW), low-level waste (LLW), transuranic waste (TRUW), high-level waste (HLW), and hazardous waste (HW)

  8. ANDRA - National Radioactive Waste Management Agency. Activity report 2006. Management report - Financial statements 2006

    International Nuclear Information System (INIS)

    2007-06-01

    Created in 1979 within the CEA, the National Radioactive Waste Management Agency (ANDRA) was established by the December 1991 Waste Act as a public body in charge of the long-term management of all radioactive waste, under the supervision of the Ministry of Ecology, Energy, Sustainable Development and the Sea (formerly the Ministry of Industry and the Ministry of Environment), and the Ministry of Research. Its 3 basic missions were extended and their funding secured through the 2006 Planning Act: - a R and D mission to propose safe long-term solution for radioactive waste without current disposal system; this mission includes long-term storage, since the 2006 Planning Act, in order to propose interim solutions while final ones are being studied; - an industrial mission concerning, on one hand, waste acceptance criteria and control and, on the other hand, siting, construction, operation, closure and monitoring of repositories. This mission includes as well a public service mission in terms of i) collection of waste of the 'small-scale nuclear activities' producers or owners (including the so-called 'household' radioactive waste, i.e. waste owned by private individuals) and ii) clean-up and rehabilitation of orphan polluted sites; - an information mission, notably through the regular publication of the National Inventory of radioactive materials and waste. This mission includes as well an active policy of dialogue with stakeholders both at national and local level. This document is the activity report with the management and financial statements report of the Andra for the year 2006

  9. Transmission System Vegetation Management Program. Draft Environmental Impact Statement

    International Nuclear Information System (INIS)

    1999-01-01

    Bonneville is responsible for maintaining a network of 24,000 kilometers (km) or 15,000 miles (mi.) of electric transmission lines and 350 substations in a region of diverse vegetation. This vegetation can interfere with electric power flow, pose safety problems for Bonneville and the public, and interfere with their ability to maintain these facilities. They need to (1) keep vegetation away from the electric facilities; (2) increase their program efficiency and consistency; (3) review herbicide use (under increased public scrutiny); and (4) maximize the range of tools they can use while minimizing environmental impact (Integrated Vegetation Management). This DEIS establishes Planning Steps for managing vegetation for specific projects (to be tiered to this EIS). In addition to No Action (current practice), alternatives are presented for Rights-of-way, Electric Yards, and Non-electric Facilities (landscaping, work yards). Four vegetation control methods are analyzed: manual, mechanical, herbicide, and biological. Also evaluated are 24 herbicide active ingredients and 4 herbicide application techniques (spot, localized, broadcast, and aerial). For rights-of-way, they consider three sets of alternatives: alternative management approaches (time-driven or establishing low-growing plant communities); alternative method packages; and, if herbicides are in a methods package, alternative vegetation selections (noxious weeds, deciduous, or any vegetation). For electric yards, one herbicide-use alternative is considered. For non-electric facilities, two method package alternatives are considered. For rights-of-way, the environmentally preferred alternative(s) would use manual, mechanical, and biological control methods, as well as spot and localized herbicide applications for noxious and deciduous plant species; the BPA-preferred alternative(s) would add broadcast and aerial herbicide applications, and would use herbicides on any vegetation. Both would favor a management

  10. WNA position statement on safe management of nuclear waste and used nuclear fuel

    International Nuclear Information System (INIS)

    Saint-Pierre, S.

    2006-01-01

    This World nuclear association (W.N.A.) Position Statement summarizes the worldwide nuclear industry's record, progress and plans in safely managing nuclear waste and used nuclear fuel. The global industry's safe waste management practices cover the entire nuclear fuel-cycle, from the mining of uranium to the long-term disposal of end products from nuclear power reactors. The Statement's aim is to provide, in clear and accurate terms, the nuclear industry's 'story' on a crucially important subject often clouded by misinformation. Inevitably, each country and each company employs a management strategy appropriate to a specific national and technical context. This Position Statement reflects a confident industry consensus that a common dedication to sound practices throughout the nuclear industry worldwide is continuing to enhance an already robust global record of safe management of nuclear waste and used nuclear fuel. This text focuses solely on modern civil programmes of nuclear-electricity generation. It does not deal with the substantial quantities of waste from military or early civil nuclear programmes. These wastes fall into the category of 'legacy activities' and are generally accepted as a responsibility of national governments. The clean-up of wastes resulting from 'legacy activities' should not be confused with the limited volume of end products that are routinely produced and safely managed by today's nuclear energy industry. On the significant subject of 'Decommissioning of Nuclear Facilities', which is integral to modern civil nuclear power programmes, the W.N.A. will offer a separate Position Statement covering the industry's safe management of nuclear waste in this context. The safe management of nuclear waste and used nuclear fuel is a widespread, well-demonstrated reality. This strong safety record reflects a high degree of nuclear industry expertise and of industry responsibility toward the well-being of current and future generations

  11. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

    Leonhardt, Henrik; Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  12. International consensus statement on the peri-operative management of anaemia and iron deficiency

    DEFF Research Database (Denmark)

    Muñoz, M.; Acheson, A. G.; Auerbach, M.

    2017-01-01

    Despite current recommendations on the management of pre-operative anaemia, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in surgical patients. A number of experienced researchers and clinicians took part in an expert workshop and developed...... in the peri-operative period. These statements include: a diagnostic approach for anaemia and iron deficiency in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up. We urge anaesthetists and peri-operative physicians to embrace...

  13. Financial Management: U.S. Army Corps of Engineers Financial Information Imported Into the Defense Departmental Reporting System - Audited Financial Statements

    National Research Council Canada - National Science Library

    Granetto, Paul J; Peek, Marvin L; Armstrong, Jack L; Wenzel, Paul C; Furey, Kathleen A; Zimmerman, Craig W

    2004-01-01

    ... are: the Corps of Engineers Financial Management System, the Corps of Engineers Enterprise Management Information System, and the Defense Departmental Reporting System - Audited Financial Statements...

  14. Acute abdominal pain : considerations on diagnosis and management

    NARCIS (Netherlands)

    Toorenvliet, Boudewijn Ronald

    2011-01-01

    In this thesis several aspects on the diagnosing and management of patients with acute abdominal pain are investigated. 1; The efficacy and safety of standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. 2; The use

  15. Contemporary Management of Acute Biliary Pancreatitis

    Directory of Open Access Journals (Sweden)

    Orhan Ozkan

    2014-03-01

    Full Text Available Acute biliary pancreatitis is one of the major causes of acute pancreatitis.Gallstones, biliary sludge and microlithiasis, especially in pancreatitis without detectable reason, can be the cause of acute pancreatitis. Acute biliary pancreatitis has many controversions in the literature, and its classification and guidelines are being updated very frequently. Atlanta classifications which determine the definitions and guidelines about acute pancreatitis were renewed and published in 2013. It has various clinical aspects, ranging from a mild form which is easily treated, to a severe form that causes complications leading to mortality. The pathogenesis of this disease has not been fully elucidated and several theories have been suggested. New scoring systems and laboratory methods such as proteomics have been suggested for both diagnosis and to predict disease severity, and research on these topics is still in progress. Novel therapeutic approaches with technological developments such as ERCP, ES, MRCP, and EUS are also suggested.

  16. Position statement on efficiency of technologies for diabetes management.

    Science.gov (United States)

    Martín-Vaquero, Pilar; Martínez-Brocca, María Asunción; García-López, José Manuel

    2014-12-01

    Di@bet.es study results are impressive, showing that diabetes affects 13.8% of the Spanish population. Not only the statistical facts are alarming, but the increasing incidence of this disease is a major problem, as pandemic proportions of type 2 diabetes are expected. Thus, the study of diabetes represents a challenge not only for health services, but also for the Ministries of Health and Finance. Technology has become an essential tool in the quality are of patients with diabetes, as it helps in the healthcare processes to obtain an optimum metabolic balance and prevent possible complications. Insulin pumps, continuous glucose monitoring nd self-monitoring blood glucose have all proved their efficiency, and telemedicine it is making good progress. The indirect costs of diabetes in Spain are much higher than the directones, showing the importance of inverting the paradox. The optimization of resources depends not only on the ability of the physicians, but also the administration, to implant and sustain technological innovations in our system, and with that make it effective in terms of benefits. Cost-effectiveness and cost-utility analysis are needed to prioritize and allow health management services to make the correct choices for approaching this prevalent chronic disease.

  17. Medical management of the acute radiation syndrome

    International Nuclear Information System (INIS)

    Lopez, M.; Martin, M.

    2011-01-01

    The acute radiation syndrome (ARS) occurs after whole-body or significant partial-body irradiation (typically at a dose of >1 Gy). ARS can involve the hematopoietic, cutaneous, gastrointestinal and the neurovascular organ systems either individually or in combination. There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. Radiation combined injury (RCI) is defined as radiation injury combined with blunt or penetrating trauma, burns, blast, or infection. The classic syndromes are: hematopoietic (doses >2 - 3 Gy), gastrointestinal (doses 5- 12 Gy) and cerebrovascular syndrome (doses 10 - 20 Gy). There is no possibility to survive after doses >10 - 12 Gy. The Phases of ARS are - prodromal: 0 - 2 days from exposure, latent: 2 - 20 days, and manifest illness: 21 - 60 days from exposure. Granulocyte-colony stimulating factor (G-CSF) at a dose of 5 micro g/kg body weight per day subcutaneously has been recommended as treatment of neutropenia, and antibiotics, antiviral and antifungal agents for prevention or treatment of infections. If taken within the first hours of contamination, stable iodine in the form of nonradioactive potassium iodide (KI) saturates iodine binding sites within the thyroid and inhibits incorporation of radioiodines into the gland. Finally, if severe aplasia persists under cytokines for more than 14 days, the possibility of a hematopoietic stem cell (HSC) transplantation should be evaluated. This review will focus on the clinical aspects of the ARS, using the European triage system (METREPOL) to evaluate the severity of radiation injury, and scoring groups of patients for the general and specific management of the syndrome. (authors)

  18. Dietary management of acute diarrhoea in childhood.

    Science.gov (United States)

    Booth, I W

    1993-04-17

    Gastroenteritis in children is usually treated with the graded introduction of milk feeds after rehydration. Although having never been rigorously tested, the practice of gradually increasing milk strength over several days has been considered an appropriate means of warding against lactose intolerance and preventing sensitization to cow's milk antigens. These guidelines were formulated in Europe and North America and invariably lead to a reduction in nutrient intake. Malnourished children in developing countries, however, may experience an average 5-6 episodes of acute diarrhea per year and the nutrient effects are cumulative. A recent study from Latin America explored whether continued feeding is safe for infants under age 6 months and whether malnourished children respond adversely. Infants randomly assigned to receive full strength cow's milk immediately after rehydration did not have more treatment failures, higher stool outputs, or longer lasting diarrhea than those whose feeds were regarded to full strength over 48 hours. It is unclear, however, whether the youngest or more malnourished subjects were overrepresented in the treatment failures. Results also indicate that deciding to change treatment should not be dictated by the presence of reducing substances in the faeces; the majority of infants with reducing substances in their stools did well. This study offers the first scientific support for rapidly reintroducing full-strength milk formula after gastroenteritis is malnourished patients under 6 months of age. The 10% of infants in which dehydration recurs after reintroducing milk feeds are still difficult to manage. In the absence of yogurt or lactose-free formula, a locally-produced modular feed of chicken, starch, and vegetable oil may be suitable.

  19. FINANCIAL STATEMENT UTILIZATION DURING DECISION MAKING PROCESS IN SMEs: A COMPARATIVE STUDY ON EUROPEAN AND TURKISH MANAGERS

    OpenAIRE

    İbicioğlu, Hasan; Kocabıyık, Turan; Dalğar, Hüseyin

    2014-01-01

    This study examines financial information requirement for decision making in small and medium sized enterprises. 131 SME managers’ responses were collected from Turkey and 8 different European countries. According to both Turkish and European managers, financial statements are mostly important to foresee the probable liquidity and financial crisis. And they find experience more important than financial statement data. A comparative analysis of Turkish and European SME managers is stated. Smal...

  20. Final Programmatic Environmental Impact Statement for stockpile stewardship and management: Volume 1

    International Nuclear Information System (INIS)

    1996-09-01

    The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed Stockpile Stewardship and Maintenance Program to provide a single highly integrated technical program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management Program Programmatic Environmental Impact Statement (PEIS) describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program. This document contains Volume I of the PEIS

  1. World Nuclear Association position statement: Safe management of nuclear waste and used nuclear fuel

    International Nuclear Information System (INIS)

    Saint-Pierre, Sylvain

    2006-01-01

    This WNA Position Statement summarises the worldwide nuclear industry's record, progress and plans in safely managing nuclear waste and used nuclear fuel. The global industry's safe waste management practices cover the entire nuclear fuel-cycle, from the mining of uranium to the long-term disposal of end products from nuclear power reactors. The Statement's aim is to provide, in clear and accurate terms, the nuclear industry's 'story' on a crucially important subject often clouded by misinformation. Inevitably, each country and each company employs a management strategy appropriate to a specific national and technical context. This Position Statement reflects a confident industry consensus that a common dedication to sound practices throughout the nuclear industry worldwide is continuing to enhance an already robust global record of safe management of nuclear waste and used nuclear fuel. This text focuses solely on modern civil programmes of nuclear-electricity generation. It does not deal with the substantial quantities of waste from military or early civil nuclear programmes. These wastes fall into the category of 'legacy activities' and are generally accepted as a responsibility of national governments. The clean-up of wastes resulting from 'legacy activities' should not be confused with the limited volume of end products that are routinely produced and safely managed by today's nuclear energy industry. On the significant subject of 'Decommissioning of Nuclear Facilities', which is integral to modern civil nuclear power programmes, the WNA will offer a separate Position Statement covering the industry's safe management of nuclear waste in this context. The paper's conclusion is that the safe management of nuclear waste and used nuclear fuel is a widespread, well-demonstrated reality. This strong safety record reflects a high degree of nuclear industry expertise and of industry responsibility toward the well-being of current and future generations. Accumulating

  2. Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.

    Science.gov (United States)

    Khamaysi, Iyad; Gralnek, Ian M

    2013-10-01

    Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Laparoscopic management of acute appendicitis in situs inversus

    Directory of Open Access Journals (Sweden)

    Golash Vishwanath

    2006-01-01

    Full Text Available Situs inversus is often detected incidentally in adults during imaging for a acute surgical emergency. We present a case of acute appendicitis in an adult who was previously unaware about his situs anomaly. A laparoscopic approach is helpful to deal with this condition. A 40 year old man was admitted with history of acute left lower abdominal pain, with uncontrolled diabetic keto-acidosis. Clinically, he was diagnosed as acute diverticulitis with localized peritonitis. Subsequent imaging studies and laparoscopy confirmed the diagnosis of situs inversus and acute left- sided appendicitis. He successfully underwent laparoscopic appendectomy. His postoperative recovery was uneventful. Although technically more challenging because of the reverse laparoscopic view of the anatomy, the laparoscopic diagnosis and management of acute appendicitis is indicated in situs inversus.

  4. Solid waste accident analysis in support of the Savannah River Waste Management Environmental Impact Statement

    International Nuclear Information System (INIS)

    Copeland, W.J.; Crumm, A.T.; Kearnaghan, D.P.; Rabin, M.S.; Rossi, D.E.

    1994-07-01

    The potential for facility accidents and the magnitude of their impacts are important factors in the evaluation of the solid waste management addressed in the Environmental Impact Statement. The purpose of this document is to address the potential solid waste management facility accidents for comparative use in support of the Environmental Impact Statement. This document must not be construed as an Authorization Basis document for any of the SRS waste management facilities. Because of the time constraints placed on preparing this accident impact analysis, all accident information was derived from existing safety documentation that has been prepared for SRS waste management facilities. A list of facilities to include in the accident impact analysis was provided as input by the Savannah River Technology Section. The accident impact analyses include existing SRS waste management facilities as well as proposed facilities. Safety documentation exists for all existing and many of the proposed facilities. Information was extracted from this existing documentation for this impact analysis. There are a few proposed facilities for which safety analyses have not been prepared. However, these facilities have similar processes to existing facilities and will treat, store, or dispose of the same type of material that is in existing facilities; therefore, the accidents can be expected to be similar

  5. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement.

    Science.gov (United States)

    Buglione, Michela; Cavagnini, Roberta; Di Rosario, Federico; Maddalo, Marta; Vassalli, Lucia; Grisanti, Salvatore; Salgarello, Stefano; Orlandi, Ester; Bossi, Paolo; Majorana, Alessandra; Gastaldi, Giorgio; Berruti, Alfredo; Trippa, Fabio; Nicolai, Pietro; Barasch, Andrei; Russi, Elvio G; Raber-Durlacher, Judith; Murphy, Barbara; Magrini, Stefano M

    2016-06-01

    Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treatment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of reaching a consensus on a clinical definition and management of these toxicities. The Delphi Appropriateness method was used for this consensus and external experts evaluated the conclusions. The paper contains 20 clusters of statements about the clinical definition and management of stomatological issues that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecrosis (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements). Copyright © 2016. Published by Elsevier Ireland Ltd.

  6. Early management and outcome of acute stroke in Auckland

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, N.E. [Auckland Hospital, Auckland, (New Zealand); Bonita, R.; Broad, J.B. [University of Auckland, Auckland, (New Zealand). Faculty of Medicine and Health Science

    1997-10-01

    Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. The aims of this study was to compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of the 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in-hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. It was concluded that in Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT. (authors). 34 refs., 4 tabs., 2 figs.

  7. Early management and outcome of acute stroke in Auckland

    International Nuclear Information System (INIS)

    Anderson, N.E.; Bonita, R.; Broad, J.B.

    1997-01-01

    Studies of acute stroke management in stroke units and tertiary referral hospitals may not accurately reflect practice within the population. Reliable information on the management of stroke within a population is sparse. The aims of this study was to compare clinical practice in acute stroke management in Auckland with guidelines for the management and treatment of stroke in other countries; to provide a baseline measure against which future changes in management can be evaluated. All new stroke events in Auckland residents in 12 months were traced through multiple case finding sources. For each patient, a record of investigations and treatment during the first week of hospital admission was kept. One thousand eight hundred and three stroke events (including subarachnoid haemorrhages) occurred in 1761 patients in one year. Twenty-seven per cent of all events were managed outside hospital and 73% of the stroke events were treated in an acute hospital. Of the 1242 stroke events admitted to an acute hospital in the first week, only 6% were managed on the neurology and neurosurgery ward, 83% were managed by a general physician or geriatrician and 42% had computed tomography (CT). Of 376 validated ischaemic strokes, 44% were treated with aspirin and 12% with intravenous heparin. Of the 690 unspecified strokes (no CT or autopsy), 38% received aspirin and 0.5% heparin. The 28 day in-hospital case fatality for all stroke events admitted to an acute hospital during the first week was 25%. It was concluded that in Auckland, management of acute stroke differed from clinical guidelines in the high proportion of patients managed in the community, the low rate of neurological consultation, and the low frequency of CT scanning. Despite these deficiencies in management, the 28 day hospital case fatality in Auckland was similar to other comparable studies which had a high proportion of cases evaluated by a neurologist and CT. (authors)

  8. Acute Bacterial Prostatitis: Diagnosis and Management.

    Science.gov (United States)

    Coker, Timothy J; Dierfeldt, Daniel M

    2016-01-15

    Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise. Although the true incidence is unknown, acute bacterial prostatitis is estimated to comprise approximately 10% of all cases of prostatitis. Most acute bacterial prostatitis infections are community acquired, but some occur after transurethral manipulation procedures, such as urethral catheterization and cystoscopy, or after transrectal prostate biopsy. The physical examination should include abdominal, genital, and digital rectal examination to assess for a tender, enlarged, or boggy prostate. Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis. Urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern. Additional laboratory studies can be obtained based on risk factors and severity of illness. Radiography is typically unnecessary. Most patients can be treated as outpatients with oral antibiotics and supportive measures. Hospitalization and broad-spectrum intravenous antibiotics should be considered in patients who are systemically ill, unable to voluntarily urinate, unable to tolerate oral intake, or have risk factors for antibiotic resistance. Typical antibiotic regimens include ceftriaxone and doxycycline, ciprofloxacin, and piperacillin/tazobactam. The risk of nosocomial bacterial prostatitis can be reduced by using antibiotics, such as ciprofloxacin, before transrectal prostate biopsy.

  9. 17 CFR 239.17a - Form N-3, registration statement for separate accounts organized as management investment companies.

    Science.gov (United States)

    2010-04-01

    ... statement for separate accounts organized as management investment companies. 239.17a Section 239.17a... accounts organized as management investment companies. Form N-3 shall be used for registration under the... register under the Investment Company Act of 1940 as management investment companies, and certain other...

  10. 17 CFR 274.11A - Form N-1A, registration statement of open-end management investment companies.

    Science.gov (United States)

    2010-04-01

    ... statement of open-end management investment companies. 274.11A Section 274.11A Commodity and Securities...(b) of the Investment Company Act of 1940 by open-end management investment companies other than... registration under the Securities Act of 1933 of the securities of all open-end management investment companies...

  11. 41 CFR 102-192.155 - What should our agency-wide mail management policy statement cover?

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What should our agency-wide mail management policy statement cover? 102-192.155 Section 102-192.155 Public Contracts and... REGULATION ADMINISTRATIVE PROGRAMS 192-MAIL MANAGEMENT Other Agency Responsibilities § 102-192.155 What...

  12. 76 FR 31359 - Notice of Intent To Prepare an Environmental Impact Statement on a General Management Plan...

    Science.gov (United States)

    2011-05-31

    ... management activities, visitor activities, and developments that would be appropriate in the park in the future. In addition, the plan will generally address visitor-use related issues and provide management... Environmental Impact Statement on a General Management Plan Amendment/Wilderness Study for Lake Clark National...

  13. 75 FR 4413 - Notice of Intent to Prepare an Environmental Impact Statement for a General Management Plan...

    Science.gov (United States)

    2010-01-27

    ... also will outline the kinds of resource management activities, visitor activities, and developments... visitor-use related issues and provide management direction for the six designated wild rivers within the... Impact Statement for a General Management Plan Amendment/Wilderness Study, for Gates of the Arctic...

  14. 78 FR 43226 - Going-to-the-Sun Road Corridor Management Plan, Environmental Impact Statement, Glacier National...

    Science.gov (United States)

    2013-07-19

    ... effort will result in an integrated visitor and transportation management plan for the Going-to-the Sun... sustainability of the park's shuttle system, management of visitor use, and congestion and protection of natural...] Going-to-the-Sun Road Corridor Management Plan, Environmental Impact Statement, Glacier National Park...

  15. 77 FR 71404 - Intent To Prepare an Environmental Impact Statement for the Proposed Flood Risk Management Study...

    Science.gov (United States)

    2012-11-30

    ... Environmental Impact Statement for the Proposed Flood Risk Management Study for the Blanchard River Watershed... the subject Flood Risk Management Study. The Buffalo District of the U.S. Army Corps of Engineers... with the proposed Flood Risk Management Study in the Blanchard River Watershed including the...

  16. HANFORD SITE SOLID WASTE MANAGEMENT ENVIRONMENTAL IMPACT STATEMENT TECHNICAL INFORMATION DOCUMENT [SEC 1 THRU 4

    International Nuclear Information System (INIS)

    FRITZ, L.L.

    2004-01-01

    This Technical Information Document (TID) provides engineering data to support DOE/EIS-0286, ''Hanford Site Solid (Radioactive and Hazardous) Waste Program Environmental Impact Statement''. Assumptions and waste volumes used to calculate engineering data are also provided in this document. This chapter provides a brief description of: the Solid Waste Management Program (including a description of waste types and known characteristics of waste covered under the program), the Hanford Site (including a general discussion of the operating areas), and the alternatives analyzed. The Hanford Site Solid Waste Management Program and DOE/EIS-0286 address solid radioactive waste types generated by various activities from both onsite and offsite generators. The Environmental Restoration (ER) waste management activities are not within the scope of DOE/EIS-0286 or this TID. Activities for processing and disposal of immobilized low-activity waste (ILAW) are not within the scope of the Solid Waste Management Program and this TID

  17. Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee.

    Science.gov (United States)

    Okosieme, Onyebuchi; Gilbert, Jackie; Abraham, Prakash; Boelaert, Kristien; Dayan, Colin; Gurnell, Mark; Leese, Graham; McCabe, Christopher; Perros, Petros; Smith, Vicki; Williams, Graham; Vanderpump, Mark

    2016-06-01

    The management of primary hypothyroidism with levothyroxine (L-T4) is simple, effective and safe, and most patients report improved well-being on initiation of treatment. However, a proportion of individuals continue to suffer with symptoms despite achieving adequate biochemical correction. The management of such individuals has been the subject of controversy and of considerable public interest. The American Thyroid Association (ATA) and the European Thyroid Association (ETA) have recently published guidelines on the diagnosis and management of hypothyroidism. These guidelines have been based on extensive reviews of the medical literature and include sections on the role of combination therapy with L-T4 and liothyronine (L-T3) in individuals who are persistently dissatisfied with L-T4 therapy. This position statement by the British Thyroid Association (BTA) summarises the key points in these guidelines and makes recommendations on the management of primary hypothyroidism based on the current literature, review of the published positions of the ETA and ATA, and in line with best principles of good medical practice. The statement is endorsed by the Association of Clinical Biochemistry, (ACB), British Thyroid Foundation, (BTF), Royal College of Physicians (RCP) and Society for Endocrinology (SFE). © 2015 John Wiley & Sons Ltd.

  18. Management of commercial high-level and transuranium-contaminated radioactive wastes. Environmental statement

    International Nuclear Information System (INIS)

    1974-09-01

    This Draft Environmental Statement is issued to assess the environmental impact of the AEC's program to manage commercial high-level and transuranium-contaminated radioactive wastes. These are the types of commercial radioactive wastes for which AEC custody is required by present or anticipated regulations. The program consists of three basic parts: development of a Retrievable Surface Storage Facility (RSSF) for commercial high-level waste, using existing technology; evaluating geological formations and sites for the development of a Geological Disposal Pilot Plant (GDPP) which would lead to permanent disposal; and providing retrievable storage for the transuranium-contaminated waste pending availability of permanent disposal. Consideration has been given to all environmental aspects of the program, using waste generation projections through the year 2000. Radiological and other impacts of implementing the program are expected to be minimal, but will be discussed in further environmental statements which will support budget actions for specific repositories. The alternatives discussed in this Draft Environmental Statement are presented. (U.S.)

  19. The paediatric acute scrotum: are we still managing correctly ...

    African Journals Online (AJOL)

    Summary background Diagnosis and management of the paediatric acute scrotum remains an elusive and often challenging area of urology. In response to this, the urology team developed local guidelines to aid the management and treatment of this potentially life-changing condition. Patients and methods We reviewed ...

  20. Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN.

    Science.gov (United States)

    Wahlgren, Nils; Moreira, Tiago; Michel, Patrik; Steiner, Thorsten; Jansen, Olav; Cognard, Christophe; Mattle, Heinrich P; van Zwam, Wim; Holmin, Staffan; Tatlisumak, Turgut; Petersson, Jesper; Caso, Valeria; Hacke, Werner; Mazighi, Mikael; Arnold, Marcel; Fischer, Urs; Szikora, Istvan; Pierot, Laurent; Fiehler, Jens; Gralla, Jan; Fazekas, Franz; Lees, Kennedy R

    2016-01-01

    The original version of this consensus statement on mechanical thrombectomy was approved at the European Stroke Organisation (ESO)-Karolinska Stroke Update conference in Stockholm, 16-18 November 2014. The statement has later, during 2015, been updated with new clinical trials data in accordance with a decision made at the conference. Revisions have been made at a face-to-face meeting during the ESO Winter School in Berne in February, through email exchanges and the final version has then been approved by each society. The recommendations are identical to the original version with evidence level upgraded by 20 February 2015 and confirmed by 15 May 2015. The purpose of the ESO-Karolinska Stroke Update meetings is to provide updates on recent stroke therapy research and to discuss how the results may be implemented into clinical routine. Selected topics are discussed at consensus sessions, for which a consensus statement is prepared and discussed by the participants at the meeting. The statements are advisory to the ESO guidelines committee. This consensus statement includes recommendations on mechanical thrombectomy after acute stroke. The statement is supported by ESO, European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), and European Academy of Neurology (EAN). © 2016 World Stroke Organization.

  1. [Causes and management of severe acute liver damage during pregnancy].

    Science.gov (United States)

    Sepulveda-Martinez, Alvaro; Romero, Carlos; Juarez, Guido; Hasbun, Jorge; Parra-Cordero, Mauro

    2015-05-01

    Abnormalities in liver function tests appear in 3% of pregnancies. Severe acute liver damage can be an exclusive condition of pregnancy (dependent or independent of pre-eclampsia) or a concomitant disease. HELLP syndrome and acute fatty liver of pregnancy are the most severe liver diseases associated with pregnancy. Both appear during the third trimester and have a similar clinical presentation. Acute fatty liver may be associated with hypoglycemia and HELLP syndrome is closely linked with pre-eclampsia. Among concomitant conditions, fulminant acute hepatitis caused by medications or virus is the most severe disease. Its clinical presentation may be hyper-acute with neurological involvement and severe coagulation disorders. It has a high mortality and patients should be transplanted. Fulminant hepatic failure caused by acetaminophen overdose can be managed with n-acetyl cysteine. Because of the high fetal mortality rate, the gestational age at diagnosis is crucial.

  2. NIH State-of-the-Science Conference Statement on management of menopause-related symptoms.

    Science.gov (United States)

    To provide health care providers, patients, and the general public with a responsible assessment of currently available data on the management of menopause-related symptoms. A non-DHHS, nonadvocate 12-member panel representing the fields of obstetrics and gynecology, general internal medicine, endocrinology, rheumatology, family and health psychology, geriatric medicine, health services research, demography, biochemistry, epidemiology, clinical research, and biostatistics. In addition, 26 experts in fields related to the conference topic presented data to the panel and to the conference audience. Presentations by experts and a systematic review of the medical literature prepared by the Oregon Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience. Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. A final copy of this statement is available, along with other recent conference statements, at the same web address of http://consensus.nih.gov. Menopause is the permanent cessation of menstrual periods that occurs naturally in women, usually in their early 50s. Many women have few or no symptoms; these women are not in need of medical treatment. Premenopausal or perimenopausal women who have menopause induced by surgery, chemotherapy, or radiation are more likely to experience bothersome and even disabling symptoms. These

  3. Resonating Statements

    DEFF Research Database (Denmark)

    Hjelholt, Morten; Jensen, Tina Blegind

    2015-01-01

    IT projects are often complex arrangements of technological components, social actions, and organizational transformation that are difficult to manage in practice. This paper takes an analytical discourse perspective to explore the process of legitimizing IT projects. We introduce the concept...... of resonating statements to highlight how central actors navigate in various discourses over time. Particularly, the statements and actions of an IT project manager are portrayed to show how individuals can legitimize actions by connecting statements to historically produced discourses. The case study...... as part of a feedback loop to re-attach the localized IT project to the broader national discourse. The paper concludes with reflections on how to actively build on resonating statements as a strategic resource for legitimizing IT projects...

  4. Anxiety management training for anxiety states: positive compared with negative self-statements.

    Science.gov (United States)

    Ramm, E; Marks, I M; Yuksel, S; Stern, R S

    1982-04-01

    Twelve patients complaining of chronic free-floating anxiety, usually also with panic attacks, were assigned at random to treatment by six hour-long sessions of anxiety-management training, either with positive or with negative self-statements, given over six weeks. Patients in both treatment conditions improved, with a small trend favouring positive over negative self-instruction, especially at follow-up. It is unclear how much self-instruction, rather than therapeutic attention or mere passage of time, accounted for the bulk of the modest improvement obtained.

  5. Asia-Pacific consensus statements on Crohn's disease. Part 2: Management.

    Science.gov (United States)

    Ooi, Choon Jin; Makharia, Govind K; Hilmi, Ida; Gibson, Peter R; Fock, Kwong Ming; Ahuja, Vineet; Ling, Khoon Lin; Lim, Wee Chian; Thia, Kelvin T; Wei, Shu-chen; Leung, Wai Keung; Koh, Poh Koon; Gearry, Richard B; Goh, Khean Lee; Ouyang, Qin; Sollano, Jose; Manatsathit, Sathaporn; de Silva, H Janaka; Rerknimitr, Rungsun; Pisespongsa, Pises; Abu Hassan, Muhamad Radzi; Sung, Joseph; Hibi, Toshifumi; Boey, Christopher C M; Moran, Neil; Leong, Rupert W L

    2016-01-01

    The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of developing best management practices, coordinating research and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis (UC) with specific relevance to the Asia-Pacific region. The present consensus statements were developed following a similar process to address the epidemiology, diagnosis and management of Crohn's disease (CD). The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses and treatment availability. It does not intend to be all-comprehensive and future revisions are likely to be required in this ever-changing field. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  6. Final Programmatic Environmental Impact Statement for stockpile stewardship and management: Volume 3

    International Nuclear Information System (INIS)

    1996-09-01

    The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed a Stockpile Stewardship and Management Program to provide a single highly integrated technical program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management Programmatic Environmental Impact Statement (PEIS) describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program. This document consists of Volume III, Appendix I entitled ''National Ignition Facility Project-Specific Analysis,'' which investigates the environmental impacts resulting from constructing and operating the proposed National Ignition Facility

  7. Fluid management in acute kidney injury

    DEFF Research Database (Denmark)

    Perner, Anders; Prowle, John; Joannidis, Michael

    2017-01-01

    Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration...... of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI....

  8. Final environmental impact statement. Management of commercially generated radioactive waste. Volume 1 of 3

    Energy Technology Data Exchange (ETDEWEB)

    1980-10-01

    This EIS analyzes the significant environmental impacts that could occur if various technologies for management and disposal of high-level and transuranic wastes from commercial nuclear power reactors were to be developed and implemented. This EIS will serve as the environmental input for the decision on which technology, or technologies, will be emphasized in further research and development activities in the commercial waste management program. The action proposed in this EIS is to (1) adopt a national strategy to develop mined geologic repositories for disposal of commercially generated high-level and transuranic radioactive waste (while continuing to examine subseabed and very deep hole disposal as potential backup technologies) and (2) conduct a R and D program to develop such facilities and the necessary technology to ensure the safe long-term containment and isolation of these wastes. The Department has considered in this statement: development of conventionally mined deep geologic repositories for disposal of spent fuel from nuclear power reactors and/or radioactive fuel reprocessing wastes; balanced development of several alternative disposal methods; and no waste disposal action. This EIS reflects the public review of and comments offered on the draft statement. Included are descriptions of the characteristics of nuclear waste, the alternative disposal methods under consideration, and potential environmental impacts and costs of implementing these methods. Because of the programmatic nature of this document and the preliminary nature of certain design elements assumed in assessing the environmental consequences of the various alternatives, this study has been based on generic, rather than specific, systems. At such time as specific facilities are identified for particular sites, statements addressing site-specific aspects will be prepared for public review and comment.

  9. Final environmental impact statement. Management of commercially generated radioactive waste. Volume 1 of 3

    International Nuclear Information System (INIS)

    1980-10-01

    This EIS analyzes the significant environmental impacts that could occur if various technologies for management and disposal of high-level and transuranic wastes from commercial nuclear power reactors were to be developed and implemented. This EIS will serve as the environmental input for the decision on which technology, or technologies, will be emphasized in further research and development activities in the commercial waste management program. The action proposed in this EIS is to (1) adopt a national strategy to develop mined geologic repositories for disposal of commercially generated high-level and transuranic radioactive waste (while continuing to examine subseabed and very deep hole disposal as potential backup technologies) and (2) conduct a R and D program to develop such facilities and the necessary technology to ensure the safe long-term containment and isolation of these wastes. The Department has considered in this statement: development of conventionally mined deep geologic repositories for disposal of spent fuel from nuclear power reactors and/or radioactive fuel reprocessing wastes; balanced development of several alternative disposal methods; and no waste disposal action. This EIS reflects the public review of and comments offered on the draft statement. Included are descriptions of the characteristics of nuclear waste, the alternative disposal methods under consideration, and potential environmental impacts and costs of implementing these methods. Because of the programmatic nature of this document and the preliminary nature of certain design elements assumed in assessing the environmental consequences of the various alternatives, this study has been based on generic, rather than specific, systems. At such time as specific facilities are identified for particular sites, statements addressing site-specific aspects will be prepared for public review and comment

  10. Nebulized corticosteroids in the management of acute exacerbation of COPD

    Directory of Open Access Journals (Sweden)

    Gaude G

    2010-01-01

    Full Text Available Acute exacerbations in chronic onstructive pulmonary disease (COPD are common and systemic steroids play an important role in the management of these cases along with the bronchodilators. Nebulized budesonide is being used in the acute attacks of bronchial asthma either in children or in adults. But the role of nebulized steroids in acute exacerbation of COPD is not much studied in the literature. In this clinical review we have evaluated the role of nebulized corticosteroids in the management of acute exacerbation of COPD (AECOPD. Through Medline, Pubmed and Embase we analyzed the various studies that has been done to study the role of nebulized corticosteroids in the management of acute exacerbation of COPD. The key words used for the search criteria were: acute exacerbation, COPD, nebulized corticosteroids, budesonide, fluticasone. Only eight studies were found which had evaluated the role of nebulized corticosteroids in acute exacerbations of COPD. All these studies had used nebulized budesonide in AECOPD in different dosages, and had been compared with both either parental or oral steroids, and standard bronchodilator therapy. All the studies had found the clinical efficacy of nebulized budesonide to be of similar extent to that of either parental or oral steroids in AECOPD. Side effects profile of nebulized budesonide was minimal and acceptable as compared to systemic steroids. Nebulized budesonide may be an alternative to parental/oral prednisolone in the treatment of acute exacerbations of COPD but further studies should be done to evaluate its long-term impact on clinical outcomes after an initial episode of COPD exacerbation.

  11. 17 CFR 274.11 - Form N-1, registration statement of open-end management investment companies.

    Science.gov (United States)

    2010-04-01

    ... statement of open-end management investment companies. 274.11 Section 274.11 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION (CONTINUED) FORMS PRESCRIBED UNDER THE INVESTMENT COMPANY ACT...(b) of the Investment Company Act of 1940 by open-end management investment companies that are...

  12. [Anesthesiological management of patients with an acute abdomen].

    Science.gov (United States)

    Sakka, Samir G; Wappler, Frank

    2008-11-01

    Patients with an acute abdomen present with marked deterioration in physiological and pathophysiological conditions, which make general anesthesia to a challenging but also potentially dangerous procedure. A broad and fundamental knowledge of the pathophysiologically involved mechanisms of cardiovascular functions during anesthesia and appropriate anesthesiological approach are crucial for a successful peri-operative management. The anesthesiologist's goal is to perform adequate anesthesia while maintaining cardiovascular stability. Monitoring and management of acid-base-status as well as cardiovascular functions are required to maintain sufficient tissue oxygenation during anesthesia. The postoperative anesthesiological management may also crucially influence the further course and therefore should be considered in the anesthesiological planning. Finally, adequate pain management in all these patients is an important and not to underestimate part in the treatment. This article gives an overview on the major aspects in the different fields in the anesthesiological management of patients with an acute abdomen.

  13. Endoscopic management of acute peptic ulcer bleeding.

    Science.gov (United States)

    Lu, Yidan; Chen, Yen-I; Barkun, Alan

    2014-12-01

    This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Diagnosis and management of acute heart failure

    Science.gov (United States)

    Ural, Dilek; Çavuşoğlu, Yüksel; Eren, Mehmet; Karaüzüm, Kurtuluş; Temizhan, Ahmet; Yılmaz, Mehmet Birhan; Zoghi, Mehdi; Ramassubu, Kumudha; Bozkurt, Biykem

    2016-01-01

    Acute heart failure (AHF) is a life threatening clinical syndrome with a progressively increasing incidence in general population. Turkey is a country with a high cardiovascular mortality and recent national statistics show that the population structure has turned to an ‘aged’ population. As a consequence, AHF has become one of the main reasons of admission to cardiology clinics. This consensus report summarizes clinical and prognostic classification of AHF, its worldwide and national epidemiology, diagnostic work-up, principles of approach in emergency department, intensive care unit and ward, treatment in different clinical scenarios and approach in special conditions and how to plan hospital discharge. PMID:26574757

  15. Low-level waste management alternatives and analysis in DOE`s programmatic environmental impact statement

    Energy Technology Data Exchange (ETDEWEB)

    Gerstein, J.S. [Dept. of Energy, Washington, DC (United States). Office of Environmental Restoration and Waste Management

    1993-03-01

    The Department of Energy is preparing a Programmatic Environmental Impact Statement (PEIS) for the Environmental Restoration and Waste Management Program. The PEIS has been divided into an Environmental Restoration section and a Waste Management section. Each section has a unique set of alternatives. This paper will focus on the waste management alternatives and analysis. The set of alternatives for waste management has been divided into waste categories. These categories are: high-level waste, transuranic waste, low-level waste, low-level mixed waste, greater-than-class C and low-level waste from commercial sources, hazardous waste, and spent nuclear fuel. This paper will discuss the alternatives and analytical approach that will be used to evaluate these alternatives for the low-level waste section. Although the same alternatives will be considered for all waste types, the analysis will be performed separately for each waste type. In the sections that follow, information will be provided on waste management configurations, the analysis of waste management alternatives, waste types and locations, facility and transportation activities, the facility and transportation impacts assessment, and the compilation of impacts.

  16. Bonneville Power Administration Transmission System Vegetation Management Program - Final Environmental Impact Statement

    Energy Technology Data Exchange (ETDEWEB)

    N/A

    2000-06-23

    Bonneville is responsible for maintaining a network of 24,000 kilometers (km) or 15,000 miles (mi.) of electric transmission lines and 350 substations in a region of diverse vegetation. This vegetation can interfere with electric power flow, pose safety problems for us and the public, and interfere with our ability to maintain these facilities. We need to (1) keep vegetation away from our electric facilities; (2) increase our program efficiency and consistency; (3) review herbicide use (under increased public scrutiny); and (4) maximize the range of tools we can use while minimizing environmental impact (Integrated Vegetation Management). This Final Environmental Impact Statement (FEIS) establishes Planning Steps for managing vegetation for specific projects (to be tiered to this Environmental Impact Statement (EIS)). In addition to No Action (current practice), alternatives are presented for Rights-of-way, Electric Yards, and Non-electric Facilities (landscaping, work yards). Four vegetation control methods are analyzed manual, mechanical, herbicide, and biological. Also evaluated are 23 herbicide active ingredients and 4 herbicide application techniques (spot, localized, broadcast, and aerial). For rights-of-way, we consider three sets of alternatives: alternative management approaches (time-driven or establishing low-growing plant communities); alternative method packages; and, if herbicides are in a methods package, alternative vegetation selections (noxious weeds, deciduous, or any vegetation). For electric yards, one herbicide-use alternative is considered. For non-electric facilities, two method package alternatives are considered. For rights-of-way, the environmentally preferred alternative(s) would use manual, mechanical, and biological control methods, as well as spot and localized herbicide applications for noxious and deciduous plant species; the BPA-preferred alternative(s) would add broadcast and aerial herbicide applications, and would use herbicides

  17. Acute gastroenteritis: evidence-based management of pediatric patients [digest].

    Science.gov (United States)

    Brady, KeriAnne; Pade, Kathryn H

    2018-02-01

    Although most cases of acute gastroenteritis require minimal medical intervention, severe dehydration and hypoglycemia may develop in cases of prolonged vomiting and diarrhea. The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution. Antiemetics allow for improved tolerance of oral rehydration solution, and, when used appropriately, can decrease the need for intravenous fluids and hospitalization. This issue reviews the common etiologies of acute gastroenteritis, discusses more-severe conditions that should be considered in the differential diagnosis, and provides evidence-based recommendations for management of acute gastroenteritis in patients with mild-to-moderate dehydration, severe dehydration, and hypoglycemia. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  18. [Management of Acute Type A Dissection Complicated with Acute Mesenteric Ischemia].

    Science.gov (United States)

    Abe, Tomonobu; Usui, Akihiko

    2017-07-01

    Acute mesenteric ischemia as malperfusion syndrome associated with acute aortic dissection is a difficult situation. The incidence is approximately 3~4% in acute type A dissection. Traditionally, most of these patients underwent immediate simple central aortic repair expecting that mesenteric artery obstruction and intestinal ischemia would be resolved by simple central aortic repair. However, short term mortality has been reported very high in this strategy. With the aid of rapidly progressing imaging techniques and newer endovascular repair techniques, results seem to be improving in recent years. Newer management strategy include aggressive and patient specific revascularization to the mesenteric arteries, delayed central aortic repair, and meticulous intensive care. Diagnosis and management of this condition require high level of expertise. Cardiac surgeons, vascular surgeons, interventional radiologists, gastroenterologists, general surgeons, anesthesiologists, intensivists must corporate to save these patients' lives. Since this is a relatively rare condition, scientific evidence is insufficient to make robust recommendations. Further studies are warranted.

  19. The "Acute coronary syndromes: consensus recommendations for translating knowledge into action" position statement is based on a false premise.

    Science.gov (United States)

    Forge, Brett H

    2010-06-21

    Recent National Heart Foundation of Australia (NHFA) guidelines for management of acute coronary syndromes (ACS) recommend increasing the rates of early invasive management of ACS and providing equal access for all Australians to percutaneous coronary intervention (PCI) facilities. For patients with ACS managed in regional hospitals without PCI facilities, review of the evidence does not show unequivocal benefit of early routine PCI over selective PCI for patients with non-ST-segment-elevation ACS or ST-elevation myocardial infarction. The current pattern of transfer based on the NHFA guidelines is expensive and disruptive of patient care, as well as undermining regional health care services. Further increase in transfer rates and increases in PCI facilities would divert resources away from supporting the regional infrastructure needed to provide evidence-based therapies, without any evidence that lives would be saved.

  20. Management of acute epididymitis: are European guidelines being followed?

    Science.gov (United States)

    Drury, Nigel E; Dyer, Jonathan P; Breitenfeldt, Nicole; Adamson, Andrew S; Harrison, G S M

    2004-10-01

    Acute epididymitis is increasing in men aged 35 years or under due to sexually-transmitted Chlamydia trachomatis. This study examines whether Urological surgeons are following European guidelines for the management of acute epididymitis in these patients. A postal questionnaire survey was conducted of specialists in Urology in two regions of the UK. Of 79 completed replies, 41 (52%) take a detailed sexual history but only 34 (43%) refer patients to a Genitourinary medicine clinic. Quinolones are the most commonly prescribed first-line antibiotic by 56 (71%) respondents, principally ciprofloxacin. The current management of acute epididymitis in young men must be improved. Ciprofloxacin is not the optimal antimicrobial for the treatment of urogenital chlamydial infection. We recommend that all such patients be referred to local Genitourinary medicine services for contact-tracing and treatment of their sexual partners.

  1. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

    NARCIS (Netherlands)

    Miura, Fumihiko; Okamoto, Kohji; Takada, Tadahiro; Strasberg, Steven M.; Asbun, Horacio J.; Pitt, Henry A.; Gomi, Harumi; Solomkin, Joseph S.; Schlossberg, David; Han, Ho-Seong; Kim, Myung-Hwan; Hwang, Tsann-Long; Chen, Miin-Fu; Huang, Wayne Shih-Wei; Kiriyama, Seiki; Itoi, Takao; Garden, O. James; Liau, Kui-Hin; Horiguchi, Akihiko; Liu, Keng-Hao; Su, Cheng-Hsi; Gouma, Dirk J.; Belli, Giulio; Dervenis, Christos; Jagannath, Palepu; Chan, Angus C. W.; Lau, Wan Yee; Endo, Itaru; Suzuki, Kenji; Yoon, Yoo-Seok; de Santibañes, Eduardo; Giménez, Mariano Eduardo; Jonas, Eduard; Singh, Harjit; Honda, Goro; Asai, Koji; Mori, Yasuhisa; Wada, Keita; Higuchi, Ryota; Watanabe, Manabu; Rikiyama, Toshiki; Sata, Naohiro; Kano, Nobuyasu; Umezawa, Akiko; Mukai, Shuntaro; Tokumura, Hiromi; Hata, Jiro; Kozaka, Kazuto; Iwashita, Yukio; Hibi, Taizo; Yokoe, Masamichi; Kimura, Taizo; Kitano, Seigo; Inomata, Masafumi; Hirata, Koichi; Sumiyama, Yoshinobu; Inui, Kazuo; Yamamoto, Masakazu

    2018-01-01

    The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory

  2. Transportation risk assessment for the US Department of Energy Environmental Management Programmatic Environmental Impact Statement

    International Nuclear Information System (INIS)

    Chen, S.Y.; Monette, F.A.; Biwer, B.M.; Lazaro, M.A.; Hartmann, H.M.; Policastro, A.J.

    1994-01-01

    In its Programmatic Environmental Impact Statement (PEIS), the Office of Environmental Management (EM) of the US Department of Energy (DOE) is considering a broad range of alternatives for the future management of radioactive and hazardous waste at the facilities of the DOE complex. The alternatives involve facilities to be used for treatment, storage, and disposal of various wastes generated from DOE's environmental restoration activities and waste management operation. Included in the evaluation are six types of waste (five types of radioactive waste plus hazardous waste), 49 sites, and numerous cases associated with each different alternative for waste management. In general, the alternatives are evaluated independently for each type of waste and reflect decentralized, regionalized, and centralized approaches. Transportation of waste materials is an integral component of the EM PEIS alternatives for waste management. The estimated impact on human health that is associated with various waste transportation activities is an important element leading to a complete appraisal of the alternatives. The transportation risk assessment performed for the EM PEIS is designed to ensure -- through uniform and judicious selection of models, data, and assumptions -- that relative comparisons of risk among the various alternatives are meaningful and consistent

  3. Pitfalls in management of acute gouty attack, a qualitative research ...

    African Journals Online (AJOL)

    Hamid Mustafa

    2014-05-17

    May 17, 2014 ... Abstract Objective: To probe doctors' attitudes and reveal wrong perception in the management of acute gouty attacks. Design: A descriptive study using a designed questionnaire that was completed through face to face interviews in hospitals, health units and polyclinics in the Makah Region. Method: This ...

  4. Pitfalls in management of acute gouty attack, a qualitative research ...

    African Journals Online (AJOL)

    Objective: To probe doctors' attitudes and reveal wrong perception in the management of acute gouty attacks. Design: A descriptive study using a designed questionnaire that was completed through face to face interviews in hospitals, health units and polyclinics in the Makah Region. Method: This is a qualitative study of ...

  5. Management of acute diarrhoeal disease at Edendale Hospital: Are ...

    African Journals Online (AJOL)

    Background. Diarrhoeal disease (DD) is a major cause of childhood mortality in developing countries. In South Africa (SA), it ranks as one of the top five causes of under-5 mortality. Local and global guidelines on the management of acute DD are readily available. The Standard Treatment Guidelines (STGs) and Essential ...

  6. Pattern and Management Outcomes of Neonatal Acute Surgical ...

    African Journals Online (AJOL)

    Pattern and Management Outcomes of Neonatal Acute Surgical Conditions in Alexandria, Egypt. HI Wella, SMM Farahat. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL.

  7. Determinants of modality of management of acute kidney injury in ...

    African Journals Online (AJOL)

    Background: The cost of taking care of children with acute kidney injury (AKI) is enormous and beyond the reach of many caregivers in sub-Saharan Africa which are largely resource poor. It is therefore imperative to determine those who may benefit from conservative management which is comparatively cheaper to the ...

  8. From words to action: visibility of management in supporting interdisciplinary team working in an acute rehabilitative geriatric hospital.

    Science.gov (United States)

    Buttigieg, Sandra C; Cassar, Vincent; Scully, Judy W

    2013-01-01

    The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. The authors draw on solid theoretical frameworks--the complexity theory, team effectiveness model and the social identity theory--to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level.

  9. EDF - Annual results 2015. Consolidated financial statements at 31 December 2015. 2015 Management report - Group results

    International Nuclear Information System (INIS)

    Levy, Jean-Bernard

    2016-01-01

    As the world's biggest electricity generator, the EDF Group covers every sector of expertise, from generation to trading and transmission grids. EDF builds on the expertise of its people, its R and D and engineering skills, its experience as a leading industry operator and the attentive support of its customers to deliver competitive solutions that successfully reconcile economic growth with climate protection. This document presents the 2015 annual results, management report and Consolidated financial statements of the Group at 31 December 2015, as well as the 2015 activity report: Group results: Key figures; economic environment; significant events of 2015; subsequent events; analysis of the business and the consolidated income statements for 2014 and 2015; net indebtedness, cash flows and investments; management and control of market risks; transactions with related parties; scope of consolidation; principal risks and uncertainties; financial outlook. consolidated financial statements: group accounting standards; comparability; significant events and transactions; regulatory events in France; changes in the scope of consolidation; segment reporting; sales; fuel and energy purchases; other external expenses; personnel expenses; taxes other than income taxes; other operating income and expenses; impairment/reversals; other income and expenses; financial result; income taxes; basic earnings per share and diluted earnings per share; operating assets and liabilities, equity; goodwill; other intangible assets; property, plant and equipment operated under French public electricity distribution concessions; property, plant and equipment operated under concessions for other activities; property, plant and equipment used in generation and other tangible assets owned by the group; investments in associates and joint ventures; inventories; trade receivables; other receivables; equity; provisions; provisions related to nuclear generation - back-end of the nuclear cycle

  10. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement.

    Science.gov (United States)

    Buglione, Michela; Cavagnini, Roberta; Di Rosario, Federico; Sottocornola, Lara; Maddalo, Marta; Vassalli, Lucia; Grisanti, Salvatore; Salgarello, Stefano; Orlandi, Ester; Paganelli, Corrado; Majorana, Alessandra; Gastaldi, Giorgio; Bossi, Paolo; Berruti, Alfredo; Pavanato, Giovanni; Nicolai, Piero; Maroldi, Roberto; Barasch, Andrei; Russi, Elvio G; Raber-Durlacher, Judith; Murphy, Barbara; Magrini, Stefano M

    2016-01-01

    Radiotherapy alone or in combination with chemotherapy and/or surgery is the typical treatment for head and neck cancer patients. Acute side effects (such as oral mucositis, dermatitis, salivary changes, taste alterations, etc.), and late toxicities in particular (such as osteo-radionecrosis, hypo-salivation and xerostomia, trismus, radiation caries etc.), are often debilitating. These effects tend to be underestimated and insufficiently addressed in the medical community. A multidisciplinary group of head and neck cancer specialists met in Milan with the aim of reaching a consensus on clinical definitions and management of these toxicities. The Delphi Appropriateness method was used for developing the consensus, and external experts evaluated the conclusions. This paper contains 10 clusters of statements about the clinical definitions and management of head and neck cancer treatment sequels (dental pathologies and osteo-radionecroses) that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecroses (10 clusters of statements), whereas this second part deals with trismus and xerostomia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. The threatened stomach: management of the acute gastric volvulus.

    Science.gov (United States)

    Light, D; Links, D; Griffin, M

    2016-05-01

    Acute presentation of gastric volvulus is a rare condition with a high mortality for acute ischaemia. This study was undertaken to investigate the acute management, diagnosis, and long-term outcomes of patients presenting with acute gastric volvulus. Cases were reviewed retrospectively from 2004 to 2014. Patients presenting as an emergency admission with acute gastric volvulus were included. Thirty-six patients were included, five of whom had previous surgery. The mean age was 71 years old. All patients presented with vomiting and chest/epigastric pain. CT was diagnostic in all 26 patients. Barium swallow was diagnostic in two/four patients. OGD was diagnostic in 9 of 20 patients. All patients had an NG tube placed, and eight patients were treated conservatively and made a full recovery. Twenty-nine patients proceeded to surgery. Nine had a laparoscopic repair with two open conversions. Four patients had gastric necrosis, and all had open surgery with resection. Three patients had a mediastinal perforation, and one patient required an additional thoracotomy. All patients with viable stomach had a hiatal repair (where appropriate), 11 had a gastropexy, and 11 had a fundoplication. Mortality for gastric necrosis/perforation was 30 %. Mean postoperative stay was 4 days for laparoscopic repair and 8 days for uncomplicated open surgery. Nine of twenty-nine had transient dysphagia postoperatively. Three of eight patients treated conservatively had an elective procedure subsequently. Acute paraoesophageal hiatus hernia requires early resuscitation and diagnosis. CT should be favoured in assessment, and an NG tube placed promptly. A conservative management may be considered safely in stable patients. Surgical management should be prompt for unstable patients. Gastric ischaemia or perforation has a mortality of 30 %. Laparoscopic repair has a shorter postoperative stay, but has a higher recurrence rate. Surgery for patients without gastric ischaemia has good long

  12. Diagnosis and management of Silver-Russell syndrome: first international consensus statement.

    Science.gov (United States)

    Wakeling, Emma L; Brioude, Frédéric; Lokulo-Sodipe, Oluwakemi; O'Connell, Susan M; Salem, Jennifer; Bliek, Jet; Canton, Ana P M; Chrzanowska, Krystyna H; Davies, Justin H; Dias, Renuka P; Dubern, Béatrice; Elbracht, Miriam; Giabicani, Eloise; Grimberg, Adda; Grønskov, Karen; Hokken-Koelega, Anita C S; Jorge, Alexander A; Kagami, Masayo; Linglart, Agnes; Maghnie, Mohamad; Mohnike, Klaus; Monk, David; Moore, Gudrun E; Murray, Philip G; Ogata, Tsutomu; Petit, Isabelle Oliver; Russo, Silvia; Said, Edith; Toumba, Meropi; Tümer, Zeynep; Binder, Gerhard; Eggermann, Thomas; Harbison, Madeleine D; Temple, I Karen; Mackay, Deborah J G; Netchine, Irène

    2017-02-01

    This Consensus Statement summarizes recommendations for clinical diagnosis, investigation and management of patients with Silver-Russell syndrome (SRS), an imprinting disorder that causes prenatal and postnatal growth retardation. Considerable overlap exists between the care of individuals born small for gestational age and those with SRS. However, many specific management issues exist and evidence from controlled trials remains limited. SRS is primarily a clinical diagnosis; however, molecular testing enables confirmation of the clinical diagnosis and defines the subtype. A 'normal' result from a molecular test does not exclude the diagnosis of SRS. The management of children with SRS requires an experienced, multidisciplinary approach. Specific issues include growth failure, severe feeding difficulties, gastrointestinal problems, hypoglycaemia, body asymmetry, scoliosis, motor and speech delay and psychosocial challenges. An early emphasis on adequate nutritional status is important, with awareness that rapid postnatal weight gain might lead to subsequent increased risk of metabolic disorders. The benefits of treating patients with SRS with growth hormone include improved body composition, motor development and appetite, reduced risk of hypoglycaemia and increased height. Clinicians should be aware of possible premature adrenarche, fairly early and rapid central puberty and insulin resistance. Treatment with gonadotropin-releasing hormone analogues can delay progression of central puberty and preserve adult height potential. Long-term follow up is essential to determine the natural history and optimal management in adulthood.

  13. Waste management programmatic environmental impact statement methodology for estimating human health risks

    International Nuclear Information System (INIS)

    Bergenback, B.; Blaylock, B.P.; Legg, J.L.

    1995-05-01

    The US Department of Energy (DOE) has produced large quantities of radioactive and hazardous waste during years of nuclear weapons production. As a result, a large number of sites across the DOE Complex have become chemically and/or radiologically contaminated. In 1990, the Secretary of Energy charged the DOE Office of Environmental Restoration and Waste management (EM) with the task of preparing a Programmatic Environmental Impact Statement (PEIS). The PEIS should identify and assess the potential environmental impacts of implementing several integrated Environmental Restoration (ER) and Waste Management (WM) alternatives. The determination and integration of appropriate remediation activities and sound waste management practices is vital for ensuring the diminution of adverse human health impacts during site cleanup and waste management programs. This report documents the PEIS risk assessment methodology used to evaluate human health risks posed by WM activities. The methodology presents a programmatic cradle to grave risk assessment for EM program activities. A unit dose approach is used to estimate risks posed by WM activities and is the subject of this document

  14. Management of acute organophosphorus pesticide poisoning

    OpenAIRE

    Eddleston, Michael; Buckley, Nick A; Eyer, Peter; Dawson, Andrew H

    2008-01-01

    Summary Organophosphorus pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200?000 people every year. Unintentional poisoning kills far fewer people but is a problem in places where highly toxic organophosphorus pesticides are available. Medical management is difficult, with case fatality generally more than 15%. We describe the limited evidence that can guide therapy and the factors that should be considered when design...

  15. Management of the acutely violent patient.

    Science.gov (United States)

    Petit, Jorge R

    2005-09-01

    Violence in the work place is a new but growing problem for our profession. It is likely that at some point a psychiatrist will be confronted with a potentially violent patient or need to assess a violent patient. Understanding predictors and associated factors in violence as well as having a clear and well-defined strategy in approaching and dealing with the violent patient, thus, are crucial. Ensuring patient, staff, and personal safety is the most important aspect in the management of a violent patient. All of the staff must be familiar with management strategies and clear guidelines that are implemented and followed when confronted with a violent patient. The more structured the approach to the violent patient, the less likely a bad outcome will occur. Manipulating one's work environment to maximize safety and understanding how to de-escalate potentially mounting violence are two steps in the approach to the violent patient. Restraint, seclusion, and psychopharmacologic interventions also are important and often are necessary components to the management of the violent patient.

  16. 78 FR 37846 - Resource Management Plan/General Plan and Environmental Impact Statement/Environmental Impact...

    Science.gov (United States)

    2013-06-24

    ...The Bureau of Reclamation and the California Department of Parks and Recreation (CDPR) have prepared a Final Environmental Impact Statement/Environmental Impact Report (EIS/EIR) for the San Luis Reservoir State Recreation Area Resource Management Plan/General Plan (RMP/GP). The Final EIS/EIR describes and presents the environmental effects of the No Action/No Project Alternative and three Action Alternatives for implementing the RMP/GP. A Notice of Availability of the Draft EIS/EIR was published in the Federal Register on August 3, 2012 (77 FR 46518). The comment period on the Draft EIS/EIR ended on October 2, 2012. The Final EIS/EIR contains responses to all comments received and reflects comments and any additional information received during the review period.

  17. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Feingold, Brian; Mahle, William T; Auerbach, Scott; Clemens, Paula; Domenighetti, Andrea A; Jefferies, John L; Judge, Daniel P; Lal, Ashwin K; Markham, Larry W; Parks, W James; Tsuda, Takeshi; Wang, Paul J; Yoo, Shi-Joon

    2017-09-26

    For many neuromuscular diseases (NMDs), cardiac disease represents a major cause of morbidity and mortality. The management of cardiac disease in NMDs is made challenging by the broad clinical heterogeneity that exists among many NMDs and by limited knowledge about disease-specific cardiovascular pathogenesis and course-modifying interventions. The overlay of compromise in peripheral muscle function and other organ systems, such as the lungs, also makes the simple application of endorsed adult or pediatric heart failure guidelines to the NMD population problematic. In this statement, we provide background on several NMDs in which there is cardiac involvement, highlighting unique features of NMD-associated myocardial disease that require clinicians to tailor their approach to prevention and treatment of heart failure. Undoubtedly, further investigations are required to best inform future guidelines on NMD-specific cardiovascular health risks, treatments, and outcomes. © 2017 American Heart Association, Inc.

  18. [2015 updated position statement of the management of hyperglycaemia in type 2 diabetes].

    Science.gov (United States)

    Scheen, A J; Paquot, N

    2015-08-26

    The strategy for the management ot type 2 diabetes, summarized by a group of European and American experts, has been updated early 2015. A patient-centered approach is recommended and the first drug choice is metformin combined with lifestyle improvement. After failure of metformin monotherapy, the selection of a second drug should be based on the efficacy, safety and cost of each pharmacological class. When compared to the position statement of 2012, the most important changes are the possible addition of a gliptin to a dual oral therapy or even to insulin, the commercialization of sodium-glucose cotransporters type 2 (SGLT2) inhibitors (gliflozins, to be used in dual or triple therapy, even in combination with insulin) and the possible combination of a glucagon-like peptide-I receptor agonist together with a basal insulin.

  19. Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Rengin Çetin Güvenç

    2016-03-01

    Full Text Available Acute mitral regurgitation (MR is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompanied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with subsequent surgical intervention to repair or replace the valve.

  20. 77 FR 1720 - Final Environmental Impact Statement for the White-Tailed Deer Management Plan, Rock Creek Park

    Science.gov (United States)

    2012-01-11

    ... Environmental Impact Statement for the White-Tailed Deer Management Plan, Rock Creek Park AGENCY: National Park...), Rock Creek Park, Washington, DC The Plan will support long-term protection, preservation, and restoration of native vegetation and other natural and cultural resources in Rock Creek Park. DATES: The NPS...

  1. Management of acute organophosphorus pesticide poisoning.

    Science.gov (United States)

    Eddleston, Michael; Buckley, Nick A; Eyer, Peter; Dawson, Andrew H

    2008-02-16

    Organophosphorus pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200,000 people every year. Unintentional poisoning kills far fewer people but is a problem in places where highly toxic organophosphorus pesticides are available. Medical management is difficult, with case fatality generally more than 15%. We describe the limited evidence that can guide therapy and the factors that should be considered when designing further clinical studies. 50 years after first use, we still do not know how the core treatments--atropine, oximes, and diazepam--should best be given. Important constraints in the collection of useful data have included the late recognition of great variability in activity and action of the individual pesticides, and the care needed cholinesterase assays for results to be comparable between studies. However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids is needed to improve oxygen delivery to tissues. The role of oximes is not completely clear; they might benefit only patients poisoned by specific pesticides or patients with moderate poisoning. Small studies suggest benefit from new treatments such as magnesium sulphate, but much larger trials are needed. Gastric lavage could have a role but should only be undertaken once the patient is stable. Randomised controlled trials are underway in rural Asia to assess the effectiveness of these therapies. However, some organophosphorus pesticides might prove very difficult to treat with current therapies, such that bans on particular pesticides could be the only method to substantially reduce the case fatality after poisoning. Improved medical management of organophosphorus poisoning should result in a reduction in worldwide deaths from suicide.

  2. National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

    Science.gov (United States)

    Kaminski, Thomas W.; Hertel, Jay; Amendola, Ned; Docherty, Carrie L.; Dolan, Michael G.; Hopkins, J. Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

    2013-01-01

    Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available. PMID:23855363

  3. Savannah River Site Spent Nuclear Fuel Management Final Environmental Impact Statement

    Energy Technology Data Exchange (ETDEWEB)

    N/A

    2000-04-14

    The proposed DOE action considered in this environmental impact statement (EIS) is to implement appropriate processes for the safe and efficient management of spent nuclear fuel and targets at the Savannah River Site (SRS) in Aiken County, South Carolina, including placing these materials in forms suitable for ultimate disposition. Options to treat, package, and store this material are discussed. The material included in this EIS consists of approximately 68 metric tons heavy metal (MTHM) of spent nuclear fuel 20 MTHM of aluminum-based spent nuclear fuel at SRS, as much as 28 MTHM of aluminum-clad spent nuclear fuel from foreign and domestic research reactors to be shipped to SRS through 2035, and 20 MTHM of stainless-steel or zirconium-clad spent nuclear fuel and some Americium/Curium Targets stored at SRS. Alternatives considered in this EIS encompass a range of new packaging, new processing, and conventional processing technologies, as well as the No Action Alternative. A preferred alternative is identified in which DOE would prepare about 97% by volume (about 60% by mass) of the aluminum-based fuel for disposition using a melt and dilute treatment process. The remaining 3% by volume (about 40% by mass) would be managed using chemical separation. Impacts are assessed primarily in the areas of water resources, air resources, public and worker health, waste management, socioeconomic, and cumulative impacts.

  4. Final environmental impact statement. Management of commercially generated radioactive waste. Volume 2. Appendices

    Energy Technology Data Exchange (ETDEWEB)

    1980-10-01

    This EIS analyzes the significant environmental impacts that could occur if various technologies for management and disposal of high-level and transuranic wastes from commercial nuclear power reactors were to be developed and implemented. This EIS will serve as the environmental input for the decision on which technology, or technologies, will be emphasized in further research and development activities in the commercial waste management program. The action proposed in this EIS is to (1) adopt a national strategy to develop mined geologic repositories for disposal of commercially generated high-level and transuranic radioactive waste (while continuing to examine subseabed and very deep hole disposal as potential backup technologies) and (2) conduct a R and D program to develop such facilities and the necessary technology to ensure the safe long-term containment and isolation of these wastes. The Department has considered in this statement: development of conventionally mined deep geologic repositories for disposal of spent fuel from nuclear power reactors and/or radioactive fuel reprocessing wastes; balanced development of several alternative disposal methods; and no waste disposal action. This volume contains appendices of supplementary data on waste management systems, geologic disposal, radiological standards, radiation dose calculation models, related health effects, baseline ecology, socio-economic conditions, hazard indices, comparison of defense and commercial wastes, design considerations, and wastes from thorium-based fuel cycle alternatives. (DMC)

  5. International Consensus Statement on the Clinical and Therapeutic Management of Leber Hereditary Optic Neuropathy.

    Science.gov (United States)

    Carelli, Valerio; Carbonelli, Michele; de Coo, Irenaeus F; Kawasaki, Aki; Klopstock, Thomas; Lagrèze, Wolf A; La Morgia, Chiara; Newman, Nancy J; Orssaud, Christophe; Pott, Jan Willem R; Sadun, Alfredo A; van Everdingen, Judith; Vignal-Clermont, Catherine; Votruba, Marcela; Yu-Wai-Man, Patrick; Barboni, Piero

    2017-12-01

    Leber hereditary optic neuropathy (LHON) is currently estimated as the most frequent mitochondrial disease (1 in 27,000-45,000). Its molecular pathogenesis and natural history is now fairly well understood. LHON also is the first mitochondrial disease for which a treatment has been approved (idebenone-Raxone, Santhera Pharmaceuticals) by the European Medicine Agency, under exceptional circumstances because of the rarity and severity of the disease. However, what remains unclear includes the optimal target population, timing, dose, and frequency of administration of idebenone in LHON due to lack of accepted definitions, criteria, and general guidelines for the clinical management of LHON. To address these issues, a consensus conference with a panel of experts from Europe and North America was held in Milan, Italy, in 2016. The intent was to provide expert consensus statements for the clinical and therapeutic management of LHON based on the currently available evidence. We report the conclusions of this conference, providing the guidelines for clinical and therapeutic management of LHON.

  6. Final environmental impact statement. Management of commercially generated radioactive waste. Volume 2. Appendices

    International Nuclear Information System (INIS)

    1980-10-01

    This EIS analyzes the significant environmental impacts that could occur if various technologies for management and disposal of high-level and transuranic wastes from commercial nuclear power reactors were to be developed and implemented. This EIS will serve as the environmental input for the decision on which technology, or technologies, will be emphasized in further research and development activities in the commercial waste management program. The action proposed in this EIS is to (1) adopt a national strategy to develop mined geologic repositories for disposal of commercially generated high-level and transuranic radioactive waste (while continuing to examine subseabed and very deep hole disposal as potential backup technologies) and (2) conduct a R and D program to develop such facilities and the necessary technology to ensure the safe long-term containment and isolation of these wastes. The Department has considered in this statement: development of conventionally mined deep geologic repositories for disposal of spent fuel from nuclear power reactors and/or radioactive fuel reprocessing wastes; balanced development of several alternative disposal methods; and no waste disposal action. This volume contains appendices of supplementary data on waste management systems, geologic disposal, radiological standards, radiation dose calculation models, related health effects, baseline ecology, socio-economic conditions, hazard indices, comparison of defense and commercial wastes, design considerations, and wastes from thorium-based fuel cycle alternatives

  7. Management preferences of pediatricians in moderate and severe acute asthma.

    Science.gov (United States)

    Arga, Mustafa; Bakirtas, Arzu; Catal, Ferhat; Derinoz, Oksan; Topal, Erdem; Demirsoy, M Sadik; Turktas, Ipek

    2013-05-01

    To assess and compare management preferences of physicians for moderate and severe acute asthma based on case scenarios and to determine the factors influencing their decisions. A questionnaire based on the Global Initiative on Asthma (GINA) guideline and comprising eight questions on management of acute asthma was delivered to participants of two national pediatric congresses. Management of moderate and severe acute asthma cases was evaluated by two clinical case scenarios for estimation of acute attack severity, initial treatment, treatment after 1h, and discharge recommendations. A uniform answer box comprising the possible choices was provided just below the questions, and respondents were requested to tick the answers they thought was appropriate. Four-hundred and eighteen questionnaires were analyzed. All questions regarding moderate and severe acute asthma case scenarios were answered accurately by 15.8% and 17.0% of physicians, respectively. The initial treatment of moderate and severe cases was known by 100.0% and 78.2% of physicians, respectively. Knowledge of the appropriate plan for treatment after 1h was low both for moderate (45.0%) and severe attacks (35.4%). Discharge recommendations were adequate in 32.5% and 70.8% of physicians for moderate and severe attacks, respectively. Multiple logistic regression analysis revealed that working at a hospital with a continuing medical education program was the only significant predictor of a correct response to all questions regarding severe attacks (p = .04; 95%CI, 1.02-3.21). No predictors were found for information on moderate attacks. Pediatricians have difficulty in planning treatment after 1 hour both for moderate and severe asthma attacks. Postgraduate education programs that target physicians in hospitals without continuing medical education facilities may improve guideline adherence.

  8. A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group.

    Science.gov (United States)

    Krumholz, Harlan M; Currie, Peter M; Riegel, Barbara; Phillips, Christopher O; Peterson, Eric D; Smith, Renee; Yancy, Clyde W; Faxon, David P

    2006-09-26

    form of postacute care, that are included in disease management. (4) Delivery personnel describes the network of healthcare providers involved in the delivery of disease management interventions, including nurses, case managers, physicians, pharmacists, case workers, dietitians, physical therapists, psychologists, and information systems specialists. (5) Method of communication identifies a broad range of disease management delivery systems that may include in-person visitation, audiovisual information packets, and some form of electronic or telecommunication technology. (6) Intensity and complexity distinguish between the frequency and duration of exposure, as well as the mix of program components, with respect to the target for disease management. (7) Environment defines the context in which disease management interventions are typically delivered and includes inpatient or hospital-affiliated outpatient programs, community or home-based programs, or some combination of these factors. (8) Clinical outcomes include traditional, frequently assessed primary and secondary outcomes, as well as patient-centered measures, such as adherence to medication, self-management, and caregiver burden. This statement presents a taxonomy for disease management that describes critical program attributes and allows for comparisons across interventions. Routine application of the taxonomy may facilitate better comparisons of structure, process, and outcome measures across a range of disease management programs and should promote uniformity in the design and conduct of studies that seek to validate disease management strategies.

  9. Recommendations for managing patients with diabetes mellitus in cardiopulmonary rehabilitation: an American Association of Cardiovascular and Pulmonary Rehabilitation statement.

    Science.gov (United States)

    Lopez-Jimenez, Francisco; Kramer, Valerie Carroll; Masters, Barbara; Stuart, Patricia Mickey W; Mullooly, Cathy; Hinshaw, Ling; Haas, Linda; Warwick, Kathy

    2012-01-01

    Diabetes mellitus is a highly prevalent condition in patients participating in cardiopulmonary rehabilitation. However, research and subsequent guidelines specifically applicable to patients with diabetes, participating in cardiopulmonary rehabilitation, are limited. Recognizing this limitation, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) initiated this statement, with the goal of developing a template that incorporated recommendations provided in the AACVPR Core Components and the American Association of Diabetes Educators 7 Self-Care Behaviors. This statement describes key processes regarding evaluation, interventions, and expected outcomes in each of the core components for the management of patients with diabetes in a cardiopulmonary rehabilitation program.

  10. Emergency management of acute colonic cancer obstruction.

    Science.gov (United States)

    Gainant, A

    2012-02-01

    Emergency management of obstructing colonic cancer depends on both tumor location and stage, general condition of the patient and surgeon's experience. Right sided or transverse colon obstructing cancers are usually treated by right hemicolectomy-extended if necessary to the transverse colon-with primary anastomosis. For left-sided obstructing cancer, in patients with low surgical risk, primary resection and anastomosis associated with on-table irrigation or manual decompression can be performed. It prevents the confection of a loop colostomy but presents the risk of anastomotic leakage. Subtotal or total colectomy allows the surgeon to encompass distended and fecal-loaded colon, and to perform one-stage resection and anastomosis. Its disadvantage is an increased daily frequency of stools. It must be performed only in cases of diastatic colon perforation or synchronous right colonic cancer. In patients with high surgical risk, Hartmann procedure must be preferred. It allows the treatment of both obstruction and cancer, and prevents anastomotic leakage but needs a second operation to reverse the colostomy. Colonic stenting is clinically successful in up to 90% in specialized groups. It is used as palliation in patients with disseminated disease or bridge to surgery in the others. If stent insertion is not possible, loop colostomy is still indicated in patients at high surgical risk. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  11. [Incidence of acute agitation and variation in acute agitation management by emergency services].

    Science.gov (United States)

    Casado Flórez, Isabel; Sánchez Santos, Luis; Rodríguez Calzada, Rafael; Rico-Villademoros, Fernando; Roset Arissó, Pere; Corral Torres, Ervigio

    2017-07-01

    To describe the management of acute agitation by Spanish emergency medical services (EMS) and assess the incidence of acute agitation. Observational descriptive study based on aggregate data from unpublished internal EMS reports. Seven participating emergency services received 4 306 213 emergency calls in 2013; 111 599 (2.6%, or 6.2 calls per 1000 population) were categorized as psychiatric emergencies. A total of 84 933 interventions (4.2%, or 4 per 1000 population) were required; 37 951 of the calls concerned agitated patients (1.9%, or 2 cases per 1000 population). Only 3 EMS mandated a specific procedure for their responders to use in such cases. The agitated patient is a common problem for EMS responders. Few teams apply specific procedures for managing these patients.

  12. An International Position Statement on the Management of Frailty in Diabetes Mellitus: Summary of Recommendations 2017.

    Science.gov (United States)

    Sinclair, A J; Abdelhafiz, A; Dunning, T; Izquierdo, M; Rodriguez Manas, L; Bourdel-Marchasson, I; Morley, J E; Munshi, M; Woo, J; Vellas, B

    2018-01-01

    The International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care. The Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty and Aging, Journal of the American Medical Directors Association, and Journals of Gerontology - Series A Biological Sciences and Medical Sciences. Two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies. We have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be

  13. Topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on nonhormonal management of vasomotor symptoms.

    Science.gov (United States)

    Carpenter, Janet S; Laine, Tei; Harrison, Blake; LePage, Meghan; Pierce, Taran; Hoteling, Nathan; Börner, Katy

    2017-10-01

    We sought to depict the topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on the nonhormonal management of menopause-associated vasomotor symptoms released on September 21, 2015, and its associated press release from September 23, 2015. Three data sources were used: online news articles, National Public Radio, and Twitter. For topical diffusion, we compared keywords and their frequencies among the position statement, press release, and online news articles. We also created a network figure depicting relationships across key content categories or nodes. For geospatial diffusion within the United States, we compared locations of the 109 National Public Radio (NPR) stations covering the statement to 775 NPR stations not covering the statement. For temporal diffusion, we normalized and segmented Twitter data into periods before and after the press release (September 12, 2015 to September 22, 2015 vs September 23, 2015 to October 3, 2015) and conducted a burst analysis to identify changes in tweets from before to after. Topical information diffused across sources was similar with the exception of the more scientific terms "vasomotor symptoms" or "vms" versus the more colloquial term "hot flashes." Online news articles indicated media coverage of the statement was mainly concentrated in the United States. NPR station data showed similar proportions of stations airing the story across the four census regions (Northeast, Midwest, south, west; P = 0.649). Release of the statement coincided with bursts in the menopause conversation on Twitter. The findings of this study may be useful for directing the development and dissemination of future North American Menopause Society position statements and/or press releases.

  14. Acute pancreatitis: The role of imaging in diagnosis and management

    Energy Technology Data Exchange (ETDEWEB)

    Bharwani, Nishat, E-mail: nishat.bharwani@nhs.ne [Imaging Department, Barts and The London NHS Trust, St Bartholomew' s Hospital, Ground Floor, King George V Wing, London EC1A 7BE (United Kingdom); Patel, Shilpa; Prabhudesai, Shirish; Fotheringham, Tim; Power, Niall [Imaging Department, Barts and The London NHS Trust, St Bartholomew' s Hospital, Ground Floor, King George V Wing, London EC1A 7BE (United Kingdom)

    2011-02-15

    Acute pancreatitis is one of the more commonly encountered aetiologies in the emergency setting and its incidence is rising. Presentations range from a mild-self limiting condition which usually responds to conservative management to one with significant morbidity and mortality in its most severe forms. While clinical criteria are necessary to make the initial diagnosis, contrast-enhanced CT is the mainstay of imaging and has a vital role in assessing the extent and evolution of the disease and its associated complications. The purpose of this article is to summarise the natural course of acute severe pancreatitis, clarify confusing nomenclature, demonstrate the morphological stages in conjunction with radiological scoring systems and illustrate the complications. We will review and illustrate the increasing and significant role interventional radiology has in the management of these patients, which are often life-saving and surgery-sparing.

  15. Leukostasis: Management to Prevent Crisis in Acute Leukemia
.

    Science.gov (United States)

    Blackburn, Lisa M; Brown, Shelly; Munyon, Aimee; Orovets, Michelle

    2017-12-01

    Hyperleukocytosis, a peripheral white blood cell count greater than 100,000/mm3,is most commonly seen in patients with newly diagnosed or relapsed acute lymphoblastic leukemia and acute myeloid leukemia. Leukostasis is a reduction in blood flow related to hyperviscosity. Hyperleukocytosis, causing leukostasis, is an oncologic emergency and requires an exacting assessment and rapid response with appropriate intervention to prevent morbidity and mortality in the first week after diagnosis. The objectives of this article are to equip oncology nurse to identify patients with hyperleukocytosis and to provide nursing interventions that will ensure safe, quality care. A case study is used to demonstrate key concepts that are critical in early assessment, identification, and treatment of patients with leukostasis.
. Oncology nurses well versed in the pathophysiology, clinical presentation, and management of leukostasis can make a significant contribution to the safe management of patients with cancer.

  16. American Society for Pain Management Nursing (ASPMN) position statement: male infant circumcision pain management.

    Science.gov (United States)

    O'Conner-Von, Susan; Turner, Helen N

    2013-12-01

    The ASPMN strongly recommends that infants who are being circumcised must receive optimal pain management. ‘‘If a decision for circumcision is made, procedural analgesia should be provided’’ (AAP, 1999, p. 691). Therefore, it is the position of the ASPMN that optimal pain management must be provided throughout the circumcision process. Furthermore, parents must be prepared for the procedure and educated about infant pain assessment. They must also be informed of pharmacologic and integrative pain management therapies that are appropriate before, during, and after the procedure.

  17. Multidetector-row computed tomography management of acute pulmonary embolism

    International Nuclear Information System (INIS)

    Yasui, Takahiro; Tanabe, Nobuhiro; Terada, Jiro

    2007-01-01

    The purpose of this study was to evaluate the usefulness and safety of multidetector-row computed tomography (MDCT) pulmonary angiography and indirect venography management of acute pulmonary embolism (PE), including indication for inferior vena cava (IVC) filter. Seventy-one consecutive patients who were clinically suspected of PE and underwent 16-slice MDCT pulmonary angiography and indirect venography were enrolled. Management included indication of IVC filter for patients with extensive deep venous thrombosis (DVT) in submassive or massive PE. A right ventricular to left ventricular short-axis diameter by MDCT >1.0 was judged as submassive PE. All patients were followed for 1 year. MDCT identified 50 patients with venous thromboembolism and 47 patients had acute PE: 4 were judged as massive, 14 as submassive, and 29 as non-massive by MDCT; 3 patients had DVT alone and 7 patients had caval or iliac DVT. Only 1 patient with massive PE and DVT near the right atrium died of recurrence. No other patients died of PE. Management based on MDCT pulmonary angiography combined with indirect venography is considered to be safe and reliable in patients with suspected acute PE. (author)

  18. Financial Management: Improper Payments Reported in Fiscal Year 2000 Financial Statements

    National Research Council Canada - National Science Library

    2001-01-01

    ...). Specifically, it provides information on the amount of improper payments' that federal agencies reported in their fiscal year 2000 financial statements and identifies some current improper payment...

  19. Life-cycle costs for the Department of Energy waste management programmatic environmental impact statement (draft)

    International Nuclear Information System (INIS)

    Sherick, M.J.; Shropshire, D.E.; Hsu, K.M.

    1995-08-01

    The U.S. Department of Energy (DOE) Office of Environmental Management has produced a Programmatic Environmental Impact Statement (PEIS) in order to assess the potential consequences resulting from a cross section of possible waste management strategies for the DOE complex. The PEIS has been prepared in compliance with the National Environmental Policy Act, and includes evaluations of a variety of alternatives. The analysis performed for the PEIS included the development of life-cycle cost estimates for the different waste management alternatives being considered. These cost estimates were used in the PEIS to support the identification and evaluation of economic impacts. Information developed during the preparation of the life-cycle cost estimates was also used to support risk and socioeconomic analyses performed for each of the alternatives. This technical report provides an overview of the methodology used to develop the life-cycle cost estimates for the PEIS alternatives. The methodology that was applied made use of the Waste Management Facility Cost Information Reports, which provided a consistent approach and estimating basis for the PEIS cost evaluations. By maintaining consistency throughout the cost analyses, life-cycle costs of the various alternatives can be compared and evaluated on a relative basis. This technical report also includes the life-cycle cost estimate results for each of the PEIS alternatives evaluated. Summary graphs showing the results for each waste type are provided in the main document, and tables showing different breakdowns of the cost estimates are provided in the Appendices A-D. Appendix E contains PEIS cost information that was developed using an approach different than the standard methodology described in this report

  20. The development of an acute care case manager orientation.

    Science.gov (United States)

    Strzelecki, S; Brobst, R

    1997-01-01

    The authors describe the development of an inpatient acute care case manager orientation in a community hospital. Benner's application of the Dreyfus model of skill acquisition provides the basis for the orientation program. The candidates for the case manager position were expert clinicians. Because of the role change it was projected that they would function as advanced beginners. It was also predicted that, as the case managers progressed within the role, the educational process would need to be adapted to facilitate progression of skills to the proficient level. Feedback from participants reinforced that the model supported the case manager in the role transition. In addition, the model provided a predictive framework for ongoing educational activities.

  1. Management of acute lymphoblastic leukemia in young adults.

    Science.gov (United States)

    Muffly, Lori S; Reizine, Natalie; Stock, Wendy

    2018-02-01

    Substantial interest in acute lymphoblastic leukemia (ALL) in young adults (YAs) and investigations focused on this patient population have resulted in therapeutic advancements that are changing the management paradigm and improving outcomes. The pediatric ALL approach is feasible and effective when administered by medical oncologists. Advanced diagnostics and minimal residual disease measurements aid in prognostication and have resulted in shifting recommendations regarding allogeneic hematopoietic cell transplant in first remission. Blinatumomab, inotuzumab, and chimeric antigen receptor T-cell therapies are transforming the treatment of relapsed/refractory ALL. This comprehensive review of the current management of ALL in YAs summarizes recent scientific developments and clinical trial findings related to ALL biology, frontline management approaches, novel therapies, and supportive care specific to this patient population. Finally, a practical guide to modern YA management for practicing clinicians is provided.

  2. Acute and long-term management of food allergy

    DEFF Research Database (Denmark)

    de Silva, D; Geromi, M; Panesar, S S

    2014-01-01

    BACKGROUND: Allergic reactions to food can have serious consequences. This systematic review summarizes evidence about the immediate management of reactions and longer-term approaches to minimize adverse impacts. METHODS: Seven bibliographic databases were searched from their inception to September...... management for non-life-threatening reactions. H1-antihistamines may be of benefit, but this evidence was in part derived from studies on those with cross-reactive birch pollen allergy. Regarding long-term management, avoiding the allergenic food or substituting an alternative was commonly recommended...... helpful, but allergen-specific immunotherapy may be disease modifying and therefore warrants further exploration. CONCLUSIONS: Food allergy can be debilitating and affects a significant number of people. However, the evidence base about acute and longer-term management is weak and needs to be strengthened...

  3. Applications for detection of acute kidney injury using electronic medical records and clinical information systems: workgroup statements from the 15(th) ADQI Consensus Conference.

    Science.gov (United States)

    James, Matthew T; Hobson, Charles E; Darmon, Michael; Mohan, Sumit; Hudson, Darren; Goldstein, Stuart L; Ronco, Claudio; Kellum, John A; Bagshaw, Sean M

    2016-01-01

    Electronic medical records and clinical information systems are increasingly used in hospitals and can be leveraged to improve recognition and care for acute kidney injury. This Acute Dialysis Quality Initiative (ADQI) workgroup was convened to develop consensus around principles for the design of automated AKI detection systems to produce real-time AKI alerts using electronic systems. AKI alerts were recognized by the workgroup as an opportunity to prompt earlier clinical evaluation, further testing and ultimately intervention, rather than as a diagnostic label. Workgroup members agreed with designing AKI alert systems to align with the existing KDIGO classification system, but recommended future work to further refine the appropriateness of AKI alerts and to link these alerts to actionable recommendations for AKI care. The consensus statements developed in this review can be used as a roadmap for development of future electronic applications for automated detection and reporting of AKI.

  4. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association.

    Science.gov (United States)

    Lichtman, Judith H; Froelicher, Erika S; Blumenthal, James A; Carney, Robert M; Doering, Lynn V; Frasure-Smith, Nancy; Freedland, Kenneth E; Jaffe, Allan S; Leifheit-Limson, Erica C; Sheps, David S; Vaccarino, Viola; Wulsin, Lawson

    2014-03-25

    Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome. Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes. Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.

  5. Management of hypertension in the setting of acute ischemic stroke.

    Science.gov (United States)

    Heitsch, Laura; Jauch, Edward C

    2007-12-01

    The optimal management of blood pressure in the first 24 hours of ischemic stroke remains a controversial topic. Most patients are hypertensive at presentation and subsequently experience a spontaneous decline in blood pressure. Decreasing penumbral blood flow and exacerbating vasogenic edema are significant concerns in whether to treat blood pressure elevations. Although an initially elevated blood pressure has been associated with poor outcome, attempts to acutely lower blood pressure are also associated with worsened outcomes. Thus, the current approach in acute ischemic stroke is permissive hypertension, in which antihypertensive treatment is warranted in patients with systolic blood pressure greater than 220 mm Hg, receiving thrombolytic therapy, or with concomitant medical issues. The use of predictable and titratable medications that judiciously reduce (approximately 10% to 15%) the initial presenting mean arterial pressure is recommended in these situations. Future study must define optimal blood pressure goals, likely on an individual basis.

  6. Clinical management of acute diabetic Charcot foot in Denmark

    DEFF Research Database (Denmark)

    Jansen, Rasmus Bo; Svendsen, Ole Lander; Kirketerp-Møller, Klaus

    2016-01-01

    INTRODUCTION: Charcot foot is a severe complication to diabetes mellitus and treatment involves several different clinical specialities. Our objective was to describe the current awareness, knowledge and treatment practices of Charcot foot among doctors who handle diabetic foot disorders. METHODS......: This study is based on a questionnaire survey sent out to healthcare professionals, primarily doctors, working with diabetic foot ulcers and Charcot feet in the public sector of the Danish healthcare system. RESULTS: The survey obtained a 52% response rate. A temperature difference of > 2 °C between the two...... and treatment practices of acute diabetic Charcot foot at diabetes foot clinics in Denmark. The responders seem to follow the international recommendations and guidelines on management of the acute diabetic Charcot foot, despite a lack of Danish guidelines. FUNDING: none. TRIAL REGISTRATION: not relevant....

  7. Usefulness of CT in the diagnosis and management of acute abdomen

    International Nuclear Information System (INIS)

    Suzuki, Takuya; Matsumoto, Junichi; Funakubo, Masakatsu; Yamashita, Hirotaka; Ehara, Norishige; Minowa, Yoshiyuki; Nakajima, Yasuo

    2010-01-01

    We prospectively evaluated the usefulness of computed tomography (CT) in the diagnosis and management of acute abdomen. Ninety-four patients with acute abdomen were enrolled. We compared the final diagnosis and management CT diagnosis and management. Then, we evaluated how many of the CT examinations were useful and the degree to which they were useful. In more than 90% of cases, CT was very useful for the diagnosis and management of acute abdomen. (author)

  8. Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association.

    Science.gov (United States)

    Hinkle, Janice L; Becker, Kyra J; Kim, Jong S; Choi-Kwon, Smi; Saban, Karen L; McNair, Norma; Mead, Gillian E

    2017-07-01

    At least half of all stroke survivors experience fatigue; thus, it is a common cause of concern for patients, caregivers, and clinicians after stroke. This scientific statement provides an international perspective on the emerging evidence surrounding the incidence, prevalence, quality of life, and complex pathogenesis of poststroke fatigue. Evidence for pharmacological and nonpharmacological interventions for management are reviewed, as well as the effects of poststroke fatigue on both stroke survivors and caregivers. © 2017 American Heart Association, Inc.

  9. DOD Financial Management: Improvements Needed in Army’s Efforts to Ensure the Reliability of Its Statement of Budgetary Resources

    Science.gov (United States)

    2014-05-01

    reasonable possibility that a material misstatement of the entity’s financial statements will not be prevented, or detected and corrected, on a timely...Financial Management Army did not (1) properly identify all key control objectives and activities and risks of misstatement related to its processes or...including beginning balances— material to the SBR and to consider the risks associated with them in developing its audit readiness strategy. In addition

  10. Principles of Prudential in Ifrs Financial Statements and Its Effect on Earnings Response Coefficient and Profit Management

    OpenAIRE

    Suryani, Arna; Herianti, Eva

    2016-01-01

    The purpose of this study is to determine the effect of prudential principle of financial statements in IFRS on earnings response coefficients and profit management of manufakturing companies. This study uses analytical methods Partial Least Square (PLS) through analisys software called Smart PLS 2.0 M3. The object of this research is manufacturing companies in Indonesia with a total of 57 analysis unit manufacturing company during the period from 2013 to 2015.Based on the results of the stud...

  11. ANDRA - National Radioactive Waste Management Agency. Activity report 2007. Management report - Financial statements at December 31, 2007

    International Nuclear Information System (INIS)

    2008-09-01

    Created in 1979 within the CEA, the National Radioactive Waste Management Agency (ANDRA) was established by the December 1991 Waste Act as a public body in charge of the long-term management of all radioactive waste, under the supervision of the Ministry of Ecology, Energy, Sustainable Development and the Sea (formerly the Ministry of Industry and the Ministry of Environment), and the Ministry of Research. Its 3 basic missions were extended and their funding secured through the 2006 Planning Act: - a R and D mission to propose safe long-term solution for radioactive waste without current disposal system; this mission includes long-term storage, since the 2006 Planning Act, in order to propose interim solutions while final ones are being studied; - an industrial mission concerning, on one hand, waste acceptance criteria and control and, on the other hand, siting, construction, operation, closure and monitoring of repositories. This mission includes as well a public service mission in terms of i) collection of waste of the 'small-scale nuclear activities' producers or owners (including the so-called 'household' radioactive waste, i.e. waste owned by private individuals) and ii) clean-up and rehabilitation of orphan polluted sites; - an information mission, notably through the regular publication of the National Inventory of radioactive materials and waste. This mission includes as well an active policy of dialogue with stakeholders both at national and local level. This document is the activity report with the management and financial statements report of the Andra for the year 2007

  12. ANDRA - National Radioactive Waste Management Agency. Annual sustainable development and activity report 2012. Management report and financial statements 2012

    International Nuclear Information System (INIS)

    2013-01-01

    Created in 1979 within the CEA, the National Radioactive Waste Management Agency (ANDRA) was established by the December 1991 Waste Act as a public body in charge of the long-term management of all radioactive waste, under the supervision of the Ministry of Ecology, Energy, Sustainable Development and the Sea (formerly the Ministry of Industry and the Ministry of Environment), and the Ministry of Research. Its 3 basic missions were extended and their funding secured through the 2006 Planning Act: - a R and D mission to propose safe long-term solution for radioactive waste without current disposal system; this mission includes long-term storage, since the 2006 Planning Act, in order to propose interim solutions while final ones are being studied; - an industrial mission concerning, on one hand, waste acceptance criteria and control and, on the other hand, siting, construction, operation, closure and monitoring of repositories. This mission includes as well a public service mission in terms of i) collection of waste of the 'small-scale nuclear activities' producers or owners (including the so-called 'household' radioactive waste, i.e. waste owned by private individuals) and ii) clean-up and rehabilitation of orphan polluted sites; - an information mission, notably through the regular publication of the National Inventory of radioactive materials and waste. This mission includes as well an active policy of dialogue with stakeholders both at national and local level. This document is the activity and Sustainable Development Report, with the management and financial statements report, of the Andra for the year 2012

  13. ANDRA - National Radioactive Waste Management Agency. Annual sustainable development and activity report 2011. Management report and financial statements 2011

    International Nuclear Information System (INIS)

    2012-01-01

    Created in 1979 within the CEA, the National Radioactive Waste Management Agency (ANDRA) was established by the December 1991 Waste Act as a public body in charge of the long-term management of all radioactive waste, under the supervision of the Ministry of Ecology, Energy, Sustainable Development and the Sea (formerly the Ministry of Industry and the Ministry of Environment), and the Ministry of Research. Its 3 basic missions were extended and their funding secured through the 2006 Planning Act: - a R and D mission to propose safe long-term solution for radioactive waste without current disposal system; this mission includes long-term storage, since the 2006 Planning Act, in order to propose interim solutions while final ones are being studied; - an industrial mission concerning, on one hand, waste acceptance criteria and control and, on the other hand, siting, construction, operation, closure and monitoring of repositories. This mission includes as well a public service mission in terms of i) collection of waste of the 'small-scale nuclear activities' producers or owners (including the so-called 'household' radioactive waste, i.e. waste owned by private individuals) and ii) clean-up and rehabilitation of orphan polluted sites; - an information mission, notably through the regular publication of the National Inventory of radioactive materials and waste. This mission includes as well an active policy of dialogue with stakeholders both at national and local level. This document is the activity and Sustainable Development Report, with the management and financial statements report, of the Andra for the year 2011

  14. Contemporary concepts in management of acute otitis media in children.

    Science.gov (United States)

    Rettig, Eleni; Tunkel, David E

    2014-10-01

    Acute otitis media (AOM) is a common disease of childhood. AOM is most appropriately diagnosed by careful otoscopy with an understanding of clinical signs and symptoms. The distinction between AOM and chronic otitis media with effusion should be emphasized. Treatment should include pain management, and initial antibiotic treatment should be given to those most likely to benefit, including young children, children with severe symptoms, and those with otorrhea and/or bilateral AOM. Tympanostomy tube placement may be helpful for those who experience frequent episodes of AOM or fail medical therapy. Recent practice guidelines may assist the clinician with such decisions. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Acute hand and wrist injuries in athletes: evaluation and management.

    Science.gov (United States)

    Morgan, W J; Slowman, L S

    2001-01-01

    Acute hand and wrist injuries in the athlete constitute a unique orthopaedic challenge. Because of the particular demands on the athlete (e.g., financial implications, coaching and administration pressures, self-esteem issues), a specialized management approach is often necessary. Common sites of injury include the ulnar collateral ligament of the thumb metacarpophalangeal joint, proximal interphalangeal joint, metacarpals and phalanges, scaphoid, hamate, and distal radius. Treatment of these injuries varies depending on the patient's age, sport, position played, and level of competition, but departures from standard practice as regards surgery, rehabilitation, and return to competition should never compromise care.

  16. Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium.

    Science.gov (United States)

    Maldonado, José R

    2017-07-01

    Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays. This article discusses the epidemiology, known etiological factors, presentation and characteristics, prevention, management, and impact of delirium. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. American Health Information Management Association. Position statement. Issue: managing health information in facility mergers and acquisitions.

    Science.gov (United States)

    1994-04-01

    Healthcare facility mergers and acquisitions are becoming more common as the industry consolidates. Many critical issues must be considered in mergers and acquisitions, including the management of patient health information. In addition to operational issues, licensure, regulatory, and accreditation requirements must be addressed. To ensure availability of health information to all legitimate users, patient records should be consolidated or linked in the master patient index. A record retention policy should be developed and implemented to meet user needs and assure compliance with legal, regulatory, and accreditation requirements. If health information from closed facilities will be stored for a period of time, its integrity and confidentiality must be preserved, and it must be readily accessible for patient care. The compatibility and functionality of existing information systems should be assessed, and a plan should be formulated for integration of the systems to the extent possible. Such integration may be essential for the organization to successfully meet the demands of integrated delivery systems. Existing databases should be maintained in an accessible form to meet anticipated future needs.

  18. Stroke Laterality Bias in the Management of Acute Ischemic Stroke.

    Science.gov (United States)

    McCluskey, Gavin; Wade, Carrie; McKee, Jacqueline; McCarron, Peter; McVerry, Ferghal; McCarron, Mark O

    2016-11-01

    Little is known of the impact of stroke laterality on the management process and outcome of patients with acute ischemic stroke (AIS). Consecutive patients admitted to a general hospital over 1 year with supratentorial AIS were eligible for inclusion in the study. Baseline characteristics and risk factors, delays in hospital admission, imaging, intrahospital transfer to an acute stoke unit, stroke severity and classification, length of hospital admission, as well as 10-year mortality were measured and compared among right and left hemisphere AIS patients. There were 141 patients (77 men, 64 women; median age 73 [interquartile range 63-79] years), There were 71 patients with left hemisphere AIS and 70 with right hemisphere AIS. Delays to hospital admission from stroke onset to neuroimaging were similar among right and left hemisphere AIS patients. Delay in transfer to an acute stroke unit (ASU) following hospital admission was on average 14 hours more for right hemisphere compared to left hemisphere AIS patients (P = .01). Laterality was not associated with any difference in 10-year survival. Patients with mild and nondominant AIS merit particular attention to minimize their intrahospital transfer time to an ASU. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Managing acute abdominal pain in pediatric patients: current perspectives

    Directory of Open Access Journals (Sweden)

    Hijaz NM

    2017-06-01

    Full Text Available Nadia M Hijaz, Craig A Friesen Division of Gastroenterology, Hepatology, and Nutrition, Children’s Mercy Kansas City, Kansas City, MO, USA Abstract: Acute abdominal pain in pediatric patients has been a challenge for providers because of the nonspecific nature of symptoms and difficulty in the assessment and physical examination in children. Although most children with acute abdominal pain have self-limited benign conditions, pain may be a manifestation of an urgent surgical or medical condition where the biggest challenge is making a timely diagnosis so that appropriate treatment can be initiated without any diagnostic delays that increase morbidity. This is weighed against the need to decrease radiation exposure and avoid unnecessary operations. Across all age groups, there are numerous conditions that present with abdominal pain ranging from a very simple viral illness to a life-threatening surgical condition. It is proposed that the history, physical examination, laboratory tests, and imaging studies should initially be directed at differentiating surgical versus nonsurgical conditions both categorized as urgent versus nonurgent. The features of the history including patient’s age, physical examination focused toward serious conditions, and appropriate tests are highlighted in the context of making these differentiations. Initial testing and management is also discussed with an emphasis on making use of surgeon and radiologist consultation and the need for adequate follow-up and reevaluation of the patient. Keywords: acute abdominal pain, surgical abdomen, ultrasound

  20. STRUCTURAL RELATIONS OF FINANCIAL STATEMENTS AND THE INSTRUMENTS OF FINANCIAL MANAGEMENT

    OpenAIRE

    CLAUDIA ISAC; ALIN ISAC

    2012-01-01

    The present paper aims to highlight the dynamic nature of the balance sheet as a component of annual financial statements and the informational support offered by the indicators calculated for financial analysis. In the first part of the paper there are presented some theoretical issues about the current context of the use of financial statements as a useful tool in the process of decision making and the forms and the parts of such situations. The balance sheet represents a model of the firm'...

  1. Principles for Management of Intraoperative Acute Type A Aortic Dissection.

    Science.gov (United States)

    Gukop, Philemon; Chandrasekaran, Vankatachalam

    2015-12-01

    Intraoperative Type A aortic dissection is a rare pathology with incidence of 0.06-0.32%. It is associated with a high mortality between 30-50%. Some associated risk factors, including hypertension, enlarged aorta, peripheral vascular disease, advanced age, atheroma, and high arterial pressure on cardiopulmonary bypass, have been identified. Modification of these risk factors could reduce the incidence of this event. Prompt diagnosis and management, with the aid of intraoperative trans-esophageal echocardiography and/or epi-aortic ultrasound has been shown to reduce the mortality to 17%. We illustrate the principles of management of this pathology with the case of a 62-year-old female who developed acute Type A aortic dissection while undergoing minimally invasive mitral valve repair.

  2. Approaches to the management of agents used for the treatment of multiple sclerosis: consensus statements from a panel of U.S. managed care pharmacists and physicians.

    Science.gov (United States)

    Miller, Ross M; Happe, Laura E; Meyer, Kellie L; Spear, Rachel J

    2012-01-01

    Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines. To outline approaches for the management of agents used to treat MS, as determined from a group of U.S. managed care pharmacists and physicians. A modified Delphi process was used to develop consensus statements regarding MS management approaches. The panel was composed of experts in managed care and included 8 pharmacy directors and 6 medical directors presently or previously involved in formulary decision making from 12 health plans, 1 specialty pharmacy, and 1 consulting company. These decision makers, who have experience designing health care benefits that include MS treatments, provided anonymous feedback through 2 rounds of web-based surveys and participated in 1 live panel meeting held in December 2010. Consensus was defined as a mean response of at least 3.3 or 100% of responses either "agree" or "strongly agree" (i.e., no panelist answered "disagree" or "strongly disagree") on a 4-item Likert scale (1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree). After 3 phases, these managed care representatives reached consensus on 25 statements for management of patients with MS. Consistent with managed care principles, this group of managed care experts found that health plans should consider efficacy, effectiveness, and safety, as well as patient preference, when evaluating MS therapies for formulary placement. Cost and contracting should be considered if efficacy and safety are judged to be comparable between agents. The consensus statements developed by a panel of managed care representatives provide some insight into decision making in formulary and utilization management of MS therapies.

  3. Management of acute cardiogenic pulmonary edema: a literature review.

    Science.gov (United States)

    Johnson, Jeremy M

    2009-01-01

    Acute cardiogenic pulmonary edema (CPE) is a pathology frequently seen in patients presenting to emergency departments (EDs) and can usually be attributed to preexisting cardiovascular disease. Heart failure alone accounts for more than 1 million hospital admissions annually and has one of the highest ED morbidity and mortality to date (). Historically, CPE has been managed by the treating clinician in a manner that is based largely on anecdotal evidence. Furosemide (Lasix), morphine, and nitroglycerin have historically been the baseline standard for drug therapy in CPE management. A lack of drastic improvement in the patient's condition over the course of the ED visit may reflect a management style that results in higher morbidity and mortality for CPE patients. Several recent articles provide evidence-based outcomes that suggest changing standard therapy along with the adjunctive use of other medications. These articles also describe treatment modalities that result in a marked improvement in the management of patients with CPE along with decreases in adverse outcomes and hospital length of stay. The goal of this article is to present a summary of the evidence regarding the management of CPE and discuss the implications for current practice.

  4. Draft Waste Management Programmatic Environmental Impact Statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume 3, Appendix A: Public response to revised NOI, Appendix B: Environmental restoration, Appendix C, Environmental impact analysis methods, Appendix D, Risk

    International Nuclear Information System (INIS)

    1995-08-01

    Volume three contains appendices for the following: Public comments do DOE's proposed revisions to the scope of the waste management programmatic environmental impact statement; Environmental restoration sensitivity analysis; Environmental impacts analysis methods; and Waste management facility human health risk estimates

  5. Recommendations from the External Auditors to the CERN Pension Fund Management on the Financial Statements of the CERN Pension Fund for the Financial Year 2013 and comments from the CERN Pension Fund Management

    CERN Document Server

    2014-01-01

    Recommendations from the External Auditors to the CERN Pension Fund Management on the Financial Statements of the CERN Pension Fund for the Financial Year 2013 and comments from the CERN Pension Fund Management

  6. Recommendations from the External Auditors to the CERN Pension Fund Management on the Annual Report and Financial Statements for the Year Ended 31 December 2016 and Comments from the CERN Pension Fund Management

    CERN Document Server

    2017-01-01

    Recommendations from the External Auditors to the CERN Pension Fund Management on the Annual Report and Financial Statements for the Year Ended 31 December 2016 and Comments from the CERN Pension Fund Management

  7. Recommendations from the External Auditors to the CERN Pension Fund Management on the Annual Report and Financial Statements for the year ended 31 December 2015 and comments from the CERN Pension Fund Management

    CERN Document Server

    2016-01-01

    Recommendations from the External Auditors to the CERN Pension Fund Management on the Annual Report and Financial Statements for the year ended 31 December 2015 and comments from the CERN Pension Fund Management

  8. Recommendations from the External Auditors to the CERN Pension Fund Management on the Financial Statements of the Pension Fund for the Financial Year 2014 and Comments from the CERN Pension Fund Management Supreme Audit Office of Poland

    CERN Document Server

    2015-01-01

    Recommendations from the External Auditors to the CERN Pension Fund Management on the Financial Statements of the Pension Fund for the Financial Year 2014 and Comments from the CERN Pension Fund Management Supreme Audit Office of Poland

  9. Etiology, clinical features and management of acute recurrent pancreatitis.

    Science.gov (United States)

    Deng, Yi Yun; Wang, Rui; Wu, Hao; Tang, Cheng Wei; Chen, Xin Zu

    2014-10-01

    To study the etiology and clinical features of acute recurrent pancreatitis (ARP) and to determine its optimal management and outcomes. ARP cases among acute pancreatitis patients who were admitted to the West China Hospital, Sichuan University from January 2008 to December 2012 were retrospectively collected. Their etiology, clinical features, treatments and outcomes were analyzed. Of all pancreatitis patients, 8.9% were classified as ARP. The proportions of mild and severe diseases were 85.7% and 14.3%, respectively. The common etiological factors were biliogenic (31.0%), alcohol (26.2%), hyperlipidemia (21.4%) and pancreaticobiliary malformation (15.4%). At first 46 cases were cryptogenic and among them 36 were subsequently confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Among the hyperlipidemic ARP patients, 72.2% failed to routinely monitor and control serum lipids. ERCP was performed in 88 cases, and 48 also required an endoscopic sphincterotomy or calculus removal. Twenty-two patients underwent cholangiopancreatic duct stent placement, and pancreatic necrosectomy was performed on eight severe cases. The overall outcomes indicate that 8.3% of the cases progressed to chronic pancreatitis and 33.3% of the cases receiving etiological treatment were recurrence-free. There were no deaths in this study. The etiological factors of ARP are similar to those of acute pancreatitis at the first attack. The management of ARP should be fully considered based on etiological investigation. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  10. Fourth branchial cleft anomaly: management strategy in acute presentation.

    Science.gov (United States)

    Carta, Filippo; Sionis, Sara; Mascia, Luigi; Puxeddu, Roberto

    2014-09-01

    Branchial malformations are common congenital head and neck lesions usually diagnosed in childhood during the first decade of life. Acute presentation is usually managed with conservative protocols before a definitive surgical procedure although the risk of life-treating septic complications may influence the physician's decision. Surgery is the treatment of choice with the removal of the lesion alone, nevertheless more aggressive approaches must be considered in complicated cases. Selective neck dissection including the removal of part of the thyroid lobe with the congenital lesion should be considered as the "ultima ratio" treatment to avoid recurrence. We reviewed literature and report our experience concerning two patients with fourth branchial cleft sinus. A three-year-old child with a clinical history of recurrent neck abscess was referred to our department after several drainages performed in another centre. A three-year-old child referred to our department for a left side lower primary neck abscess. In both cases the diagnosis of a complicated fourth cleft remnant was confirmed by rigid endoscopic visualization of the mucosal orifice of the sinus in the pyriform fossa. Surgical management during acute presentation was challenging; in one patient the early fasciitis required an emergency procedure to remove the infected sinus that were strictly adherent to the deep vascular-nervous axis. Surgery was the definitive treatment in both cases and at 12 and 25 months follow-up respectively no recurrences were observed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. [Transfer managment of postoperative acute pain therapy to outpatient aftercare].

    Science.gov (United States)

    Tank, C; Lefering, R; Althaus, A; Simanski, C; Neugebauer, E

    2014-10-01

    The significance of postoperative pain management for patients in the hospital is well known and has been a focus of research for several years. The ambulatory care after hospital discharge, however, is not well investigated. A prospective observational study was therefore conducted to study the transfer management from in-hospital patients to ambulatory care. A patient questionnaire was developed and patients were asked to fill it out at different time points after the operation: during the time in the hospital, then at 2 weeks and 6 months after hospital discharge. In addition, the responsible family doctor was approached and interviewed. The main focus of the questionnaire was the measurement of post-surgical pain (numeric rating scale NRS), patient satisfaction (Cologne patient questionnaire), and quality of life (SF 12). Of a total of 128 patients 72.9% described moderate to severe pain after the orthopaedic operations in the hospital. 90.8% of the patients had pain directly after discharge from the hospital; in 67.4% of the cases pain was ≥3 and in 23.4% of the cases pain was ≥6. Six months after discharge pain was significant in 29.4% of the patients, 60.8% of the patients were satisfied with the transfer to the home setting. 16% were not satisfied at all and 23.2% were neutral. Important factors for dissatisfaction with the transfer management were, according to stepwise logistic regeression analysis, sex (female patients), young age, a poor bodily constitution at the hospital and thereafter, and the pain management in the hospital and after discharge. The study shows the significance of the acute pain therapy not only during the hospital stay but also after discharge. There are very few data on pain therapy after discharge from the hospital. Based on the significance of the chronification of acute pain it is of the utmost importance to close this gap. © Georg Thieme Verlag KG Stuttgart · New York.

  12. How to diagnose and manage hepatic encephalopathy: a consensus statement on roles and responsibilities beyond the liver specialist.

    Science.gov (United States)

    Shawcross, Debbie L; Dunk, Arthur A; Jalan, Rajiv; Kircheis, Gerald; de Knegt, Robert J; Laleman, Wim; Ramage, John K; Wedemeyer, Heiner; Morgan, Ian E J

    2016-02-01

    Hepatic encephalopathy is defined as brain dysfunction caused by liver insufficiency and/or portosystemic shunting. Symptoms include nonspecific cognitive impairment, personality changes and changes in consciousness. Overt (symptomatic) hepatic encephalopathy is a common complication of cirrhosis that is associated with a poor prognosis. Patients with hepatic encephalopathy may present to healthcare providers who do not have primary responsibility for management of patients with cirrhosis. Therefore, we developed a series of 'consensus points' to provide some guidance on management. Using a modified 'Delphi' process, consensus statements were developed that summarize our recommendations for the diagnosis and management of patients with hepatic encephalopathy. Points on which full consensus could not be reached are also discussed. Our recommendations emphasize the role of all healthcare providers in the identification of cognitive impairment in patients with cirrhosis and provide guidance on steps that might be considered to make a diagnosis of overt hepatic encephalopathy. In addition, treatment recommendations are summarized. Minimal hepatic encephalopathy can have a significant impact on patients; however, in most circumstances identification and management of minimal hepatic encephalopathy remains the responsibility of specialists in liver diseases. Our opinion statements aim to define the roles and responsibilities of all healthcare providers who at times care for patients with cirrhosis and hepatic encephalopathy. We suggest that these recommendations be considered further by colleagues in other disciplines and hope that future guidelines consider the management of patients with cirrhosis and with a 'suspicion' of cognitive impairment through to a formal diagnosis of hepatic encephalopathy.

  13. Assessment of quality of care in acute postoperative pain management

    Directory of Open Access Journals (Sweden)

    Milutinović Dragana

    2009-01-01

    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p

  14. Current concepts in the management of acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Gautham Srinivasan

    2016-01-01

    Full Text Available Guidelines for the management of acute pancreatitis (AP are based on the Western experience, which may be difficult to extrapolate in India due to socioeconomic constraints. Hence, modifications based on the available resources and referral patterns should be introduced so as to ensure appropriate care. We reviewed the current literature on the management of AP available in English on Medline and proposed guidelines locally applicable. Patients of AP presenting with systemic inflammatory response syndrome are at risk of moderate-severe pancreatitis and hence, should be referred to a tertiary center early. The vast majority of patients with AP have mild disease and can be managed at smaller centers. Early aggressive fluid resuscitation with controlled fluid expansion, early enteral nutrition, and culture-directed antibiotics improve outcomes in AP. Infected pancreatic necrosis should be managed in a tertiary care hospital within a multidisciplinary setup. The “step up” approach involving antibiotics, percutaneous drainage, and minimally invasive necrosectomy instituted sequentially based on clinical response has improved the outcomes in this subgroup of patients.

  15. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume III of V

    International Nuclear Information System (INIS)

    1997-01-01

    The Final Waste Management Programmatic Environmental Impact Statement (WM PEIS) examines the potential environmental and cost impacts of strategic management alternatives for managing five types of radioactive and hazardous wastes that have resulted and will continue to result from nuclear defense and research activities at a variety of sites around the United States. The five waste types are low-level mixed waste, low-level waste, transuranic waste, high-level waste, and hazardous waste. The WM PEIS provides information on the impacts of various siting alternatives which the Department of Energy (DOE) will use to decide at which sites to locate additional treatment, storage, and disposal capacity for each waste type

  16. Final environmental impact statement supplement for wastewater management systems, North Jefferson County, Kentucky wastewater facilities

    International Nuclear Information System (INIS)

    1992-12-01

    The Final Environmental Impact Statement Supplement (FEISS) serves to update the wastewater treatment alternatives presented in the original EIS (The North County Area Environmental Impact Statement, Jefferson County, KY, July 1984), determine the best alternative, and compare that alternative to the Louisville and Jefferson County Metropolitan Sewer District's North County Action Plan (NCAP). The NCAP was determined to have the greatest cost effectiveness, lowest environmental impact, and best implementability and reliability and so is the preferred alternative in the FEISS. Significant environmental impacts of the alternative are described and mitigative measures discussed

  17. Update on pathogenesis and clinical management of acute pancreatitis

    Science.gov (United States)

    Cruz-Santamaría, Dulce M; Taxonera, Carlos; Giner, Manuel

    2012-01-01

    Acute pancreatitis (AP), defined as the acute nonbacterial inflammatory condition of the pancreas, is derived from the early activation of digestive enzymes found inside the acinar cells, with variable compromise of the gland itself, nearby tissues and other organs. So, it is an event that begins with pancreatic injury, elicits an acute inflammatory response, encompasses a variety of complications and generally resolves over time. Different conditions are known to induce this disorder, although the innermost mechanisms and how they act to develop the disease are still unknown. We summarize some well established aspects. A phase sequence has been proposed: etiology factors generate other conditions inside acinar cells that favor the AP development with some systemic events; genetic factors could be involved as susceptibility and modifying elements. AP is a disease with extremely different clinical expressions. Most patients suffer a mild and limited disease, but about one fifth of cases develop multi organ failure, accompanied by high mortality. This great variability in presentation, clinical course and complications has given rise to the confusion related to AP related terminology. However, consensus meetings have provided uniform definitions, including the severity of the illness. The clinical management is mainly based on the disease´s severity and must be directed to correct the underlying predisposing factors and control the inflammatory process itself. The first step is to determine if it is mild or severe. We review the principal aspects to be considered in this treatment, as reflected in several clinical practice guidelines. For the last 25 years, there has been a global increase in incidence of AP, along with many advances in diagnosis and treatment. However, progress in knowledge of its pathogenesis is scarce. PMID:22737590

  18. Acute heart failure with and without concomitant acute coronary syndromes: patient characteristics, management, and survival.

    Science.gov (United States)

    Tarvasmäki, Tuukka; Harjola, Veli-Pekka; Nieminen, Markku S; Siirilä-Waris, Krista; Tolonen, Jukka; Tolppanen, Heli; Lassus, Johan

    2014-10-01

    Acute coronary syndromes (ACS) may precipitate up to a third of acute heart failure (AHF) cases. We assessed the characteristics, initial management, and survival of AHF patients with (ACS-AHF) and without (nACS-AHF) concomitant ACS. Data from 620 AHF patients were analyzed in a prospective multicenter study. The ACS-AHF patients (32%) more often presented with de novo AHF (61% vs. 43%; P coronary procedures (angiography, percutaneous coronary intervention, coronary artery bypass graft surgery), were more frequent in ACS-AHF (P < .001 for all). Although 30-day mortality was significantly higher for ACS-AHF (13% vs. 8%; P = .03), survival in the 2 groups at 5 years was similar. Overall, ACS was an independent predictor of 30-day mortality (adjusted odds ratio 2.0, 95% confidence interval 1.07-3.79; P = .03). Whereas medical history and the manifestation and initial treatment of AHF between ACS-AHF and nACS-AHF patients differ, long-term survival is similar. ACS is, however, independently associated with increased short-term mortality. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

    Science.gov (United States)

    Povar, Gail J; Blumen, Helen; Daniel, John; Daub, Suzanne; Evans, Lois; Holm, Richard P; Levkovich, Natalie; McCarter, Alice O; Sabin, James; Snyder, Lois; Sulmasy, Daniel; Vaughan, Peter; Wellikson, Laurence D; Campbell, Amy

    2004-07-20

    Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.

  20. Management of acute rhinosinusitis in Danish general practice: a survey

    Directory of Open Access Journals (Sweden)

    Hansen JG

    2011-07-01

    Full Text Available Jens Georg HansenDepartment of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aalborg, DenmarkPurpose: To evaluate whether the ongoing debate over diagnostic problems and treatment choices for acute rhinosinusitis has had any influence on the management of the disease.Methods: We randomly selected 300 Danish general practitioners (GPs from the files of the Research Unit for General Practice at Aarhus University. Invitations to participate and a questionnaire were sent to the GPs by mail.Results: A total of 149 (49% GPs answered the questionnaire. When asked about symptoms, the highest priority was given to sinus pain and signs of tenderness. The most frequent examinations were objective examination of the ear-nose-throat (ENT, palpation of the maxillofacial area, and C-reactive protein point-of-care testing (or CRP rapid test. Nearly all GPs prescribed local vasoconstrictors, and in 70% of cases, antibiotics were prescribed. Phenoxymethylpenicillin was the preferred antibiotic. Use of the CRP rapid test, years in practice, or employment in an ENT department did not have a significant impact on the diagnostic certainty and antibiotic prescribing rate.Conclusion: The clinical diagnoses are based on a few symptoms, signs, and the CRP rapid test. Other examinations, including imaging techniques, are seldom used. Phenoxymethylpenicillin is the preferred antibiotic, and the GPs' diagnostic certainty was 70%.Keywords: general practice, acute rhinosinusitis, diagnosis, treatment, antibiotic

  1. Laparoscopic management of maldescended ovary presenting with recurrent acute abdomen

    Directory of Open Access Journals (Sweden)

    Eghoihunu Ireo

    2018-01-01

    Full Text Available Ovarian maldescent is an extremely rare gynecological phenomenon, usually associated with Müllerian abnormalities. We report a 27-year-old woman, presenting with acute, right-sided abdominal pain. She has a history of subfertility and repeated admissions with chronic pelvic pain. Previous hysterosalpingogram and laparoscopy demonstrated unicornuate uterus with absent right fallopian tube and ovary. A right-sided, ectopic ovary was identified on later imaging and suspected as the cause of her symptoms. She underwent laparoscopic excision of the maldescended ovary with remnant fimbrial end and gubernaculum. She was discharged the following day as she was pain-free and remains so 11 months later. This case report prompts a gynecologist to consider diagnosis of maldescended ovary in the women with uterine abnormalities and repeated episodes of abdominal pain. This is the first case report to the best of our knowledge where surgical management of ovarian maldescent was performed via minimal access approach, thus avoiding laparotomy in this acute setting.

  2. Cholecystectomy vs. percutaneous cholecystostomy for the management of critically ill patients with acute cholecystitis: a protocol for a systematic review.

    Science.gov (United States)

    Ambe, Peter C; Kaptanis, Sarantos; Papadakis, Marios; Weber, Sebastian A; Zirngibl, Hubert

    2015-05-30

    methodological heterogeneity of included studies. Both interventions would be compared with regard to in-hospital mortality, 30-day mortality, procedure-dependent complications, re-intervention, length of intensive care unit (ICU) stay, length of hospital stay, re-admission, and cost of treatment. The review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. This systematic review aims at identifying and evaluating the clinical value of percutaneous cholecystostomy in the management of critically ill patients with acute cholecystitis. PROSPERO CRD42015016205.

  3. Emergency Management of Malignant Acute Left-Sided Colonic Obstruction

    Science.gov (United States)

    Trompetas, Vasileios

    2008-01-01

    INTRODUCTION The management of acute left-sided colonic obstruction still remains a challenging problem despite significant progress. METHODS A literature search was undertaken using PubMed and the Cochrane Library regarding the options in emergency management of left-sided colonic obstruction focusing on outcomes such as mortality, morbidity, long-term prognosis and cost effectiveness. DISCUSSION Colonic stenting is the best option either for palliation or as a bridge to surgery. It reduces morbidity and mortality rate and the need for colostomy formation. Stenting is likely to be cost effective, but data are variable depending on the individual healthcare system. Nevertheless, surgical management remains relevant as colonic stenting has a small rate of failure, and it is not always available. There are various surgical options. One-stage primary resection and anastomosis is the preferred choice for low-risk patients. Intra-operative colonic irrigation has no proven benefit. Subtotal colectomy is useful in cases of proximal bowel damage or synchronous tumours. Hartmann's procedure should be reserved for high-risk patients. Simple colostomy has no role other than for use in very ill patients who are not fit for any other procedure. PMID:18430330

  4. The Acute Management of Sport Concussion in Pediatric Athletes.

    Science.gov (United States)

    Resch, Jacob E; Kutcher, Jeffrey S

    2015-10-01

    During the past two decades the focus on sport concussion has increased significantly. Young athletes represent the most vulnerable population to sustain a sport concussion yet receive the least amount of attention. Specifically, young athletes who sustain a sport concussion can go unrecognized and continue to participate in sport putting them at an increased risk for a more significant injury. The purpose of this review is to provide a clinical framework for the evaluation and management of sport concussion. In addition, this review provides considerations for health care professionals in regard to clinical measures and follow-up strategies during the acute phase following concussion in young concussed athletes following injury. © The Author(s) 2015.

  5. Contemporary management of infected necrosis complicating severe acute pancreatitis

    Science.gov (United States)

    Jamdar, Saurabh; Siriwardena, Ajith K

    2006-01-01

    Pancreatic necrosis complicating severe acute pancreatitis is a challenging scenario in contemporary critical care practice; it requires multidisciplinary care in a setting where there is a relatively limited evidence base to support decision making. This commentary provides a concise overview of current management of patients with infected necrosis, focusing on detection, the role of pharmacologic intervention, and the timing and nature of surgical interventions. Fine-needle aspiration of necrosis remains the mainstay for establishment of infection. Pharmacological intervention includes antibiotic therapy as an adjunct to surgical debridement/drainage and, more recently, drotrecogin alfa. Specific concerns remain regarding the suitability of drotrecogin alfa in this setting. Early surgical intervention is unhelpful; surgery is indicated when there is strong evidence for infection of necrotic tissue, with the current trend being toward 'less drastic' surgical interventions. PMID:16356213

  6. Management outcome of acute urinary retention: model of prediction.

    LENUS (Irish Health Repository)

    Daly, Padraig

    2012-01-31

    OBJECTIVES: To assess for predictors of outcome in patients presenting with acute urinary retention (AUR). METHODS: A study was performed in our unit to evaluate trial without catheter (TWOC) and successive management. We assessed for predictors of surgical or medical management, which included: age, volume drained at time of catheterisation, cause of retention, serum creatinine, success of trial of voiding, co-morbidities, prostate-specific antigen (PSA) and prostate size on digital rectal examination (DRE). RESULTS: 72 men were entered into the study over an 18-month period: 27 had a successful first TWOC, 20 patients had a second TWOC, and 6 were successful. In total, 31 of the 33 patients with a successful TWOC remained on alpha-blockers without a further episode of AUR within a minimum of 6 months\\' follow-up. Patients failing TWOC were managed by transurethral resection of the prostate (n = 22), long-term catheterisation (n = 15) or prostatic stents (n = 3), and 1 patient died prior to intervention. Three predictors were significant on multivariate analysis: PSA (>2.9 ng\\/ml), prostate size on DRE (large) and volume drained at time of catheterisation (>or=1,000 ml). CONCLUSION: Patients with elevated PSA (>2.9 ng\\/ml), a large prostate size on DRE and a volume drained at time of catheterisation >1,000 ml are best managed by surgical intervention, while those with volumes drained at time of catheterisation of <1,000 ml, a PSA managed medically.

  7. Enhancing systems to improve the management of acute, unscheduled care.

    Science.gov (United States)

    Braithwaite, Sabina A; Pines, Jesse M; Asplin, Brent R; Epstein, Stephen K

    2011-06-01

    For acutely ill patients, health care services are available in many different settings, including hospital-based emergency departments (EDs), retail clinics, federally qualified health centers, and outpatient clinics. Certain conditions are the sole domain of particular settings: stabilization of critically ill patients can typically only be provided in EDs. By contrast, many conditions that do not require hospital resources, such as advanced radiography, admission, and same-day consultation can often be managed in clinic settings. Because clinics are generally not open nights, and often not on weekends or holidays, the ED remains the only option for face-to-face medical care during these times. For patients who can be managed in either setting, there are many open research questions about which is the best setting, because these venues differ in terms of access, costs of care, and potentially, quality. Consideration of these patients must be risk-adjusted, as patients may self-select a venue for care based upon perceived acuity. We present a research agenda for acute, unscheduled care in the United States developed in conjunction with an Agency for Healthcare Research and Quality-funded conference hosted by the American College of Emergency Physicians in October 2009, titled "Improving the Quality and Efficiency of Emergency Care Across the Continuum: A Systems Approach." Given the possible increase in ED utilization over the next several years as more people become insured, understanding differences in cost, quality, and access for conditions that may be treated in EDs or clinic settings will be vital in guiding national health policy. © 2011 by the Society for Academic Emergency Medicine.

  8. [Optimized logistics in the prehospital management of acute stroke].

    Science.gov (United States)

    Luiz, T; Moosmann, A; Koch, C; Behrens, S; Daffertshofer, M; Ellinger, K

    2001-12-01

    Current management of acute stroke is characterised by an aggressive approach including specific therapy i. e. reperfusion therapy. However currently stroke patients often arrive too late in hospitals offering adequate treatment. Therefore optimized logistics play a predominant role in modern stroke management. 1. Does teaching of EMS staff and the public result in reduced prehospital latencies 2. Will EMS personnel be able to effectively screen patients potentially suitable for thrombolysis? During a six week-period all EMS patients presenting with possible signs of an acute stroke were prospectively registered (period 1). Data of interest were age, mode of primary contact, prehospital latencies, mode of transportation, destination and final diagnosis. Next an algorithm was established allowing EMS personnel to transfer patients with an assumed stroke to the best suitable hospital. Teaching comprised clinical signs, indication of CT scanning, pathophysiology, specific therapeutic options (thrombolysis), and criteria to identify patients suitable for thrombolysis. In a second step the public was continuously taught about stroke symptoms and the necessity to instantly seek EMS assistance. After 12 months data were compared to baseline (period 2). (period 2 vs. Period 1): Rate of patients transferred to a stroke center: 60 % vs. 54 %; rate of those transported to hospitals not offering CT scans: 17 % vs. 26 % (p < 0.05). Percentage of patients primarily contacting the EMS system: 33 % vs. 24 %. Median interval between onset of symptoms and emergency call: 54 vs. 263 minutes Median interval between the emergency call and arrival at the emergency department: 44 vs. 58 minutes (p < 0.01). Rate of patients admitted with a diagnosis other than stroke: 18 % vs. 25 % (n. s.). Median interval between onset of symptoms and hospital admission: 140 vs. 368 minutes (p < 0.001). Median age: 69 vs. 75 years (p < 0.01). This study demonstrates the efficacy of educational efforts in

  9. Naval Petroleum and Oil Shale Reserves Combined Financial Statements September 30, 1994 and 1993 and Management Overview and Supplemental Financial and Management Information

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-12-31

    This report presents the results of the independent certified public accountant`s audit of the Department of Energy`s (Department) Naval Petroleum and Oil Shale Reserves (NPOSR) financial statements as of September 30, 1994. The auditors have expressed an unqualified opinion on the 1994 statements. Their reports on the NPOSR internal control structure and on compliance with laws and regulations, and management letter on addressing needed improvements are also provided. NPOSR consists of petroleum reserves in California and Wyoming, and oil shale reserves in Colorado and Utah. The Government`s interests in NPOSR are managed by the Department through its headquarters office in Washington, D.C. In addition, the Department has site offices in both California and Wyoming that are responsible for contractor oversight functions. Daily operations are conducted under contract by two management and operating contractors. By law, NPOSR was authorized to produce crude oil at the maximum efficient rate for six years. The law allowed production to be extended for three year periods, provided that the President of the United States certified that continued maximum production was in the best interest of the nation. The current three year period ends on April 5, 1997. Additional information about NPOSR is provided in the overview and notes to the financial statements.

  10. State of the evidence on acute asthma management in children: a critical appraisal of systematic reviews

    NARCIS (Netherlands)

    Boluyt, Nicole; van der Lee, Johanna H.; Moyer, Virginia A.; Brand, Paul L. P.; Offringa, Martin

    2007-01-01

    OBJECTIVE: Our goal was to evaluate clinical, methodologic, and reporting aspects of systematic reviews on the management of acute asthma in children. METHODS: We undertook a systematic review of systematic reviews on acute asthma management in children. We identified eligible reviews by searching

  11. Managing the acute painful episode in sickle cell disease

    Directory of Open Access Journals (Sweden)

    B. Kaya

    2011-12-01

    Full Text Available Sickle cell pain is a complex but frequently experienced symptom. Acute painful events in children can be managed effectively in the community with appropriate support and education. If hospital management is required, rapid access to a consistent, reliable and safe analgesic pathway is recommended to ensure a good standard of care. Use of oral opiates in addition to short acting easily administrable forms of analgesia and strict adherence to protocoled monitoring will enable the acute event to be well managed and the negative pain experience minimised. An important part of the outpatient evaluation is determining the impact pain events are having on the child’s quality of life. Addressing psycho-social aspects, defining and modifying precipitating factors, if any are identified, and having a holistic approach to pain management is helpful. Education and use of self-management techniques can also be productive. Use of sickle modifying interventions such as hydroxycarbamide therapy or transfusion therapy can have a significant impact on reducing the severity and frequency of the acute pain event. 镰状细胞疼痛是一种复杂的常发症。 通过适当的支助和教育,儿童急性疼痛症可以得到有效抑制。 如果需要在医院进行护理,患者应尽快寻求持续可靠且安全的止痛方式,确保良好的护理。 除采取作用短、管理方便的止痛治疗和遵守监测协议之外,患者还需口服鸦片剂,这样,急性症状可以得到良好的抑制,还可尽量减轻疼痛感。 诊断门诊病人一个重要的部分就是确定疼痛症对患儿生活质量产生的影响。 问询生理社会方面问题,确定和修改诱发因子(如有),并整体分析可行的疼痛护理方法。 教育和使用个人护理法也很有效果。 采用镰状细胞修改干预法,例如羟基尿素疗法或输液疗法,对减轻急性疼痛症和减少发作频率有着显著效果。

  12. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

    Science.gov (United States)

    Ekås, Guri Ranum; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J; Feller, Julian A; Karlsson, Jón; Kocher, Minider S; LaPrade, Robert F; McNamee, Michael; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas; Reider, Bruce; Roe, Justin; Seil, Romain; Siebold, Rainer; Witvrouw, Erik; Engebretsen, Lars

    2018-01-01

    In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. PMID:29478021

  13. Statement of John H. Anttonen, Project Manager, Basalt Waste Isolation Project, Richland Operations Office, Department of Energy

    International Nuclear Information System (INIS)

    Anon.

    1987-01-01

    My name is John Anttonen and I am the Project Manager for the Basalt Waste Isolation Project (BWIP) at the Department of Energy Richland Operation Office. The responsibilities of may office are to manage the day-to-day activities of the site suitability investigations of the basalt formations at the Hanford Site, a Department complex that is involved in a variety of national missions, including defense materials production, nuclear energy research, and radioactive waste management. In may prepared comments today I would like to touch upon four specific subject areas relating to the BWIP program and then I would be happy to answer any questions you might have. The topics I will cover are: (1) historical aspects; (2) site specific technical issues and how they will be addressed during site characterization of the basalt site at Hanford; (3) current project status and; (4) institutional interaction. For clarity, I have attached several charts to my statement

  14. The diagnosis and management of acute otitis media.

    Science.gov (United States)

    Lieberthal, Allan S; Carroll, Aaron E; Chonmaitree, Tasnee; Ganiats, Theodore G; Hoberman, Alejandro; Jackson, Mary Anne; Joffe, Mark D; Miller, Donald T; Rosenfeld, Richard M; Sevilla, Xavier D; Schwartz, Richard H; Thomas, Pauline A; Tunkel, David E

    2013-03-01

    This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM. In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships. The practice guideline underwent comprehensive peer review before formal approval by the AAP. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this

  15. Acute intracerebral haemorrhage: grounds for optimism in management.

    Science.gov (United States)

    Delcourt, Candice; Anderson, Craig

    2012-12-01

    Spontaneous intracerebral haemorrhage (ICH) is one of the most devastating types of stroke, which has considerable disease burden in "non-white" ethnic groups where the population-attributable risks of elevated blood pressure are very high. Since the treatment of ICH remains largely supportive and expectant, nihilism and the early withdrawal of active therapy influence management decisions in clinical practice. However, approaches to management are now better defined on the basis of evidence that both survival and speed (and degree) of recovery are critically dependent on the location, size, and degree of expansion and extension into the intraventricular system of the haematoma of the ICH. Although no medical treatment has been shown to improve outcome in ICH, several promising avenues have emerged that include haemostatic therapy and intensive control of elevated blood pressure. Conversely, there is continued controversy over the role of evacuation of the haematoma of ICH via open craniotomy. Despite being an established practice for several decades, and having undergone evaluation in multiple randomised trials, there is uncertainty over which patients have the most to gain from an intervention with clear procedural risk. Minimally invasive surgery via local anaesthetic applied drill-puncture of the cranium and infusion of a thrombolytic agent is an attractive option for patients requiring critical management of the haematoma, not just in low resource settings but arguably also in specialist centres of western countries. With several ongoing clinical trials nearing completion, these treatments could enter routine practice within the next few years, further justifying the urgency of "time is brain" and that active management within well-organized, comprehensive acute stroke care units includes patients with ICH. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Pediatric Acute Respiratory Distress Syndrome: Fluid Management in the PICU.

    Science.gov (United States)

    Ingelse, Sarah A; Wösten-van Asperen, Roelie M; Lemson, Joris; Daams, Joost G; Bem, Reinout A; van Woensel, Job B

    2016-01-01

    The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS). Patients with ARDS have widespread damage of the alveolar-capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes.

  17. Pediatric acute respiratory distress syndrome: fluid management in the PICU

    Directory of Open Access Journals (Sweden)

    Sarah A Ingelse

    2016-03-01

    Full Text Available The administration of an appropriate volume of intravenous fluids, while avoiding fluid overload, is a major challenge in the pediatric intensive care unit. Despite our efforts, fluid overload is a very common clinical observation in critically ill children, in particular in those with pediatric acute respiratory distress syndrome (PARDS. Patients with ARDS have widespread damage of the alveolar capillary barrier, potentially making them vulnerable to fluid overload with the development of pulmonary edema leading to prolonged course of disease. Indeed, studies in adults with ARDS have shown that an increased cumulative fluid balance is associated with adverse outcome. However, age-related differences in the development and consequences of fluid overload in ARDS may exist due to disparities in immunologic response and body water distribution. This systematic review summarizes the current literature on fluid imbalance and management in PARDS, with special emphasis on potential differences with adult patients. It discusses the adverse effects associated with fluid overload and the corresponding possible pathophysiological mechanisms of its development. Our intent is to provide an incentive to develop age-specific fluid management protocols to improve PARDS outcomes.

  18. Management of Patients with Acute Lower Gastrointestinal Bleeding

    Science.gov (United States)

    Strate, Lisa L.; Gralnek, Ian M.

    2016-01-01

    This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery

  19. Using multifaceted education to improve management in acute viral bronchiolitis.

    Science.gov (United States)

    Murch, Hannah; Oakley, Juliette; Pierrepoint, Marcus; Powell, Colin

    2015-07-01

    To establish current bronchiolitis management across hospitals in Wales, improve compliance with national guidelines and standardise evidence-based clinical practice. A complete audit cycle with implementation of a multifaceted education bundle prior to the follow-up audit. Twelve acute paediatric departments between 1 November and 31 December in 2012 and 2013. All infants under 12 months with a clinical diagnosis of bronchiolitis. The first audit assessed management of bronchiolitis with reference to both the Scottish Intercollegiate Guideline Network (SIGN) guidelines and local hospital guidelines. Following analysis and dissemination of these results, an education bundle was implemented nationwide, with completion of the audit cycle to assess change. Compliance with SIGN recommendations for investigation, treatment and discharge. Compliance with the education bundle requirements also assessed in 2013. Data were collected for 1599 infants. The education bundle was delivered in all hospitals. The level of severity, defined by oxygen saturations in air at presentation, length of stay and paediatric intensive care unit transfers, was equivalent for both years. Mean compliance percentage (95% CI) across Wales significantly improved between 2012 and 2013, with compliance with investigations increasing from 50% (46% to 53%) to 71% (68% to 74%), with management increasing from 65% (61% to 68%) to 74% (71% to 77%), and overall compliance improving from 38% (37% to 39%) to 59% (56% to 62%) in 2013. This audit demonstrated a significant improvement in compliance following implementation of our educational bundle. This has enabled improvement in standardised and evidence-based patient care across Wales. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Final environmental impact statement. Management of commercially generated radioactive waste. Volume 3. Public comments hearing board report

    International Nuclear Information System (INIS)

    1980-10-01

    This EIS analyzes the significant environmental impacts that could occur if various technologies for management and disposal of high-level and transuranic wastes from commercial nuclear power reactors were to be developed and implemented. This EIS will serve as the environmental input for the decision on which technology, or technologies, will be emphasized in further research and development activities in the commercial waste management program. The action proposed in this EIS is to (1) adopt a national strategy to develop mined geologic repositories for disposal of commercially generated high-level and transuranic radioactive waste (while continuing to examine subseabed and very deep hole disposal as potential backup technologies) and (2) conduct a R and D program to develop such facilities and the necessary technology to ensure the safe long-term containment and isolation of these wastes. The Department has considered in this statement: development of conventionally mined deep geologic repositories for disposal of spent fuel from nuclear power reactors and/or radioactive fuel reprocessing wastes; balanced development of several alternative disposal methods; and no waste disposal action. This volume contains written public comments and hearing board responses and reports offered on the draft statement

  1. Do published ADA studies support the ADA-EASD position statement for the management of hyperglycaemia in type 2 diabetics?

    Science.gov (United States)

    Rimareix, Frédérique; Bauduceau, Bernard

    2013-07-01

    The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a position statement in 2012 on the management of hyperglycaemia in patients with type 2 diabetes. The Société Francophone du Diabète (SFD) adopted it while awaiting future French recommendations. This new care approach individualises the therapeutic choices and objectives for each patient based on their characteristics, through emphasis on the need for mutual cooperation with the patient in decision-making. Glycaemic management should naturally be considered in the context of overall cardiovascular risk reduction, which should remain the primary objective of treatment. The cornerstone of this treatment is based on lifestyle modifications, with the addition of metformin monotherapy if the desired glycaemic control is not attained. There are multiple second- and third-line treatment possibilities, and insulin therapy is an option that can be considered early in the bitherapy stage. On the whole, large published studies at the ADA conference in Philadelphia in June 2012, which are the subject of this article, support this patient-centred position statement. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  2. Final environmental impact statement. Management of commercially generated radioactive waste. Volume 3. Public comments hearing board report

    Energy Technology Data Exchange (ETDEWEB)

    1980-10-01

    This EIS analyzes the significant environmental impacts that could occur if various technologies for management and disposal of high-level and transuranic wastes from commercial nuclear power reactors were to be developed and implemented. This EIS will serve as the environmental input for the decision on which technology, or technologies, will be emphasized in further research and development activities in the commercial waste management program. The action proposed in this EIS is to (1) adopt a national strategy to develop mined geologic repositories for disposal of commercially generated high-level and transuranic radioactive waste (while continuing to examine subseabed and very deep hole disposal as potential backup technologies) and (2) conduct a R and D program to develop such facilities and the necessary technology to ensure the safe long-term containment and isolation of these wastes. The Department has considered in this statement: development of conventionally mined deep geologic repositories for disposal of spent fuel from nuclear power reactors and/or radioactive fuel reprocessing wastes; balanced development of several alternative disposal methods; and no waste disposal action. This volume contains written public comments and hearing board responses and reports offered on the draft statement.

  3. THE STATEMENT OF CASH FLOWS USING FINANCIAL STATEMENT EQUATIONS

    OpenAIRE

    Harold Fletcher; Thomas Ulrich

    2010-01-01

    This paper addresses one of the more difficult topics in teaching MBA level financial management, the statement of cash flows. By employing financial statement equations in preparing the statement of cash flows, students: (1) are employing tools that they are more familiar and comfortable with which mitigates their anxiety and enhances their understanding, (2) are better able to understand the logic of the statement of cash flows and the relationships that exist between it and the income stat...

  4. Development of Novel Local Analgesics for Management of Acute Tissue Injury Pain

    Science.gov (United States)

    2017-09-01

    Project Manager Boston Biomedical Innovation Center 215 First Street, Suite 500; Cambridge, MA 02142 857-307-2441 | rblackman1@partners.org | b...AWARD NUMBER: W81XWH-15-1-0480 TITLE: Development of Novel Local Analgesics for Management of Acute Tissue Injury Pain PRINCIPAL...31/2017 4. TITLE AND SUBTITLE Development of Novel Local Analgesics for Management of Acute Tissue Injury Pain 5a. CONTRACT NUMBER Tissue Injury

  5. Consensus statement: Management of drug-induced liver injury in HIV-positive patients treated for TB

    Directory of Open Access Journals (Sweden)

    E Jong

    2013-09-01

    Full Text Available Drug-induced liver injury (DILI in HIV/tuberculosis (TB co-infected patients is a common problem in the South African setting, and re-introduction of anti-TB drugs can be challenging for the healthcare worker. Although international guidelines on the re-introduction of TB treatment are available, the definition of DILI is not uniform, management of antiretroviral therapy (ART in HIV co-infection is not mentioned, and the guidance on management is not uniform and lacks a practical approach. In this consensus statement, we summarise important aspects of DILI and provide practical guidance for healthcare workers for different patient groups and healthcare settings on the re-introduction of anti-TB drugs and ART in HIV/TB co-infected individuals presenting with DILI.

  6. Effect of Professionalism, Competence, Knowledge of Financial Management, and Intensity Guidance Apparatus Inspectorate for Quality of Financial Statements (Study on Inspectorate Regencies/Cities in Aceh

    Directory of Open Access Journals (Sweden)

    Darwanis Darwanis

    2016-04-01

    Full Text Available This research aims to: 1. Examine the influence of professionalism, competence, knowledge of financial management and intensity guidance apparatus Inspectorate together to the quality of the financial statements of Regions; 2. Examine the effect of professionalism partially on the quality of the financial statements of Regions; 3. Test the effect of partial competencies to the quality of the financial statements of Regions; 4. Examine the effect of knowledge of financial management partially on the quality of the financial statements of Regions; 5. The authorities test the effects of intensity guidance apparatus partially on the quality of the financial statements of Regions. The object of this research is the Government Internal Supervisory Apparatus (APIP working in the Inspectorate districts/cities in Aceh amounted to 23 people who perform inspection tasks.  The source of data in this study uses primary data which is the result of the acquisition of questionnaires from survey respondent, while research data collection techniques are done with documentation techniques. The analytical method used is Multiple Linear Regression Analysis. The results showed that: 1. Professionalism, competence, knowledge of financial management and intensity guidance apparatus jointly affect the quality of financial reporting area. 2. Professionalism partially affects the quality of financial reporting area. 3. Competence partially affects the quality of financial reporting area. 4. Knowledge of financial management partially affects the quality of financial reporting area. 5. The intensity guidance apparatus partially affects the quality of financial reporting area.

  7. Clinical practice guidelines for the surgical management of colon cancer: a consensus statement of the Hellenic and Cypriot Colorectal Cancer Study Group by the HeSMO.

    Science.gov (United States)

    Xynos, Evaghelos; Gouvas, Nikolaos; Triantopoulou, Charina; Tekkis, Paris; Vini, Louiza; Tzardi, Maria; Boukovinas, Ioannis; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Chrysou, Evangelia; Dervenis, Christos; Emmanouilidis, Christos; Georgiou, Panagiotis; Katopodi, Ourania; Kountourakis, Panteleimon; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Vassiliou, Vassilios; Xynogalos, Spyridon; Ziras, Nikolaos; Karachaliou, Niki; Zoras, Odysseas; Agalianos, Christos; Souglakos, John

    2016-01-01

    Despite considerable improvement in the management of colon cancer, there is a great deal of variation in the outcomes among European countries, and in particular among different hospital centers in Greece and Cyprus. Discrepancy in the approach strategies and lack of adherence to guidelines for the management of colon cancer may explain the situation. The aim was to elaborate a consensus on the multidisciplinary management of colon cancer, based on European guidelines (ESMO and EURECCA), and also taking into account local special characteristics of our healthcare system. Following discussion and online communication among members of an executive team, a consensus was developed. Statements entered the Delphi voting system on two rounds to achieve consensus by multidisciplinary international experts. Statements with an agreement rate of ≥80% achieved a large consensus, while those with an agreement rate of 60-80% a moderate consensus. Statements achieving an agreement of colon cancer were subjected to the Delphi methodology. Voting experts were 109. The median rate of abstain per statement was 10% (range: 0-41%). In the end of the voting process, all statements achieved a consensus by more than 80% of the experts. A consensus on the management of colon cancer was developed by applying the Delphi methodology. Guidelines are proposed along with algorithms of diagnosis and treatment. The importance of centralization, care by a multidisciplinary team, and adherence to guidelines is emphasized.

  8. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume IV of V

    International Nuclear Information System (INIS)

    1997-01-01

    The Final Waste Management Programmatic Environmental Impact Statement (WM PEIS) examines the potential environmental and cost impacts of strategic management alternatives for managing five types of radioactive and hazardous wastes that have resulted and will continue to result from nuclear defense and research activities at a variety of sites around the United States. The five waste types are low-level mixed waste, low-level waste, transuranic waste, high-level waste, and hazardous waste. The WM PEIS provides information on the impacts of various siting alternatives which the Department of Energy (DOE) will use to decide at which sites to locate additional treatment, storage, and disposal capacity for each waste type.Transportation is an integral component of the alternatives being considered for each type of radioactive waste in the U.S. Department of Energy (DOE) Waste Management Programmatic Environmental Impact Statement (WM PEIS). The types of radioactive waste considered in Part I are high-level waste (HLW), low-level waste (LLW), transuranic waste (TRUW), and low-level mixed waste (LLMW). For some alternatives, radioactive waste would be shipped among the DOE sites at various stages of the treatment, storage, and disposal (TSD) process. The magnitude of the transportation-related activities varies with each alternative, ranging from minimal transportation for decentralized approaches to significant transportation for some centralized approaches. The human health risks associated with transporting various waste materials were assessed to ensure a complete appraisal of the impacts of each PEIS alternative being considered

  9. Department of Energy Programmatic Spent Nuclear Fuel Management and Idaho National Engineering Laboratory Environmental Restoration and Waste Management Programs, Draft Environmental Impact Statement

    International Nuclear Information System (INIS)

    1994-06-01

    Volume 1 to the Department of Energy's Programmatic Spent Nuclear Fuel Management and Idaho National Engineering Laboratory Environmental Management Programs Environmental Impact Statement evaluates a range of alternatives for managing naval spent nuclear fuel expected to be removed from US Navy nuclear-powered vessels and prototype reactors through the year 2035. The Environmental Impact Statement (EIS) considers a range of alternatives for examining and storing naval spent nuclear fuel, including alternatives that terminate examination and involve storage close to the refueling or defueling site. The EIS covers the potential environmental impacts of each alternative, as well as cost impacts and impacts to the Naval Nuclear Propulsion Program mission. This Appendix covers aspects of the alternatives that involve managing naval spent nuclear fuel at four naval shipyards and the Naval Nuclear Propulsion Program Kesselring Site in West Milton, New York. This Appendix also covers the impacts of alternatives that involve examining naval spent nuclear fuel at the Expended Core Facility in Idaho and the potential impacts of constructing and operating an inspection facility at any of the Department of Energy (DOE) facilities considered in the EIS. This Appendix also considers the impacts of the alternative involving limited spent nuclear fuel examinations at Puget Sound Naval Shipyard. This Appendix does not address the impacts associated with storing naval spent nuclear fuel after it has been inspected and transferred to DOE facilities. These impacts are addressed in separate appendices for each DOE site

  10. Introduction of an acute surgical unit: comparison of performance indicators and outcomes for operative management of acute appendicitis.

    Science.gov (United States)

    Lancashire, John F; Steele, M; Parker, D; Puhalla, H

    2014-08-01

    The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia. A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients. Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay. This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.

  11. Acute respiratory distress syndrome: epidemiology and management approaches

    Directory of Open Access Journals (Sweden)

    Walkey AJ

    2012-07-01

    Full Text Available Allan J Walkey,1 Ross Summer,1 Vu Ho,1 Philip Alkana21The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; 2Asthma Research Center, Brigham and Women's Hospital, Boston, MA, USAAbstract: Acute lung injury and the more severe acute respiratory distress syndrome represent a spectrum of lung disease characterized by the sudden onset of inflammatory pulmonary edema secondary to myriad local or systemic insults. The present article provides a review of current evidence in the epidemiology and treatment of acute lung injury and acute respiratory distress syndrome, with a focus on significant knowledge gaps that may be addressed through epidemiologic methods.Keywords: acute lung injury, acute respiratory distress syndrome, review, epidemiology

  12. Are diuretics harmful in the management of acute kidney injury?

    Science.gov (United States)

    Ejaz, A Ahsan; Mohandas, Rajesh

    2014-03-01

    To assess the role of diuretics in acute kidney injury (AKI) and their effectiveness in preventing AKI, achieving fluid balance, and decreasing progression to chronic kidney disease (CKD). Diuretics are associated with increased risk for AKI. The theoretical advantage of diuretic-induced preservation of renal medullary oxygenation to prevent AKI has not been proven. A higher cumulative diuretic dose during the dialysis period can cause hypotension and increase mortality in a dose-dependent manner. Data on the use of forced euvolemic diuresis to prevent AKI remains controversial. Positive fluid balance has emerged as an independent predictor of adverse outcomes. Post-AKI furosemide dose had a favorable effect on mortality due in part to the reduction of positive fluid balance. There are exciting experimental data suggesting that spironolactone may prevent AKI once an ischemic insult has occurred and thus prevent the progression to CKD. Diuretics are ineffective and even detrimental in the prevention and treatment of AKI, and neither shorten the duration of AKI, nor reduce the need for renal replacement therapy. Diuretics have an important role in volume management in AKI, but they are not recommended for the prevention of AKI. There is increased emphasis on the prevention of progression of AKI to CKD.

  13. Management of acute bursitis: outcome study of a structured approach.

    Science.gov (United States)

    Stell, I M

    1999-01-01

    In patients with septic bursitis the indications for admission and surgical intervention remain unclear, and practice has varied widely. The effectiveness of a conservative outpatient based approach was assessed by an outcome study in a prospective case series. Consecutive patients attending an emergency department with acute swelling of the olecranon or prepatellar bursa were managed according to a structured approach, subjective and objective outcomes being assessed after two to three days, and subsequently as required until clinical discharge. Long-term outcomes were assessed by telephone follow-up for up to eighteen months. 47 patients were included in the study: 22 had septic bursitis, 15 of the olecranon bursa and 7 of the prepatellar bursa. The mean visual analogue pain scores of those with septic bursitis improved from 4.8 at presentation to 1.7 at first follow-up for olecranon bursitis, and from 3.8 to 2.7 for prepatellar bursitis. Symptoms improved more slowly for patients with non-septic bursitis. No patients were admitted initially, but 2 were admitted (two days each) after the first follow-up appointment. One patient had incision and drainage on the third attendance, and 3 patients developed discharging sinuses, which all healed spontaneously. All patients made a good long-term symptomatic recovery and all could lean on the elbow or kneel by the end of the follow-up period. The management protocol, with specific criteria for admission and surgical intervention, thus produced good results with little need for operation or admission. PMID:10692903

  14. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    van Diepen, Sean; Katz, Jason N; Albert, Nancy M; Henry, Timothy D; Jacobs, Alice K; Kapur, Navin K; Kilic, Ahmet; Menon, Venu; Ohman, E Magnus; Sweitzer, Nancy K; Thiele, Holger; Washam, Jeffrey B; Cohen, Mauricio G

    2017-10-17

    Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. © 2017 American Heart Association, Inc.

  15. Detached Statements

    Directory of Open Access Journals (Sweden)

    Mark McBride

    2018-04-01

    Full Text Available Joseph Raz has introduced an interesting class of statements —detached statements— into the philosophical lexicon. In brief, such statements are (informa- tive normative statements, yet the speaker does not, in so uttering them, express or convey acceptance of the point of view of the hearer to whom they are addressed (as contrasted with committed statements, where the speaker does express or convey such acceptance. I propose to offer a novel analysis of such statements (and to clear away some confusions about them. In brief, such statements will be analysed as wide-scope normative conditionals.

  16. Impact of electronic-alerting of acute kidney injury: workgroup statements from the 15(th) ADQI Consensus Conference.

    Science.gov (United States)

    Hoste, Eric A J; Kashani, Kianoush; Gibney, Noel; Wilson, F Perry; Ronco, Claudio; Goldstein, Stuart L; Kellum, John A; Bagshaw, Sean M

    2016-01-01

    Among hospitalized patients, acute kidney injury is common and associated with significant morbidity and risk for mortality. The use of electronic health records (EHR) for prediction and detection of this important clinical syndrome has grown in the past decade. The steering committee of the 15(th) Acute Dialysis Quality Initiative (ADQI) conference dedicated a workgroup with the task of identifying elements that may impact the course of events following Acute Kidney Injury (AKI) e-alert. Following an extensive, non-systematic literature search, we used a modified Delphi process to reach consensus regarding several aspects of the utilization of AKI e-alerts. Topics discussed in this workgroup included progress in evidence base practices, the characteristics of an optimal e-alert, the measures of efficacy and effectiveness, and finally what responses would be considered best practices following AKI e-alerts. Authors concluded that the current evidence for e-alert system efficacy, although growing, remains insufficient. Technology and human-related factors were found to be crucial elements of any future investigation or implementation of such tools. The group also concluded that implementation of such systems should not be done without a vigorous plan to evaluate the efficacy and effectiveness of e-alerts. Efficacy and effectiveness of e-alerts should be measured by context-specific process and patient outcomes. Finally, the group made several suggestions regarding the clinical decision support that should be considered following successful e-alert implementation. This paper reflects the findings of a non-systematic review and expert opinion. We recommend implementation of the findings of this workgroup report for use of AKI e-alerts.

  17. Clinical Characteristics, Management, and Outcomes of Suspected Poststroke Acute Coronary Syndrome

    OpenAIRE

    Biso, Sylvia Marie; Lu, Marvin; De Venecia, Toni Anne; Wongrakpanich, Supakanya; Rodriguez-Ziccardi, Mary; Yadlapati, Sujani; Kishlyansky, Marina; Rammohan, Harish Seetha; Figueredo, Vincent M.

    2017-01-01

    Background Acute coronary syndrome (ACS) can complicate acute ischemic stroke, causing significant morbidity and mortality. To date, literatures that describe poststroke acute coronary syndrome and its morbidity and mortality burden are lacking. Methods This is a single center, retrospective study where clinical characteristics, cardiac evaluation, and management of patients with suspected poststroke ACS were compared and analyzed for their association with inpatient mortality and 1-year all-...

  18. The Influence of External User Interdependence of Financial Statements, Possibility of Clients Facing Financial Difficulties, and Auditor Evaluation of Management Integrity To Acceptable Audit Risk.

    Directory of Open Access Journals (Sweden)

    Andini Sih Afsari Utami

    2016-12-01

    Full Text Available The purpose of this research is to analyze. Analyses the influence of external users reliance on financial statements, likelihood of financial difficulties and management integrity toward acceptable audit risk were performed with 10 public accountant office who had listed from Direktorat IAPI 2013. The sample used the “Gay” theory. The analyzed method in this research uses multiple linear. The result shown that performing external users reliance on financial statements significantly influences toward acceptable audit risk, likelihood of financial difficulties significantly influences toward acceptable audit risk, and management integrity significantly influences toward acceptable audit risk.

  19. Preliminary Hanford technical input for the Department of Energy programmatic spent nuclear fuel management and Idaho National Engineering Laboratory environmental restoration and waste management programs environmental impact statement

    International Nuclear Information System (INIS)

    Bergsman, K.H.

    1995-03-01

    The US Department of Energy (DOE) is currently evaluating its programmatic options for the safe management of its diverse spent nuclear fuel (SNF) inventory in the Department of Energy Programmatic Spent Nuclear Fuel Management and Idaho National Engineering Laboratory Environmental Restoration and Waste Management Programs Environmental Impact Statement (SNF and INEL EIS). In the SNF and INEL EIS, the DOE is assessing five alternatives for SNF management, which consider at which of the DOE sites each of the various SNF types should be managed until ultimate disposition. The range of SNF inventories considered for management at the Hanford Site in the SNF and INEL EIS include the current Hanford Site inventory, only the current Hanford Site defense production SNF inventory, the DOE complex-wide SNF inventory, or none at all. Site-specific SNF management decisions will be evaluated in separate National Environmental Policy Act evaluations. Appendixes A and B include information on (1) additional facilities required to accommodate inventories of SNF within each management alternative, (2) existing and new SNF management facility descriptions, (3) facility costs for construction and operation, (4) facility workforce requirements for construction and operation, and (5) facility discharges. The information was extrapolated from existing analyses to the extent possible. New facility costs, manpower requirements, and similar information are based on rough-order-of-magnitude estimates

  20. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association.

    Science.gov (United States)

    Chow, Sheryl L; Maisel, Alan S; Anand, Inder; Bozkurt, Biykem; de Boer, Rudolf A; Felker, G Michael; Fonarow, Gregg C; Greenberg, Barry; Januzzi, James L; Kiernan, Michael S; Liu, Peter P; Wang, Thomas J; Yancy, Clyde W; Zile, Michael R

    2017-05-30

    Natriuretic peptides have led the way as a diagnostic and prognostic tool for the diagnosis and management of heart failure (HF). More recent evidence suggests that natriuretic peptides along with the next generation of biomarkers may provide added value to medical management, which could potentially lower risk of mortality and readmissions. The purpose of this scientific statement is to summarize the existing literature and to provide guidance for the utility of currently available biomarkers. The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. A number of biomarkers associated with HF are well recognized, and measuring their concentrations in circulation can be a convenient and noninvasive approach to provide important information about disease severity and helps in the detection, diagnosis, prognosis, and management of HF. These include natriuretic peptides, soluble suppressor of tumorgenicity 2, highly sensitive troponin, galectin-3, midregional proadrenomedullin, cystatin-C, interleukin-6, procalcitonin, and others. There is a need to further evaluate existing and novel markers for guiding therapy and to summarize their data in a standardized format to improve communication among researchers and practitioners. HF is a complex syndrome involving diverse pathways and pathological processes that can manifest in circulation as biomarkers. A number of such biomarkers are now clinically available, and monitoring their

  1. Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis.

    Science.gov (United States)

    Beck, Belinda R; Daly, Robin M; Singh, Maria A Fiatarone; Taaffe, Dennis R

    2017-05-01

    Osteoporotic fractures are associated with substantial morbidity and mortality. Although exercise has long been recommended for the prevention and management of osteoporosis, existing guidelines are often non-specific and do not account for individual differences in bone health, fracture risk and functional capacity. The aim of the current position statement is to provide health practitioners with specific, evidence-based guidelines for safe and effective exercise prescription for the prevention or management of osteoporosis, accommodating a range of potential comorbidities. Position statement. Interpretation and application of research reports describing the effects of exercise interventions for the prevention and management of low bone mass, osteoporosis and osteoporotic fracture. Evidence from animal and human trials indicates that bone responds positively to impact activities and high intensity progressive resistance training. Furthermore, the optimisation of muscle strength, balance and mobility minimises the risk of falls (and thereby fracture), which is particularly relevant for individuals with limited functional capacity and/or a very high risk of osteoporotic fracture. It is important that all exercise programs be accompanied by sufficient calcium and vitamin D, and address issues of comorbidity and safety. For example, loaded spine flexion is not recommended, and impact activities may require modification in the presence of osteoarthritis or frailty. Specific guidelines for safe and effective exercise for bone health are presented. Individual exercise prescription must take into account existing bone health status, co-morbidities, and functional or clinical risk factors for falls and fracture. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  2. Superselective transarterial embolization for the management of acute gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon; Cho, Chol Kyoon; Kang, Heoung Keun

    2006-01-01

    We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During the

  3. Superselective transarterial embolization for the management of acute gastrointestinal bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, In Kyoung; Kim, Young Min; Kim, Jeong; Shin, Sang Soo; Yoon Woong; Kim, Jae Kyu; Park, Jin Gyoon [Chonnam National University Hospital, Gwangju (Korea, Republic of); Cho, Chol Kyoon; Kang, Heoung Keun [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2006-03-15

    We wanted to evaluate the safety and effectiveness of superselective transarterial embolization for the management of gastrointestinal bleeding. We evaluated 97 of 115 patients who had undergone diagnostic angiography and transarterial embolization for gastrointestinal bleeding from February 2001 to July 2004, and they subsequently underwent superselective transarterial embolization. Their ages ranged from 17 to 88 years (mean age: 58.5 years), and 73 were men and 24 were women. The etiologies were a postoperative condition (n=31), ulcer (n=23), Mallory-Weiss syndrome (n=3), trauma (n=3), pseudoaneurysm from pancreatitis (n=3), diverticula (n=2), inflammatory bowel disease (n=2), tumor (n=2), Behcet's disease (n=2), hemobilia (n=1), and unknown origin (n=25). The regions of bleeding were the esophagus (n=3), stomach and duodenum (n=41), small bowel (n=38) and colon (n=15). All the patients underwent superselective transarterial embolization using microcoils, gelfoam or a combination of microcoils and gelfoam. Technical success was defined as devascularization of targeted vascular lesion or the disappearance of extravasation of the contrast media, as noted on the angiography after embolization. Clinical success was defined as the disappearance of clinical symptoms and the reestablishment of normal cardiovascular hemodynamics after transarterial embolization without any operation or endoscopic management. The technical success rate was 100%. The primary clinical success rate was 67% (65 of 97 patients). Of the 32 primary failures, fourteen patients underwent repeat embolization; of these, clinical success was achieved in all the patients and so the secondary clinical success rate was 81% (79 of 97 patients). Of the 18 patients with primary failures, five patients underwent operation, one patient underwent endoscopic management and the others died during the observation period due to disseminated coagulopathy or complications of their underlying diseases. During

  4. ANDRA - National Radioactive Waste Management Agency. Activity and sustainable development report 2010 - a year with Andra. Management report and financial statements 2010 - Managing today to prepare for tomorrow

    International Nuclear Information System (INIS)

    2011-01-01

    Created in 1979 within the CEA, the National Radioactive Waste Management Agency (ANDRA) was established by the December 1991 Waste Act as a public body in charge of the long-term management of all radioactive waste, under the supervision of the Ministry of Ecology, Energy, Sustainable Development and the Sea (formerly the Ministry of Industry and the Ministry of Environment), and the Ministry of Research. Its 3 basic missions were extended and their funding secured through the 2006 Planning Act: - a R and D mission to propose safe long-term solution for radioactive waste without current disposal system; this mission includes long-term storage, since the 2006 Planning Act, in order to propose interim solutions while final ones are being studied; - an industrial mission concerning, on one hand, waste acceptance criteria and control and, on the other hand, siting, construction, operation, closure and monitoring of repositories. This mission includes as well a public service mission in terms of i) collection of waste of the 'small-scale nuclear activities' producers or owners (including the so-called 'household' radioactive waste, i.e. waste owned by private individuals) and ii) clean-up and rehabilitation of orphan polluted sites; - an information mission, notably through the regular publication of the National Inventory of radioactive materials and waste. This mission includes as well an active policy of dialogue with stakeholders both at national and local level. This document is the activity and Sustainable Development Report, with the management and financial statements report, of the Andra for the year 2010

  5. Effect of Zinc supplementation on the Management of Acute ...

    African Journals Online (AJOL)

    Supplementing the treatment of acute watery diarrhea with Zinc in just 2 cases will prevent recurrence of diarrhea in one of the children in the following 12 weeks. Fourteen days supplementation of Zinc in the treatment of acute diarrhea in children significantly reduced the average number of watery stools and duration of ...

  6. Acute abdominal pain: Advances in diagnosis and management

    NARCIS (Netherlands)

    Gans, S.L.

    2015-01-01

    The term acute abdominal pain refers to non-traumatic abdominal pain of rapid onset with duration of less than five days. Acute abdominal pain can be divided in urgent and non-urgent conditions. Urgent causes require treatment within 24 hours to prevent serious complications whereas for non-urgent

  7. Acute Management and Secondary Prophylaxis of Esophageal Variceal Bleeding: A Western Canadian Survey

    Directory of Open Access Journals (Sweden)

    Justin Cheung

    2006-01-01

    Full Text Available BACKGROUND: Acute esophageal variceal bleeding (EVB is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.

  8. Acute Mastoiditis in Children: Susceptibility Factors and Management

    Directory of Open Access Journals (Sweden)

    Slobodan Spremo

    2007-05-01

    Full Text Available The objective was to review our experience with clinical course, diagnostic and therapeutic profile of children treated for acute mastoiditis, and to investigate for possible susceptibility factors. Study was designed as retrospective review of pediatric patients presenting with acute mastoiditis secondary to acute otitis media over the last 6 years, from 2000 to 2006. The study involved children aged from 1 to 16 years treated for acute mastoiditis and subsequent intratemporal and intracranial complications in Clinic for otorhinolaryngology, Clinic Center Banja Luka. Selected clinical parameters, mastoid coalescence and risk factors for necessity of surgical intervention were analyzed. Medical history review of a total of 13 patients with acute mastoiditis was analyzed. Acute coalescent mastoiditis occurred 11 patients (84% while noncoalescent form of acute mastoiditis occurred in 2 cases (16%. Intracranial complication occurred in 3 patients (2 meningitis and 1 peridural intracranial abscess, while 2 patients had intratemporal complication (subperiostal abscess associated to coalescent mastoiditis. We observed clinical profile of acute mastoiditis in regard to pathology found on the tympanic membrane, middle ear mucosa and destructions on the bony wall of the middle ear and mastoid. The main signs of progressive infection were tympanic membrane perforation, pulsatile suppurative secretion from the mucosa, and intratemporal abscess. All patients with coalescent mastoiditis required mastoidectomy, while noncoalescent mastoiditis was treated conservatively with broad-spectrum intravenous antibiotics and myringotomy. In conclusion acute mastoiditis is uncommon but serious complication of acute otitis media in children associated with significant morbidity. Coalescent mastoiditis concomitant with subperiostal abscess, intracranial complications and mastoiditis not responsive after 48 hours to intravenous antibiotics should urge clinician to timely

  9. [Inpatient acute pain management in German hospitals: results from the national survey "Akutschmerzzensus 2012"].

    Science.gov (United States)

    Erlenwein, J; Stamer, U; Koschwitz, R; Koppert, W; Quintel, M; Meißner, W; Petzke, F

    2014-04-01

    In 2007, the German national guidelines on "Treatment of acute perioperative and post-traumatic pain" were published. The aim of this study was to describe current structure and process data for acute pain management in German hospitals and to compare how the guidelines and other initiatives such as benchmarking or certification changed the healthcare landscape in the last decade. All directors of German departments of anesthesiology according to the DGAI ("Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin", German Society for Anesthesiology and Intensive Care) were mailed a standardized questionnaire on structures and processes of acute pain management in their hospitals. A total of 403 completed questionnaires (46 %) could be evaluated. Of hospitals, 81 % had an acute pain service (ASD), whereby only 45 % met defined quality criteria. Written standards for acute pain management were available in 97 % of the hospitals on surgical wards and 51 % on nonsurgical wards. In 96 %, perioperative pain was regularly recorded (generally pain at rest and/or movement, pain-related functional impairment in 16 % only). Beside these routine measurements, only 38 % of hospitals monitored pain for effectiveness after acute medications. Often interdisciplinary working groups and/or pain managers are established for hospital-wide control. As specific therapy, the patient-controlled analgesia and epidural analgesia are largely prevalent (> 90 % of all hospitals). In the last decade, intravenous and oral opioid administration of opioids (including slow release preparations) has become established in acute pain management. The survey was representative by evaluating 20 % of all German hospitals. The organizational requirements for appropriate pain management recommended by the German guidelines for acute pain recommended have been established in the hospital sector in recent years. However, the organizational enforcement for acute pain management in

  10. The use of fund accounting and the need for single fund reporting by institutional healthcare providers. Principles and Practices Board Statement No. 8. Healthcare Financial Management Association.

    Science.gov (United States)

    1986-06-01

    For many years, hospitals and other institutional healthcare providers used fund accounting as a basis for presenting their financial statements. Recently, authoritative literature has placed less emphasis on separate fund reporting. This is evidenced by the reduction of fund classifications specified in the literature. This trend seems to follow the recognition that institutional healthcare activities should be reported in a manner comparable to other businesses. The Principles and Practices Board (P&P Board) of the Healthcare Financial management Association believes that general purpose financial statements of institutional healthcare providers should be comparable to reporting by other businesses. That is, all assets, liabilities, and equity are presented in a single aggregated balance sheet without differentiation by fund. This form of presentation, referred to in this statement as single fund reporting, should be used by all institutional healthcare providers including those that are part of HMOs, universities, municipalities, and other larger entities when separate reports of the provider are issued. The P&P Board is studying other significant issues concerning the reporting of revenues and components of equity and changes therein. The conclusion in this statement can be implemented even though conclusions on these related subjects are not yet complete. The P&P Board recognizes that certain circumstances may require detailed records and reports for special purposes. This statement deals only with those general purpose financial statements on which an independent accountant's opinion is expressed.

  11. Frequency, Pattern and Management of Acute Abdomen in Dengue Fever in Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Muhammad Shamim

    2010-07-01

    Conclusion: Early diagnosis and prompt conservative management of dengue acute abdomen is necessary to avoid mortality and emergency surgery-related morbidity. However, if needed, surgery can be performed with acceptable morbidity.

  12. Tokyo Guidelines 2018: management strategies for gallbladder drainage in patients with acute cholecystitis (with videos)

    NARCIS (Netherlands)

    Mori, Yasuhisa; Itoi, Takao; Baron, Todd H.; Takada, Tadahiro; Strasberg, Steven M.; Pitt, Henry A.; Ukai, Tomohiko; Shikata, Satoru; Noguchi, Yoshinori; Teoh, Anthony Yuen Bun; Kim, Myung-Hwan; Asbun, Horacio J.; Endo, Itaru; Yokoe, Masamichi; Miura, Fumihiko; Okamoto, Kohji; Suzuki, Kenji; Umezawa, Akiko; Iwashita, Yukio; Hibi, Taizo; Wakabayashi, Go; Han, Ho-Seong; Yoon, Yoo-Seok; Choi, In-Seok; Hwang, Tsann-Long; Chen, Miin-Fu; Garden, O. James; Singh, Harjit; Liau, Kui-Hin; Huang, Wayne Shih-Wei; Gouma, Dirk J.; Belli, Giulio; Dervenis, Christos; de Santibañes, Eduardo; Giménez, Mariano Eduardo; Windsor, John A.; Lau, Wan Yee; Cherqui, Daniel; Jagannath, Palepu; Supe, Avinash Nivritti; Liu, Keng-Hao; Su, Cheng-Hsi; Deziel, Daniel J.; Chen, Xiao-Ping; Fan, Sheung Tat; Ker, Chen-Guo; Jonas, Eduard; Padbury, Robert; Mukai, Shuntaro; Honda, Goro; Sugioka, Atsushi; Asai, Koji; Higuchi, Ryota; Wada, Keita; Yoshida, Masahiro; Mayumi, Toshihiko; Hirata, Koichi; Sumiyama, Yoshinobu; Inui, Kazuo; Yamamoto, Masakazu

    2018-01-01

    Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore,

  13. 78 FR 68469 - Draft General Management Plan/Wilderness Study/Environmental Impact Statement, Channel Islands...

    Science.gov (United States)

    2013-11-14

    ... decision making, which will allow managers to effectively address future opportunities and problems, such... will serve as the basis for future detailed management documents, such as five-year strategic plans and...

  14. Assessment of transportation risk for the U.S. Department of Energy Environmental Management programmatic environmental impact statement

    International Nuclear Information System (INIS)

    Chen, S.Y.; Monette, F.A.; Biwer, B.M.; Lazaro, M.A.; Hartmann, H.M.; Policastro, A.J.

    1995-01-01

    In its Programmatic Environmental Impact Statement (PEIS), the Office of Environmental Management (EM) of the U.S. Department of Energy (DOE) is considering a broad range of alternatives for the future management of radioactive and hazardous waste at the facilities of the DOE complex. The alternatives involve facilities to be used for treatment, storage, and disposal of various wastes generated from DOE environmental restoration activities and waste management operations. The evaluation includes five types of waste (four types of radioactive waste plus hazardous waste), 49 sites, and numerous cases associated with each alternative for waste management. In general, the alternatives are evaluated independently for each type of waste and reflect decentralized, regionalized, and centralized approaches. Transportation of waste materials is an integral component of the EM PEIS alternatives for waste management. The estimated impact on human health that is associated with various waste transportation activities is an important component of a complete appraisal of the alternatives. The transportation risk assessment performed for the EM PEIS is designed to ensure through uniform and judicious selection of models, data, and assumptions that relative comparisons of risk among the various alternatives are meaningful and consistent. Among other tasks, Argonne National Laboratory is providing technical assistance to the EM PEIS on transportation risk assessment. The objective is to perform a human health risk assessment for each type of waste relative to the EM PEIS alternatives for waste management. The transportation risk assessed is part of the overall impacts being analyzed for the EM PEIS to determine the safest, most environmentally and economically sound manner in which to satisfy requirements for waste management in the coming decades

  15. Comprehensive in-hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

    Science.gov (United States)

    Harjola, Veli-Pekka; Parissis, John; Brunner-La Rocca, Hans-Peter; Čelutkienė, Jelena; Chioncel, Ovidiu; Collins, Sean P; De Backer, Daniel; Filippatos, Gerasimos S; Gayat, Etienne; Hill, Loreena; Lainscak, Mitja; Lassus, Johan; Masip, Josep; Mebazaa, Alexandre; Miró, Òscar; Mortara, Andrea; Mueller, Christian; Mullens, Wilfried; Nieminen, Markku S; Rudiger, Alain; Ruschitzka, Frank; Seferovic, Petar M; Sionis, Alessandro; Vieillard-Baron, Antoine; Weinstein, Jean Marc; de Boer, Rudolf A; Crespo Leiro, Maria G; Piepoli, Massimo; Riley, Jillian P

    2018-04-30

    This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure. © 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.

  16. Medical Management of Acute Radiation Syndromes : Immunoprophylaxis by Antiradiation Vaccine

    Science.gov (United States)

    Popov, Dmitri; Maliev, Vecheslav; Jones, Jeffrey; Casey, Rachael; Kedar, Prasad

    Introduction: Traditionally, the treatment of Acute Radiation Syndrome (ARS) includes supportive therapy, cytokine therapy, blood component transfusions and even stem cell transplantation. Recommendations for ARS treatment are based on clinical symptoms, laboratory results, radiation exposure doses and information received from medical examinations. However, the current medical management of ARS does not include immune prophylaxis based on antiradiation vaccines or immune therapy with hyperimmune antiradiation serum. Immuneprophylaxis of ARS could result from stimulating the immune system via immunization with small doses of radiation toxins (Specific Radiation Determinants-SRD) that possess significant immuno-stimulatory properties. Methods: Principles of immuno-toxicology were used to derive this method of immune prophylaxis. An antiradiation vaccine containing a mixture of Hematotoxic, Neurotoxic and Non-bacterial (GI) radiation toxins, underwent modification into a toxoid forms of the original SRD radiation toxins. The vaccine was administered to animals at different times prior to irradiation. The animals were subjected to lethal doses of radiation that induced different forms of ARS at LD 100/30. Survival rates and clinical symptoms were observed in both control and vaccine-treated animals. Results: Vaccination with non-toxic doses of Radiation toxoids induced immunity from the elaborated Specific Radiation Determinant (SRD) toxins. Neutralization of radiation toxins by specific antiradiation antibodies resulted in significantly improved clinical symptoms in the severe forms of ARS and observed survival rates of 60-80% in animals subjected to lethal doses of radiation expected to induce different forms of ARS at LD 100/30. The most effective vaccination schedule for the antiradiation vaccine consisted of repeated injections 24 and 34 days before irradiation. The vaccine remained effective for the next two years, although the specific immune memory probably

  17. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement.

    Science.gov (United States)

    Flack, John M; Sica, Domenic A; Bakris, George; Brown, Angela L; Ferdinand, Keith C; Grimm, Richard H; Hall, W Dallas; Jones, Wendell E; Kountz, David S; Lea, Janice P; Nasser, Samar; Nesbitt, Shawna D; Saunders, Elijah; Scisney-Matlock, Margaret; Jamerson, Kenneth A

    2010-11-01

    Since the first International Society on Hypertension in Blacks consensus statement on the "Management of High Blood Pressure in African American" in 2003, data from additional clinical trials have become available. We reviewed hypertension and cardiovascular disease prevention and treatment guidelines, pharmacological hypertension clinical end point trials, and blood pressure-lowering trials in blacks. Selected trials without significant black representation were considered. In this update, blacks with hypertension are divided into 2 risk strata, primary prevention, where elevated blood pressure without target organ damage, preclinical cardiovascular disease, or overt cardiovascular disease for whom blood pressure consistently secondary prevention, where elevated blood pressure with target organ damage, preclinical cardiovascular disease, and/or a history of cardiovascular disease, for whom blood pressure consistently blood pressure is ≤10 mm Hg above target levels, monotherapy with a diuretic or calcium channel blocker is preferred. When blood pressure is >15/10 mm Hg above target, 2-drug therapy is recommended, with either a calcium channel blocker plus a renin-angiotensin system blocker or, alternatively, in edematous and/or volume-overload states, with a thiazide diuretic plus a renin-angiotensin system blocker. Effective multidrug therapeutic combinations through 4 drugs are described. Comprehensive lifestyle modifications should be initiated in blacks when blood pressure is ≥115/75 mm Hg. The updated International Society on Hypertension in Blacks consensus statement on hypertension management in blacks lowers the minimum target blood pressure level for the lowest-risk blacks, emphasizes effective multidrug regimens, and de-emphasizes monotherapy.

  18. Editor's Choice-The organization of chest pain units: Position statement of the Acute Cardiovascular Care Association.

    Science.gov (United States)

    Claeys, Marc J; Ahrens, Ingo; Sinnaeve, Peter; Diletti, Roberto; Rossini, Roberta; Goldstein, Patrick; Czerwińska, Kasia; Bueno, Héctor; Lettino, Maddalena; Münzel, Thomas; Zeymer, Uwe

    2017-04-01

    Chest pain units are defined as organizational short stay units with specific management protocols designed to facilitate and optimize the diagnosis of patients presenting with chest pain in the emergency department. The present document is intended to standardize and facilitate the installation of chest pain units nearby to the emergency department or as an integral part of the emergency department. Recommendations on organizational structure, physical and technical requirements and on disease management are presented. More standardized installation and implementation of chest pain units will enhance the quality of chest pain units and improve the quality of care of our chest pain patients.

  19. Hyperglycemia in acute ischemic stroke: pathophysiology and clinical management

    NARCIS (Netherlands)

    Kruyt, Nyika D.; Biessels, Geert Jan; DeVries, J. Hans; Roos, Yvo B.

    2010-01-01

    Patients with acute ischemic stroke frequently test positive for hyperglycemia, which is associated with a poor clinical outcome. This association between poor glycemic control and an unfavorable prognosis is particularly evident in patients with persistent hyperglycemia, patients without a known

  20. Management of acute complex traumatic wound with a dermal ...

    African Journals Online (AJOL)

    Background: Acute complex traumatic wounds of the lower limbs are usually ... The recovery is lengthy, and the outcome dependent on the initial injury, the surgical ... of fracture and use of a dermal regeneration template over the fracture site, ...

  1. Consumption coagulopathy in acute aortic dissection: principles of management.

    Science.gov (United States)

    Liu, Yuyong; Han, Lu; Li, Jiachen; Gong, Ming; Zhang, Hongjia; Guan, Xinliang

    2017-06-12

    The effect of acute aortic dissection itself on coagulopathy or surgery-related coagulopathy has never been specifically studied. The aim of the present study was to perioperatively describe consumption coagulopathy in patients with acute aortic dissection. Sixty-six patients with acute type A aortic dissection were enrolled in this study from January 2015 to September 2016. Thirty-six patients with thoracic aortic aneurysms were used as a control group during the same period. Consumption coagulopathy was evaluated using standard laboratory tests, enzyme-linked immunosorbent assay and thromboelastograghy at five perioperative time-points. A significant reduction in clotting factors and fibrinogen was observed at the onset of acute aortic dissection. Enzyme-linked immunosorbent assay and thromboelastograghy also revealed a persistent systemic activation of the coagulation system and the consumption of clotting factors. In contrast, although platelet counts were consistently low, we did not find that platelet function was more impaired in the acute aortic dissection group than the control group. After surgery, clotting factors and fibrinogen were more impaired than platelet function. Thus, we proposed that hemostatic therapy should focus on the rapid and sufficient supplementation of clotting factors and fibrinogen to improve consumption coagulopathy in patients with acute aortic dissection.

  2. Origin and evolution of the Office of Environmental Restoration and Waste Management programmatic environmental impact statement

    International Nuclear Information System (INIS)

    Strider, P.; Huizenga, D.

    1993-01-01

    Prior to November 1989, the diverse environmental restoration and waste management activities of the U.S. Department of Energy (DOE) were the responsibility of the various line organizations, which had the primary missions of weapons production, research, and related departmental activities. At that time, Secretary of Energy Admiral James Watkins saw the need to establish the Office of Environmental Restoration and Waste Management (EM), which consolidated those activities under a single management structure

  3. Communication received from France concerning its policies regarding the management of plutonium. Voluntary statement on highly enriched uranium

    International Nuclear Information System (INIS)

    2002-01-01

    The Director General has received a note verbale, dated 12 September 2001, from the Permanent Mission of France to the IAEA in the enclosures of which the Government of France has made available statements of the stocks of highly enriched uranium held by it as of 31 December 1999 and 31 December 2000. With reference to the Guidelines for the Management of Plutonium (contained in INFCIRC/549 of 16 March 1998), the Permanent Mission of France has also conveyed in its note verbale that 'Concerned to promote transparency in the management of highly enriched uranium used for peaceful nuclear activities, the Government of the French Republic has decided to publish, on a voluntary basis, information on the highly enriched uranium it holds for civil purposes'. In the light of the request expressed by the Government of France in its note verbale of 28 November 1997 concerning its policies regarding the management of plutonium (INFCIRC/549 of 16 March 1998), and the request in its note verbale of 12 September 2001, the texts of the enclosures of the note verbale of 12 September 2001 are attached for the information of all Member States

  4. 2018 International Olympic Committee Consensus Statement on Prevention, Diagnosis, and Management of Pediatric Anterior Cruciate Ligament Injuries

    Science.gov (United States)

    Ardern, Clare L.; Ekås, Guri; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F.; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J.; Feller, Julian A.; Karlsson, Jón; Kocher, Mininder S.; LaPrade, Robert F.; McNamee, Mike; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas G.H.; Reider, Bruce; Roe, Justin P.; Seil, Romain; Siebold, Rainer; Silvers-Granelli, Holly J.; Soligard, Torbjørn; Witvrouw, Erik; Engebretsen, Lars

    2018-01-01

    In October 2017, the International Olympic Committee hosted an international expert group of physical therapists and orthopaedic surgeons who specialize in treating and researching pediatric anterior cruciate ligament (ACL) injuries. The purpose of this meeting was to provide a comprehensive, evidence-informed summary to support the clinician and help children with ACL injury and their parents/guardians make the best possible decisions. Representatives from the following societies attended: American Orthopaedic Society for Sports Medicine; European Paediatric Orthopaedic Society; European Society for Sports Traumatology, Knee Surgery, and Arthroscopy; International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; Pediatric Orthopaedic Society of North America; and Sociedad Latinoamericana de Artroscopia, Rodilla, y Deporte. Physical therapists and orthopaedic surgeons with clinical and research experience in the field and an ethics expert with substantial experience in the area of sports injuries also participated. This consensus statement addresses 6 fundamental clinical questions regarding the prevention, diagnosis, and management of pediatric ACL injuries. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision making with children and the potential long-term ramifications of the injury. PMID:29594177

  5. Hazardous waste database: Waste management policy implications for the US Department of Energy's Environmental Restoration and Waste Management Programmatic Environmental Impact Statement

    International Nuclear Information System (INIS)

    Lazaro, M.A.; Policastro, A.J.; Antonopoulos, A.A.; Hartmann, H.M.; Koebnick, B.; Dovel, M.; Stoll, P.W.

    1994-01-01

    The hazardous waste risk assessment modeling (HaWRAM) database is being developed to analyze the risk from treatment technology operations and potential transportation accidents associated with the hazardous waste management alternatives. These alternatives are being assessed in the Department of Energy's Environmental Restoration and Waste Management Programmatic Environmental Impact Statement (EM PEIS). To support the risk analysis, the current database contains complexwide detailed information on hazardous waste shipments from 45 Department of Energy installations during FY 1992. The database is currently being supplemented with newly acquired data. This enhancement will improve database information on operational hazardous waste generation rates, and the level and type of current on-site treatment at Department of Energy installations

  6. Insights on radiological risks of US Department of Energy radioactive waste management alternatives in the Environmental Management Programmatic Environmental Impact Statement

    International Nuclear Information System (INIS)

    Mueller, C.

    1994-01-01

    A Facility Accident Analysis (1) was performed in support of the US Department of Energy (DOE) Environmental Management (EM) Programmatic Environmental Impact Statement (PEIS). It used an integrated risk-based approach (2) to allow risk comparisons of EM PEIS strategies for consolidating the storage and treatment of wastes at different DOE sites throughout the country. This approach was developed in accordance with the latest National Environmental Protection Act (NEPA) compliance guidance from DOE (3), which calls for consideration of a spectrum of accident scenarios that could occur in implementing the various actions evaluated in the EM PEIS. This paper discusses our insights with respect to the likely importance of the relative treatment technologies, waste management facilities and operations, and waste consolidation strategies considered in the EM PEIS

  7. Department of Energy Programmatic Spent Nuclear Fuel Management and Idaho National Engineering Laboratory Environmental Restoration and Waste Management Programs Draft Environmental Impact Statement

    International Nuclear Information System (INIS)

    1994-06-01

    The US Department of Energy (DOE) is engaged in two related decision making processes concerning: (1) the transportation, receipt, processing, and storage of spent nuclear fuel (SNF) at the DOE Idaho National Engineering Laboratory (INEL) which will focus on the next 10 years; and (2) programmatic decisions on future spent nuclear fuel management which will emphasize the next 40 years. DOE is analyzing the environmental consequences of these spent nuclear fuel management actions in this two-volume Environmental Impact Statement (EIS). Volume 1 supports broad programmatic decisions that will have applicability across the DOE complex and describes in detail the purpose and need for this DOE action. Volume 2 is specific to actions at the INEL. This document, which limits its discussion to the Savannah River Site (SRS) spent nuclear fuel management program, supports Volume 1 of the EIS. Following the introduction, Chapter 2 contains background information related to the SRS and the framework of environmental regulations pertinent to spent nuclear fuel management. Chapter 3 identifies spent nuclear fuel management alternatives that DOE could implement at the SRS, and summarizes their potential environmental consequences. Chapter 4 describes the existing environmental resources of the SRS that spent nuclear fuel activities could affect. Chapter 5 analyzes in detail the environmental consequences of each spent nuclear fuel management alternative and describes cumulative impacts. The chapter also contains information on unavoidable adverse impacts, commitment of resources, short-term use of the environment and mitigation measures

  8. Pain Management in the Emergency Chain: The Use and Effectiveness of Pain Management in Patients With Acute Musculoskeletal Pain

    NARCIS (Netherlands)

    Pierik, Jorien; IJzerman, Maarten Joost; Gaakeer, Menno I.; Berben, Sivera A.; Eenennaam, Fred L.; van Vugt, Arie B.; Doggen, Catharina Jacoba Maria

    2015-01-01

    Objective While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and

  9. 76 FR 56220 - Draft Environmental Impact Statement for General Management Plan for Golden Gate National...

    Science.gov (United States)

    2011-09-12

    ... serve as a blueprint to guide management of these units of the National Park System over the next 15-20... Recreation Area (GGNRA) has been operating under its first GMP, approved in 1980. During the 30 years since... cultural resources. The fundamental resources of each showcased site would be managed at the highest level...

  10. 77 FR 62214 - Travel Management Supplemental Environmental Impact Statement (SEIS), Eldorado National Forest...

    Science.gov (United States)

    2012-10-12

    ... DEPARTMENT OF AGRICULTURE Forest Service Travel Management Supplemental Environmental Impact....S. Forest Service completed the Eldorado National Forest Public Wheeled Motorized Travel Management... travel. In 2009 a complaint was filed with the Eastern District Federal Court (Court Case No. 2:09-CV...

  11. 78 FR 7450 - Final Environmental Impact Statement for Protecting and Restoring Native Ecosystems by Managing...

    Science.gov (United States)

    2013-02-01

    ... framework to systematically guide non-native ungulate management activities in a manner that supports long... Hawaii Volcanoes National Park K[imacr]lauea Visitor Center, One Crater Rim Drive, Hawaii National Park... for further information, please contact: Rhonda Loh, Chief of Natural Resources Management, P.O. Box...

  12. Allergy/Anaphylaxis Management in the School Setting. Position Statement. Revised

    Science.gov (United States)

    Zacharski, Susan; DeSisto, Marie; Pontius, Deborah; Sheets, Jodi; Richesin, Cynthia

    2012-01-01

    It is the position of the National Association of School Nurses (NASN) that the safe and effective management of allergies and anaphylaxis in schools requires a collaborative, multidisciplinary team approach. The registered professional school nurse (hereinafter referred to as the school nurse), is the leader in a comprehensive management approach…

  13. Frequency, pattern and management of acute abdomen in dengue fever in Karachi, Pakistan.

    Science.gov (United States)

    Shamim, Muhammad

    2010-07-01

    This study aimed to determine the frequency, pattern and management of acute abdomen in patients with dengue fever. This descriptive case series is a prospective analysis of acute abdomen in dengue fever that was performed at three secondary care hospitals in Karachi, Pakistan from June 1, 2005 to December 31, 2008. The inclusion criterion was all patients with confirmed diagnosis of dengue fever. Patients with incomplete laboratory, ultrasound or histopathology data were excluded. Among 357 patients with dengue fever, 43 (12.04%) had acute abdomen. There were 15 men and 28 women, with a median age of 29 years. These included 26 cases of acute cholecystitis, 7 cases of acute appendicitis, 7 cases of nonspecific peritonitis, and 3 cases of acute pancreatitis. Dengue hemorrhagic fever/shock syndrome was found in acute pancreatitis, and two of these patients died. Emergency surgery was required in eight patients (5 appendectomy and 3 open cholecystectomy). Substantial transfusion of blood and its components was required in eight patients who underwent emergency surgery. Early diagnosis and prompt conservative management of dengue acute abdomen is necessary to avoid mortality and emergency surgery-related morbidity. However, if needed, surgery can be performed with acceptable morbidity. Copyright © 2010 Asian Surgical Association. Published by Elsevier B.V. All rights reserved.

  14. Concussion is Treatable: Statements of Agreement from the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting held in Pittsburgh, October 15–16, 2015

    Science.gov (United States)

    Collins, Michael W.; Kontos, Anthony P.; Okonkwo, David O.; Almquist, Jon; Bailes, Julian; Barisa, Mark; Bazarian, Jeffrey; Bloom, O. Josh; Brody, David; Cantu, Robert; Cardenas, Javier; Clugston, Jay; Cohen, Randall; Echemendia, Ruben; Elbin, R.J.; Ellenbogen, Richard; Fonseca, Janna; Gioia, Gerard; Guskiewicz, Kevin; Heyer, Robert; Hotz, Gillian; Iverson, Grant L.; Jordan, Barry; Manley, Geoffrey; Maroon, Joseph; McAllister, Thomas; McCrea, Michael; Mucha, Anne; Pieroth, Elizabeth; Podell, Kenneth; Pombo, Matthew; Shetty, Teena; Sills, Allen; Solomon, Gary; Thomas, Danny G.; Valovich McLeod, Tamara C.; Yates, Tony; Zafonte, Ross

    2016-01-01

    Background Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective To describe the current landscape of treatment for concussion and provide summary agreements related to treatment in order to assist clinicians in the treatment of concussion. Methods On October 14–16, 2015, the Targeted Evaluation & Active Management (TEAM) Approaches To Treating Concussion meeting was convened in Pittsburgh, Pennsylvania, USA. 37 concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research, and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. Results A total of 16 statements of agreement were supported covering: 1) Summary of the Current Approach to Treating Concussion, 2) Heterogeneity and Evolving Clinical Profiles of Concussion, 3) Targeted Evaluation and Active Management Approach to Concussion Treatment: Specific Strategies, and 4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97–100%. Conclusion Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies based on modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery following concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments. PMID:27741219

  15. ANESTHETIC MANAGEMENT FOR A PATIENT WITH ACUTE INTERMITTENT PORPHYRIA

    Directory of Open Access Journals (Sweden)

    Nenad Savić

    2010-09-01

    Full Text Available Acute intermittent porphyria is a rare metabolic disorder resulting from a partial deficiency of porphobilinogen deaminase, enzyme in the heme biosynthetic pathway. Its inheritance is autosomal dominant. A deficiency of porphobilinogen deaminase is not sufficient by its self to produce acute intermittent porphyria, and other activating factors must also be present. These include some drugs, hormones, infection, injury and alcohol. Besides others, anesthetics have been implicated in the triggering of a number of severe porphyric reactions. Although there is no clinical evidence, the fear of hypothesized porphyrinogenicity of repetitive anesthetics exposures still remains. Despite these doubts, we report here the case of uneventful repeated exposure to anesthetics in a patient suffering from acute intermittent porphyria, within a fifteen- month period. On both occasions, the patient was safely exposed to certain anesthetics included: propofol, sevoflurane, rocuronium, midazolam and fentanyl.

  16. MANAGEMENT OF ACUTE GASTROENTERITIS IN CHILDREN: WHAT IS NEW?

    Directory of Open Access Journals (Sweden)

    I. N. Zakharova

    2013-01-01

    Full Text Available High prevalence of acute enteric infections in children, the majority of which affects infants, determines the necessity of development of modern recommendation on diagnostics and treatment of such conditions. The authors show data on etiology of enteric infections and results of various Russian and international research on efficacy of treatment of acute gastroenteritis, including information about sorbents, probiotics, antiemetic agents and antibacterial drugs usage. Recommendations on treatment of acute gastroenteritis are based on the modern protocol of the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists (ESPGHAN, which was published in 2008. According to these recommendations, oral rehydration is one of the main components of treatment, decreasing children’s mortality rates. However due to the absence of the effect of this measure on the intestinal peristalsis, duration of the diarrhea and concomitant symptoms (abdominal pain and distension, additional therapy is necessary. In Russia combinations of enterosorbents and probiotics are used in order to relieve such conditions.

  17. Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: an advisory statement from the American Dental Association Council on Scientific Affairs.

    Science.gov (United States)

    Edwards, Beatrice J; Hellstein, John W; Jacobsen, Peter L; Kaltman, Steven; Mariotti, Angelo; Migliorati, Cesar A

    2008-12-01

    and Overview. In 2005, the American Dental Association (ADA) Council on Scientific Affairs convened an expert panel to develop clinical recommendations for dentists treating patients who are receiving oral bisphosphonate therapy. The Journal of the American Dental Association published the resulting report in 2006. This 2008 advisory statement is the first of projected periodic updates of the 2006 clinical recommendations. This 2008 advisory statement concludes, on the basis of a review of the current literature, that for patients receiving bisphosphonate therapy, the risk of developing bisphosphonate-associated osteonecrosis (BON) of the jaw apparently remains low. It also newly concludes that current screening and diagnostic tests are unreliable for predicting a patient's risk of developing the condition. This statement updates the 2006 recommendations regarding general dentistry, management of periodontal diseases, implant placement and maintenance, oral and maxillofacial surgery, endodontics, restorative dentistry and prosthodontics, and orthodontics.

  18. 76 FR 81962 - Final Environmental Impact Statement for General Management Plan, Ross Lake National Recreation...

    Science.gov (United States)

    2011-12-29

    ... soundscapes, and scenery through traditional outdoor activities. The NPS would actively manage to reduce... Ross Lake NRA in order to protect and enhance soundscapes and wilderness character, experience, and...

  19. Draft Waste Management Programmatic Environmental Impact Statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume 3, Appendix A: Public response to revised NOI, Appendix B: Environmental restoration, Appendix C, Environmental impact analysis methods, Appendix D, Risk

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-08-01

    Volume three contains appendices for the following: Public comments do DOE`s proposed revisions to the scope of the waste management programmatic environmental impact statement; Environmental restoration sensitivity analysis; Environmental impacts analysis methods; and Waste management facility human health risk estimates.

  20. Management of non variceal upper gastrointestinal bleeding: position statement of the Catalan Society of Gastroenterology.

    Science.gov (United States)

    García-Iglesias, Pilar; Botargues, Josep-Maria; Feu Caballé, Faust; Villanueva Sánchez, Càndid; Calvet Calvo, Xavier; Brullet Benedi, Enric; Cánovas Moreno, Gabriel; Fort Martorell, Esther; Gallach Montero, Marta; Gené Tous, Emili; Hidalgo Rosas, José-Manuel; Lago Macía, Amelia; Nieto Rodríguez, Ana; Papo Berger, Michel; Planella de Rubinat, Montserrat; Saló Rich, Joan; Campo Fernández de Los Ríos, Rafel

    2017-05-01

    In recent years there have been advances in the management of non-variceal upper gastrointestinal bleeding that have helped reduce rebleeding and mortality. This document positioning of the Catalan Society of Digestologia is an update of evidence-based recommendations on management of gastrointestinal bleeding peptic ulcer. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  1. Contemporary Review of Risk-Stratified Management in Acute Uncomplicated and Complicated Diverticulitis.

    Science.gov (United States)

    Boermeester, Marja A; Humes, David J; Velmahos, George C; Søreide, Kjetil

    2016-10-01

    Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis. We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases. We used the search terms "diverticulitis, colonic" or "acute diverticulitis" or "divertic*" in combination with the terms "management," "antibiotics," "non-operative," or "surgery." Registers for clinical trials (such as the WHO registry and the https://clinicaltrials.gov/ ) were searched for ongoing, recruiting, or closed trials not yet published. Antibiotic treatment can be avoided in simple, non-complicated diverticulitis and outpatient management is safe. The management of complicated disease, ranging from a localized abscess to perforation with diffuse peritonitis, has changed towards either percutaneous or minimally invasive approaches in selected cases. The role of laparoscopic lavage without resection in perforated non-fecal diverticulitis is still debated; however, recent evidence from two randomised controlled trials has found a higher re-intervention in this group of patients. A shift in management has occurred towards conservative management in acute uncomplicated disease. Those with uncomplicated acute diverticulitis may be treated without antibiotics. For complicated diverticulitis with purulent peritonitis, the use of peritoneal lavage appears to be non-superior to resection.

  2. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society.

    Science.gov (United States)

    2015-11-01

    To update and expand The North American Menopause Society's evidence-based position on nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the position statement on the management of VMS. NAMS enlisted clinical and research experts in the field and a reference librarian to identify and review available evidence. Five different electronic search engines were used to cull relevant literature. Using the literature, experts created a document for final approval by the NAMS Board of Trustees. Nonhormonal management of VMS is an important consideration when hormone therapy is not an option, either because of medical contraindications or a woman's personal choice. Nonhormonal therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others. The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications all need to be carefully weighed against potential effectiveness during decision making. Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are

  3. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

    Science.gov (United States)

    Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

    2016-02-01

    Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly

  4. EDF - Full-year results up in 2014, Solid performance in low-carbon energies, 2018 ambition reiterated. Annual results 2014. Consolidated financial statements 2014. Management report 2014 - Group results. Annual financial statements 2014

    International Nuclear Information System (INIS)

    Levy, Jean-Bernard

    2015-01-01

    As the world's biggest electricity generator, the EDF Group covers every sector of expertise, from generation to trading and transmission grids. EDF builds on the expertise of its people, its R and D and engineering skills, its experience as a leading industry operator and the attentive support of its customers to deliver competitive solutions that successfully reconcile economic growth with climate protection. This document presents the 2014 annual results, management report and Consolidated financial statements of the Group at 31 December 2014, as well as the 2014 activity report: Group EBITDA: euro 17.3 bn, +6.5% organic growth, +3.2% excluding Edison and the tariff catch-up. A record-setting performance by low-carbon energies: French nuclear output: 415.9 TWh, the second best performance of the last six years; French CO_2 emissions: 17 g/kWh, an all-time low; Renewable energy capacity under construction: 2.2 GW, an all-time high. Net income excluding non-recurring items: euro 4,852 m, +17.9%; Net income - Group share: euro 3,701 m, +5.2%; Net financial debt/EBITDA: 2.0x vs. 2.1x at 31 December 2013; Dividend proposed for 2014: euro 1.25 per share in cash, equivalent to a 52% pay-out ratio and 58% when excluding the tariff catch-up. Financial guidance for 2015: Group EBITDA: organic growth of 0 to 3%; Net financial debt/EBITDA: between 2x and 2.5x; Pay-out ratio of net income excluding non-recurring items post hybrid: 55% to 65%. 2018 ambition: Enhanced action plan on cash flow generation levers: EBITDA growth, CSPE balance, WCR action plan, control of net investments; Cash flow after dividends: positive in 2018. EDF's financial statements: Income statements; Balance sheets; Cash flow statements; Notes to the financial statements: Accounting principles and methods, Significant events and transactions, Regulatory events in 2014 with an impact on the financial statements, Sales, Operating subsidies, Reversals of provisions and depreciation, Other operating income

  5. A RETROSPECTIVE STUDY OF MANAGEMENT OF ACUTE PANCREATITIS IN A PERIPHERAL TERTIARY HOSPITAL

    Directory of Open Access Journals (Sweden)

    Thomas Karunahara

    2016-06-01

    Full Text Available BACKGROUND & OBJECTIVES Acute pancreatitis (AP is one of the most common diseases in gastroenterology. Two percent of all patients admitted to hospital are diagnosed with AP. During the last decade, an increasing incidence was observed, mostly because of a higher sensitivity of diagnostic tests. Treatment of Acute Pancreatitis is still symptomatic and no specific medication is available today. As a result of popular belief that the pancreas should be put to rest during acute pancreatitis, the parenteral route for nutrition is still predominantly used in Acute Pancreatitis. There has been increasing evidence; however, about gut being main source of microorganisms causing infectious pancreatic complications and multiorgan failure. In patients with severe pancreatitis, oral intake is inhibited by nausea and subileus. Although some reports show that enteral feeding is possible in acute pancreatitis and associated with fewer septic complications. Although the evidence is inconclusive to support enteral nutrition in all patients with severe acute pancreatitis, the enteral route may be used if tolerated. Supportive treatment is the most important line of management in acute pancreatitis. The aim is to study the management of acute pancreatitis in a peripheral tertiary hospital and to assess the outcome of the management. METHODS & MATERIALS Data Collection: Patients with acute abdominal pain are admitted in hospital and diagnosed as acute pancreatitis based on blood investigations and radiological findings. Patients categorised- Revised Atlanta Classification. Different medical management modes followed and outcomes recorded, tabulated and analysed. Research Design: Retrospective study. Research Settings: Mahatma Gandhi Memorial Government Hospital, Trichy, Tamilnadu. Duration: 5 yrs. (2010-2015 Sample Size: 186. Inclusion Criteria: Patients between 12 and 75 yrs. of age, patients admitted to the hospital as a case of acute pancreatitis, both sexes

  6. Early management of acute pancreatitis: A review of the best evidence.

    Science.gov (United States)

    Stigliano, Serena; Sternby, Hanna; de Madaria, Enrique; Capurso, Gabriele; Petrov, Maxim S

    2017-06-01

    In the 20th century early management of acute pancreatitis often included surgical intervention, despite overwhelming mortality. The emergence of high-quality evidence (randomized controlled trials and meta-analyses) over the past two decades has notably shifted the treatment paradigm towards predominantly non-surgical management early in the course of acute pancreatitis. The present evidence-based review focuses on contemporary aspects of early management (which include analgesia, fluid resuscitation, antibiotics, nutrition, and endoscopic retrograde cholangiopancreatography) with a view to providing clear and succinct guidelines on early management of patients with acute pancreatitis in 2017 and beyond. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  7. New paradigms in the management of acute type B aortic dissection.

    Science.gov (United States)

    Parisi, Rosario; Secco, Gioel Gabrio; Fattori, Rossella

    2015-11-01

    Type B aortic dissection is a relatively uncommon and multifaceted disease, whose management is ongoing debated. Its wide range of clinical presentations and anatomical features hamper the early identification and medical management. In the past few years, the introduction of endovascular techniques opened new paradigms in comprehension and management of aortic diseases. Aim of this review is to discuss contemporary therapeutic approaches of acute type B aortic dissections highlighting the growing role of thoracic endovascular aortic repair (TEVAR) in focusing its complex physiopathology. Prompt medical therapy followed by endovascular repair should be considered as the gold standard in complicated acute type B aortic dissection. Moreover, recent findings also suggest a potential benefit in case of uncomplicated cases. Management of acute type B aortic dissection is progressively shifting into endovascular approach. However, further studies are warranted to define the optimal treatment strategy in each subset of patients and anatomical features.

  8. Management of Acute Apendicitis in the New Millennium

    NARCIS (Netherlands)

    K-H. in 't Hof (Klaas)

    2009-01-01

    textabstractThe prevalence of acute appendicitis in The Netherlands is 16460 times a year, 8647 man and 7813 women in 2006 and is still increasing. The chance of undergoing an appendectomy is higher in women than in men, 23 versus 12 percent, this is in contradiction with the chance of developing

  9. Anaesthesia management of acute aortic dissection type B in Marfan ...

    African Journals Online (AJOL)

    Pregnancy in women with Marfan syndrome (MFS) is linked to approximately a 4.4% risk of acute aortic dissection (AAD). The natural history of pregnancy and the ability to deliver a viable fetus depends on the interaction between the pace of changes in the cardiovascular system and the advancement of pregnancy.

  10. Management of acute moderate and severe childhood malnutrition

    Science.gov (United States)

    Acute childhood malnutrition affects about a tenth of the world's children under 5 years of age, particularly those living in circumstances of extreme poverty in the developing world. Malnutrition is typically the result of an inadequate diet and is one of the most common diagnoses in children in he...

  11. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis

    NARCIS (Netherlands)

    Okamoto, Kohji; Suzuki, Kenji; Takada, Tadahiro; Strasberg, Steven M.; Asbun, Horacio J.; Endo, Itaru; Iwashita, Yukio; Hibi, Taizo; Pitt, Henry A.; Umezawa, Akiko; Asai, Koji; Han, Ho-Seong; Hwang, Tsann-Long; Mori, Yasuhisa; Yoon, Yoo-Seok; Huang, Wayne Shih-Wei; Belli, Giulio; Dervenis, Christos; Yokoe, Masamichi; Kiriyama, Seiki; Itoi, Takao; Jagannath, Palepu; Garden, O. James; Miura, Fumihiko; Nakamura, Masafumi; Horiguchi, Akihiko; Wakabayashi, Go; Cherqui, Daniel; de Santibañes, Eduardo; Shikata, Satoru; Noguchi, Yoshinori; Ukai, Tomohiko; Higuchi, Ryota; Wada, Keita; Honda, Goro; Supe, Avinash Nivritti; Yoshida, Masahiro; Mayumi, Toshihiko; Gouma, Dirk J.; Deziel, Daniel J.; Liau, Kui-Hin; Chen, Miin-Fu; Shibao, Kazunori; Liu, Keng-Hao; Su, Cheng-Hsi; Chan, Angus C. W.; Yoon, Dong-Sup; Choi, In-Seok; Jonas, Eduard; Chen, Xiao-Ping; Fan, Sheung Tat; Ker, Chen-Guo; Giménez, Mariano Eduardo; Kitano, Seigo; Inomata, Masafumi; Hirata, Koichi; Inui, Kazuo; Sumiyama, Yoshinobu; Yamamoto, Masakazu

    2018-01-01

    We propose a new flowchart for the treatment of acute cholecystitis (AC) in the Tokyo Guidelines 2018 (TG18). Grade III AC was not indicated for straightforward laparoscopic cholecystectomy (Lap-C). Following analysis of subsequent clinical investigations and drawing on Big Data in particular, TG18

  12. approach to and management of acute ankle ligamentous injuries

    African Journals Online (AJOL)

    Enrique

    Tibionavicular part. Medial (deltoid) ligament of ankle {. Table I. Differential diagnosis of acute ankle injury. ATFL sprain. CFL sprain. Syndesmosis sprain. Anterior process calcaneus fracture. Lateral process talus fracture. Fifth metatarsal base fracture. Subtalar injury. Peroneal tendon injury. Osteochondral injury of the talus.

  13. Savannah River Site, spent nuclear fuel management, draft environmental impact statement

    International Nuclear Information System (INIS)

    1998-12-01

    The management of spent nuclear fuel (SNF) has been an integral part of the mission of the Savannah River Site (SRS) for more than 40 years. Until the early 1990s, SNF management consisted primarily of short-term onsite storage and reprocessing in the SRS chemical separation facilities to produce strategic nuclear materials. With the end of the Cold War, the US Department of Energy (DOE) decided to phase out reprocessing of SNF for the production of nuclear weapons materials. Therefore, the management strategy for this fuel has shifted from short-term storage and reprocessing for the recovery of highly-enriched uranium and transuranic isotopes to stabilization, when necessary, and interim storage pending final disposition that includes preparing aluminum-based SNF for placement in a geologic repository. In addition to the fuel already onsite, the SRS will receive SNF from foreign research reactors until 2009 and from domestic research reactors until, potentially, 2035. As a result, the safe and efficient management of SNF will continue to be an important SRS mission. This EIS evaluates the potential environmental impacts of DOE's proposed plans for management SNF assigned to SRS

  14. National athletic trainers' association position statement: management of the athlete with type 1 diabetes mellitus.

    Science.gov (United States)

    Jimenez, Carolyn C; Corcoran, Matthew H; Crawley, James T; Guyton Hornsby, W; Peer, Kimberly S; Philbin, Rick D; Riddell, Michael C

    2007-01-01

    To present recommendations for the certified athletic trainer in the management of type 1 diabetes in the athlete. In managing diabetes, the most important goal is to keep blood glucose levels at or as close to normal levels as possible without causing hypoglycemia. This goal requires the maintenance of a delicate balance among hypoglycemia, euglycemia, and hyperglycemia, which is often more challenging in the athlete due to the demands of physical activity and competition. However, effectively managing blood glucose, lipid, and blood pressure levels is necessary to ensuring the long-term health and well-being of the athlete with diabetes. These recommendations are intended to provide the certified athletic trainer participating in the management of an athlete with type 1 diabetes mellitus with the specific knowledge and problem-solving skills needed. Athletic trainers have more contact with the athlete with diabetes than most members of the diabetes management team do and so must be prepared to assist the athlete as required.

  15. Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

    Directory of Open Access Journals (Sweden)

    Luca Castellazzi

    2016-06-01

    Full Text Available Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

  16. Final programmatic environmental impact statement for stockpile stewardship and management. Comment response document. Volume 4

    International Nuclear Information System (INIS)

    1996-09-01

    In response to the end of the Cold War and changes in the world's political regimes, the United States is not producing new-design nuclear weapons. Instead, the emphasis on the U.S. nuclear weapons program is on reducing the size of the Nation's nuclear stockpile by dismantling existing nuclear weapons. The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed a Stockpile Stewardship and Management Program to provide a single highly integrated program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management PEIS describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program

  17. Use of Ulipristal Acetate for the Management of Fibroid-Related Acute Abnormal Uterine Bleeding.

    Science.gov (United States)

    Arendas, Kristina; Leyland, Nicholas A

    2016-01-01

    Episodes of acute abnormal uterine bleeding related to uterine fibroids can cause significant morbidity. Traditional management with high-dose hormonal regimens may not be as effective when used in women with fibroids. A 32-year-old woman with a 12 cm uterine fibroid presented with an episode of acute abnormal uterine bleeding requiring blood transfusion. In lieu of using a hormonal maintenance regimen after the bleeding had stabilized, the patient was treated with ulipristal acetate 5 mg daily for three months. Amenorrhea was induced rapidly and the patient had no further episodes of acute excessive uterine bleeding. She subsequently underwent a laparoscopic myomectomy with a satisfactory outcome. Ulipristal acetate has been shown to induce amenorrhea rapidly in women with uterine fibroids, and it can be a useful treatment in the emergency management of fibroid-related acute abnormal uterine bleeding. Copyright © 2016 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

  18. Department of Energy Programmatic Spent Nuclear Fuel Management and Idaho National Engineering Laboratory Environmental Restoration and Waste Management Programs Draft Environmental Impact Statement

    International Nuclear Information System (INIS)

    1994-06-01

    Two types of projects in the spent nuclear fuel and environmental restoration and waste management activities at the Idaho National Engineering Laboratory (INEL) are described. These are: foreseeable proposed projects where some funding for preliminary planning and/or conceptual design may already be authorized, but detailed design or planning will not begin until the Department of Energy (DOE) has determined that the requirements of the National Environmental Policy Act process for the project have been completed; planned or ongoing projects not yet completed but whose National Environmental Policy Act documentation is already completed or is expected to be completed before the Record of Decision for this Envirorunental Impact Statement (EIS) is issued. The section on project summaries describe the projects (both foreseeable proposed and ongoing).They provide specific information necessary to analyze the environmental impacts of these projects. Chapter 3 describes which alternative(s) each project supports. Summaries are included for (a) spent nuclear fuel projects, (b) environmental remediation projects, (c) the decontamination and decommissioning of surplus INEL facilities, (d) the construction, upgrade, or replacement of existing waste management facilities, (e) infrastructure projects supporting waste management activities, and (f) research and development projects supporting waste management activities

  19. Department of Energy Programmatic Spent Nuclear Fuel Management and Idaho National Engineering Laboratory Environmental Restoration and Waste Management Programs Draft Environmental Impact Statement. Volume 2, Part B

    Energy Technology Data Exchange (ETDEWEB)

    1994-06-01

    Two types of projects in the spent nuclear fuel and environmental restoration and waste management activities at the Idaho National Engineering Laboratory (INEL) are described. These are: foreseeable proposed projects where some funding for preliminary planning and/or conceptual design may already be authorized, but detailed design or planning will not begin until the Department of Energy (DOE) has determined that the requirements of the National Environmental Policy Act process for the project have been completed; planned or ongoing projects not yet completed but whose National Environmental Policy Act documentation is already completed or is expected to be completed before the Record of Decision for this Envirorunental Impact Statement (EIS) is issued. The section on project summaries describe the projects (both foreseeable proposed and ongoing).They provide specific information necessary to analyze the environmental impacts of these projects. Chapter 3 describes which alternative(s) each project supports. Summaries are included for (a) spent nuclear fuel projects, (b) environmental remediation projects, (c) the decontamination and decommissioning of surplus INEL facilities, (d) the construction, upgrade, or replacement of existing waste management facilities, (e) infrastructure projects supporting waste management activities, and (f) research and development projects supporting waste management activities.

  20. 17 CFR 270.19a-1 - Written statement to accompany dividend payments by management companies.

    Science.gov (United States)

    2010-04-01

    ... that an open-end company may treat as a separate source its net profits from such sales during its... specify the sources from which the remainder was paid. Every company which in any fiscal year elects to... dividend payments by management companies. 270.19a-1 Section 270.19a-1 Commodity and Securities Exchanges...

  1. 75 FR 15457 - Notice of Availability of Final Elk Management Plan and Environmental Impact Statement for...

    Science.gov (United States)

    2010-03-29

    ...://parkplanning.nps.gov/THRO ); click on the link to Elk Management Plan/ EIS. You may also obtain a copy of the.... The Park would not pay private contractors or outside individuals to shoot elk. The initial reduction..., by removing approximately 275 elk per year. Following the initial reduction phase, the Park would...

  2. On-Line Investment Analysis and Portfolio Management: Using Learning Outcome Statements To Design Projects.

    Science.gov (United States)

    Pettijohn, James B.; Ragan, Gay A.; Ragan, Kent P.

    2003-01-01

    Describes an Internet-based project to familiarize students with online investment analysis and stock portfolio management. Outlines a process for writing learning outcomes that address three levels of cognition: knowledge/comprehension, application/analysis, and synthesis/evaluation. (SK)

  3. 77 FR 37438 - Draft Trail Management Plan and Environmental Impact Statement for Cuyahoga Valley National Park...

    Science.gov (United States)

    2012-06-21

    ... DEPARTMENT OF THE INTERIOR National Park Service [NPS-MWR-CUVA-10100; 6065-4000-409] Draft Trail... Park Service, Interior. ACTION: Notice of Availability. SUMMARY: The National Park Service (NPS... blueprint to guide the expansion, elimination, restoration, management, and use of the trail system and its...

  4. 77 FR 39253 - Final Environmental Impact Statement on the Denali Park Road Vehicle Management Plan, Denali...

    Science.gov (United States)

    2012-07-02

    ... online at the NPS Planning, Environmental and Public Comment Web site at http://parkplanning.nps.gov/dena... served well as a way to manage vehicle use, while providing high quality visitor opportunities to see... framework for vehicle use based on indicators and standards for visitor experiences and resource protection...

  5. 76 FR 57759 - Notice of Availability of Draft Resource Management Plan and Draft Environmental Impact Statement...

    Science.gov (United States)

    2011-09-16

    ... federally-owned subsurface mineral estate. The Colorado River Valley Field Office and the KFO were... Office, Colorado AGENCY: Bureau of Land Management, Interior. ACTION: Notice of availability. SUMMARY: In... Avenue, Kremmling, Colorado 80459. Copies of the Kremmling Draft RMP/EIS are available in the KFO at the...

  6. Frequency, Pattern and Management of Acute Abdomen in Dengue Fever in Karachi, Pakistan

    OpenAIRE

    Muhammad Shamim

    2010-01-01

    This study aimed to determine the frequency, pattern and management of acute abdomen in patients with dengue fever. Methods: This descriptive case series is a prospective analysis of acute abdomen in dengue fever that was performed at three secondary care hospitals in Karachi, Pakistan from June 1, 2005 to December 31, 2008. The inclusion criterion was all patients with confirmed diagnosis of dengue fever. Patients with incomplete laboratory, ultrasound or histopathology data were excluded...

  7. Management of acute gastroenteritis in healthy children in Lebanon - A national survey

    OpenAIRE

    Alameddine, Aouni; Mourad, Sawsan; Rifai, Nahida

    2010-01-01

    Background: Acute gastroenteritis remains a common condition among infants and children throughout the world. In 1996, The American Academy of Pediatrics (AAP) revised its recommendations for the treatment of infants and children with acute gastroenteritis. Aim: The purpose of this survey was to determine how closely current treatment among Lebanese pediatricians compares with the AAP recommendations and to determine the impact of such management on the healthcare system. Patients and Methods...

  8. Intramuscular aripiprazole in the acute management of psychomotor agitation.

    Science.gov (United States)

    De Filippis, Sergio; Cuomo, Ilaria; Lionetto, Luana; Janiri, Delfina; Simmaco, Maurizio; Caloro, Matteo; De Persis, Simone; Piazzi, Gioia; Simonetti, Alessio; Telesforo, C Ludovica; Sciarretta, Antonio; Caccia, Federica; Gentile, Giovanna; Kotzalidis, Georgios D; Girardi, Paolo

    2013-06-01

    To assess acute efficacy and safety of 9.75 mg of intramuscular (IM) injections of the atypical antipsychiatric aripiprazole in patients with schizophrenia or bipolar disorder and acute agitation. Open-label trial of IM injections of aripiprazole and 24-hour monitoring of clinical response in patients with major psychoses and acute agitation. Partial analysis of blood levels of the administered drug to correlate with clinical response. Acute psychiatric care wards in a single university hospital. A total of 201 acutely agitated patients (79 with schizophrenia and 122 with bipolar disorder I). Aripiprazole 9.75 mg IM injection. We evaluated clinical response using the Excitatory Component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation/Calmness Evaluation Scale (ACES), and the Clinical Global Impressions scale (CGI). Assessments were conducted 30, 60, 90, and 120 minutes and 24 hours after the first injection for PANSS-EC and ACES, and 2, 4, 6, and 24 hours for CGI. Response was at least a 40% decrease in PANSS-EC scores. We measured serum aripiprazole and dehydroaripiprazole levels in a subsample. IM aripiprazole significantly improved clinical measures. PANSS-EC improved progressively, starting after 30 minutes. ACES improved after 90 minutes and continued thereafter. Effects were sustained, with steadily decreasing CGI scores, until the 24th hour. Response rate was 83.6% after 2 hours, but with repeat injections, it rose to over 90% with no differences among diagnostic groups. Although there were gender differences in the response to individual PANSS-EC items, the responses were similar overall. Neither clinical monitoring nor patient reporting revealed any side effects. No therapeutic window was identified, and levels did not correlate with any clinical measure. Aripiprazole was effective and safe in reducing acute agitation in patients with bipolar disorder or schizophrenia. Our results compare favorably to double-blind trials, probably

  9. Healthcare Financial Management Association, Principles and Practices Board. Statement No. 16. Classifying, valuing, and analyzing accounts receivable related to patient services.

    Science.gov (United States)

    1993-05-01

    This Principles and Practices Board project was undertaken in response to the frequent requests from HFMA members for a standard calculation of "days of revenue in receivables." The board's work on this project indicated that every element of the calculation required standards, which is what this statement provides. Since there have been few standards for accounts receivable related to patient services, the industry follows a variety of practices, which often differ from each other. This statement is intended to provide a framework for enhanced external comparison of accounts receivable related to patient services, and thereby improve management information related to this very important asset. Thus, the standards described in this statement represent long-term goals for gradual transition of recordkeeping practices and not a sudden or revolutionary change. The standards described in this statement will provide the necessary framework for the most meaningful external comparisons. Furthermore, management's understanding of deviations from these standards will immediately assist in analysis of differences in data between providers.

  10. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma.

    Science.gov (United States)

    Wall, Christopher J; Lynch, Joan; Harris, Ian A; Richardson, Martin D; Brand, Caroline; Lowe, Adrian J; Sugrue, Michael

    2010-03-01

    Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.

  11. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2009-01-01

    The Director General has received a letter dated 16 July 2009 from the Permanent Mission of the Federal Republic of Germany to the IAEA in enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2008. 2. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2008 [es

  12. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2012-01-01

    The Director General has received a note verbale dated 14 October 2010 from the Permanent Mission of the Federal Republic of Germany to the IAEA in enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2009. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2009 [es

  13. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2012-01-01

    The Secretariat has received a note verbale dated 20 September 2012 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2011. The Government of the Federal Republic of Germany has also made available a statement of the estimated amounts of highly enriched uranium (HEU) as of 31 December 2011 [es

  14. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of Highly Enriched Uranium

    International Nuclear Information System (INIS)

    2007-01-01

    The Director General has received a Note Verbale dated 3 July 2007 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/549 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2006. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil highly enriched uranium (HEU) as of 31 December 2006 [es

  15. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2013-01-01

    The Secretariat has received a note verbale dated 2 July 2013 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2012. The Government of the Federal Republic of Germany has also made available a statement of the estimated amounts of highly enriched uranium (HEU) as of 31 December 2012 [es

  16. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2011-01-01

    The Director General has received a note verbale dated 29 April 2011 from the Permanent Mission of the Federal Republic of Germany to the IAEA in enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2010. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2010 [es

  17. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2011-01-01

    The Director General has received a note verbale dated 29 April 2011 from the Permanent Mission of the Federal Republic of Germany to the IAEA in enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2010. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2010 [fr

  18. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of Highly Enriched Uranium

    International Nuclear Information System (INIS)

    2007-01-01

    The Director General has received a Note Verbale dated 3 July 2007 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/549 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2006. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil highly enriched uranium (HEU) as of 31 December 2006

  19. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2012-01-01

    The Secretariat has received a note verbale dated 20 September 2012 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2011. The Government of the Federal Republic of Germany has also made available a statement of the estimated amounts of highly enriched uranium (HEU) as of 31 December 2011

  20. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2011-01-01

    The Director General has received a note verbale dated 14 October 2010 from the Permanent Mission of the Federal Republic of Germany to the IAEA in enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2009. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2009

  1. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2011-01-01

    The Director General has received a note verbale dated 29 April 2011 from the Permanent Mission of the Federal Republic of Germany to the IAEA in enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2010. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2010

  2. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2009-01-01

    The Director General has received a letter dated 16 July 2009 from the Permanent Mission of the Federal Republic of Germany to the IAEA in enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2008. 2. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2008

  3. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2013-01-01

    The Secretariat has received a note verbale dated 2 July 2013 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2012. The Government of the Federal Republic of Germany has also made available a statement of the estimated amounts of highly enriched uranium (HEU) as of 31 December 2012

  4. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2010-01-01

    The Director General has received a note verbale dated 14 October 2010 from the Permanent Mission of the Federal Republic of Germany to the IAEA in enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2009. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2009

  5. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2013-01-01

    The Secretariat has received a note verbale dated 2 July 2013 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2012. The Government of the Federal Republic of Germany has also made available a statement of the estimated amounts of highly enriched uranium (HEU) as of 31 December 2012 [fr

  6. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of Highly Enriched Uranium

    International Nuclear Information System (INIS)

    2007-01-01

    The Director General has received a Note Verbale dated 3 July 2007 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/549 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2006. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil highly enriched uranium (HEU) as of 31 December 2006 [fr

  7. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2010-01-01

    The Director General has received a note verbale dated 14 October 2010 from the Permanent Mission of the Federal Republic of Germany to the IAEA in enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2009. The Government of the Federal Republic of Germany has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2009 [fr

  8. Communication Received from Germany Concerning its Policies regarding the Management of Plutonium. Statements on the Management of Plutonium and of High Enriched Uranium

    International Nuclear Information System (INIS)

    2012-01-01

    The Secretariat has received a note verbale dated 20 September 2012 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/5491 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2011. The Government of the Federal Republic of Germany has also made available a statement of the estimated amounts of highly enriched uranium (HEU) as of 31 December 2011 [fr

  9. [The acute (surgical) abdomen - epidemiology, diagnosis and general principles of management].

    Science.gov (United States)

    Grundmann, R T; Petersen, M; Lippert, H; Meyer, F

    2010-06-01

    This review comments on epidemiology, diagnosis and general principles of surgical management in patients with acute abdomen. DEFINITION AND EPIDEMIOLOGY: The most common cause of acute abdominal pain is non-specific abdominal pain (24 - 44.3 % of the study populations), followed by acute appendicitis (15.9 - 28.1 %), acute biliary disease (2.9 - 9.7 %) and bowel obstruction or diverticulitits in elderly patients. Acute appendicitis represents the cause of surgical intervention in two-thirds of the children with acute abdomen. A standardised physical examination combined with ultrasonography (US) represents the initial investigation in patients with acute abdominal pain. Due to the risk associated with radiation and due to the costs, a selective use of CT imaging is recommended. The work-flow given in this paper restricts the use of CT imaging to less than 50 % of patients with acute abdominal pain. Diagnostic laparoscopy should be considered in patients without a specific diagnosis after appropriate imaging and as an alternative to active clinical observation which is the current practice in patients with non-specific abdominal pain. Acute small bowel obstruction has previously been considered as a relative contraindication for laparoscopic management, but it has been shown in the meantime that laparoscopic treatment is an elegant tool for the management of simple band small bowel obstruction. Bedside diagnostic laparoscopy is recommended in intensive care unit (ICU) patients with acute abdomen or sepsis of unknown origin, in suspicion of acute cholecystitis, diffuse gut hypoperfusion and mesenteric ischaemia or in refractory lactic acidosis, especially after cardiac surgery. Early administration of analgesia to patients with acute abdominal pain in the emergency department will reduce the patient's discomfort without impairing clinically important diagnostic accuracy and is recommended on the basis of some prospective randomised trials. However, the impact on

  10. Description of source term data on contaminated sites and buildings compiled for the waste management programmatic environmental impact statement (WMPEIS)

    International Nuclear Information System (INIS)

    Short, S.M.; Smith, D.E.; Hill, J.G.; Lerchen, M.E.

    1995-10-01

    The U.S. Department of Energy (DOE) and its predecessor agencies have historically had responsibility for carrying out various national missions primarily related to nuclear weapons development and energy research. Recently, these missions have been expanded to include remediation of sites and facilities contaminated as a result of past activities. In January 1990, the Secretary of Energy announced that DOE would prepare a Programmatic Environmental Impact Statement on the DOE's environmental restoration and waste management program; the primary focus was the evaluation of (1) strategies for conducting remediation of all DOE contaminated sites and facilities and (2) potential configurations for waste management capabilities. Several different environmental restoration strategies were identified for evaluation, ranging from doing no remediation to strategies where the level of remediation was driven by such factors as final land use and health effects. A quantitative assessment of the costs and health effects of remediation activities and residual contamination levels associated with each remediation strategy was made. These analyses required that information be compiled on each individual contaminated site and structure located at each DOE installation and that the information compiled include quantitative measurements and/or estimates of contamination levels and extent of contamination. This document provides a description of the types of information and data compiled for use in the analyses. Also provided is a description of the database used to manage the data, a detailed discussion of the methodology and assumptions used in compiling the data, and a summary of the data compiled into the database as of March 1995. As of this date, over 10,000 contaminated sites and structures and over 8,000 uncontaminated structures had been identified across the DOE complex of installations

  11. Utilization and cost of a new model of care for managing acute knee injuries: the Calgary acute knee injury clinic

    Directory of Open Access Journals (Sweden)

    Lau Breda HF

    2012-12-01

    Full Text Available Abstract Background Musculoskeletal disorders (MSDs affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC. The goal of this paper is to evaluate and report on the appropriateness, efficiency, and effectiveness of the C-AKIC through healthcare utilization and costs associated with acute knee injuries. Methods This quasi-experimental study measured and evaluated cost and utilization associated with specific healthcare services for patients presenting with acute knee injuries. The goal was to compare patients receiving care from two clinical care pathways: the existing pathway (i.e. comparison group and a new model, the C-AKIC (i.e. experimental group. This was accomplished through the use of a Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ. Results Data from 138 questionnaires were analyzed in the experimental group and 136 in the comparison group. A post-hoc analysis determined that both groups were statistically similar in socio-demographic characteristics. With respect to utilization, patients receiving care through the C-AKIC used significantly less resources. Overall, patients receiving care through the C-AKIC incurred 37% of the cost of patients with knee injuries in the comparison group and significantly incurred less costs when compared to the comparison group. The total aggregate average cost for the C-AKIC group was $2,549.59 compared to $6,954.33 for the comparison group (p Conclusions The Calgary Acute Knee Injury Clinic was able to manage and treat knee injured patients for less cost than the existing state of healthcare delivery. The

  12. Women and the management of acute coronary syndrome

    Czech Academy of Sciences Publication Activity Database

    Ošťádal, P.; Ošťádal, Bohuslav

    2012-01-01

    Roč. 90, č. 9 (2012), s. 1151-1159 ISSN 0008-4212 R&D Projects: GA MŠk(CZ) 1M0510 Grant - others:GA MZd(CZ) NT12153 Institutional research plan: CEZ:AV0Z50110509 Keywords : sex differences * acute coronary syndrome * women Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 1.556, year: 2012

  13. Observation unit management of acute decompensated heart failure.

    Science.gov (United States)

    Schrock, Jon W; Emerman, Charles L

    2009-01-01

    Acute decompensated heart failure (ADHF) is a common illness presenting to the emergency department (ED) that is amenable to observation unit (OU) treatment. As the number of baby boomers continues to grow and the incidence of heart failure increases, the financial implications of ADHF treatment will become more prominent. Obtaining institutional support and developing a good working relationship with cardiology colleagues is vital to creating workable ADHF protocols for whichever type of OU an institution decides to use.

  14. Spanish Consensus Statement: Clinical Management and Treatment of Tendinopathies in Sport.

    Science.gov (United States)

    Fernandez-Jaén, Tomas; Rey, Guillermo Álvarez; Angulo, Francisco; Cuesta, Jordi Ardevol; Loureda, Rafael Arriaza; España, Fernando Ávila; Ayala, Juan; Matas, Ramón Balius; Pazos, Fernando Baró; de Dios Beas Jiménez, Juan; Rosell, Jorge Candel; Fernandez, César Cobián; Del Pilar Doñoro Cuevas, M; Ros, Francisco Esparza; Colmenero, Josefina Espejo; de Prado, Jorge Fernández; García Cota, Juan José; Garrido González, Jose Ignacio; de Vega, Carlos Gonzalez; Santander, Manuela González; Herrador Munilla, Miguel Ángel; Ruiz, Francisco Ivorra; Díaz, Fernando Jiménez; Fernandez, Antonio Maestro; Marqueta, Pedro Manonelles; Muñoz Benito, Juan José; Vilás, Ramón Olivé; Pedret, Carles; Teres, Xavier Peirau; Amaro, José Peña; Grifell, Jordi Puigdellivoll; San Roque, Juan Pérez; Parenteu, Christophe Ramírez; Serna, Juan Ribas; Rodas, Gil; Álvarez, Mikel Sánchez; Marchori, Carlos Sanchez; Perez, Lluis Til; Durán, Rosario Ureña; Del Valle Soto, Miguel; Villalón Alonso, José María; García, Pedro Guillen

    2017-10-01

    On October 15, 2016, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of the Spanish Society for Sports Traumatology (SETRADE), the Spanish Society of Sports Medicine (SEMED), the Spanish Association of Medical Services for Football Clubs (AEMEF), the Spanish Association of Medical Services for Basketball Clubs (AEMB), F.C. Barcelona, and Clínica CEMTRO. The purpose was to consider the most appropriate clinical management and treatment of tendinopathies in sports, based on proven scientific data described in the medical literature as well as on each expert's experience. Prior to the meeting, each expert received a questionnaire regarding clinical management and treatment of tendinopathies in sports. The present consensus document summarizes the answers to the questionnaire and the resulting discussion and consensus regarding current concepts on tendinopathies in sports.

  15. Statement of J.O. Neff, Manager, Salt Repository Project Office, Department of Energy

    International Nuclear Information System (INIS)

    Anon.

    1987-01-01

    My name is Jeff Neff and I am the Manager of the US Department of Energy's Salt Repository Project Office, now located in Hereford, Texas. The responsibilities of my office are to manage the day-to-day activities of the site suitability investigations of the designated nine-square-mile site located in Deaf Smith County, near Hereford in the Texas Panhandle. The location is indicated on several of the attachments. My remarks will be divided into five categories: (1) a brief history of how the Deaf Smith County site was designated; (2) a review of major issues for the Texas site and how these are expected to be resolved during site characterization; (3) a summary of major institutional issues; (4) a summary of consultation and cooperation activities with the State of Texas, through its Nuclear Waste Programs Office; and (5) highlights of current and past interactions with local governmental officials and the public in the Panhandle

  16. RTE - Activity and sustainable development report 2014. Management report consolidated financial statements 2014

    International Nuclear Information System (INIS)

    2015-01-01

    After an interview of RTE's CEO, an overview of governance issues within the company, and a presentation of its business model, the activity report addresses the various aspects of RTE activities during 2014: grid expertise, a fair and balanced service, performance at the right price, cooperation between all players, a long term commitment, and perspectives. It also focuses on the corporate aspects: collective intelligence, workforce involvement, safety culture. The management report contains financial and legal information (significant events of 2014, economic environment, business and results, financing, financial structure, outlook for 2015, risk analysis), company information (employment, work organisation, labour relations, health and safety, training, diversity and equal opportunities, compliance with International Labour Organisation conventions), environmental information (general environmental policy, pollution and waste management, sustainable use of resources, climate change, protection and development of biodiversity), and societal information (local, economic and social impact of RTE's business, relations with people and organisations concerned by RTE's business, out-sourcing and suppliers, fair practices, other action to promote human rights). The third report presents the supervisory board (members and missions, operation, committees), the Executive Board (members and remuneration principles), the operation of general assemblies. It describes the internal control of RTE (organisation, actors), presents the policy of risk management and control, activities of audit and control within RTE. It finally presents external controls made by different public bodies

  17. Consensus Statement of the Indian Academy of Pediatrics on Evaluation and Management of Autism Spectrum Disorder.

    Science.gov (United States)

    Dalwai, Samir; Ahmed, Shabina; Udani, Vrajesh; Mundkur, Nandini; Kamath, S S; C Nair, M K

    2017-05-15

    Autism Spectrum Disorder (ASD) is a clinically heterogenous condition with a wide range of etiological factors and causing significant public health burden. ASD poses a serious developmental disadvantage to the child in the form of poor schooling, social function and adult productivity. Thus, framing evidence-based national guidelines is a pressing need. The meeting on formulation of national consensus guidelines on neurodevelopmental disorders was organized by Indian Academy of Paediatrics in Mumbai on 18th and 19th December 2015. The invited experts included Pediatricians, Developmental Pediatricians, Psychiatrists, Remedial Educators, Pediatric Neurologists and Clinical Psychologists. The participants framed guidelines after extensive discussions. Thereafter, a committee was established to review the points discussed in the meeting. To provide consensus guidelines on evaluation and management of ASD in children in India. Intervention should begin as early as possible. A definitive diagnosis is not necessary for commencing intervention. Intervention should target core features of autism i.e. deficits in social communication and interaction, and restricted repetitive patterns of behavior, activities and/ or interests. Intervention should be specific, evidence-based, structured and appropriate to the developmental needs of the child. Management of children should be provided through interdisciplinary teams, coordinated by the Pediatrician. Management of co-morbidities is critical to effectiveness of treatment. Pharmacotherapy may be offered to children when there is a specific target symptom or co-morbid condition.

  18. [Consensus statement on the clinical management of human immunodeficiency virus-associated neurocognitive disorders].

    Science.gov (United States)

    Podzamczer Palter, Daniel; Muñoz-Moreno, José A; Alcolea Rodríguez, Daniel; Alonso Villaverde, Carlos; Antela López, Antonio; Blanch Andreu, Jordi; Casado Osorio, José Luis; Galindo Puerto, M José; Garolera i Freixa, Maite; Locutura Rupérez, Jaime; Lleó Bisa, Albert; Prats París, Anna; Pérez-Valero, Ignacio; Portilla Sogorb, Joaquín; Rovira Cañellas, Alex; Téllez Molina, M Jesús; Tiraboschi, Juan Manuel; Vergara Moragues, Esperanza; Arribas López, José Ramón; Goenaga Sánchez, Miguel Ángel; de León-Naranjo, Fernando Lozano; Martínez Chamorro, Esteban; Polo Rodríguez, Rosa; Muñoz-Moreno, José A; Podzamczer, Daniel

    2014-01-01

    To develop a consensus document containing clinical recommendations for the management of human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND). We assembled a panel of experts appointed by GeSIDA and the Secretariat of the National AIDS Plan (PNS), including internal medicine physicians with expertise in the field of HIV, neuropsychologists, neurologists and neuroradiologists. Scientific information was reviewed to October 2012 in publications and conference papers. In support of the recommendations using two levels of evidence: the strength of the recommendation in the opinion of the experts (A, B, C) and the level of empirical evidence (I, II, III), two levels based on the criteria of the Infectious Disease Society of America, already used in previous documents GeSIDA/SPNS. Multiple recommendations for the clinical management of these disorders are provided, including two graphics algorithms, considering both the diagnostic and possible therapeutic strategies. Neurocognitive disorders associated with HIV infection is currently highly prevalent, are associated with a decreased quality of life and daily activities, and given the possibility of occurrence of an increase in the coming years, there is a need to adequately manage these disorders, from a diagnostic as well as therapeutic point of view, and always from a multidisciplinary perspective. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  19. The European Federation of Organisations for Medical Physics Policy Statement No 14, The role of the Medical Physicist in the management of safety within the magnetic resonance imaging environment, EFOMP recommendations

    NARCIS (Netherlands)

    Hand, J.; Bosmans, H.; Caruana, C.; Keevil, S.; Norris, David Gordon; Padovani, R.; Speck, O.

    2013-01-01

    This European Federation of Organisations for Medical Physics (EFOMP) Policy Statement outlines the way in which a Safety Management System can be developed for MRI units. The Policy Statement can help eliminate or at least minimize accidents or incidents in the magnetic resonance environment and is

  20. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume V of V

    International Nuclear Information System (INIS)

    1997-01-01

    The Final Waste Management Programmatic Environmental Impact Statement (WM PEIS) examines the potential environmental and cost impacts of strategic management alternatives for managing five types of radioactive and hazardous wastes that have resulted and will continue to result from nuclear energy research and the development, production, and testing of nuclear weapons at a variety of sites around the United States. The five waste types are low-level mixed waste, low-level waste, transuranic waste, high-level waste, and hazardous waste. The WM PEIS provides information on the impacts of various siting alternatives, which the Department of Energy (DOE) will use to decide at which sites to locate additional treatment, storage, and disposal capacity for each waste type. This information includes the cumulative impacts of combining future siting configurations for the five waste types and the collective impacts of other past, present, and reasonably foreseeable future activities. The selected waste management facilities being considered for these different waste types are treatment and disposal facilities for low-level mixed waste; treatment and disposal facilities for low-level waste; treatment and storage facilities for transuranic waste in the event that treatment is required before disposal; storage facilities for created (vitrified) high-level waste canisters; and treatment of nonwastewater hazardous waste by DOE and commercial vendors. In addition to the No Action Alternative, which includes only existing of approved waste management facilities, the alternatives for each of the waste-type configurations include Decentralized, Regionalized, and Centralized Alternatives for using existing and operating new waste management facilities. However, the siting, construction, and operations of any new facility at a selected site will not be decided until completion of a sitewide or project-specific environmental impact review

  1. Final waste management programmatic environmental impact statement for managing treatment, storage, and disposal of radioactive and hazardous waste. Volume I of V

    International Nuclear Information System (INIS)

    1997-05-01

    The Final Waste Management Programmatic Environmental Impact Statement (WM PEIS) examines the potential environmental and cost impacts of strategic management alternatives for managing five types of radioactive and hazardous wastes that have resulted and will continue to result from nuclear defense and research activities at a variety of sites around the United States. The five waste types are low-level mixed waste, low-level waste, transuranic waste, high-level waste, and hazardous waste. The WM PEIS provides information on the impacts of various siting alternatives which the Department of Energy (DOE) will use to decide at which sites to locate additional treatment, storage, and disposal capacity for each waste type. This information includes the cumulative impacts of combining future siting configurations for the five waste types and the collective impacts of other past, present, and reasonably foreseeable future activities. The selected waste management facilities being considered for these different waste types are treatment and disposal facilities for low-level mixed waste; treatment and disposal facilities for low-level waste; treatment and storage facilities for transuranic waste in the event that treatment is required before disposal; storage facilities for treated (vitrified) high-level waste canisters; and treatment of nonwastewater hazardous waste by DOE and commercial vendors. In addition to the no action alternative, which includes only existing or approved waste management facilities, the alternatives for each of the waste type configurations include decentralized, regionalized, and centralized alternatives for using existing and operating new waste management facilities. However, the siting, construction and operations of any new facility at a selected site will not be decided until completion of a sitewide or project-specific environmental impact review

  2. Person-centred pain management for the patient with acute abdominal pain

    DEFF Research Database (Denmark)

    Avallin, Therese; Muntlin Athlin, Åsa; Sorensen, Erik Elgaard

    2018-01-01

    AIMS: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contribute to or detract from successful pain management for the patient with acute abdominal pain across the acute care pathway. BACKGROUND: Although pain management...... is a recognised human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance. DESIGN: Focused ethnography, applying the Developmental Research Sequence...... and the Fundamentals of Care framework. METHODS: Participant observation and informal interviews (92 hours) were performed at one emergency department and two surgical wards at a University Hospital during April - November 2015. Data includes 261 interactions between patients, aged ≥18 years seeking care for acute...

  3. Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults.

    Science.gov (United States)

    Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G

    2017-11-01

    Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

  4. Managing acute complications of sickle cell disease in pediatric patients [digest].

    Science.gov (United States)

    Subramaniam, Sathyaseelan; Chao, Jennifer H; Chaudhari, Pradip

    2016-11-22

    Sickle cell disease is a chronic hematologic disease with a variety of acute, and often recurring, complications. Vaso-occlusive crisis, a unique but common presentation in sickle cell disease, can be challenging to manage. Acute chest syndrome is the leading cause of death in patients with sickle cell disease, occurring in more than half of patients who are hospitalized with a vaso-occlusive crisis. Uncommon diagnoses in children, such as stroke, priapism, and transient red cell aplasia, occur more frequently in patients with sickle cell disease and necessitate a degree of familiarity with the disease process and its management. Patients with sickle cell trait generally have a benign course, but are also subject to serious complications. This issue provides a current review of evidence-based management of the most common acute complications of sickle cell disease seen in pediatric patients in the emergency department. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  5. Department of the Navy final environmental impact statement for a container system for the management of naval spent nuclear fuel

    International Nuclear Information System (INIS)

    1996-11-01

    This Final Environmental Impact Statement (EIS) addresses six general alternative systems for the loading, storage, transport, and possible disposal of naval spent nuclear fuel following examination. This EIS describes environmental impacts of (1) producing and implementing the container systems (including those impacts resulting from the addition of the capability to load the containers covered in this EIS in dry fuel handling facilities at Idaho National Engineering Laboratory (INEL)); (2) loading of naval spent nuclear fuel at the Expended Core Facility or at the Idaho Chemical Processing Plant with subsequent storage at INEL; (3) construction of a storage facility (such as a paved area) at alternative locations at INEL; and (4) loading of containers and their shipment to a geologic repository or to a centralized interim storage site outside the State of Idaho once one becomes available. As indicated in the EIS, the systems and facilities might also be used for handling low-level radiological waste categorized as special case waste. The Navy's preferred alternative for a container system for the management of naval spent fuel is a dual-purpose canister system. The primary benefits of a dual-purpose canister system are efficiencies in container manufacturing and fuel reloading operations, and potential reductions in radiation exposure

  6. Final Long-Term Management and Storage of Elemental Mercury Environmental Impact Statement Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    2011-01-01

    Pursuant to the Mercury Export Ban Act of 2008 (P.L. 110-414), DOE was directed to designate a facility or facilities for the long-term management and storage of elemental mercury generated within the United States. Therefore, DOE has analyzed the storage of up to 10,000 metric tons (11,000 tons) of elemental mercury in a facility(ies) constructed and operated in accordance with the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act (74 FR 31723). DOE prepared this Final Mercury Storage EIS in accordance with the National Environmental Policy Act of 1969 (NEPA), as amended (42 U.S.C. 4321 et seq.), the Council on Environmental Quality (CEQ) implementing regulations (40 CFR 1500–1508), and DOE’s NEPA implementing procedures (10 CFR 1021) to evaluate reasonable alternatives for a facility(ies) for the long-term management and storage of elemental mercury. This Final Mercury Storage EIS analyzes the potential environmental, human health, and socioeconomic impacts of elemental mercury storage at seven candidate locations: Grand Junction Disposal Site near Grand Junction, Colorado; Hanford Site near Richland, Washington; Hawthorne Army Depot near Hawthorne, Nevada; Idaho National Laboratory near Idaho Falls, Idaho; Kansas City Plant in Kansas City, Missouri; Savannah River Site near Aiken, South Carolina; and Waste Control Specialists, LLC, site near Andrews, Texas. As required by CEQ NEPA regulations, the No Action Alternative was also analyzed as a basis for comparison. DOE intends to decide (1) where to locate the elemental mercury storage facility(ies) and (2) whether to use existing buildings, new buildings, or a combination of existing and new buildings. DOE’s Preferred Alternative for the long-term management and storage of mercury is the Waste Control Specialists, LLC, site near Andrews, Texas.

  7. Final Long-Term Management and Storage of Elemental Mercury Environmental Impact Statement Volume1

    Energy Technology Data Exchange (ETDEWEB)

    2011-01-01

    Pursuant to the Mercury Export Ban Act of 2008 (P.L. 110-414), DOE was directed to designate a facility or facilities for the long-term management and storage of elemental mercury generated within the United States. Therefore, DOE has analyzed the storage of up to 10,000 metric tons (11,000 tons) of elemental mercury in a facility(ies) constructed and operated in accordance with the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act (74 FR 31723).DOE prepared this Final Mercury Storage EIS in accordance with the National Environmental Policy Act of 1969 (NEPA), as amended (42 U.S.C. 4321 et seq.), the Council on Environmental Quality (CEQ) implementing regulations (40 CFR 1500–1508), and DOE’s NEPA implementing procedures (10 CFR 1021) to evaluate reasonable alternatives for a facility(ies) for the long-term management and storage of elemental mercury. This Final Mercury Storage EIS analyzes the potential environmental, human health, and socioeconomic impacts of elemental mercury storage at seven candidate locations:Grand Junction Disposal Site near Grand Junction, Colorado; Hanford Site near Richland, Washington; Hawthorne Army Depot near Hawthorne, Nevada; Idaho National Laboratory near Idaho Falls, Idaho;Kansas City Plant in Kansas City, Missouri; Savannah River Site near Aiken, South Carolina; and Waste Control Specialists, LLC, site near Andrews, Texas. As required by CEQ NEPA regulations, the No Action Alternative was also analyzed as a basis for comparison. DOE intends to decide (1) where to locate the elemental mercury storage facility(ies) and (2) whether to use existing buildings, new buildings, or a combination of existing and new buildings. DOE’s Preferred Alternative for the long-term management and storage of mercury is the Waste Control Specialists, LLC, site near Andrews, Texas.

  8. Prevention and management of non-communicable disease: the IOC consensus statement, Lausanne 2013.

    Science.gov (United States)

    Matheson, Gordon O; Klügl, Martin; Engebretsen, Lars; Bendiksen, Fredrik; Blair, Steven N; Börjesson, Mats; Budgett, Richard; Derman, Wayne; Erdener, Uğur; Ioannidis, John P A; Khan, Karim M; Martinez, Rodrigo; van Mechelen, Willem; Mountjoy, Margo; Sallis, Robert E; Schwellnus, Martin; Shultz, Rebecca; Soligard, Torbjørn; Steffen, Kathrin; Sundberg, Carl Johan; Weiler, Richard; Ljungqvist, Arne

    2013-11-01

    Morbidity and mortality from preventable, non-communicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology, and design thinking. The purpose of this paper is to summarize the results of a consensus meeting on NCD prevention sponsored by the International Olympic Committee (IOC) in April, 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within health care systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: 1. Focus on behavioural change as the core component of all clinical programs for the prevention and management of chronic disease. 2. Establish actual centres to design, implement, study, and improve preventive programs for chronic disease. 3. Use human-centered design in the creation of prevention programs with an inclination to action, rapid prototyping and multiple iterations. 4. Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programs for the prevention and treatment of chronic disease focused on physical activity, diet and lifestyle. 5. Mobilize resources and leverage networks to scale and distribute programs of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programs within health care. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad-hoc Working Group charged with the responsibility of moving this

  9. Prevention and management of noncommunicable disease: the IOC Consensus Statement, Lausanne 2013.

    Science.gov (United States)

    Matheson, Gordon O; Klügl, Martin; Engebretsen, Lars; Bendiksen, Fredrik; Blair, Steven N; Börjesson, Mats; Budgett, Richard; Derman, Wayne; Erdener, Uğur; Ioannidis, John P A; Khan, Karim M; Martinez, Rodrigo; van Mechelen, Willem; Mountjoy, Margo; Sallis, Robert E; Schwellnus, Martin; Shultz, Rebecca; Soligard, Torbjørn; Steffen, Kathrin; Sundberg, Carl Johan; Weiler, Richard; Ljungqvist, Arne

    2013-11-01

    Morbidity and mortality from preventable, noncommunicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology, and design thinking. The purpose of this paper is to summarize the results of a consensus meeting on NCD prevention sponsored by the International Olympic Committee (IOC) in April 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within health care systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: 1. Focus on behavioral change as the core component of all clinical programs for the prevention and management of chronic disease. 2. Establish actual centers to design, implement, study, and improve preventive programs for chronic disease. 3. Use human-centered design (HCD) in the creation of prevention programs with an inclination to action, rapid prototyping and multiple iterations. 4. Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programs for the prevention and treatment of chronic disease focused on physical activity, diet, and lifestyle. 5. Mobilize resources and leverage networks to scale and distribute programs of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programs within health care. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad hoc Working Group charged with the responsibility of moving this

  10. The Management of Disinvestment Decision and its Impact on Financial Statements

    Directory of Open Access Journals (Sweden)

    Moisescu Florentina

    2016-07-01

    Full Text Available The political and economic context of the world noticeably influenced, in recent years, the economic development of corporations, causing sometimes resounding failures, forcing businesses to act with caution. In this context, senior management decisions are oriented towards achieving financial stability, even if this implies a stagnation in terms of the financial result and not a constant profit growth. This paper examines the impact of fixed alienation on the entity's financial results, the importance of rational management strategie that lead to the creation of new sources of investment and the timing of disinvestments by applying the Altman model to the Romanian energy companies quoted at BVB. It has been found that the incorrect clasification of assets held for sale, changes the structure of the expenses incurred with the amortization said tangible assets because at the moments of their classification as assets held for sale, assests cease to be amortized. In the case of the failure of the Retail Plan, the recording of the accounting depreciation stops and the asset is being over-evaluated.

  11. ILK statement about the proposed EU directives on nuclear safety and the management of radioactive waste

    International Nuclear Information System (INIS)

    2003-01-01

    In November 2002, the European Commission proposed a package of measures for a community concept of the EU on nuclear safety. It includes a proposed directive on the safety of nuclear installations during operating and decommissioning, and a proposed directive on the management of radioactive waste. In the opinion of the International Nuclear Committee (ILK), the competences and obligations of the member states and their safety authorities must be preserved in the future. Primary responsibility for plant safety rests with the operator. This objective is served by transparent, harmonized EU-wide safety standards. New standards and definitions are not generally required. Harmonized safety standards to be developed should initially be limited to nuclear power plants because of the fundamental differences in design of nuclear facilities. The Commission should obtain the technical competence required to perform the duties arising from the application of the proposed directive. Formal inspections by the Commission of the national regulatory authorities are not necessary. Instead, a peer review process will be the better solution. A reporting system at three-year intervals is generally regarded as the most effective approach. The ILK considers the tight schedule for final storage, especially of high-level waste, problematic. Joint repository projects, also for countries with low waste arisings, are suitable approaches. The envisaged reports about the state of radioactive waste management should be integrated into the reporting systems under other international agreements. The Commission's intention to intensify cooperation in the field of research is welcomed. (orig.) [de

  12. Evolution of blood pressure management in acute intracerebral hemorrhage [version 1; referees: 4 approved

    Directory of Open Access Journals (Sweden)

    Stacy Chu

    2017-11-01

    Full Text Available Intracerebral hemorrhage (ICH remains a prevalent and severe cause of death and disability worldwide. Control of the hypertensive response in acute ICH has been a mainstay of ICH management, yet the optimal approaches and the yield of recommended strategies have been difficult to establish despite a large body of literature. Over the years, theoretical and observed risks and benefits of intensive blood pressure reduction in ICH have been studied in the form of animal models, radiographic studies, and two recent large, randomized patient trials. In this article, we review the historical and developing data and discuss remaining questions surrounding blood pressure management in acute ICH.

  13. Advanced imaging in acute stroke management-Part I: Computed tomographic.

    Science.gov (United States)

    Saini, Monica; Butcher, Ken

    2009-01-01

    Neuroimaging is fundamental to stroke diagnosis and management. Non-contrast computed tomography (NCCT) has been the primary imaging modality utilized for this purpose for almost four decades. Although NCCT does permit identification of intracranial hemorrhage and parenchymal ischemic changes, insights into blood vessel patency and cerebral perfusion are limited. Advances in reperfusion strategies have made identification of potentially salvageable brain tissue a more practical concern. Advances in CT technology now permit identification of acute and chronic arterial lesions, as well as cerebral blood flow deficits. This review outlines principles of advanced CT image acquisition and its utility in acute stroke management.

  14. Recent Advances in Managing Acute Pancreatitis [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Nigeen Janisch

    2015-12-01

    Full Text Available This article will review the recent advances in managing acute pancreatitis. Supportive care has long been the standard of treatment for this disease despite extensive, but ultimately unsuccessful, efforts to develop disease-specific pharmacologic therapies. The primary interventions center on aggressive fluid resuscitation, initiation of early enteral nutrition, targeted antibiotic therapy, and the management of complications. In this article, we will detail treatment of acute pancreatitis with a focus on intravenous fluid resuscitation, enteral feeding, and the current evidence behind the use of antibiotics and other pharmacologic therapies.

  15. Acute peg in hole docking in the management of infected non-union of long bones

    OpenAIRE

    Dhar, Shabir Ahmed; Mir, Mohammed Ramzan; Ahmed, Molvi Sajjad; Afzal, Suhail; Butt, Mohammed Farooq; Badoo, A. R.; Dar, Irshad Tabasum; Hussain, Anwar

    2007-01-01

    The Ilizarov method has been studied extensively in the management of non-union of long bones. In most cases this involves filling of defects present primarily or after débridement by bone transport. Acute docking over gaps longer than 2 cm has not been adequately studied, however. The purpose of this paper is to report the efficacy of acute peg in hole docking as a bone graft-sparing modality in the management of infected non-union of long bones.

  16. Acute peg in hole docking in the management of infected non-union of long bones.

    Science.gov (United States)

    Dhar, Shabir Ahmed; Mir, Mohammed Ramzan; Ahmed, Molvi Sajjad; Afzal, Suhail; Butt, Mohammed Farooq; Badoo, A R; Dar, Irshad Tabasum; Hussain, Anwar

    2008-08-01

    The Ilizarov method has been studied extensively in the management of non-union of long bones. In most cases this involves filling of defects present primarily or after débridement by bone transport. Acute docking over gaps longer than 2 cm has not been adequately studied, however. The purpose of this paper is to report the efficacy of acute peg in hole docking as a bone graft-sparing modality in the management of infected non-union of long bones.

  17. Recurrent acute pancreatitis: an approach to diagnosis and management.

    Science.gov (United States)

    Kedia, Saurabh; Dhingra, Rajan; Garg, Pramod Kumar

    2013-01-01

    Recurrent acute pancreatitis (RAP) is defined as more than two attacks of acute pancreatitis (AP) without any evidence of underlying chronic pancreatitis (CP). As the known causes of AP are generally taken care of, RAP usually occurs in the idiopathic group, which forms 20%-25% of cases of AP. The causes of idiopathic RAP (IRAP) can be mechanical, toxic-metabolic, anatomical, or miscellaneous. Microlithiasis commonly reported from the West is not a common cause of IRAP among Indian patients. Pancreas divisum (PD) is now believed as a cofactor, the main factor being associated genetic mutations. The role of Sphincter of Oddi dysfunction (SOD) as a cause of IRAP remains controversial. Malignancy should be ruled out in any patient with IRAP > 50 years of age. Early CP can present initially as RAP. The work-up of patients with IRAP includes a detailed history and investigations. Primary investigations include liver function tests (LFT), serum calcium and triglyceride, abdominal ultrasonography (USG) and contrast-ehhanced computed tomography (CECT) abdomen. Endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP) and possibly endoscopic retrograde cholangiopancreatography (ERCP) are indicated in the secondary phase if the work-up is negative after the primary investigations. EUS is advised usually 6-8 weeks after an acute episode. Treatment of patients with IRAP is aimed at the specific aetiology. In general, empirical cholecystectomy should be discouraged with the availability and widespread use of EUS. Endoscopic sphincterotomy is advised if there is strong suspicion of SOD. Minor papilla sphincterotomy should be carried out in those with PD but with limited expectations. Regular follow-up of patients with IRAP is necessary because most patients are likely to develop CP in due course.

  18. Opening Statement to ICTP/IAEA School of Nuclear Energy Management, 8 August 2011, Trieste, Italy

    International Nuclear Information System (INIS)

    Bychkov, A.

    2011-01-01

    Today is an exciting day for all of us. It is the start of an intensive three-week course that covers a wide range of important topics in the nuclear energy sector. You - the new generation of nuclear energy leaders - will have the unique opportunity here to learn and benefit from the specific knowledge of the Agency and its senior experts in nuclear energy, nuclear safety, nuclear security and nuclear safeguards. You will be able to gain a broad international perspective on many issues related to the peaceful uses of nuclear technology. And you will be required to take an exam at the end. This will help you - and us - to confirm that you will have understood the lectures and group work, and that it will be sustainable knowledge. Getting to know and working with peers from around the world - and maybe making friends for a life time - is an extra bonus. Many countries are concerned that they will not have enough skilled professionals in the nuclear field in the coming decades. When you return to your countries after these three weeks, you will be better prepared to contribute to building and managing nuclear power programmes responsibly, safely and sustainably. Nuclear energy has played an important role during all my life. I call myself a 'nuclear man'. For the past 30 years, I spent my professional career at the Research Institute of Atomic Reactors - or RIAR - in Dimitrovgrad, where I started as a young engineer and researcher. When the former Soviet Union collapsed twenty years ago, many scientific institutes were faced with a long period of crisis. At that time, my scientific boss, Professor Skiba, and the Director of our Institute, Professor Ivanov, asked me to head my Laboratory. This was a great challenge. We and some other groups worked in the field of new pyro- electrochemical technologies for fast reactor fuel recycling. We wanted to preserve existing knowledge and develop new one. I encouraged my team to look into the future. It was an opportunity to

  19. Imaging and Percutaneous Management of Acute Complicated Pancreatitis

    International Nuclear Information System (INIS)

    Shankar, Sridhar; Sonnenberg, Eric van; Silverman, Stuart G.; Tuncali, Kemal; Banks, Peter A.

    2004-01-01

    Acute pancreatitis varies from a mild, self-limited disease to one with significant morbidity and mortality in its most severe forms. While clinical criteria abound, imaging has become indispensable to diagnose the extent of the disease and its complications, as well as to guide and monitor therapy. Percutaneous interventional techniques offer options that can be life-saving, surgery-sparing or important adjuncts to operation. Close cooperation and communication between the surgeon, gastroenterologist and interventional radiologist enhance the likelihood of successful patient care

  20. Pathophysiology and Management of Acute Respiratory Distress Syndrome in Children.

    Science.gov (United States)

    Heidemann, Sabrina M; Nair, Alison; Bulut, Yonca; Sapru, Anil

    2017-10-01

    Acute respiratory distress syndrome (ARDS) is a syndrome of noncardiogenic pulmonary edema and hypoxia that accompanies up to 30% of deaths in pediatric intensive care units. Pediatric ARDS (PARDS) is diagnosed by the presence of hypoxia, defined by oxygenation index or Pao 2 /Fio 2 ratio cutoffs, and new chest infiltrate occurring within 7 days of a known insult. Hallmarks of ARDS include hypoxemia and decreased lung compliance, increased work of breathing, and impaired gas exchange. Mortality is often accompanied by multiple organ failure. Although many modalities to treat PARDS have been investigated, supportive therapies and lung protective ventilator support remain the mainstay. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Final Environmental Impact Statement for the Treatment and Management of Sodium-Bonded Spent Nuclear Fuel

    International Nuclear Information System (INIS)

    2000-01-01

    DOE is responsible for the safe and efficient management of its sodium-bonded spent nuclear fuel. This fuel contains metallic sodium, a highly reactive material; metallic uranium, which is also reactive; and in some cases, highly enriched uranium. The presence of reactive materials could complicate the process of qualifying and licensing DOE's sodium-bonded spent nuclear fuel inventory for disposal in a geologic repository. Currently, more than 98 percent of this inventory is located at the Idaho National Engineering and Environmental Laboratory (INEEL), near Idaho Falls, Idaho. In addition, in a 1995 agreement with the State of Idaho, DOE committed to remove all spent nuclear fuel from Idaho by 2035. This EIS evaluates the potential environmental impacts associated with the treatment and management of sodium-bonded spent nuclear fuel in one or more facilities located at Argonne National Laboratory-West (ANL-W) at INEEL and either the F-Canyon or Building 105-L at the Savannah River Site (SRS) near Aiken, South Carolina. DOE has identified and assessed six proposed action alternatives in this EIS. These are: (1) electrometallurgical treatment of all fuel at ANL-W, (2) direct disposal of blanket fuel in high-integrity cans with the sodium removed at ANL-W, (3) plutonium-uranium extraction (PUREX) processing of blanket fuel at SRS, (4) melt and dilute processing of blanket fuel at ANL-W, (5) melt and dilute processing of blanket fuel at SRS, and (6) melt and dilute processing of all fuel at ANL-W. In addition, Alternatives 2 through 5 include the electrometallurgical treatment of driver fuel at ANL-W. Under the No Action Alternative, the EIS evaluates both the continued storage of sodium-bonded spent nuclear fuel until the development of a new treatment technology or direct disposal without treatment. Under all of the alternatives, the affected environment is primarily within 80 kilometers (50 miles) of spent nuclear fuel treatment facilities. Analyses indicate

  2. Nutritional Management of Acute Diarrhea in Infants and Children.

    Science.gov (United States)

    National Academy of Sciences-National Research Council, Washington, DC. Food and Nutrition Board.

    Written primarily for health professionals advising on programs and policy related to nutrition and diarrhea therapy, this report is aimed at management of diarrhea in less-developed countries, but its information and technical insights are relevant to an understanding of diarrhea and its management throughout the world. Technical in orientation…

  3. Pattern and Management Outcomes of Neonatal Acute Surgical

    African Journals Online (AJOL)

    Hp 630 Dual Core

    July/August 2015 Volume 20 (2). Patterns and Management Outcomes of Neonatal cute Surgical Conditions in lexandria, ... Permission to carry out this study was obtained from the hospital management. Results. A total of 156 newborns ..... and financial constraints were the predominant reasons. This indicates good heath ...

  4. Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society

    Directory of Open Access Journals (Sweden)

    DE Moulin

    2007-01-01

    Full Text Available Neuropathic pain (NeP, generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence-based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost-effectiveness. Analgesic agents recommended for first-line treatments are certain antidepressants (tricyclics and anticonvulsants (gabapentin and pregabalin. Second-line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled-release opioid analgesics are recommended as third-line treatments for moderate to severe pain. Recommended fourth-line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Further studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes, and treatment of pediatric and central NeP.

  5. Statement to ICTP/IAEA School of Nuclear Energy Management, 8 August 2011, Trieste, Italy

    International Nuclear Information System (INIS)

    Amano, Y.

    2011-01-01

    It is a pleasure for me to welcome you to the ICTP/IAEA School of Nuclear Energy Management. I would like to express my sincere thanks to ICTP and its Director, Professor Fernando Quevedo, and to the Government of Italy, for hosting this important event. Nuclear power is facing a major challenge throughout the world following the accident at the Fukushima Daiichi nuclear power plant in Japan five months ago. The accident, caused by an earthquake and tsunami of unprecedented severity undermined confidence in the safety of nuclear power in many countries. I saw for myself just how powerful and destructive nature can be when I visited the Fukushima Daiichi plant a few weeks ago. But I was also deeply impressed by the passion and energy of the engineers and workers at the site who are determined to restore full control over the facility. Great progress has already been made. I am also confident that the right lessons are being learned internationally. An IAEA Ministerial Conference, which I convened in Vienna in June, agreed on significant measures to improve nuclear safety, emergency preparedness and radiation protection of people and the environment throughout the world. These include strengthening IAEA Safety Standards, systematically reviewing the safety of all nuclear power plants - including by expanding the IAEA's programme of expert peer review missions - and enhancing the effectiveness of national nuclear regulatory bodies. Despite Fukushima Daiichi, global use of nuclear power will continue to grow in the coming decades. The factors that had contributed to increasing interest in nuclear power before the accident, such as persistent energy demand growth due to population growth and economic development, and concerns of climate change largely remain the same. Even the few countries which have decided to abandon nuclear power will still need a highly qualified workforce for decades to come - to run existing nuclear power plants, to decommission them and to

  6. Radioactive waste management. Introductory statement of the 3rd scientific forum during the 44th session of the IAEA General Conference. Vienna, 19 September 2000

    International Nuclear Information System (INIS)

    ElBaradei, M.

    2000-01-01

    The document reproduces the text of the introductory statement made by the Director General of the IAEA at the 3rd scientific forum organized during the 44th session of the IAEA General Conference, Vienna, 19 september 2000, on the management of radioactive waste. He emphasized the following aspects: progress made in technology and public acceptance, global challenges, international co-operation, building a stronger framework

  7. State of the Art Management of Acute Vaso-occlusive Pain in Sickle Cell Disease.

    Science.gov (United States)

    Puri, Latika; Nottage, Kerri A; Hankins, Jane S; Anghelescu, Doralina L

    2018-02-01

    Acute vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD). Multiple complex pathophysiological processes can result in pain during a VOC. Despite significant improvements in the understanding and management of SCD, little progress has been made in the management of pain in SCD, although new treatments are being explored. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment of VOC pain, but new classes of drugs are being tested to prevent and treat acute pain. Advancements in the understanding of the pathophysiology of SCD and pain and the pharmacogenomics of opioids have yet to be effectively utilized in the management of VOC. Opioid tolerance and opioid-induced hyperalgesia are significant problems associated with the long-term use of opioids, and better strategies for chronic pain therapy are needed. This report reviews the mechanisms of pain associated with acute VOC, describes the current management of VOC, and describes some of the new therapies under evaluation for the management of acute VOC in SCD.

  8. [The role of county health center in the management of patients with acute coronary syndrome].

    Science.gov (United States)

    Krcmar, Nevenka; Pristas, Ivan; Stevanović, Ranko

    2009-02-01

    Health emergency service teams play an important role in the management of patients with acute coronary syndrome. They have to be educated, equipped, skilful and supported by the entire health care system. The role of county health center in the management of patients with acute coronary syndrome is illustrated in the article, based on the experience acquired at Medimurje County Health Center from Cakovec. The reformed Health Center activities including organization, coordination and linking of teams, population health monitoring at the local level, epidemiologic surveillance, education (active and passive, on both sides of college chair), joint diagnostic and other services, and quality control are discussed in detail. In contrast to a bureaucratic and formal one, a real and innovative reform should take account of necessary changes in the management and organization, not just in standards, rights and obligations. The management protocol for acute coronary syndrome patients is described: setting the main objective (acute coronary disease morbidity and mortality reduction), setting short-term and long-term specific goals, adoption of strategy based on the main objective (education, completion and particular programs pursuit, connecting, collaboration, quality assurance through clinical guidelines and protocols) and other elements, including dignity, leadership, teamwork, adoption and implementation of patient management protocols.

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

    Science.gov (United States)

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

    2016-01-01

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

  10. Effectiveness of conservative management of uncomplicated acute appendicitis: A single hospital based prospective study

    Directory of Open Access Journals (Sweden)

    Mumtaz KH. Alnaser

    Full Text Available Background: Acute appendicitis is one of the commonest causes of acute abdomen. There is a wide discussion and controversy on the surgical and nonsurgical treatment of acute uncomplicated appendicitis. The aim of this study was to evaluate the efficacy and outcomes of the conservative management of selected cases of acute appendicitis with an antibiotic first plan. Patients and methods: This was a single hospital-based prospective study with a duration of 25 months. Patients with clinical and radiological features of acute appendicitis presenting within 72 h of the beginning of abdominal pain with Alvarado score ≥5 were included. The patients received a therapeutic dose of broad-spectrum antibiotics and symptomatic treatment. The follow-up period was 6 months. Results: 90 patients were evaluated, 54 (60% patients were female and 36 (40% patients were male with mean age 34.4 years. Conservative treatment was successful in 68 (75.6% patients and failed in 22 (24.4% patients. No mortality recorded in this study. The main complications which occurred in those patients who failed to respond to conservative treatment were perforated appendicitis (3 patients, appendicular abscess (3 patients and appendicular mass (4 patients. Conclusion: Majority of cases of the first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment demands precise communication, close monitoring and follow-up to recognize failure which needs to be treated immediately by surgery. Keywords: Acute appendicitis, Conservative treatment, Surgery, Antibiotics

  11. Acute pulmonary oedema: clinical characteristics, prognostic factors, and in-hospital management.

    Science.gov (United States)

    Parissis, John T; Nikolaou, Maria; Mebazaa, Alexandre; Ikonomidis, Ignatios; Delgado, Juan; Vilas-Boas, Fabio; Paraskevaidis, Ioannis; Mc Lean, Antony; Kremastinos, Dimitrios; Follath, Ferenc

    2010-11-01

    Acute pulmonary oedema (APE) is the second, after acutely decompensated chronic heart failure (ADHF), most frequent form of acute heart failure (AHF). This subanalysis examines the clinical profile, prognostic factors, and management of APE patients (n = 1820, 36.7%) included in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). ALARM-HF included a total of 4953 patients hospitalized for AHF in Europe, Latin America, and Australia. The final diagnosis was made at discharge, and patients were classified according to European Society of Cardiology guidelines. Patients with APE had higher in-hospital mortality (7.4 vs. 6.0%, P = 0.057) compared with ADHF patients (n = 1911, 38.5%), and APE patients exhibited higher systolic blood pressures (P chronic renal disease (P renal function, and history may identify high-risk APE patients.

  12. Acute kidney injury in pediatric patients: diagnosis and management in the emergency department [digest].

    Science.gov (United States)

    Mohrer, Daniel; Langhan, Melissa; Chaudhari, Pradip

    2017-05-22

    Pediatric acute kidney injury is a condition that is underdiagnosed among children seen in the emergency department, and it has been associated with significant morbidity and mortality, including increased risk for chronic kidney disease. The most common etiologies in pediatric patients are now known to be due to hypovolemia, sepsis, shock, and cardiac dysfunction. This issue compares 3 classification systems for the diagnosis and staging of acute kidney injury and reviews the etiologies that lead to kidney injury in children. The management of pediatric acute kidney injury focuses on identifying patients at high risk, monitoring intravascular volume status, avoiding nephrotoxic medication exposure, and involving a pediatric nephrologist once acute kidney injury is diagnosed. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  13. Assessment, management and treatment of acute fingertip injuries.

    Science.gov (United States)

    Kearney, Anthony; Canty, Louise

    2016-06-01

    Fingertip injuries with nail bed trauma can require specialist hand surgery, depending on severity. However, most of these injuries can be managed in well-equipped emergency departments by emergency nurses with an in-depth knowledge and understanding of the anatomy and physiology of the fingernail and surrounding structures, assessment and examination, pain management and treatment. This article describes the surface and underlying anatomy and physiology of the nail, the most common mechanisms of injury, relevant diagnostic investigations, and initial assessment and management. It also discusses treatment options, referral pathways, and patient discharge advice.

  14. Starting early: integration of self-management support into an acute stroke service.

    Science.gov (United States)

    Mäkelä, Petra; Gawned, Sara; Jones, Fiona

    2014-01-01

    Self-management support following stroke is rare, despite emerging evidence for impact on patient outcomes. The promotion of a common approach to self-management support across a stroke pathway requires collaboration between professionals. To date, the feasibility of self-management support in acute stroke settings has not been evaluated. The Bridges stroke self-management package (SMP) is based on self-efficacy principles. It is delivered by professionals and supported by a patient-held workbook. The aim of this project was to introduce the Bridges stroke SMP to the multidisciplinary staff of a London hyperacute and acute stroke unit. The 'Plan Do Study Act' (PDSA) cycle guided iterative stages of project development, with normalisation process theory helping to embed the intervention into existing ways of working. Questionnaires explored attitudes, beliefs and experiences of the staff who were integrating self-management support into ways of working in the acute stroke setting. Self-management support training was delivered to a total of 46 multidisciplinary stroke staff. Of the staff who attended the follow-up training, 66% had implemented Bridges self-management support with patients since initial training, and 100% felt their practice had changed. Questionnaire findings demonstrated that staff attitudes and beliefs had changed following training, particularly regarding ownership and type of rehabilitation goals set, and prioritisation of self-management support within acute stroke care. Staff initiated an audit of washing and dressing practices pre- and post-training. This was designed to evaluate the number of occasions when techniques were used by staff to facilitate patients' independence and self-management. They found that the number of occasions featuring optimum practice went from 54% at baseline to 63% at three months post-training. This project demonstrated the feasibility of integrating self-management support into an acute stroke setting. Further

  15. Position Statement on the management of continuous subcutaneous insulin infusion (CSII): The Italian Lazio experience.

    Science.gov (United States)

    Maurizi, Anna R; Suraci, Concetta; Pitocco, Dario; Schiaffini, Riccardo; Tubili, Claudio; Morviducci, Lelio; Giordano, Renato; Manfrini, Silvia; Lauro, Davide; Frontoni, Simona; Pozzilli, Paolo; Buzzetti, Raffaella

    2016-01-01

    This document has been developed by a group of Italian diabetologists with extensive experience in continuous subcutaneous insulin infusion (CSII) therapy to provide indications for the clinical management of CSII in diabetic patients (both type 1 and type 2) based on delivery mode operating in Italy. Although the potential benefits of pump therapy in achieving glycemic goals is now accepted, such results cannot be obtained without specific knowledge and skills being conveyed to patients during ad hoc educational training. To ensure that these new technologies reach their full effectiveness, as demonstrated theoretically and clinically, a careful assessment of the overall therapeutic and educational process is required, in both qualitative and quantitative terms. Therefore, to ensure the cost-effectiveness of insulin pump therapy and to justify reimbursement of therapy costs by the National Health System in Italy, in this article we present a model for diabetes and healthcare centers to follow that provides for different levels of expertise in the field of CSII therapy. This model will guarantee the provision of excellent care during insulin pump therapies, thus representing the basis for a successful outcome and expansion of this form of insulin treatment in patients with diabetes while also keeping costs under control. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  16. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

    Science.gov (United States)

    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.

  17. Role of Ankle Arthroscopy in Management of Acute Ankle Fracture.

    Science.gov (United States)

    Chan, Kwok Bill; Lui, Tun Hing

    2016-11-01

    To report the operative findings of ankle arthroscopy during open reduction and internal fixation of acute ankle fractures. This was a retrospective review of 254 consecutive patients with acute ankle fractures who were treated with open reduction and internal fixation of the fractures, and ankle arthroscopy was performed at the same time. The accuracy of fracture reduction, the presence of syndesmosis disruption and its reduction, and the presence of ligamentous injuries and osteochondral lesions were documented. Second-look ankle arthroscopy was performed during syndesmosis screw removal 6 weeks after the key operation. There were 6 patients with Weber A, 177 patients with Weber B, 51 patients with Weber C, and 20 patients with isolated medial malleolar fractures. Syndesmosis disruption was present in 0% of patients with Weber A fracture, 52% of patients with Weber B fracture, 92% of patients with Weber C fracture, and 20% of the patients with isolated medial malleolar fracture. Three patients with Weber B and one patient with Weber C fracture have occult syndesmosis instability after screw removal. Osteochondral lesion was present in no patient with Weber A fracture, 26% of the Weber B cases, 24% of the Weber C cases, and 20% of isolated medial malleolar fracture cases. The association between the presence of deep deltoid ligament tear and syndesmosis disruption (warranting syndesmosis screw fixation) in Weber B cases was statistically significant but not in Weber C cases. There was no statistically significant association between the presence of posterior malleolar fracture and syndesmosis instability that warrant screw fixation. Ankle arthroscopy is a useful adjuvant tool to understand the severity and complexity of acute ankle fracture. Direct arthroscopic visualization ensures detection and evaluation of intra-articular fractures, syndesmosis disruption, and associated osteochondral lesions and ligamentous injuries. Level IV, case series

  18. Management of violent behaviour in acutely relapsed schizophrenics

    Directory of Open Access Journals (Sweden)

    L. Koen

    2004-09-01

    Full Text Available The management of aggressive behaviour has always been a criticai issue in psychiatry. Finding measures that can be used to accurately predict the likelihood of assaultative behaviour and thus ensure timeous appropriate pharmacological management remains a dilemma. The study objective was to investigate the naturalistic, pharmacological management of inpatient aggressive behaviour in a group of 50 schizophrenic subjects with a view to determine: (1 whether a presenting history of recent violence lead to altered pharmacological management and (2 whether the NOSIE could be regarded as a useful assessment tool with regards to inpatient behaviour management. No significant difference could be demonstrated between the 2 subsets of subjects (history of violence vs none with respect to total doses of medication administered. No statistical correlation could be found between the total NOSIE score and the dose of psychotropic medication used. The relationship between a subset of NOSIE-items and the total dose of medication was more complex and a clear linear relationship could be demonstrated for a total score of 0 to 5. In this particular ward setting a presenting history of recent violent behaviour did not influence the administration of medication and neither could the clinical judgement employed by the nursing staff to manage inpatient behaviour be captured by the NOSIE. However, a five-item subset of the NOSIE with questions relating to aggression and irritability warrants further scrutiny in this regard.

  19. South Asian women with diabetes: Psychosocial challenges and management: Consensus statement.

    Science.gov (United States)

    Bajaj, Sarita; Jawad, Fatema; Islam, Najmul; Mahtab, Hajera; Bhattarai, Jyoti; Shrestha, Dina; Wijeyaratne, Chandrika; Muthukuda, Dimuthu T; Widanage, Niranjala Weegoda; Aye, Than Than; Aung, Moe Wint; Kalra, Bharti; Anjana, R M; Sreedevi, Aswathy; Verma, Komal

    2013-07-01

    in women attending diabetes clinics across South Asia. Guidelines for counselling in female sexual dysfunction, written in culturally appropriate manner for South Asia, are needed. Diabetes affects women more severely because of their unique biological, cultural and socioeconomic circumstances. Women have limited access to health care facilities because of illiteracy, ignorance and negative social customs. Transcending the gender hierarchy and inequality is a formidable challenge. Sensitising men, empowering women on self care and providing peer support maybe the answer to this challenge. It is essential for health care providers to use appropriate coping mechanism such as building psychological contact with the patient, including family and friends as part of social support and empower patient with complete process of managing diabetes. Increasing awareness through the media, seminars, posters, group discussions and education, regular monitoring and consulting the doctor, support group for women and facilities for aerobic exercises are recommended. The health care systems should consider custom-designed prevention and control programs tailored for women based on local and regional attitudes on health care, cultural beliefs, and available social support systems. Policies that empower adolescent girls and young women to take control of their metabolic management must be encouraged. Provision of gender specific diabetes education with a holistic life-cycle approach is recommended.

  20. South Asian women with diabetes: Psychosocial challenges and management: Consensus statement

    Directory of Open Access Journals (Sweden)

    Sarita Bajaj

    2013-01-01

    of sexual issues in women attending diabetes clinics across South Asia. Guidelines for counselling in female sexual dysfunction, written in culturally appropriate manner for South Asia, are needed. Diabetes affects women more severely because of their unique biological, cultural and socioeconomic circumstances. Women have limited access to health care facilities because of illiteracy, ignorance and negative social customs. Transcending the gender hierarchy and inequality is a formidable challenge. Sensitising men, empowering women on self care and providing peer support maybe the answer to this challenge. It is essential for health care providers to use appropriate coping mechanism such as building psychological contact with the patient, including family and friends as part of social support and empower patient with complete process of managing diabetes. Increasing awareness through the media, seminars, posters, group discussions and education, regular monitoring and consulting the doctor, support group for women and facilities for aerobic exercises are recommended. The health care systems should consider custom-designed prevention and control programs tailored for women based on local and regional attitudes on health care, cultural beliefs, and available social support systems. Policies that empower adolescent girls and young women to take control of their metabolic management must be encouraged. Provision of gender specific diabetes education with a holistic life-cycle approach is recommended.

  1. South Asian women with diabetes: Psychosocial challenges and management: Consensus statement

    Science.gov (United States)

    Bajaj, Sarita; Jawad, Fatema; Islam, Najmul; Mahtab, Hajera; Bhattarai, Jyoti; Shrestha, Dina; Wijeyaratne, Chandrika; Muthukuda, Dimuthu T.; Widanage, Niranjala Weegoda; Aye, Than Than; Aung, Moe Wint; Kalra, Bharti; Anjana, R. M.; Sreedevi, Aswathy; Verma, Komal

    2013-01-01

    in women attending diabetes clinics across South Asia. Guidelines for counselling in female sexual dysfunction, written in culturally appropriate manner for South Asia, are needed. Diabetes affects women more severely because of their unique biological, cultural and socioeconomic circumstances. Women have limited access to health care facilities because of illiteracy, ignorance and negative social customs. Transcending the gender hierarchy and inequality is a formidable challenge. Sensitising men, empowering women on self care and providing peer support maybe the answer to this challenge. It is essential for health care providers to use appropriate coping mechanism such as building psychological contact with the patient, including family and friends as part of social support and empower patient with complete process of managing diabetes. Increasing awareness through the media, seminars, posters, group discussions and education, regular monitoring and consulting the doctor, support group for women and facilities for aerobic exercises are recommended. The health care systems should consider custom-designed prevention and control programs tailored for women based on local and regional attitudes on health care, cultural beliefs, and available social support systems. Policies that empower adolescent girls and young women to take control of their metabolic management must be encouraged. Provision of gender specific diabetes education with a holistic life-cycle approach is recommended. PMID:23961469

  2. Financial Statements

    International Development Research Centre (IDRC) Digital Library (Canada)

    Financial Statements and accompanying notes provided on .... to good governance principles. there is the risk that ...... responsibilities of the centre's internal auditor includes reviewing internal controls, including accounting and financial.

  3. Communication received from France concerning its policies regarding the management of plutonium. Statements on the management of plutonium and of highly enriched uranium

    International Nuclear Information System (INIS)

    2004-01-01

    The Director General has received a Note Verbale, dated 12 October 2004, from the Permanent Mission of France to the IAEA in the enclosures of which the Government of France, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/549 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2003. The Government of France has also made available a statement of its annual figures for holdings of civil high enriched uranium (HEU) as of 31 December 2003. In light of the request expressed by the Government of France in its Note Verbale of 28 November 1997 concerning its policies regarding the management of plutonium (INFCIRC/549 of 16 March 1998), the enclosures of the Note Verbale of 12 October 2004 are attached for the information of all Member States

  4. Communication received from Germany concerning its policies regarding the management of plutonium. Statements on the management of plutonium and of high enriched uranium

    International Nuclear Information System (INIS)

    2005-01-01

    The Director General has received a letter dated 18 April 2005 from the Permanent Mission of the Federal Republic of Germany to the IAEA in the enclosures of which the Government of Germany, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/549 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2004. The Government of the Federal Republic of Germany has also made available a statement of the estimated amounts of high enriched uranium (HEU) as of 31 December 2004. In light of the request expressed by the Federal Republic of Germany in its Note Verbale of 1 December 1997 concerning its policies regarding the management of plutonium (INFCIRC/549 of 16 March 1998), the enclosures of the letter of 18 April 2005 are attached for the information of all Member States

  5. Communication received from France concerning its policies regarding the management of plutonium. Statements on the management of plutonium and of highly enriched uranium

    International Nuclear Information System (INIS)

    2003-01-01

    The Director General has received a Note Verbale, dated 2 September 2003, from the Permanent Mission of France to the IAEA in the enclosures of which the Government of France, in keeping with its commitment under the Guidelines for the Management of Plutonium (contained in INFCIRC/549 of 16 March 1998 and hereinafter referred to as the 'Guidelines'), and in accordance with Annexes B and C of the Guidelines, has made available annual figures for holdings of civil unirradiated plutonium and the estimated amounts of plutonium contained in spent civil reactor fuel as of 31 December 2002. The Government of France has also made available a statement of its annual figures for holdings of civil high-enriched uranium (HEU) as of 31 December 2002. In light of the request expressed by the Government of France in its Note Verbale of 28 November 1997 concerning its policies regarding the management of plutonium (INFCIRC/549 of 16 March 1998), the enclosures of the Note Verbale of 2 September 2003 are attached for the information of all Member States

  6. Clinical Management of Acute Interstitial Pneumonia: A Case Report

    Directory of Open Access Journals (Sweden)

    Yang Xia

    2012-01-01

    Full Text Available We describe a 51-year-old woman who was admitted to hospital because of cough and expectoration accompanied with general fatigue and progressive dyspnea. Chest HRCT scan showed areas of ground glass attenuation, consolidation, and traction bronchiectasis in bilateral bases of lungs. BAL fluid test and transbronchial lung biopsy failed to offer insightful evidence for diagnosis. She was clinically diagnosed with acute interstitial pneumonia (AIP. Treatment with mechanical ventilation and intravenous application of methylprednisolone (80 mg/day showed poor clinical response and thus was followed by steroid pulse therapy (500 mg/day, 3 days. However, she died of respiratory dysfunction eventually. Autopsy showed diffuse alveolar damage associated with hyaline membrane formation, pulmonary interstitial, immature collagen edema, and focal type II pneumocyte hyperplasia.

  7. Medical management of patients overexposed to irradiation in acute and subacute accidents

    Energy Technology Data Exchange (ETDEWEB)

    Genyao, Ye; Guilin, Wang; Shimin, Huang; Xiyuan, Cheng; Bingzhi, Mao; Yingqi, Li [North Taiping Road Hospital, Beijing, BJ (China)

    1991-11-01

    The authors summarize the experiences in the medical management of 7 radiation accidents resulting in 5 cases of acute radiation sickness, 3 cases of subacute radiation sickness and 8 cases of overexposed persons with estimated physical doses below 1 Gy in the past 5 years. The therapeutic measures including the application of antiradiation drugs such as estriol and herbal medicine '208', measures to improve the microcirculation and transfusion of fetal liver cells, etc., were emphasized in the treatment of acute radiation sickness. For subacute radiation sickness, large doses of stanozolum (18 mg/d) in combination with 654-2 (60 mg/d) were administered as the principal therapeutic agents. The advances in the medical management of acute accidentally overexposed cases in China are briefly reviewed and discussed.

  8. Role of interventional radiology in the management of acute gastrointestinal bleeding

    Science.gov (United States)

    Ramaswamy, Raja S; Choi, Hyung Won; Mouser, Hans C; Narsinh, Kazim H; McCammack, Kevin C; Treesit, Tharintorn; Kinney, Thomas B

    2014-01-01

    Acute gastrointestinal bleeding (GIB) can lead to significant morbidity and mortality without appropriate treatment. There are numerous causes of acute GIB including but not limited to infection, vascular anomalies, inflammatory diseases, trauma, and malignancy. The diagnostic and therapeutic approach of GIB depends on its location, severity, and etiology. The role of interventional radiology becomes vital in patients whose GIB remains resistant to medical and endoscopic treatment. Radiology offers diagnostic imaging studies and endovascular therapeutic interventions that can be performed promptly and effectively with successful outcomes. Computed tomography angiography and nuclear scintigraphy can localize the source of bleeding and provide essential information for the interventional radiologist to guide therapeutic management with endovascular angiography and transcatheter embolization. This review article provides insight into the essential role of Interventional Radiology in the management of acute GIB. PMID:24778770

  9. IAP/APA evidence-based guidelines for the management of acute pancreatitis.

    Science.gov (United States)

    2013-01-01

    There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach. Twelve multidisciplinary review groups performed systematic literature reviews to answer 38 predefined clinical questions. Recommendations were graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The review groups presented their recommendations during the 2012 joint IAP/APA meeting. At this one-day, interactive conference, relevant remarks were voiced and overall agreement on each recommendation was quantified using plenary voting. The 38 recommendations covered 12 topics related to the clinical management of acute pancreatitis: A) diagnosis of acute pancreatitis and etiology, B) prognostication/predicting severity, C) imaging, D) fluid therapy, E) intensive care management, F) preventing infectious complications, G) nutritional support, H) biliary tract management, I) indications for intervention in necrotizing pancreatitis, J) timing of intervention in necrotizing pancreatitis, K) intervention strategies in necrotizing pancreatitis, and L) timing of cholecystectomy. Using the GRADE system, 21 of the 38 (55%) recommendations, were rated as 'strong' and plenary voting revealed 'strong agreement' for 34 (89%) recommendations. The 2012 IAP/APA guidelines provide recommendations concerning key aspects of medical and surgical management of acute pancreatitis based on the currently available evidence. These recommendations should serve as a reference standard for current management and guide future clinical research on acute pancreatitis. Copyright © 2013 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  10. Quality indicators for the acute and long-term management of anaphylaxis

    DEFF Research Database (Denmark)

    Dhami, Sangeeta; Sheikh, Aadam; Muraro, Antonella

    2017-01-01

    BACKGROUND: The quality of acute and long-term anaphylaxis management is variable and this contributes to the poor outcomes experienced by many patients. Clinical practice guidelines have the potential to improve outcomes, but implementing guideline recommendations in routine practice is challeng...

  11. Surgical management of acute necrotizing pancreatitis: a 13-year experience and a systematic review

    NARCIS (Netherlands)

    Nieuwenhuijs, V. B.; Besselink, M. G. H.; van Minnen, L. P.; Gooszen, H. G.

    2003-01-01

    BACKGROUND: The course of acute pancreatitis (AP) is unpredictable and can vary from mild to lethal. Mortality varies from low ( <2%) in mild cases to high (20%-70%) in the case of infected pancreatic necrosis. Surgical management has not been investigated in well-designed trials. Based on

  12. Improving the management of post-operative acute pain: Priorities for change

    NARCIS (Netherlands)

    Meissner, W. (Winfried); F. Coluzzi (Flaminia); Fletcher, D. (Dominique); F.J.P.M. Huygen (Frank); B. Morlion (Bart); Neugebauer, E. (Edmund); Pérez, A.M. (Antonio Montes); J. Pergolizzi (Joseph)

    2015-01-01

    textabstractPoor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive

  13. Current discharge management of acute coronary syndromes: Data from the Rijnmond Collective Cardiology Research (CCR) study

    NARCIS (Netherlands)

    T. Yetgin; M.M.J.M. van der Linden (Mark); A.G. de Vries (A.); P.C. Smits (Pieter); R. van Mechelen; S-C. Yap (Sing-Chien); H. Boersma (Eric); F. Zijlstra (Felix); R.J.M. van Geuns (Robert Jan)

    2014-01-01

    textabstractBackground Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics

  14. IAP/APA evidence-based guidelines for the management of acute pancreatitis

    NARCIS (Netherlands)

    Goor, H. van; et al.,

    2013-01-01

    BACKGROUND: There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise

  15. IAP/APA evidence-based guidelines for the management of acute pancreatitis

    NARCIS (Netherlands)

    Besselink, Marc; van Santvoort, Hjalmar; Freeman, Martin; Gardner, Timothy; Mayerle, Julia; Vege, Santhi Swaroop; Werner, Jens; Banks, Peter; McKay, Colin; Fernandez-del Castillo, Carlos; French, Jeremy; Gooszen, Hein; Johnson, Colin; Sarr, Mike; Takada, Tadahiro; Windsor, John; Saluja, Ashok; Liddle, Rodger; Papachristou, Georgios; Singh, Vijay; Rünzi, Michael; Wu, Bechien; Singh, Vikesh; Bollen, Thomas; Morgan, Desiree; Mortele, Koenraad; Mittal, Anubhav; En-qiang, Mao; de Waele, Jan; Petrov, Maxim; Dellinger, Patchen; Lerch, Markus M.; Anderson, Roland; McClave, Stephen; Hartwig, Werner; Bruno, Marco; Oria, Alejandro; Baron, Todd; Castillo, Carlos Fernandez-Del; Fagenholz, Peter; Horvath, Karen; van Baal, Mark; Nealon, William; Andren-Sandberg, Ake; Bakker, Olaf; Bassi, Claudio; Buchler, Markus; Boermeester, Marja; Bradley, Ed; Fockens, Paul

    2013-01-01

    There have been substantial improvements in the management of acute pancreatitis since the publication of the International Association of Pancreatology (IAP) treatment guidelines in 2002. A collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these

  16. Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis.

    LENUS (Irish Health Repository)

    McDermott, F D

    2014-01-01

    The severity of acute diverticulitis ranges from mild, simple inflammation to pericolic abscesses, or perforation with faeculent peritonitis. Treatment of diverticulitis has evolved towards more conservative and minimally invasive strategies. The aim of this review is to highlight recent concepts and advances in management.

  17. Acute flaccid paralysis: a five–year review of cases managed by ...

    African Journals Online (AJOL)

    kemrilib

    A 5-year (1999-2004) review of acute flaccid paralysis (AFP) cases managed at the physiotherapy ... Sciatic nerve palsy accounted for majority (72.0%) of the AFP; only. 43.2% of the ... children with febrile illnesses is suggested. Importance of ...

  18. Promoting the management of acute upper gastrointestinal bleeds among junior doctors: a quality improvement project.

    Science.gov (United States)

    Saunsbury, Emma; Allison, Emma; Colleypriest, Ben

    2015-01-01

    Though they are knowledgeable, foundation year one (FY1) doctors can lack skills and confidence in acute situations due to inexperience. This was witnessed when a new FY1 on call attended an acute upper gastrointestinal bleed (UGIB), a common emergency with a 10% in hospital mortality rate. We aimed to improve FY1s' ability to manage these critical patients through simulation based teaching, before and after the introduction of an algorithm summarising current guidelines. After assessing the FY1s' perceived level of confidence in managing UGIBs, they individually attended a simulation session which evaluated specific aspects of their assessment and management plans. Immediate debriefing and subsequent teaching sessions reinforced learning points, with an algorithm instituted as an aide mémoire to improve efficiency. A repeat simulation session assessed improvements in both subjective confidence and objective management targets. All FY1s expressed improved confidence in managing patients with UGIBs. There were improvements across the board in their assessment and management, notably: verbalisation of concern for hypotension increased to 100% (from 60%), two points of intravenous access requested in 100% of cases (from 53%), and a 76 second reduction in time to call for senior support. Collectively, these individual aspects led to improved patient care. Effective management of acute patients is best learnt through exposure, and simulation based teaching provides a safe but powerful modality to aid transition from textbook theory to ward situations. Algorithms can streamline care and hasten the stabilisation of patients. This project reinforces generic competencies that FY1s can translate to their management of not only UGIBs, but many acute presentations, providing a convincing argument for broader simulation use in FY1 teaching.

  19. Opioid exit plan: A pharmacist's role in managing acute postoperative pain.

    Science.gov (United States)

    Genord, Cheryl; Frost, Timothy; Eid, Deeb

    The benefits of a pharmacist's involvement in medication reconciliation and discharge counseling are well documented in the literature as improving patient outcomes. In contrast, no studies have focused on the initiation of a pharmacist-led opioid exit plan (OEP) for acute postoperative pain management. This paper summarizes a pharmacist-led OEP practice model and the potential role that pharmacists and student pharmacists can have at the point of admission, during postoperative recovery, and on discharge in acute pain management patients. The pain management team at St. Joseph Mercy Hospital in Ann Arbor, MI, has developed and implemented a pharmacist-led OEP to better manage acute postoperative pain in neurosurgery and orthopedic and colorectal surgery in an effort to ensure appropriate patient and provider education and understanding of pain management. OEP is a tool with the potential to expand the role of pharmacists in managing acute pain in postoperative patients at the point of admission, during the postoperative inpatient stay, and on discharge. Its benefits include medication reconciliation review and prescription drug-monitoring program search before admission, interdisciplinary rounds with the medical team to provide optimal inpatient postoperative pain management, clinical assessment of outpatient prescriptions with opioid discharge counseling, and medication evaluation of prescribed pain regimen and opioid discontinuation status at the post-discharge follow-up appointment. A hospital pain management team operating a pharmacist-led OEP can be key to guiding the appropriate prescribing practice of opioids and assisting with transitions of care on discharge. Further outcomes-based evaluations of the practice model are planned and encouraged to validate and improve the pharmacist-led OEP practice. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  20. Recent advances in acute pain management: understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Richa Wardhan

    2017-11-01

    Full Text Available In this review, we discuss advances in acute pain management, including the recent report of the joint American Pain Society and American Academy of Pain Medicine task force on the classification of acute pain, the role of psychosocial factors, multimodal pain management, new non-opioid therapy, and the effect of the “opioid epidemic”. In this regard, we propose that a fundamental principle in acute pain management is identifying patients who are most at risk and providing an “opioid free anesthesia and postoperative analgesia”. This can be achieved by using a multimodal approach that includes regional anesthesia and minimizing the dose and the duration of opioid prescription. This allows prescribing medications that work through different mechanisms. We shall also look at the recent pharmacologic and treatment advances made in acute pain and regional anesthesia.

  1. Acute right ventricular dysfunction: real-time management with echocardiography.

    Science.gov (United States)

    Krishnan, Sundar; Schmidt, Gregory A

    2015-03-01

    In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.

  2. Thrombectomy assisted by carotid stenting in acute ischemic stroke management

    DEFF Research Database (Denmark)

    Steglich-Arnholm, Henrik; Holtmannspötter, Markus; Kondziella, Daniel

    2015-01-01

    .0). Early clinical improvement was detected in 22 (46%) patients. Favorable outcome at 3 months occurred in 32 (68%) patients. Expedited patient management was associated with favorable clinical outcome. Two (4%) patients experienced symptomatic hemorrhage. Eight (17%) patients experienced stent thrombosis....... Four (9%) patients died. Thrombectomy assisted by carotid stenting seems beneficial and reasonably safe with a promising rate of favorable outcome. Nevertheless, adverse events and complications call for additional clinical investigations prior to recommendation as clinical standard. Expeditious...... patient management is central to achieve good clinical outcome....

  3. The CRASH report: emergency management dilemmas facing acute physicians in patients with pulmonary arterial hypertension.

    Science.gov (United States)

    Price, Laura C; Dimopoulos, Konstantinos; Marino, Philip; Alonso-Gonzalez, Rafael; McCabe, Colm; Kemnpy, Aleksander; Swan, Lorna; Boutsikou, Maria; Al Zahrani, Ahmed; Coghlan, Gerry J; Schreiber, Benjamin E; Howard, Luke S; Davies, Rachel; Toshner, Mark; Pepke-Zaba, Joanna; Church, Alistair C; Peacock, Andrew; Corris, Paul A; Lordan, James L; Gaine, Sean; Condliffe, Robin; Kiely, David G; Wort, Stephen John

    2017-11-01

    Treatment of acute emergencies in patients with pulmonary arterial hypertension (PAH) can be challenging. In the UK and Ireland, management of adult patients with PAH is centred in eight nationally designated pulmonary hypertension (PH) centres. However, many patients live far from these centres and physicians in local hospitals are often required to manage PAH emergencies. A committee of physicians from nationally designated PH centres identified the 'most common' emergency clinical scenarios encountered in patients with PAH. Thereafter, a review of the literature was performed centred on these specified topics and a management approach was developed based on best available evidence and expert consensus. Management protocols were developed on the following PAH emergencies: chest pain (including myocardial ischaemia), right ventricular failure, arrhythmias, sepsis, haemoptysis ('CRASH'), as well as considerations relevant to surgery, anaesthesia and pregnancy. Emergencies are not uncommon in PAH. While expertise in PAH management is essential, all physicians involved in acute care should be aware of the principles of acute management of PAH emergencies. A multidisciplinary approach is necessary, with physicians from tertiary PH centres supporting care locally and planning safe transfer of patients to PH centres when appropriate. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Telephone versus usual care in management of acute whiplash ...

    African Journals Online (AJOL)

    Whiplash associated disorder (WAD) is a common and costly condition, and recommended management includes advice to “act as usual” and exercise. Providing this treatment through a telephonic intervention may help to improve access to care, and reduce costs. This pilot study assessed: (1) the effectiveness of a ...

  5. The trend of acute burns pre-hospital management

    Directory of Open Access Journals (Sweden)

    Abubakar Hamdiya

    2015-08-01

    Conclusions: Burn injuries are common in our settings, a more reason for all to know the immediate intervention to give to victims of such accidents. The kind of first aid administered to burns victims possibly affects the burns management outcome. Thus, the earlier the right intervention implemented, the lesser the complications.

  6. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

    Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M

    2018-01-01

    /unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving...

  7. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

    Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M

    2017-01-01

    /unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving...

  8. BokSmart: medical management of suspected serious acute spinal ...

    African Journals Online (AJOL)

    Although risk and injury cannot be totally avoided in a contact sport, it does appear that there are deficits in the management of this risk and subsequent injury. SA Rugby has introduced an educational programme (BokSmart) to increase the level of understanding by players and support staff. This article was prepared for ...

  9. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis

    NARCIS (Netherlands)

    Mayumi, Toshihiko; Okamoto, Kohji; Takada, Tadahiro; Strasberg, Steven M.; Solomkin, Joseph S.; Schlossberg, David; Pitt, Henry A.; Yoshida, Masahiro; Gomi, Harumi; Miura, Fumihiko; Garden, O. James; Kiriyama, Seiki; Yokoe, Masamichi; Endo, Itaru; Asbun, Horacio J.; Iwashita, Yukio; Hibi, Taizo; Umezawa, Akiko; Suzuki, Kenji; Itoi, Takao; Hata, Jiro; Han, Ho-Seong; Hwang, Tsann-Long; Dervenis, Christos; Asai, Koji; Mori, Yasuhisa; Huang, Wayne Shih-Wei; Belli, Giulio; Mukai, Shuntaro; Jagannath, Palepu; Cherqui, Daniel; Kozaka, Kazuto; Baron, Todd H.; de Santibañes, Eduardo; Higuchi, Ryota; Wada, Keita; Gouma, Dirk J.; Deziel, Daniel J.; Liau, Kui-Hin; Wakabayashi, Go; Padbury, Robert; Jonas, Eduard; Supe, Avinash Nivritti; Singh, Harjit; Gabata, Toshifumi; Chan, Angus C. W.; Lau, Wan Yee; Fan, Sheung Tat; Chen, Miin-Fu; Ker, Chen-Guo; Yoon, Yoo-Seok; Choi, In-Seok; Kim, Myung-Hwan; Yoon, Dong-Sup; Kitano, Seigo; Inomata, Masafumi; Hirata, Koichi; Inui, Kazuo; Sumiyama, Yoshinobu; Yamamoto, Masakazu

    2018-01-01

    Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13),

  10. Fiscal Year 2015 U.S. Government Financial Statements: Need to Address the Governments Remaining Financial Management Challenges and Long Term Fiscal Path

    Science.gov (United States)

    2016-04-06

    consolidated financial statements (governmentwide financial statements ). Unless these...the U.S. government’s fiscal year 2015 consolidated financial statements (governmentwide financial statements ), which is included in the Financial ...Processes Used to Prepare the U.S. Consolidated Financial Statements , GAO-15-630 (Washington, D.C.: July 30, 2015). A detailed discussion of

  11. Department of Energy Programmatic Spent Nuclear Fuel Management and Idaho National Engineering Laboratory Environmental Restoration and Waste Management Programs, Draft Environmental Impact Statement. Volume 1, Appendix D: Part A, Naval Spent Nuclear Fuel Management

    Energy Technology Data Exchange (ETDEWEB)

    1994-06-01

    Volume 1 to the Department of Energy`s Programmatic Spent Nuclear Fuel Management and Idaho National Engineering Laboratory Environmental Management Programs Environmental Impact Statement evaluates a range of alternatives for managing naval spent nuclear fuel expected to be removed from US Navy nuclear-powered vessels and prototype reactors through the year 2035. The Environmental Impact Statement (EIS) considers a range of alternatives for examining and storing naval spent nuclear fuel, including alternatives that terminate examination and involve storage close to the refueling or defueling site. The EIS covers the potential environmental impacts of each alternative, as well as cost impacts and impacts to the Naval Nuclear Propulsion Program mission. This Appendix covers aspects of the alternatives that involve managing naval spent nuclear fuel at four naval shipyards and the Naval Nuclear Propulsion Program Kesselring Site in West Milton, New York. This Appendix also covers the impacts of alternatives that involve examining naval spent nuclear fuel at the Expended Core Facility in Idaho and the potential impacts of constructing and operating an inspection facility at any of the Department of Energy (DOE) facilities considered in the EIS. This Appendix also considers the impacts of the alternative involving limited spent nuclear fuel examinations at Puget Sound Naval Shipyard. This Appendix does not address the impacts associated with storing naval spent nuclear fuel after it has been inspected and transferred to DOE facilities. These impacts are addressed in separate appendices for each DOE site.

  12. Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence.

    Science.gov (United States)

    Fitzmaurice, Gerard J; McWilliams, Billy; Hurreiz, Hisham; Epanomeritakis, Emanuel

    2011-10-01

    Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence.

  13. Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence

    Science.gov (United States)

    Fitzmaurice, Gerard J.; McWilliams, Billy; Hurreiz, Hisham; Epanomeritakis, Emanuel

    2011-01-01

    Background Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. Methods A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. Results Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. Conclusion Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence. PMID:21651835

  14. US Department of Energy Naval Petroleum and Oil Shale Reserves combined financial statements and management overview and supplemental financial and management information, September 30, 1995 and 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-02-15

    This report presents the results of the independent certified public accountant`s audit of the Department of Energy`s (Department) Naval Petroleum and Oil Shale Reserves (NPOSR) financial statements as of September 30, 1995. The auditors have expressed an unqualified opinion on the 1995 statements. Their reports on the NPOSR internal control structure and compliance with laws and regulations are also provided.

  15. Fluid in the management of the acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Karki S

    2013-06-01

    Full Text Available Introduction Non-cardiogenic pulmonary edema is the hallmark of the acute respiratory distress syndrome (ARDS. The amount of fluid and which fluid should be used in these patients is controversial. Methods 43 patients with ARDS treated in the intensive care unit (ICU of the Second Hospital, Jilin University between November 1, 2011-November 1, 2012 were prospectively analyzed and was observational. Volume and the type of fluid administered were compared to 90 day mortality and the 24 and 72 hour sequential organ failure assessment (SOFA score, lactate level, oxygenation index (PaO2/FiO2, duration of ICU stay, total ventilator days, and need for continuous renal replacement therapy (CRRT. Results Mortality was increased when hydroxylethyl starch (HES was used in the first day or plasma substitutes were used during the first 3 days (P3000 ml during the first 24 hours or >8000 ml during the first 72 hours were associated with higher SOFA scores at 24 and 72 hours (P<0.05, both comparisons. Colloid, especially higher volume colloid use was also associated with increased SOFA scores at either 24 or 72 hours. Conclusions Limiting the use of colloids and the total amount of fluid administered to patients with ARDS is associated with improved mortality and SOFA scores.

  16. [Managment of acute low back pain without trauma - an algorithm].

    Science.gov (United States)

    Melcher, Carolin; Wegener, Bernd; Jansson, Volkmar; Mutschler, Wolf; Kanz, Karl-Georg; Birkenmaier, Christof

    2018-05-14

    Low back pain is a common problem for primary care providers, outpatient clinics and A&E departments. The predominant symptoms are those of so-called "unspecific back pain", but serious pathologies can be concealed by the clinical signs. Especially less experienced colleagues have problems in treating these patients, as - despite the multitude of recommendations and guidelines - there is no generally accepted algorithm. After a literature search (Medline/Cochrane), 158 articles were selected from 15,000 papers and classified according to their level of evidence. These were attuned to the clinical guidelines of the orthopaedic and pain-physician associations in Europe, North America and overseas and the experience of specialists at LMU Munich, in order to achieve consistency with literature recommendations, as well as feasibility in everyday clinical work and optimised with practical relevance. An algorithm was formed to provide the crucial differential diagnosis of lumbar back pain according to its clinical relevance and to provide a plan of action offering reasonable diagnostic and therapeutic steps. As a consequence of distinct binary decisions, low back patients should be treated at any given time according to the guidelines, with emergencies detected, unnecessary diagnostic testing and interventions averted and reasonable treatment initiated pursuant to the underlying pathology. In the context of the available evidence, a clinical algorithm has been developed that translates the complex diagnostic testing of acute low back pain into a transparent, structured and systematic guideline. Georg Thieme Verlag KG Stuttgart · New York.

  17. Operative management of acute pavement burns: a case series.

    Science.gov (United States)

    Silver, A G; Zamboni, W A; Baynosa, R C

    2014-11-01

    Acute burns suffered from contact with environmentally heated roadways and walkways are a rare entity. The aim of this report is to assess the information gained from the treatment of a series of patients. A retrospective review of a consecutive series of cases, where operative treatment was necessary, that occurred during July 2010 in southern Arizona. Seven patients were included, with an average total body surface area burn of 10.2%. Direct fascial excision and tangential excision were carried out on three and four patients, respectively. Although tangential excision was carried out to normal endpoints, there was commonly a need for repetitive debridement. The total hospital costs were over $4,400,000 (£2,730,000). Burns suffered from contact with roadways/walkways are often deeper than suggested by their appearance. Direct fascial excision minimises the number of debridement sessions. We hypothesise that the failure to offload pressure on these wounds may be a causative factor in their observed deepening.

  18. Fundamentals of management of acute postoperative pulmonary hypertension.

    Science.gov (United States)

    Taylor, Mary B; Laussen, Peter C

    2010-03-01

    In the last several years, there have been numerous advancements in the field of pulmonary hypertension as a whole, but there have been few changes in the management of children with pulmonary hypertension after cardiac surgery. Patients at particular risk for postoperative pulmonary hypertension can be identified preoperatively based on their cardiac disease and can be grouped into four broad categories based on the mechanisms responsible for pulmonary hypertension: 1) increased pulmonary vascular resistance; 2) increased pulmonary blood flow with normal pulmonary vascular resistance; 3) a combination of increased pulmonary vascular resistance and increased blood flow; and 4) increased pulmonary venous pressure. In this review of the immediate postoperative management of pulmonary hypertension, various strategies are discussed including medical therapies, monitoring, ventilatory strategies, and weaning from these supports. With early recognition of patients at particular risk for severe pulmonary hypertension, management strategies can be directed at preventing or minimizing hemodynamic instability and thereby prevent the development of ventricular dysfunction and a low output state.

  19. Management of arterial hypertension in patients with acute stroke.

    Science.gov (United States)

    Adeoye, Opeolu; Jauch, Edward C

    2006-11-01

    Management of arterial hypertension in the hyperacute period immediately after stroke ictus remains controversial. Extremes of blood pressure (BP) are associated with poor outcomes in all stroke subtypes. Severely hypertensive patients likely benefit from modest BP reductions, but aggressive BP reduction may worsen outcome. Although little evidence is currently available to definitively establish guideline recommendations for optimal BP goals at stroke presentation, recently published research is shedding some light on how to approach management of BP after stroke. Antihypertensive treatment should probably be deferred in ischemic stroke patients except in cases of severe hypertension or when thrombolytic therapy is warranted and the patient's BP is above acceptable levels. Hypertensive hemorrhagic stroke patients may benefit from modest BP reductions. Relative hypotension causing regional hypoperfusion is an increasingly understood concept immediately following ischemic or hemorrhagic stroke, emphasizing the need for careful titration of appropriate medications to minimize fluctuations in BP for treated patients. Ongoing trials will improve our current knowledge regarding BP management after ischemic and hemorrhagic stroke.

  20. Conservative approach to the acute management of a large mesenteric cyst.

    Science.gov (United States)

    Leung, Billy C; Sankey, Ruth; Fronza, Matteo; Maatouk, Mohamed

    2017-09-16

    Mesenteric cysts are rare, benign gastrointestinal cystic lesions, which are often non-troublesome and present as an incidental radiological finding. However, surgery is often performed in the acute setting to remove lesions that are symptomatic. This report highlights the case of a large, symptomatic mesenteric cyst managed successfully with initial conservative measures followed by planned elective surgery. A 44-year-old female presented with a four-day history of generalised abdominal pain associated with distension, fever, diarrhoea and vomiting. Computer tomography revealed a large (21.7 cm × 11.8 cm × 14 cm) mesenteric cyst within the left abdomen cavity. She was admitted and treated conservatively with intravenous fluids and antibiotics for four days, which lead to complete symptom resolution. Follow-up at intervals of one and three months revealed no return of symptoms. An elective laparotomy and excision of the mesenteric cyst was then scheduled and performed safely at nine months after the initial presentation. Compared to acute surgery, acute conservative management followed by planned elective resection of a symptomatic mesenteric cyst may prove safer. The withholding of an immediate operation may potentially avoid unnecessary operative risk and should be considered in patients without obstructive and peritonitic symptoms. Our case demonstrated the safe use of initial conservative management followed by planned elective surgery of a mesenteric cyst found in the acute setting, which was symptomatic but was not obstructive or causing peritonitic symptoms.

  1. Risk-Adapted Management of Acute Pulmonary Embolism: Recent Evidence, New Guidelines

    Directory of Open Access Journals (Sweden)

    Anja Käberich

    2014-10-01

    Full Text Available Venous thromboembolism (VTE, the third most frequent acute cardiovascular syndrome, may cause life-threatening complications and imposes a substantial socio-economic burden. During the past years, several landmark trials paved the way towards novel strategies in acute and long-term management of patients with acute pulmonary embolism (PE. Risk stratification is increasingly recognized as a cornerstone for an adequate diagnostic and therapeutic management of the highly heterogeneous population of patients with acute PE. Recently published European Guidelines emphasize the importance of clinical prediction rules in combination with imaging procedures (assessment of right ventricular function and laboratory biomarkers (indicative of myocardial stress or injury for identification of normotensive PE patients at intermediate risk for an adverse short-term outcome. In this patient group, systemic full-dose thrombolysis was associated with a significantly increased risk of intracranial bleeding, a complication which discourages its clinical application unless hemodynamic decompensation occurs. A large-scale clinical trial program evaluating new oral anticoagulants in the initial and long-term treatment of venous thromboembolism showed at least comparable efficacy and presumably increased safety of these drugs compared to the current standard treatment. Research is continuing on catheter-directed, ultrasound-assisted, local, low-dose thrombolysis in the management of intermediate-risk PE.

  2. Clinical Characteristics, Management, and Outcomes of Suspected Poststroke Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Sylvia Marie Biso

    2017-01-01

    Full Text Available Background. Acute coronary syndrome (ACS can complicate acute ischemic stroke, causing significant morbidity and mortality. To date, literatures that describe poststroke acute coronary syndrome and its morbidity and mortality burden are lacking. Methods. This is a single center, retrospective study where clinical characteristics, cardiac evaluation, and management of patients with suspected poststroke ACS were compared and analyzed for their association with inpatient mortality and 1-year all-cause mortality. Results. Of the 82 patients, 32% had chest pain and 88% had ischemic ECG changes; mean peak troponin level was 18, and mean ejection fraction was 40%. The medical management group had older individuals (73 versus 67 years, p<0.05, lower mean peak troponin levels (12 versus 49, p<0.05, and lower mean length of stay (12 versus 25 days, p<0.05 compared to those who underwent stent or CABG. Troponin levels were significantly associated with 1-year all-cause mortality. Conclusion. Age and troponin level appear to play a role in the current clinical decision making for patient with suspected poststroke ACS. Troponin level appears to significantly correlate with 1-year all-cause mortality. In the management of poststroke acute coronary syndrome, optimal medical therapy had similar inpatient and all-cause mortality compared to PCI and/or CABG.

  3. Clinical Characteristics, Management, and Outcomes of Suspected Poststroke Acute Coronary Syndrome

    Science.gov (United States)

    De Venecia, Toni Anne; Wongrakpanich, Supakanya; Rodriguez-Ziccardi, Mary; Yadlapati, Sujani; Kishlyansky, Marina; Rammohan, Harish Seetha; Figueredo, Vincent M.

    2017-01-01

    Background Acute coronary syndrome (ACS) can complicate acute ischemic stroke, causing significant morbidity and mortality. To date, literatures that describe poststroke acute coronary syndrome and its morbidity and mortality burden are lacking. Methods This is a single center, retrospective study where clinical characteristics, cardiac evaluation, and management of patients with suspected poststroke ACS were compared and analyzed for their association with inpatient mortality and 1-year all-cause mortality. Results Of the 82 patients, 32% had chest pain and 88% had ischemic ECG changes; mean peak troponin level was 18, and mean ejection fraction was 40%. The medical management group had older individuals (73 versus 67 years, p < 0.05), lower mean peak troponin levels (12 versus 49, p < 0.05), and lower mean length of stay (12 versus 25 days, p < 0.05) compared to those who underwent stent or CABG. Troponin levels were significantly associated with 1-year all-cause mortality. Conclusion Age and troponin level appear to play a role in the current clinical decision making for patient with suspected poststroke ACS. Troponin level appears to significantly correlate with 1-year all-cause mortality. In the management of poststroke acute coronary syndrome, optimal medical therapy had similar inpatient and all-cause mortality compared to PCI and/or CABG. PMID:29130017

  4. Novel findings in the management of acute pancreatitis.

    Science.gov (United States)

    Bolado, Federico; de-Madaria, Enrique

    2016-09-01

    Acute pancreatitis (AP) is a potentially serious disease whose incidence is on the increase. Pancreas divisum does not meet the required criteria to be considered an aetiological factor. Sphincter of Oddi dysfunction may be another cause of idiopathic AP. Less invasive methods cannot replace Sphincter of Oddi manometry in diagnosis. Almost half of patients with systemic inflammatory response syndrome develop organ failure, but the mechanisms involved are not completely understood. Obesity is a risk factor for severity in AP; the cause could be the presence of free unsaturated fatty acids, which have pro-inflammatory activity. Prognosis is better in patients with isolated extra-pancreatic necrosis than in those with parenchymal necrosis or with both. The mortality rate among those with infected pancreatic necrosis is 15-20%. The "moderately severe" group is widely heterogeneous and this category may require redefinition. Laparoscopic treatment of pseudocysts is an alternative to endoscopic drainage and could be the first-line option in patients requiring cholecystectomy. The use of lumen-apposing metal stents to treat pancreatic necrosis is cost-effective. Quality of life in some patients following an attack of AP is significantly impaired even at 1 year. Aggressive fluid therapy is not superior to standard fluid therapy in preventing post-ERCP AP. The role of statins in AP prevention is still unclear. Aggressive fluid resuscitation and the use of lactated Ringer solution seem to be beneficial in the treatment of AP. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  5. Management of acute dislocation of the temporomandibular joint in dental practice.

    LENUS (Irish Health Repository)

    McGoldrick, David M

    2010-12-01

    Acute dislocation of the temporomandibular joint is a situation that, although rare, may present to the dentist in practice at any time. A number of activities, such as removal of a tooth, may cause dislocation. The event is painful and distressing for the patient, their family and the dental team. Prompt management minimises discomfort, distress and long-term morbidity to the patient. We describe the aetiology of acute dislocation and outline a number of techniques that will aid the clinican in dealing with this event.

  6. MODERN MANAGEMENT OF ACUTE RESPIRATORY INFECTIONS IN CHILDREN. RECOURSES OF SYSTEM ANTI INFLAMMATORY TREATMENT

    Directory of Open Access Journals (Sweden)

    O.V. Zaitseva

    2008-01-01

    Full Text Available A problem of etiology and pathogenesis of acute respiratory infections in children are observed in this article. Modern approach to management of its treatment in pediatric patients, including often ailing children, is described. Authors give characteristics to main directions of treatment of obstructive syndrome. An experience of anti-inflammatory therapy with fenspiride (eurespal in children of different age is summa ized in this article.Key words: often ailing children, acute respiratory infections, bronchoobstructive syndrome, anti-inflammatory treatment, fenspiride.

  7. [Are urgent imaging tests indicated in the management of acute pancreatitis?].

    Science.gov (United States)

    Fornell Pérez, R; Lozano Rodríguez, A

    2016-01-01

    Acute pancreatitis is a common emergency within abdominal disease. It is accepted that two of three conditions must be fulfilled for its diagnosis: characteristic clinical presentation, characteristic laboratory findings, and/or characteristic diagnostic imaging findings. The first two conditions are the most often used, probably for reasons of efficiency and frequency. Nevertheless, the need for imaging studies is sometimes a source of conflict. For this reason, we decided to review the current evidence regarding the indication of urgent imaging tests in the management of acute pancreatitis. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  8. A prospective audit against national standards of the presentation and management of acute pancreatitis in the South of England

    OpenAIRE

    Toh, S; Phillips, S; Johnson, C

    2000-01-01

    BACKGROUND—The incidence of acute pancreatitis shows regional variations in the UK.
AIMS—To document the incidence and presentation of acute pancreatitis in hospitals in Wessex, and to audit the process and outcome of management of patients against the UK guidelines.
METHODS—A prospective survey was carried out of all patients with acute pancreatitis in a one year period, in eight geographically adjacent acute hospitals in the Wessex region.
RESULTS—186 patients with acute pancreatitis were i...

  9. Emergent management of postpartum hemorrhage for the general and acute care surgeon

    Directory of Open Access Journals (Sweden)

    Blankenship Charles L

    2009-11-01

    Full Text Available Abstract Background Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. Methods The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. Results A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. Conclusion The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.

  10. MANAGEMENT OF ACUTE SEVERE ULCERATIVE COLITIS: A CLINICAL UPDATE.

    Science.gov (United States)

    Sobrado, Carlos Walter; Sobrado, Lucas Faraco

    2016-01-01

    Acute severe colitis is a potentially lethal medical emergency and, even today, its treatment remains a challenge for clinicians and surgeons. Intravenous corticoid therapy, which was introduced into the therapeutic arsenal in the 1950s, continues to be the first-line treatment and, for patients who are refractory to this, the rescue therapy may consist of clinical measures or emergency colectomy. To evaluate the indications for and results from drug rescue therapy (cyclosporine, infliximab and tacrolimus), and to suggest a practical guide for clinical approaches. The literature was reviewed using the Medline/PubMed, Cochrane library and SciELO databases, and additional information from institutional websites of interest, by cross-correlating the following keywords: acute severe colitis, fulminating colitis and treatment. Treatments for acute severe colitis have avoided colectomy in 60-70% of the cases, provided that they have been started early on, with multidisciplinary follow-up. Despite the adverse effects of intravenous cyclosporine, this drug has been indicated in cases of greater severity with an imminent risk of colectomy, because of its fast action, short half-life and absence of increased risk of surgical complications. Therapy using infliximab has been reserved for less severe cases and those in which immunosuppressants are being or have been used (AZA/6-MP). Indication of biological agents has recently been favored because of their ease of therapeutic use, their good short and medium-term results, the possibility of maintenance therapy and also their action as a "bridge" for immunosuppressant action (AZA/6-MP). Colectomy has been reserved for cases in which there is still no response five to seven days after rescue therapy and in cases of complications (toxic megacolon, profuse hemorrhage and perforation). Patients with a good response to rescue therapy who do not undergo emergency operations should be considered for maintenance therapy using

  11. Financial Management: U.S. Army Corps of Engineers Financial Information Imported Into the Defense Departmental Reporting System - Audited Financial Statements

    National Research Council Canada - National Science Library

    Granetto, Paul J; Peek, Marvin L; Armstrong, Jack L; Wenzel, Paul C; Furey, Kathleen A; Zimmerman, Craig W

    2004-01-01

    .... The USACE Civil Works principal financial statements consist of a consolidated balance sheet, a consolidated statement of net cost, a consolidated statement of changes ill net position, a combined...

  12. Management of Patients With Diverticulosis and Diverticular Disease: Consensus Statements From the 2nd International Symposium on Diverticular Disease.

    Science.gov (United States)

    Tursi, Antonio; Picchio, Marcello; Elisei, Walter; Di Mario, Francesco; Scarpignato, Carmelo; Brandimarte, Giovanni

    2016-10-01

    The statements produced by the Chairmen of the 2nd International Symposium on Diverticular Disease, held in Rome on April 8th to 9th, 2016, are reported. Topics such as epidemiology, risk factors, diagnosis, medical and surgical treatment of diverticular disease in patients with uncomplicated and complicated diverticular disease were reviewed by the Chairmen who proposed 41 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 80 physicians from 6 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas.

  13. Copeptin in acute coronary syndromes and heart failure management: State of the art and future directions.

    Science.gov (United States)

    Schurtz, Guillaume; Lamblin, Nicolas; Bauters, Christophe; Goldstein, Patrick; Lemesle, Gilles

    2015-01-01

    Over the past two decades, the use of multiple biomarkers has changed cardiovascular disease management. Recently, several trials have assessed the diagnostic and prognostic performances of copeptin, especially in patients with heart failure or acute coronary syndromes. Primary results are interesting, with copeptin looking promising for: the management of patients who present at emergency departments early after chest pain onset and the risk stratification of patients with heart failure. The purpose of this article is to review the data on the place of copeptin in the management of patients with chest pain or heart failure. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Final environmental impact statement for the Nevada Test Site and off-site locations in the State of Nevada. Framework for the resource management plan, Volume 2

    International Nuclear Information System (INIS)

    1996-08-01

    The purpose of this document is to publicize how the U.S. Department of Energy Nevada Operations Office (DOE/NV) proposes to develop and use a Resource Management Plan for the Nevada Test Site (NTS) so the public could comment on and assist in the following activities: (1) Developing the methods for creating and using the plan; (2) Identifying the values people place on manmade and natural resources found on the NTS; (3) Developing the goals the DOE/NV will use to guide the conservation and use of those resources; (4) Identifying the management actions needed to meet constraints and resource management goals; and (5) Incorporating the principles of ecosystem management into land and resource management on the NTS. This framework for the Resource Management Plan was developed in conjunction with the Environmental Impact Statement for the Nevada Test Site and off-site locations in the state of Nevada (NTS EIS) to take advantage of the extensive data collection and public participation activities associated with the National Environmental Policy Act. After public input was received during the comment period for the Draft NTS EIS, DOE/NV revised this description of the Resource Management Plan and published it with the NTS Final EIS. This revision includes the goals DOE/NV has developed for managing resources and land-use constraints. It also includes the final plans for developing the Resource Management Plan. These plans will guide DOE/NV as it develops a Resource Management Plan in the coming years

  15. An investigation into the management of acute skin reactions from tangential breast irradiation

    International Nuclear Information System (INIS)

    Meegan, M.A.; Haycocks, T.R.

    1997-01-01

    This research examined the acute skin reaction of two consecutive groups receiving tangetial breast irradiation for carcinoma of the breast. The first group used the traditional skin care advice of using warm water only within the treatment area, while the second group continued with their normal skin care regime. Data was collected on the physical manifestations of the acute reaction, medical history, the use of concurrent cytotoxic agents, treatment parameters and skin care products used. Statistical analysis using the T-test method showed no difference in the skin reaction between the two groups. The investigation has lead to a change of policy in the management of acute breast reactions. Patients receiving radiation therapy to the breast or chest wall can now use their routine skin care products with no adverse effect on skin reactions. (author)

  16. Update on the management of non-obstetric acute abdomen in pregnant patients.

    Science.gov (United States)

    Barber-Millet, Sebastián; Bueno Lledó, José; Granero Castro, Pablo; Gómez Gavara, Immaculada; Ballester Pla, Neus; García Domínguez, Rafael

    2016-05-01

    Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500-635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and fetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. An overview of acute burn management in the Emergency Centre

    Directory of Open Access Journals (Sweden)

    Adaira Landry

    2013-03-01

    Full Text Available Despite the frequency and severity of burns in Low Income Countries, including many in Africa, there is a paucity of research and funding for these populations to aid in prevention, treatment and recovery of burn patients. The objectives of this paper are four-fold. First, by addressing the pathophysiology of burns the reader may strengthen understanding of the clinical progression of burns. Second, through describing proper assessment of burn patients one will learn how to decide if patients can be discharged, admitted or transferred to burn centre. Third, the inclusion of treatments solidifies the steps necessary to manage a patient in a hospital setting. Lastly, the overall goal of the paper, is to raise awareness that more research, publication and funding is required to create a better understanding of burns in Africa and why they continue to be devastating social and economic burdens.

  18. The quality of reporting of RCTs used within a postoperative pain management meta-analysis, using the CONSORT statement

    Directory of Open Access Journals (Sweden)

    Borg Debono Victoria

    2012-07-01

    Full Text Available Abstract Background Randomized controlled trials (RCTs are routinely used in systematic reviews and meta-analyses that help inform healthcare and policy decision making. The proper reporting of RCTs is important because it acts as a proxy for health care providers and researchers to appraise the quality of the methodology, conduct and analysis of an RCT. The aims of this study are to analyse the overall quality of reporting in 23 RCTs that were used in a meta-analysis by assessing 3 key methodological items, and to determine factors associated with high quality of reporting. It is hypothesized that studies with larger sample sizes, that have funding reported, that are published in journals with a higher impact factor and that are in journals that have adopted or endorsed the CONSORT statement will be associated with better overall quality of reporting and reporting of key methodological items. Methods We systematically reviewed RCTs used within an anesthesiology related post-operative pain management meta-analysis. We included all of the 23 RCTs used, all of which were parallel design that addressed the use of femoral nerve block in improving outcomes after total knee arthroplasty. Data abstraction was done independently by two reviewers. The two main outcomes were: 1 15 point overall quality of reporting score (OQRS based on the Consolidated Standards for Reporting Trials (CONSORT and 2 3 point key methodological item score (KMIS based on allocation concealment, blinding and intention-to-treat analysis. Results Twenty-three RCTs were included. The median OQRS was 9.0 (Interquartile Range = 3. A multivariable regression analysis did not show any significant association between OQRS or KMIS and our four predictor variables hypothesized to improve reporting. The direction and magnitude of our results when compared to similar studies suggest that the sample size and impact factor are associated with improved key methodological item reporting

  19. Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons.

    Science.gov (United States)

    Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier

    2014-10-01

    There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  20. Brief review: Adoption of electronic medical records to enhance acute pain management.

    Science.gov (United States)

    Goldstein, David H; Phelan, Rachel; Wilson, Rosemary; Ross-White, Amanda; VanDenKerkhof, Elizabeth G; Penning, John P; Jaeger, Melanie

    2014-02-01

    The purpose of this paper is to examine physician barriers to adopting electronic medical records (EMRs) as well as anesthesiologists' experiences with the EMRs used by the acute pain management service at two tertiary care centres in Canada. We first review the recent literature to determine if physician barriers to adoption are changing given the exponential growth of information technology and the evolving healthcare environment. We next report on institutional experience from two academic health sciences centres regarding the challenges they encountered over the past ten years in developing and implementing an electronic medical record system for acute pain management. The key identified barriers to adoption of EMRs are financial, technological, and time constraints. These barriers are identical to those reported in a systematic review performed prior to 2009 and remain significant factors challenging implementation. These challenges were encountered during our institution's process of adopting EMRs specific to acute pain management. In addition, our findings emphasize the importance of physician participation in the development and implementation stages of EMRs in order to incorporate their feedback and ensure the EMR system is in keeping with their workflow. Use of EMRs will inevitably become the standard of care; however, many barriers persist to impede their implementation and adoption. These challenges to implementation can be facilitated by a corporate strategy for change that acknowledges the barriers and provides the resources for implementation. Adoption will facilitate benefits in communication, patient management, research, and improved patient safety.

  1. Assessment and Management of Acute Severe Mitral Regurgitation in the Intensive Care Unit.

    Science.gov (United States)

    Leitman, Marina; Tyomkin, Vladimir; Raanani, Ehud; Sharony, Ram; Tzatskin, Ludmila; Peleg, Eli; Blatt, Alex; Vered, Zvi

    2017-03-01

    Acute severe mitral regurgitation (MR) is a serious medical condition. Whilst clear guidelines exist regarding the management of chronic MR, acute severe MR is usually treated on an individual basis. Currently, few data exist regarding acute MR in the era of primary coronary interventions (PCI). The present study included patients admitted to the Department of Cardiology during recent years with acute severe MR of different etiologies, and an analysis of these data in the light of previous investigations. The digital database of the present authors' hospital was searched for patients diagnosed with severe MR between 2008 and 2015. From a total of 228 patients identified, 19 with primary MR and 17 with secondary (functional) MR were admitted to the Department of Cardiology. The clinical data and outcome of these patients were analyzed. Among patients with MR due to acute myocardial infarction (MI), 13 had functional MR and six had MR due to mechanical complications, namely rupture of the papillary muscle or chordae tendineae. Among patients with MR not in the setting of MI, 13 had primary MR and four had functional MR. Patients with MR due to acute MI were more often in cardiogenic shock or had pulmonary edema and had a higher mortality. The strongest predictor of mortality was the presence of shock, followed by female gender, hypertension, age ≥68 years; previous MI and pulmonary edema were also predictors of mortality. In patients with acute MI and secondary MR, PCI to the culprit coronary artery was associated with a lesser degree of MR on follow up. Patients with severe MR are at high risk of in-hospital death. Patients with functional MR are likely to benefit from prompt PCI to the culprit artery, and for those with primary MR urgent surgery is life-saving.

  2. MANAGEMENT OF DIABETES IN ACUTE MYOCARDIAL INFARCTION IN CELJE GENERAL HOSPITAL IN 1999

    Directory of Open Access Journals (Sweden)

    Gregor Veninšek

    2001-12-01

    Full Text Available Background. DIGAMI study showed that intrahospital mortality and mortality at one year after myocardial infarction can be significantly reduced in diabetics treated in acute phase of myocardial infarction by GI infusion and afterwards for at least three months with intensive insulin treatment. Mortality can be reduced for more than 50% in a subgroup of patients younger than 70 years, without congestive heart failure, with first myocardial infarction, not treated with insulin or digitalis. In this perspective we reviewed treatment of diabetics with acute myocardial infarction in 1999 in Celje General Hospital.Methods. We reviewed documentation of treatment of all diabetics with acute myocardial infarction treated in Celje General Hospital in 1999. We collected data on number of newly discovered diabetes, on previous treatment of diabetes, on treatment of diabetes during hospitalization and at discharge, on drugs used for treatment of diabetes and on mortality during hospitalization.Results. Diabetics presented 20% of all patients with acute myocardial infarction treated in Celje General Hospital in 1999. None of patients received GI infusion, none had intensively managed blood sugar. 24% of patients were treated with sulfonylureas in acute phase of myocardial infarction. 33% of patients were discharged from hospital with insulin therapy. Intrahospital mortality was 9%, comparable with patients without diabetes.Conclusions. In 1999 was intrahospital treatment of diabetics with acute myocardial infarction in Celje General Hospital successful as their intrahospital mortality equaled non-diabetics. Treatment of diabetes itself, during hospitalization and after discharge, on the other hand, in 1999 had not been up to date according to results of recent studies. In our opinion, it is mandatory for diabetologist to make part of the team that treats diabetic with acute myocardial infarction

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

    Science.gov (United States)

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

    2017-09-01

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

  4. Rio 2016 financial statements

    OpenAIRE

    2015-01-01

    These documents include the report from independent auditors balance sheet, the statement of income, the statement of changes in equity, the statement of cash flows and the explanatory notes to the financial statements.

  5. CLINICAL ASPECTS OF ACUTE POST-OPERATIVE PAIN MANAGEMENT & ITS ASSESSMENT

    Directory of Open Access Journals (Sweden)

    R.S.R Murthy

    2010-06-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  6. Clinical aspects of acute post-operative pain management & its assessment

    Directory of Open Access Journals (Sweden)

    Anuj Gupta

    2010-01-01

    Full Text Available Management of postoperative pain relieve suffering and leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. An effective postoperative management is not a standardized regime rather is tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition; age; level of fear or anxiety; surgical procedure; personal preference; and response to therapeutic agents given. The major goal in the management of postoperative pain is to minimize the dose of medications to lessen side effects & provide adequate analgesia. Postoperative pain is still under managed due to obstacles in implementation of Acute Pain Services due to insufficient education, fear of complications associated with available analgesic drugs, poor pain assessment and inadequate staff. This review reflects the clinical aspects of postoperative pain & its assessment & management with an emphasis on research for new analgesic molecules & delivery system.

  7. Emergency department management of children with acute isoniazid poisoning.

    Science.gov (United States)

    Parish, R A; Brownstein, D

    1986-06-01

    We suggest that the following therapeutic regimen be followed in cases of isoniazid poisoning in children. In cases of intractable seizure activity in a child which remains unexplained, consider isoniazid poisoning. Give pyridoxine as an intravenous bolus to all children in whom isoniazid toxicity is suspected, who exhibit seizure activity and are known to have been exposed to isoniazid, or who have a history of ingesting one gram or more of isoniazid. It should be given on a gram-for-gram basis, and the clinician need not await serum isoniazid levels before administering pyridoxine. It can be safely given at a rate of five grams per three minutes in a 50 ml volume. In fact, serum isoniazid determinations are not available in many emergency departments and have not been shown to correlate closely with symptomatology. When available, serum isoniazid levels at best are subject to variability owing to sampling procedures (serum protein must be removed within two hours of sampling). The result is that serum isoniazid levels play only a minor role in the emergency department management of isoniazid poisoning. To potentiate the antidotal effects of pyridoxine, diazepam (0.1 mg/kg) may be given intravenously, preferably at a second intravenous site. Because the lactic acidosis seen after seizures resolves spontaneously, and because metabolic alkalosis may result following excess lactate loading, administration of bicarbonate is usually not necessary, and may be harmful in some cases. After pyridoxine treatment, syrup of ipecac may be given to empty the stomach.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Pharmacist's impact on acute pain management during trauma resuscitation.

    Science.gov (United States)

    Montgomery, Kayla; Hall, A Brad; Keriazes, Georgia

    2015-01-01

    The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.

  9. A Rare Cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception.

    Science.gov (United States)

    Sertkaya, Mehmet; Emre, Arif; Pircanoglu, Eyüp Mehmet; Yazar, Fatih Mehmet; Tepe, Murat; Cengiz, Emrah; Isler, Ali; Vicdan, Halit

    2016-01-01

    Intussusception in adults is very rarely seen, and this cause acute abdomen. A computed tomography (CT) scan, clinical suspicion, history, and a physical examination are important for the diagnosis. We present two cases of colonic intussusceptions induced by lipoma. The cases had similar locations, diagnoses, and management. Both lipomas were located close to the cecum in the ascending colon, and a right segmental colon resection was performed in both cases. The follow-up of both cases was uneventful. Although benign lesions can cause colonic intussusception, the high incidence of malignancy in colonic lesions should always be considered. Therefore, oncologic surgical procedures should be applied. The definitive diagnosis can be made by histopathology. Sertkaya M, Emre A, Pircanoglu EM, Yazar FM, Tepe M, Cengiz E, Isler A, Vicdan H. A Rare cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception. Euroasian J Hepato-Gastroenterol 2016;6(2):179-182.

  10. Quality Assessment of Acute Inpatient Pain Management in an Academic Health Center.

    Science.gov (United States)

    Lin, Richard J; Reid, M Carrington; Chused, Amy E; Evans, Arthur T

    2016-02-01

    The quality of acute inpatient pain management remains suboptimal and poorly understood. In this retrospective study, we analyze acute pain management practice in a large academic health center using several quality indicators. Not surprisingly, despite high rate of pain assessment, many patients still have frequent, prolonged, and unrelieved severe pain episodes. Upon examination of naloxone administration, we identify potential inappropriate opioid prescription practices such as the use of wrong opioids in hepatic and renal failure and simultaneous use of multiple short-acting opioids. Most importantly, we find that chronic opioid users appear to suffer the most in terms of undertreatment of pain as well as opioid overdose, highlighting the urgent need to target this underserved population of patients. © The Author(s) 2014.

  11. Ecological Data in Support of the Tank Closure and Waste Management Environmental Impact Statement. Part 2: Results of Spring 2007 Field Surveys

    Energy Technology Data Exchange (ETDEWEB)

    Sackschewsky, Michael R.; Downs, Janelle L.

    2007-05-31

    This review provides an evaluation of potential impacts of actions that have been proposed under various alternatives to support the closure of the high level waste tanks on the Hanford Site. This review provides a summary of data collected in the field during the spring of 2007 at all of the proposed project sites within 200 East and 200 West Areas, and at sites not previously surveyed. The primary purpose of this review is to provide biological data that can be incorporated into or used to support the Tank Closure and Waste Management Environmental Impact Statement.

  12. Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

    Directory of Open Access Journals (Sweden)

    Doucet Jean

    2008-01-01

    Full Text Available Abstract Background There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP. Methods The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments – Urology (U, Infectious Diseases (ID, Internal Medicine (IM, Geriatrics (G – of two French university hospitals. Results The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen. Overall, a 3:1 ratio of community-acquired AP (CA-AP to nosocomial AP (N-AP was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP, with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen. For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p vs. 19%, p Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p Conclusion This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.

  13. "That Doesn't Translate": The Role of Evidence-Based Practice in Disempowering Speech Pathologists in Acute Aphasia Management

    Science.gov (United States)

    Foster, Abby; Worrall, Linda; Rose, Miranda; O'Halloran, Robyn

    2015-01-01

    Background: An evidence-practice gap has been identified in current acute aphasia management practice, with the provision of services to people with aphasia in the acute hospital widely considered in the literature to be inconsistent with best-practice recommendations. The reasons for this evidence-practice gap are unclear; however, speech…

  14. Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation

    Directory of Open Access Journals (Sweden)

    Ali Torkaman

    2016-01-01

    Full Text Available Background: Surgical treatments for acromioclavicular (AC joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. Methods: This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH, constant and visual analogue scale (VAS scores, and all complications of the cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71% were male and four (14.28% were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements (P=0.001, P=0.0001, P=0.0001, respectively. There were not any significant differences between right and left coracoclavicular (P=0.238, but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. Conclusion: According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments.

  15. Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation

    Science.gov (United States)

    Torkaman, Ali; Bagherifard, Abolfazl; Mokhatri, Tahmineh; Haghighi, Mohammad Hossein Shabanpour; Monshizadeh, Siamak; Taraz, Hamid; Hasanvand, Amin

    2016-01-01

    Background: Surgical treatments for acromioclavicular (AC) joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. Methods: This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH), constant and visual analogue scale (VAS) scores, and all complications of the cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71%) were male and four (14.28%) were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements. There were not any significant differences between right and left coracoclavicular, but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. Conclusion: According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments. PMID:26894217

  16. Practice nurse and health visitor management of acute minor illness in a general practice.

    Science.gov (United States)

    Pritchard, A; Kendrick, D

    2001-11-01

    To evaluate practice nurse (PN) and health visitor (HV) management of patients with acute minor illnesses, monitor the effect on general practitioner (GP) workload, and describe the range of conditions seen by nurses. Patients requesting 'urgent' appointments (within 24 hours) were offered consultations with a PN or HV trained in the management of acute minor illness. Comparative data were collected before and after the establishment of the acute minor illness service. A general practice in Nottingham, England. Patient satisfaction, consultation rate, prescriptions, investigations, referrals and urgent re-consultations for the same condition within 2 weeks. About 2056 urgent consultations were recorded in the study period, of which 332 (16.1%) were seen by PNs and 46 (2.2%) by a HV. High levels of patient satisfaction were reported for all health professionals. Patients seeing the HV reported higher levels of satisfaction than those consulting GPs (P=0.033) and PNs (P=0.010). There was no difference by health professional for prescription rates (P=0.76), re-consultations (P=0.14), or referrals to secondary care (P=0.07). General practitioners were more likely to initiate further investigations than the PNs or HV (P manage patients with a range of conditions. General practitioner workload can be reduced while maintaining high patient satisfaction levels.

  17. Reading and understanding financial statements.

    Science.gov (United States)

    White, Joseph P

    2005-01-01

    Feeling comfortable reading and understanding financial statements is critical to the success of healthcare executives and physicians involved in management. Businesses use three primary financial statements: a balance sheet represents the equation, Assets = Liabilities + Equity; an income statement represents the equation, Revenues - Expenses = Net Income; a statement of cash flows reports all sources and uses of cash during the represented period. The balance sheet expresses financial indicators at one particular moment in time, whereas the income statement and the statement of cash flows show activity that occurred over a stretch of time. Additional information is disclosed in attached footnotes and other supplementary materials. There are two ways to prepare financial statements. Cash-basis accounting recognizes revenue when it is received and expenses when they are paid. Accrual-basis accounting recognizes revenue when it is earned and expenses when they are incurred. Although cash-basis is acceptable, periodically using the accrual method reveals important information about receivables and liabilities that could otherwise remain hidden. Become more engaged with your financial statements by spending time reading them, tracking key performance indicators, and asking accountants and financial advisors questions. This will help you better understand your business and build a successful future.

  18. Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics.

    Science.gov (United States)

    Indinnimeo, Luciana; Chiappini, Elena; Miraglia Del Giudice, Michele

    2018-04-06

    Acute asthma attack is a frequent condition in children. It is one of the most common reasons for emergency department (ED) visit and hospitalization. Appropriate care is fundamental, considering both the high prevalence of asthma in children, and its life-threatening risks. Italian Society of Pediatrics recently issued a guideline on the management of acute asthma attack in children over age 2, in ambulatory and emergency department settings. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was adopted. A literature search was performed using the Cochrane Library and Medline/PubMed databases, retrieving studies in English or Italian and including children over age 2 year. Inhaled ß 2 agonists are the first line drugs for acute asthma attack in children. Ipratropium bromide should be added in moderate/severe attacks. Early use of systemic steroids is associated with reduced risk of ED visits and hospitalization. High doses of inhaled steroids should not replace systemic steroids. Aminophylline use should be avoided in mild/moderate attacks. Weak evidence supports its use in life-threatening attacks. Epinephrine should not be used in the treatment of acute asthma for its lower cost / benefit ratio, compared to β 2 agonists. Intravenous magnesium solphate could be used in children with severe attacks and/or forced expiratory volume1 (FEV1) lower than 60% predicted, unresponsive to initial inhaled therapy. Heliox could be administered in life-threatening attacks. Leukotriene receptor antagonists are not recommended. This Guideline is expected to be a useful resource in managing acute asthma attacks in children over age 2.

  19. Frequency of conservatively managed traumatic acute subdural haematoma changing into chronic subdural haematoma

    International Nuclear Information System (INIS)

    Ahmed, E.; Aurangzeb, A.; Khan, S.A.; Ali, A.; Maqbool, S.

    2012-01-01

    Background: Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Acute subdural haematoma is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcome of patients conservatively managed may help the neurosurgeon in the decision-making process. Methods: We prospectively analysed 27 patients with age ranges 15-90 years, in whom a CT scan diagnosis of acute subdural haematoma was made, and in whom craniotomy for evacuation was not initially performed, to the neurosurgery department of Ayub Teaching Hospital Abbottabad (2008-2011). Patients with deranged bleeding profile, anticoagulant therapy, chronic liver disease, any other associated intracranial abnormalities, such as cerebral contusions, as shown on CT, were excluded from this study. All patients were followed by serial CT scans, and a neurological assessment was done. Results: There were 18 male and 9 female patients, Cerebral atrophy was present in over half of the sample. In 22 of our patients, the acute subdural haematoma resolved spontaneously, without evidence of damage to the underlying brain, as shown by CT or neurological findings. Four patients subsequently required burr hole drainage for chronic subdural haematoma. In each of these patients, haematoma thickness was greater than 10 mm. The mean delay between injury and operation in this group was 15-21 days. Among these patients 1 patient required craniotomy for haematoma removal due to neurological deterioration. Conclusion: Certain conscious patients with small acute subdural haematomas, without mass effect on CT, may be safely managed conservatively, but due to high risk of these acute subdural haematoma changing into chronic subdural haematoma these patients should be reinvestigated in case of neurological deterioration. (author)

  20. Acute pain in children and adults with sickle cell disease: management in the absence of evidence-based guidelines.

    Science.gov (United States)

    Field, Joshua J; Knight-Perry, Jessica E; Debaun, Michael R

    2009-05-01

    Acute, vaso-occlusive pain is the most characteristic complication of sickle cell disease (SCD). Although there has been rigorous work examining the pathogenesis of vaso-occlusion, fewer studies have focused on approaches to the clinical management of acute pain. In this review, we will examine the epidemiology and management strategies of acute pain events and we will identify limitations in the best available studies. Most acute pain events in adults with SCD are managed at home without physician contact. Prior descriptions of the natural history of pain episodes from the Cooperative Study of Sickle Cell Disease relied on physician contact, limiting the generalizability of these findings to current practice. Patient-controlled analgesia has replaced on-demand therapy to become the standard for management of severe pain events in children and adults with SCD requiring hospital admission. Unfortunately, most clinical practice guidelines for the management of acute pain are not based on randomized clinical trials. As a result, our practice of pain management is primarily limited to expert opinion and inferences from observational studies. Additional clinical trials in management of acute pain in children and adults with SCD are critical for the development of evidence-based guidelines.