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1

National Guideline Clearinghouse (NGC)  

NSDL National Science Digital Library

Operated by the US Department of Health and Human Services, the Agency for Health Care Policy and Research (AHCPR), the American Medical Association (AMA) and the American Association of Health Plans (AAHP), The National Guideline Clearinghouse provides information about hundreds of "evidence-based clinical practice guidelines" for health care professionals. Guidelines from over 100 different medical organizations can be searched or browsed by disease or condition; treatment or intervention method; or issuing organization. Each record includes the date of release and current status of the guideline, major recommendations for interventions and practices, organization(s) and committee members responsible for the guideline, and methods used to collect evidence and rate the quality of evidence. A link to the full text of the guideline is provided if available. When more than one guideline has been released on a topic, users can compare selected guidelines in chart format. A News section tells developers how to submit guidelines to the Clearinghouse.

1999-01-01

2

Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines  

Microsoft Academic Search

The Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program issued an evidence-based set of guidelines on cholesterol management in 2001. Since the publication of ATP III, 5 major clinical trials of statin therapy with clinical end points have been published. These trials addressed issues that were not examined in previous clinical trials of cholesterol-lowering therapy. The

Scott M. Grundy; James I. Cleeman; C. Noel Bairey Merz; H. Bryan Brewer Jr; Luther T. Clark; Donald B. Hunninghake; Richard C. Pasternak; Sidney C. Smith Jr; Neil J. Stone

2004-01-01

3

National Bookmobile Guidelines, 1992.  

ERIC Educational Resources Information Center

This publication is based on the work of The State Library of Ohio, the National Bookmobile Guidelines Committee, and staff of local Ohio bookmobile programs. Draft guidelines were approved by the 7th National Bookmobile Conference (May 31-June 2, 1992). The Guidelines provide brief statements of standards followed by specifics which indicate…

Ohio State Library, Columbus.

4

Guideline 3: Psychosocial Treatment.  

ERIC Educational Resources Information Center

The third in seven sets of guidelines based on the consensus of experts in the treatment of psychiatric and behavioral problems in mental retardation (MR) focuses on psychosocial treatment. Guidelines cover general principles, choosing among psychosocial treatments, severity of MR and psychiatric/behavior symptoms, diagnosable disorders, target…

American Journal on Mental Retardation, 2000

2000-01-01

5

NANETS Treatment Guidelines  

PubMed Central

Well-differentiated neuroendocrine tumors (NETs) of the stomach and pancreas represent 2 major subtypes of gastrointestinal NETs. Historically, there has been little consensus on the classification and management of patients with these tumor subtypes. We provide an overview of well-differentiated NETs of the stomach and pancreas and describe consensus guidelines for the treatment of patients with these malignancies. PMID:20664472

Kulke, Matthew H.; Anthony, Lowell B.; Bushnell, David L.; de Herder, Wouter W.; Goldsmith, Stanley J.; Klimstra, David S.; Marx, Stephen J.; Pasieka, Janice L.; Pommier, Rodney F.; Yao, James C.; Jensen, Robert T.

2011-01-01

6

National Bookmobile Guidelines, 1988.  

ERIC Educational Resources Information Center

These guidelines were developed by the bookmobile community that has met in Columbus, Ohio, since 1985 for their annual conference. The guidelines comprise the collaborative effort of hundreds of conference participants and representatives from 79 libraries throughout the United States and Canada, who discussed the guidelines in regional and state…

Ohio State Library, Columbus.

7

Adherence to national guidelines for drug treatment of suspected acute myocardial infarction: evidence for undertreatment in women and the elderly  

Microsoft Academic Search

BACKGROUND: Evidence-based guidelines for the treatment of patients with acute myocardial infarction (AMI) have been published and disseminated by the American College of Cardiology and the American Heart Association. Few studies have examined the rates of adherence to these guidelines in eligible populations and the influence of age and gender on highly effective AMI treatments in community hospital settings. METHODS:

Thomas J. McLaughlin; Stephen B. Soumerai; Donald J. Willison; Jerry H. Gurwitz; Catherine Borbas; Edward Guadagnoli; Barbara McLaughlin; Nora Morris; Su Chun Cheng; Paul J. Hauptman; Elliott Antman; Linda Casey; Richard Asinger; Fredarick Gobel

1996-01-01

8

[Practice guideline 'Prostate cancer: diagnosis and treatment'  

Microsoft Academic Search

--A national, multidisciplinary practice guideline was developed concerning diagnosis and treatment of patients with prostate cancer. Because of the lack of sufficient scientific evidence at this moment no practice guideline on screening is included. --The diagnosis of prostate cancer is made by transrectal ultrasound-guided prostate biopsies. The Gleason score is used for histological grading. --In localized prostate cancer and comorbidity

T. M. de Reijke; J. J. Battermann; R. J. A. van Moorselaar; IJ de Jong; A. P. Visser; J. S. Burgers

2008-01-01

9

National Scholarship Guidelines December 2013  

E-print Network

National Scholarship Guidelines December 2013 For 2014/2015 Academic Year Overview The Thornton Tomasetti Foundation (TTF) was established in 2008 with a mission to fund fellowships, scholarships, design or technology. To date, the TTF has awarded three national $10,000 scholarships per year, since

10

A thirteen-year analysis of Plasmodium falciparum populations reveals high conservation of the mutant pfcrt haplotype despite the withdrawal of chloroquine from national treatment guidelines in Gabon  

PubMed Central

Background Chloroquine resistance (CR) decreased after the removal of chloroquine from national treatment guidelines in Malawi, Kenia and Tanzania. In this investigation the prevalence of the chloroquine resistance (CQR) conferring mutant pfcrt allele and its associated chromosomal haplotype were determined before and after the change in Gabonese national treatment guidelines from chloroquine (CQ) to artesunate plus amodiaquine (AQ) in 2003. Methods The prevalence of the wild type pfcrt allele was assessed in 144 isolates from the years 2005 - 07 by PCR fragment restriction digest and direct sequencing. For haplotype analysis of the chromosomal regions flanking the pfcrt locus, microsatellite analysis was done on a total of 145 isolates obtained in 1995/96 (43 isolates), 2002 (47 isolates) and 2005 - 07 (55 isolates). Results The prevalence of the mutant pfcrt allele decreased from 100% in the years 1995/96 and 2002 to 97% in 2005 - 07. Haplotype analysis showed that in 1995/96 79% of the isolates carried the same microsatellite alleles in a chromosomal fragment spanning 39 kb surrounding the pfcrt locus. In 2002 and 2005 - 07 the prevalence of this haplotype was 62% and 58%, respectively. Pfcrt haplotype analysis showed that all wild type alleles were CVMNK. Conclusion Four years after the withdrawal of CQ from national treatment guidelines the prevalence of the mutant pfcrt allele remains at 97%. The data suggest that the combination of artesunate plus AQ may result in continued selection for the mutant pfcrt haplotype even after discontinuance of CQ usage. PMID:22004584

2011-01-01

11

Treatment for Panic Disorder: Practical Guidelines.  

ERIC Educational Resources Information Center

This article presents current research information on the treatment of panic disorder. Specific guidelines are presented to guide the mental health counselor in the delivery of effective psychopharmacological and cognitive-behavioral treatment. (Contains 81 references.) (Author)

Beamish, Patricia M.; Granello, Darcy Haag; Belcastro, Amy L.

2002-01-01

12

Guidelines for makeup water treatment  

Microsoft Academic Search

The EPRI Fossil Plant Cycle Chemistry Program, RP 2712, was developed in recognition of the importance of controlling cycle water and steam purity in attainment of maximized unit availability, reliability and efficiency. This guideline characterizes the state-of-the-art technology for production of cycle makeup water. It is intended to complement other RP 2712 projects in the areas of cycle chemistry guidelines,

D. A. Jr. Cline; K. J. Shields

1990-01-01

13

National and multinational guidelines in Europe: results from an online survey on awareness of different national and European psoriasis guidelines.  

PubMed

Guidelines can be developed on a national or multinational level. There are discussions concerning the relevance of different guidelines at different regional levels. Guidelines' evaluation can be approached by looking at the items "awareness", "agreement", "adoption" and "adherence". To assess the awareness of national and European (EDF/EADV) guidelines as a means of guidelines' evaluation. Online survey in five selected European countries (Germany [D], Spain [E], France [F], Italy [I], and the United Kingdom [UK]) among 257 dermatologists assessing awareness of different guidelines (European [EDF/EADV], German, Spanish, French, British). Participants were volunteers registered with a field market research company database. Mean awareness of EDF/EADV guidelines in all countries was 54 %, with lower results in the UK (33 %) and Germany (37 %) and higher awareness in Spain (63 %) and Italy (79 %). Awareness of the national guidelines was very high within the respective countries (mean 92 %). The European guidelines where always the best known guidelines after the respective national guidelines. The most important tools for dissemination of all guidelines were the original publication (63 %) and scientific presentations (46 %).This study identified widespread interest in guidelines as assessed by the grade of awareness. Awareness of European guidelines was higher in countries with late development of national guidelines (i.e. Spain and Italy) compared to countries with early development of own national guidelines such as Germany and the UK. National guidelines can reach almost complete awareness within their respective countries. The original publication is still the most important dissemination tool for guidelines. PMID:23589094

Nast, Alexander; Mrowietz, Ulrich; Kragballe, Knud; Puig, Luis; Reich, Kristian; Warren, Richard B; Schmitt, Jochen

2013-09-01

14

A review of current European treatment guidelines for migraine.  

PubMed

Migraine is one of the ten most disabling disorders worldwide, and despite recent developments in the management of migraine, it remains underdiagnosed and undertreated. Guidelines for the management of migraine aim to improve the quality of patient care and to assist professionals in decision making in relation to the overall healthcare process. Most European countries have published national clinical practice guidelines for migraine treatment. These guidelines need to be kept up-to-date with the most recent best clinical evidence and therapeutic strategies to ensure their optimal use to improve health outcomes. The aim of this review is to compare the English language guidelines available across Europe, analyzing differences and similarities, in order to provide a general overview to assist in assessing whether a European consensus on migraine treatment can be achieved. PMID:20020170

Antonaci, Fabio; Dumitrache, Cezar; De Cillis, Ilaria; Allena, Marta

2010-02-01

15

[Quality indicators for National Disease Management Guidelines using the example of the National Disease Management Guideline for "Chronic Heart Failure"].  

PubMed

Together with an expert committee a structured approach to determining quality indicators for National Disease Management Guidelines has been developed. The key steps of this approach include: introducing guideline authors to the methodology at an early stage of the process of guideline development, pre-selecting recommendations of the guideline which are potentially measurable by means of quality indicators, assessing the potentially measurable quality indicators in written form using five criteria (including their importance for the health care system and clarity of definitions) and approving them in a formal consensus process. For lack of a database these quality indicators must be regarded as preliminary. For the National Disease Management Guideline "Chronic Heart Failure" nine rate-based indicators have been chosen. The indicators correspond to important strong recommendations (grade of recommendation: A) from the fields of diagnosis (two), general therapeutic strategy (two), specific treatment (three), clinical monitoring (one) and co-ordination of care (one). In a second step, the quality indicators have to be validated within a pilot project. The determination and assessment of the potential quality indicators have revealed room for improvement of guideline development. In particular, there is a need for more health care data and for specification of recommendations. PMID:21382602

Nothacker, Monika Judith; Langer, Thomas; Weinbrenner, Susanne

2011-01-01

16

Guidelines for the identification, investigation and treatment of individuals with concomitant tuberculosis and HIV infection. Bureau of Communicable Disease Epidemiology, Canada Department of National Health and Welfare.  

PubMed Central

The following recommended guidelines, jointly prepared by the Canadian Thoracic Society, the Tuberculosis Directors of Canada, and the Department of National Health and Welfare in consultation with the provincial and territorial epidemiologists, AIDS coordinators and HIV caregivers, and approved by the Canadian Lung Association and the Canadian Thoracic Society are provided to assist health care workers who are caring for patients in the overlapping group. PMID:8500033

1993-01-01

17

[National Guidelines System: the Italian experience].  

PubMed

The Italian's experience of the guidelines development group is discussed through the evaluation of its ten years of activity. Focus is placed on the Italian guidelines working group organization and on the kind of documents developed. The horizontal architecture of the system and the several partnerships settled over time allowed the definition of a small coordinating group connected with a multitude of territorial stakeholders, such as scientific societies and local health units pertaining to the Italian National Health System. Different kinds of documents were produced, as adaptations of already existing guidelines elaborated by international institutions, short reviews addressing specific clinical issues and consensus conferences aimed at providing clinical governance on issues which lack on evidence. The steps needed to produce a high quality guideline are presented, considering and comparing all the different international experiences, to define and discuss a common and well-structured methodology, and to face the ethical and epistemological implications of each method. The multidisciplinary of the working groups, the importance of the active surveillance on conflicts of interests, the definition of a minimum set of rules to be followed during the whole activity and the transparency of all the steps are the milestones of the Italian experience. The lack of a continuous and stable source of funding and the subsequent instability of the central structure are endangering all the knowledge and the experience gained during these years of activity. It is therefore crucial to guarantee and safeguard the role of a national, independent and public institution in the supervision of the guidelines development process and the provision of clinical governance. PMID:24736962

Mele, Alfonso; D'Angelo, Franca; Della Seta, Maurella; Lacorte, Eleonora; Laricchiuta, Paola; Morciano, Cristina; De Masi, Salvatore

2014-01-01

18

Guidelines for depot antipsychotic treatment in schizophrenia  

Microsoft Academic Search

These guidelines for depot antipsychotic treatment in schizophrenia were developed during a two-day consensus conference held on July 29 and 30, 1995 in Siena, Italy.Depot antipsychotic medications were developed in the 1960s as an attempt to improve the long-term treatment of schizophrenia (and potentially other disorders benefiting from long-term antipsychotic medication). Depot drugs as distinguishable from shorter acting intramuscularly administered

John M Kane; Eugenio Aguglia; A. Carlo Altamura; José Luis Ayuso Gutierrez; Nicoletta Brunello; W. Wolfgang Fleischhacker; Wolfang Gaebel; Jes Gerlach; Julien-D Guelfi; Werner Kissling; Yvon D Lapierre; Eva Lindström; Julien Mendlewicz; Giorgio Racagni; Luis Salvador Carulla; Nina R Schooler

1998-01-01

19

Standard Treatment Guidelines in Primary Healthcare Practice  

PubMed Central

In India, healthcare delivery is implemented at primary, secondary and tertiary levels. Of these, primary health care is the essential health care and is the first point of care for the public across the country. The primary health care system caters to nearly 70% of the population by treating about 90% of the common and locally prevailing problems. One of the integral elements of primary health care is provision of essential medicines, which should be available at all times in adequate amounts in appropriate dosage forms and at an affordable cost. It has an important bearing on the medical, economical and social outcomes of the healthcare delivery system. This situation mandates the need for rational use of medicines by standardizing the treatment of commonly occurring illness at the primary health care level. Standard Treatment Guidelines (STGs) have been in vogue in India only since recent times and is gaining popularity among practitioners. STGs have many advantages for the patients, healthcare providers, drug manufacturers and marketing agencies, and above all, the policy makers and the legislative system of the country. The drawback in STGs lies in the difficulties in implementation on a large scale. With due efforts to prioritize the health needs, comprehensive coverage of national health programs involving all the stakeholders including professional organizations, undergraduate medical curriculum planners and medical practitioners, STGs can be implemented effectively and thereby we can ensure a quality health care at the primary care level at an affordable cost as part of the now redefined Universal Health Coverage. This article is intended as a guide to understand the concept of STGs, prepared with the aim of capacity building for medical professionals in rationally treating patients in their day-to-day clinical practice.

Gopalakrishnan, S.; Udayshankar, P.M.; Rama, R.

2014-01-01

20

[National and international schizophrenia guidelines. Update 2013 regarding recommendations about antipsychotic pharmacotherapy].  

PubMed

Treatment guidelines provide evidence-based recommendations for diagnosis and treatment to assist clinicians, care givers and patients in finding an optimized treatment option in given clinical situations. Specific treatment guidelines for schizophrenia issued by the German Association of Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and published under the auspices of the Working Group for Scientific Medical Specialist Societies (AWMF) (i.e. fulfilling the highest quality standards at the S3 level) have been available in Germany since 2006. Currently, a comprehensive revision process is ongoing to update these guidelines with the aim to publish the revision before 2014. However, since publication of the German treatment guidelines many clinical trials and meta-analyses have been published which appear to make a new evaluation of antipsychotic drug treatment necessary. Currently available national and international guidelines, such as the WFSBP, PORT and NICE guidelines, place less emphasis on the general superiority of atypical antipsychotic medication but support the idea to evaluate antipsychotic drugs based on the side effect profiles. The present overview discusses the recent guidelines development processes regarding schizophrenia and compares the available German treatment guidelines with recently published international guidelines. Current developments and issues for discussion are described in detail to provide possible implications for changes in treatment recommendations. PMID:24077969

Hasan, A; Wobrock, T; Gaebel, W; Janssen, B; Zielasek, J; Falkai, P

2013-11-01

21

Practitioners’ Attitudes concerning Evidence-Based Guidelines in Belgian Substance Abuse Treatment  

Microsoft Academic Search

Background\\/Aim: Evidence-based guidelines for substance abuse treatment are available in many European countries. In Belgium, no such guidelines have been developed yet at a national level although their need has repeatedly been emphasized. This study aims to assess Belgian practitioners’ attitudes concerning evidence-based guidelines for substance abuse treatment. Methods: A survey was conducted with clinical coordinators in a representative sample

Mieke Autrique; Wouter Vanderplasschen; Eric Broekaert; Bernard Sabbe

2009-01-01

22

Oxygen therapy: professional compliance with national guidelines.  

PubMed

One of the major causes of critical illness in the UK is the deterioration of respiratory function (British Thoracic Society (BTS), 2008). The administration of supplemental oxygen therapy, although often lifesaving, can also have serious consequences if performed inappropriately. A literature review was carried out to establish whether oxygen therapy was prescribed and administered in acute care in accordance with both national guidelines and local policy. Four common themes were identified from the literature: prescribing, monitoring, administration and equipment. The review suggests that an educational programme ranging from pre-registration curriculum content to the practical experiences of junior doctors with regard to oxygen management would be appropriate. The authors suggest that the current practice of healthcare practitioners should undergo a planned timetable of audit to improve the prescription, administration and monitoring of supplemental oxygen therapy for the benefit of patient outcomes. PMID:24732992

Nippers, Ingrid; Sutton, Andrew

23

First Dutch national guidelines – pharmacological care for detained opioid addicts  

Microsoft Academic Search

Heterogenic care of addicted detainees in the various prisons in the Netherlands triggered the National Agency of Correctional Institutions of the Ministry of Justice, to order the Dutch Institute for Health Care Improvement (CBO) to formulate the first national guideline titled ‘Pharmacological care for detained addicts’. This article presents the content of this guideline, which mainly focuses on opioid-dependent addicts.

M. T. Arends; H. A. de Haan; G. I. C. M. van't Hoff

2009-01-01

24

Guidelines for the treatment of head and neck venous malformations  

PubMed Central

Venous malformation is one of the most common benign vascular lesions, with approximately 40% of cases appearing in the head and neck. They can affect a patient’s appearance and functionality and even cause life-threatening bleeding or respiratory tract obstruction. The current methods of treatment include surgery, laser therapy, sclerotherapy, or a combined. The treatment of small and superficial venous malformations is relatively simple and effective; however, the treatment of deep and extensive lesions involving multiple anatomical sites remains a challenge for the physicians. For complex cases, the outcomes achieved with one single treatment approach are poor; therefore, individualized treatment modalities must be formulated based on the patient’s condition and the techniques available. Comprehensive multidisciplinary treatments have been adapted to achieve the most effective results. In this paper, based on the national and international literature, we formulated the treatment guidelines for head and neck venous malformations to standardize clinical practice. The guideline will be renewed and updated in a timely manner to reflect cutting-edge knowledge and to provide the best treatment modalities for patients. PMID:23724158

Zheng, Jia Wei; Mai, Hua Ming; Zhang, Ling; Wang, Yan An; Fan, Xin Dong; Su, Li Xin; Qin, Zhong Ping; Yang, Yao Wu; Jiang, Yin Hua; Zhao, Yi Fang; Suen, James Y

2013-01-01

25

Treatment Guidelines for Children and Adolescents with Bipolar Disorder  

ERIC Educational Resources Information Center

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

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

2005-01-01

26

Laparoscopic gastrectomies for cancer: The ACOI-IHTSC national guidelines.  

PubMed

Guidelines for laparoscopy and cancer of stomach have been outlined by several scientific societies: The main recommendation being that laparoscopy should be used only by surgeons already highly skilled in gastric surgery. The laparoscopic approach to gastric cancer surgery has become more and more frequent in most Italian centers. On behalf of the Guideline Committee of the Italian Society of Hospital Surgeons and the Italian Hi-Tech Surgical Club, a panel of experts analyzed the highest evidence of all scientific papers focusing on laparoscopic gastrectomies for cancer and published from 2003 to 2011, and drew these national guidelines. Laparoscopic gastrectomy may be considered as a safe procedure with better short-term and comparable long-term results. compared to open gastrectomy (Grade A). There is a general agreement that a laparoscopic approach to the treatment of gastric cancer should be chosen only by surgeons already highly skilled in gastric surgery and other advanced laparoscopic interventions. Furthermore, the first procedures should be carried out during a tutoring program. Diagnostic laparoscopy is strongly recommended as the first step of laparoscopic as well as laparotomic gastrectomies (Grade B). Additional randomized controlled trials (RCT) that compare and investigate the long-term oncological outcomes of laparoscopic assisted gastrectomy are required. PMID:22793780

Bracale, Umberto; Pignata, Giusto; Lirici, Marco Maria; Hüscher, Cristiano Gs; Pugliese, Raffaele; Sgroi, Giovanni; Romano, Giovanni; Spinoglio, Giuseppe; Gualtierotti, Monica; Maglione, Valeria; Azagra, Santiago; Kanehira, Eiji; Kim, Jun Gi; Song, Kyo Young

2012-09-01

27

75 FR 13137 - National Institutes of Health Guidelines for Human Stem Cell Research  

Federal Register 2010, 2011, 2012, 2013

...Institutes of Health Guidelines for Human Stem Cell Research SUMMARY: The National Institutes...the definition of human embryonic stem cells (hESCs) in the ``National Institutes of Health Guidelines for Human Stem Cell Research'' (Guidelines). Due to...

2010-03-18

28

75 FR 8085 - National Institutes of Health Guidelines for Human Stem Cell Research  

Federal Register 2010, 2011, 2012, 2013

...Institutes of Health Guidelines for Human Stem Cell Research SUMMARY: The National Institutes...the definition of human embryonic stem cells (hESCs) in the ``National Institutes of Health Guidelines for Human Stem Cell Research'' (Guidelines). On July...

2010-02-23

29

Nutrition practices of nurseries in England. Comparison with national guidelines.  

PubMed

Recent national guidelines call for improved nutrition within early years settings. The aim of this cross-sectional study was to describe foods and beverages served in nurseries, assess provider behaviors related to feeding, and compare these practices to national guidelines. We administered a mailed survey to a random sample of nurseries across England, stratifying by tertile of deprivation. A total of 851 nurseries returned the survey (54.3% response rate). We fitted separate multivariate logistic regression models to estimate the association of deprivation with each of the 13 food and beverage guidelines and the seven provider behavior guidelines. We also conducted a joint F-test for any deprivation effect, to evaluate the effect of the guidelines combined. After adjusting for confounders, we observed differences in the frequency of nurseries that reported serving healthier foods across the tertiles of deprivation (p?=?0.02 for joint F test). These adjusted results were driven mainly by nurseries in more deprived areas serving more whole grains (OR 1.57 (95% CI 1.00, 2.46)) and legumes, pulses, and lentils (1.40 (1.01, 2.14)). We also observed differences in the frequency of nurseries reporting more provider behaviors consistent with national guidelines across the tertiles of deprivation (p?=?0.01 for joint F test). Nurseries in more deprived areas were more likely to dilute juice with water (2.35 (1.48, 3.73)), allow children to select their own portions (1.09 (1.06, 1.58)), and sit with children during meals (1.84 (1.07, 3.15)). While nurseries in the most deprived areas reported serving more healthy foods, a large percentage were still not meeting national guidelines. Policy and intervention efforts may increase compliance with national guidelines in nurseries in more deprived areas, and across England. PMID:25450898

Neelon, Sara E Benjamin; Burgoine, Thomas; Hesketh, Kathryn R; Monsivais, Pablo

2015-02-01

30

Nutrition practices of nurseries in England. Comparison with national guidelines?  

PubMed Central

Recent national guidelines call for improved nutrition within early years settings. The aim of this cross-sectional study was to describe foods and beverages served in nurseries, assess provider behaviors related to feeding, and compare these practices to national guidelines. We administered a mailed survey to a random sample of nurseries across England, stratifying by tertile of deprivation. A total of 851 nurseries returned the survey (54.3% response rate). We fitted separate multivariate logistic regression models to estimate the association of deprivation with each of the 13 food and beverage guidelines and the seven provider behavior guidelines. We also conducted a joint F-test for any deprivation effect, to evaluate the effect of the guidelines combined. After adjusting for confounders, we observed differences in the frequency of nurseries that reported serving healthier foods across the tertiles of deprivation (p?=?0.02 for joint F test). These adjusted results were driven mainly by nurseries in more deprived areas serving more whole grains (OR 1.57 (95% CI 1.00, 2.46)) and legumes, pulses, and lentils (1.40 (1.01, 2.14)). We also observed differences in the frequency of nurseries reporting more provider behaviors consistent with national guidelines across the tertiles of deprivation (p?=?0.01 for joint F test). Nurseries in more deprived areas were more likely to dilute juice with water (2.35 (1.48, 3.73)), allow children to select their own portions (1.09 (1.06, 1.58)), and sit with children during meals (1.84 (1.07, 3.15)). While nurseries in the most deprived areas reported serving more healthy foods, a large percentage were still not meeting national guidelines. Policy and intervention efforts may increase compliance with national guidelines in nurseries in more deprived areas, and across England. PMID:25450898

Neelon, Sara E. Benjamin; Burgoine, Thomas; Hesketh, Kathryn R.; Monsivais, Pablo

2015-01-01

31

76 FR 22342 - National Standard 10 Guidelines  

Federal Register 2010, 2011, 2012, 2013

...gov. Fax: 301-713-1193, Attn: Debra Lambert. Mail: Debra Lambert; National Marine Fisheries Service, NOAA; 1315...only. FOR FURTHER INFORMATION CONTACT: Debra Lambert, National Marine Fisheries Service,...

2011-04-21

32

UK national guideline on safer sex advice.  

PubMed

This guideline provides evidence-based guidance on the content of safer sex advice and the provision of brief behaviour change interventions deliverable in genitourinary (GU) medicine clinics. Much of the advice is applicable to other healthcare settings including general practice and clinics providing HIV care. Advice on condom use and effectiveness, oral sex and other sexual practices, testing for sexually transmitted infections (STI) and partner reduction is provided. Advice specific to the transmission of HIV infection including seroadaptive behaviours and negotiated safety is also included. An accompanying review of the evidence supporting the guideline with a complete reference list is available online. A patient information leaflet based on the advice statements developed is also available through the BASHH website. PMID:22807529

Clutterbuck, D J; Flowers, P; Barber, T; Wilson, H; Nelson, M; Hedge, B; Kapp, S; Fakoya, A; Sullivan, A K

2012-06-01

33

78 FR 28865 - Request for Comment on the Federal Guidelines for Opioid Treatment  

Federal Register 2010, 2011, 2012, 2013

...on the Federal Guidelines for Opioid Treatment AGENCY: Substance Abuse and Mental Health...of the Federal Guidelines for Opioid Treatment. These guidelines elaborate upon the Federal opioid treatment standards set forth under 42 CFR...

2013-05-16

34

[Radiotherapy of invasive breast cancer: French national guidelines].  

PubMed

The French National Cancer Institute (INCa) and Société française de sénologie et pathologie mammaire (SFSPM), in collaboration with a multidisciplinary experts group, have published the French national clinical practice guidelines on a selection of 11 currently debated questions regarding the management of invasive breast cancer. Those guidelines are based on a comprehensive analysis of the current published evidence dealing with those issues, secondly reviewed by 100 reviewers. Radiotherapy was concerned by five of the 11 questions: indications for the boost after whole gland irradiation; hypofractionated radiotherapy; partial breast irradiation; indications for mammary internal nodes irradiation, and indications of radiotherapy after neo-adjuvant chemotherapy. PMID:22921978

Besnard, S; Cutuli, B; Fourquet, A; Giard, S; Hennequin, C; Leblanc-Onfroy, M; Mazeau-Woynar, V; Verdoni, L

2012-09-01

35

Transparency Matters: Kaiser Permanente's National Guideline Program Methodological Processes  

PubMed Central

Introduction: The practice-guideline process of collecting, critically appraising, and synthesizing available evidence, then developing expert panel recommendations based on appraised evidence, makes it possible to provide high-quality care for patients. Unwanted variability in the quality and rigor of evidence summaries and Clinical Practice Guidelines has been a long-standing challenge for clinicians seeking evidence-based guidance to support patient care decisions. Methods: A multidisciplinary group of stakeholders, with representation from all eight Kaiser Permanente Regions, is responsible for creating National Guidelines. Conducting high-quality systematic reviews and creating clinical guidelines are time-, labor-, and resource-intensive processes, which raises challenges for an organization striving to balance rigor with efficiency. For these reasons, the National Guideline Program elected to allow for the identification, assessment, and possible adoption of existing evidence-based guidelines and systematic reviews using the ADAPTE; Appraisal of Guidelines Research and Evaluation; Assessment of Multiple Systematic Reviews (AMSTAR); and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) frameworks. If no acceptable external guidelines are identified, the Guideline Development Team then systematically searches for relevant high-quality systematic reviews, meta-analyses, and original studies. Existing systematic reviews are assessed for quality using a measurement tool to assess systematic reviews (the AMSTAR systematic review checklist). Study Appraisal: Following the screening and selection process, the included studies (the “body of evidence”) are critically appraised for quality, using the GRADE methodology, which focuses on four key factors that must be considered when assigning strength to a recommendation: balance between desirable and undesirable effects, quality of evidence, values and preferences, and cost. The evidence is then used to create preliminary clinical recommendations. The strength of these recommendations is graded to reflect the extent to which a guideline panel is confident that the desirable effects of an intervention outweigh undesirable effects (or vice versa) across the range of patients for whom the recommendation is intended. Dissemination: The Care Management Institute disseminates all KP national guidelines to its eight Regions via postings on its Clinical Library Intranet site, a Web-based internal information resource. PMID:22529761

Davino-Ramaya, Carrie; Krause, L Kendall; Robbins, Craig W; Harris, Jeffrey S; Koster, Marguerite; Chan, Wiley; Tom, Gladys I

2012-01-01

36

Carbamazepine in Bipolar Disorder With Pain: Reviewing Treatment Guidelines  

PubMed Central

Objective: To determine if any monotherapy drug treatment has robust efficacy to treat comorbid bipolar disorder and chronic pain. Data Sources: The American Psychiatric Association (APA) treatment guidelines for bipolar mood disorder and the 2012 Cochrane database for pain disorders. Study Selection: We relied on the treatment guides to determine if the drugs that are APA guideline–supported to treat bipolar disorder have supporting data from the Cochrane database for chronic pain. Data Synthesis: No single drug was mentioned by either guideline to treat this comorbidity. However, carbamazepine was the only drug that has guideline-supported robust efficacy in the management of each condition separately. Conclusions: Carbamazepine was found to have strong preclinical data for the treatment of comorbid bipolar mood disorder and chronic pain disorders. While requiring more studies in this population, we propose that this treatment modality may benefit patients.

Campbell, Austin; O’Connell, Christopher R.; Nallapula, Kishan

2014-01-01

37

Treatment of hepatocellular carcinoma: beyond international guidelines.  

PubMed

The management of hepatocellular carcinoma (HCC) is decided according to evidence-based recommendations generated by international societies: according to these recommendations, the tumour stage, as determined by the Barcelona clinical liver cancer (BCLC) score, divides patients into five prognostic categories, each with a distinct treatment indication. Radical therapies such as hepatic resection, orthotopic liver transplantation and percutaneous local ablation are strongly indicated in patients with very early and early stage tumours (BCLC O and A), a choice which mainly depends on a combination of tumour volume, status of underlying liver disease, the presence of comorbidities and the patient's age. Although radical therapies provide a survival rate of between 50% and 75% at year five in well selected patients, tumour recurrence is frequent following resection and ablation compared to transplantation (70% vs. 10% respectively), which has the additional advantage of preventing morbidity and mortality from portal hypertension. Generally, while radical therapies are contraindicated in patients with a large tumour burden, such as those with intermediate stage BCLC B, survival in the subset of these patients with well compensated cirrhosis may improve from 16 to 20 months, on average, following repeated treatments with transarterial chemoembolization (TACE). Survival may also improve in patients who are in poor condition or who do not respond to TACE and in those with an advanced HCC (BCLC C) following oral therapy with the multikinase inhibitor sorafenib. However, because most recommendations are based on uncontrolled studies and expert opinions rather than well designed, high powered randomized controlled trials, treatment criteria need to be adapted to special groups because real life cohorts do not match the selection criteria suggested by the guidelines. Indeed, up to one-third of patients with early stage tumours who are unfit for radical therapy because of advanced age, the presence of significant comorbidities or a strategic location of the nodule, are forced to receive palliative care. BCLC A patients with moderate portal hypertension and certain BCLC B patients could still be eligible for hepatic resection if a chance for 50% survival at 5 years is still perceived as being cost-effective by both the patient and caregivers. PMID:25529098

Colombo, Massimo; Sangiovanni, Angelo

2015-01-01

38

A systematic review of treatment guidelines for metastatic colorectal cancer  

PubMed Central

Aim A systematic review of treatment guidelines for metastatic colorectal cancer (mCRC) was performed to assess recommendations for monoclonal antibody therapy in these guidelines. Method Relevant papers were identified through electronic searches of MEDLINE, MEDLINE In Process, EMBASE and the Cochrane Library; through manual searches of reference lists; and by searching the Internet. Results A total of 57 relevant guidelines were identified, 32 through electronic database searches and 25 through the website searches. The majority of guidelines were published between 2004 and 2010. The country publishing the most guidelines was the USA (12), followed by the UK (10), Canada (eight), France (eight), Germany (three), Australia (two), Spain (two) and Italy (one). In addition, eight European and three international guidelines were identified. As monoclonal antibody therapy for mCRC was not introduced until 2004, no firm recommendations for monoclonal antibody therapy were made in guidelines published between 2004 and 2006. Recommendations for monoclonal antibody therapy first appeared in 2007 and evolved as more data became available. The most recent international, European and US guidelines recommend combination chemotherapy with the addition of a monoclonal antibody for the first-line treatment of mCRC. Second-line treatment depends on the first-line regimen used. For chemoresistant mCRC, cetuximab or panitumumab are recommended as monotherapy in patients with wild-type KRAS tumours. Conclusion The study indicates that recent treatment guidelines have recognized the role of monoclonal antibodies in the management of mCRC, and that treatment guidelines should be updated in a timely manner to reflect the most recently available data. PMID:21848897

Edwards, M S; Chadda, S D; Zhao, Z; Barber, B L; Sykes, D P

2012-01-01

39

Use of antidepressants in the treatment of depression in Asia: guidelines, clinical evidence, and experience revisited.  

PubMed

Major depressive disorder is prevalent worldwide, and only about half of those affected will experience no further episodes or symptoms. Additionally, depressive symptoms can be challenging to identify, with many patients going undiagnosed despite a wide variety of available treatment options. Antidepressants are the cornerstone of depression treatment; however, a large number of factors must be considered in selecting the treatment best suited to the individual. To help support physicians in this process, international and national treatment guidelines have been developed. This review evaluates the current use of antidepressant treatment for major depressive disorder in six Asian countries (China, Korea, Malaysia, Philippines, Taiwan, and Thailand). No remarkable differences were noted between Asian and international treatment guidelines or among those from within Asia as these are adapted from western guidelines, although there were some local variations. Importantly, a shortage of evidence-based information at a country level is the primary problem in developing guidelines appropriate for Asia, so most of the guidelines are consensus opinions derived from western research data utilized in western guidelines. Treatment guidelines need to evolve from being consensus based to evidence based when evidence is available, taking into consideration cost/effectiveness or cost/benefit with an evidence-based approach that more accurately reflects clinical experience as well as the attributes of each antidepressant. In everyday practice, physicians must tailor their treatment to the patient's clinical needs while considering associated external factors; better tools are needed to help them reach the best possible prescribing decisions which are of maximum benefit to patients. PMID:23857712

Treuer, Tamás; Liu, Chia-Yih; Salazar, Gerardo; Kongsakon, Ronnachai; Jia, Fujun; Habil, Hussain; Lee, Min-Soo; Lowry, Amanda; Dueñas, Héctor

2013-12-01

40

Treatment Guidelines for Children and Adolescents With Bipolar Disorder: Child Psychiatric Workgroup on Bipolar Disorder  

Microsoft Academic Search

Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute treatment, and main- tenance treatment. These guidelines are not intended to serve as

ROBERT A. KOWATCH; MARY FRISTAD; BORIS BIRMAHER; KAREN DINEEN WAGNER; ROBERT L. FINDLING; MARTHA HELLANDER

41

[Treatment of elderly hypertension based on various hypertension management guidelines--comparison between European and American guidelines and Japanese guidelines].  

PubMed

In civilized countries blood pressure is increased in association with age. Elderly population is lately increased both in Japan and Western countries and therefore elderly hypertensive patients are expected to increase. Recently, several guidelines and statements for the treatment of hypertension, such as JNC 7, 2003 ESH/ESC, 2003 WHO/ISH, and BSH IV, are reported in Western countries. In Japan, Japanese Society of Hypertension reported guidelines for management of hypertension in 2000 (JSH 2000) and JSH 2000 is now revised and a new version was published at the end of 2004 (JSH 2004). In this article, management of hypertension (when starts the treatment, target blood pressure level, and choice of drugs, etc) in the elderly is described based on these guidelines and statements. PMID:15948374

Matsuoka, Hiroaki

2005-06-01

42

Receipt of Guideline-Concordant Treatment in Elderly Prostate Cancer Patients  

SciTech Connect

Purpose: To examine the proportion of elderly prostate cancer patients receiving guideline-concordant treatment, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Methods and Materials: A total of 29,001 men diagnosed in 2004-2007 with localized prostate cancer, aged 66 to 79 years, were included. We characterized the proportion of men who received treatment concordant with the National Comprehensive Cancer Network guidelines, stratified by risk group and age. Logistic regression was used to examine covariates associated with receipt of guideline-concordant management. Results: Guideline concordance was 79%-89% for patients with low- or intermediate-risk disease. Among high-risk patients, 66.6% of those aged 66-69 years received guideline-concordant management, compared with 51.9% of those aged 75-79 years. Discordance was mainly due to conservative management—no treatment or hormone therapy alone. Among the subgroup of patients aged ?76 years with no measured comorbidity, findings were similar. On multivariable analysis, older age (75-79 vs 66-69 years, odds ratio 0.51, 95% confidence interval 0.50-0.57) was associated with a lower likelihood of guideline concordance for high-risk prostate cancer, but comorbidity was not. Conclusions: There is undertreatment of elderly but healthy patients with high-risk prostate cancer, the most aggressive form of this disease.

Chen, Ronald C., E-mail: Ronald_chen@med.unc.edu [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Carpenter, William R. [Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Hendrix, Laura H. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Bainbridge, John [Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Wang, Andrew Z. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Nielsen, Matthew E. [Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); and others

2014-02-01

43

Gastric cancer treatment guidelines in Japan  

Microsoft Academic Search

.  \\u000a Recent developments in treatment modalities for gastric cancer have allowed the selection of a variety of treatments, and\\u000a this has resulted in some confusion in daily practice. The Japan Gastric Cancer Association issued the first edition of Gastric cancer treatment guidlelines in March, 2001 to provide a common basis of understanding of the extent of disease and selection of

Toshifusa Nakajima

2002-01-01

44

Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children: Recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics  

PubMed Central

Summary This report updates and combines into one document earlier versions of guidelines for preventing and treating opportunistic infections (OIs) among HIV-exposed and HIV-infected children, last published in 2002 and 2004, respectively. These guidelines are intended for use by clinicians and other health-care workers providing medical care for HIV-exposed and HIV-infected children in the United States. The guidelines discuss opportunistic pathogens that occur in the United States and one that might be acquired during international travel (i.e., malaria). Topic areas covered for each OI include a brief description of the epidemiology, clinical presentation, and diagnosis of the OI in children; prevention of exposure; prevention of disease by chemoprophylaxis and/or vaccination; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; and discontinuation of secondary prophylaxis after immune reconstitution. A separate document about preventing and treating of OIs among HIV-infected adults and postpubertal adolescents (Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents) was prepared by a working group of adult HIV and infectious disease specialists. The guidelines were developed by a panel of specialists in pediatric HIV infection and infectious diseases (the Pediatric Opportunistic Infections Working Group) from the U.S. government and academic institutions. For each OI, a pediatric specialist with content-matter expertise reviewed the literature for new information since the last guidelines were published; they then proposed revised recommendations at a meeting at the National Institutes of Health (NIH) in June 2007. After these presentations and discussions, the guidelines underwent further revision, with review and approval by the Working Group, and final endorsement by NIH, CDC, the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Disease Society (PIDS), and the American Academy of Pediatrics (AAP). The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of the evidence supporting the recommendation so readers can ascertain how best to apply the recommendations in their practice environments. An important mode of acquisition of OIs, as well as HIV infection among children, is from their infected mother; HIV-infected women coinfected with opportunistic pathogens might be more likely than women without HIV infection to transmit these infections to their infants. In addition, HIV-infected women or HIV-infected family members coinfected with certain opportunistic pathogens might be more likely to transmit these infections horizontally to their children, resulting in increased likelihood of primary acquisition of such infections in the young child. Therefore, infections with opportunistic pathogens might affect not just HIV-infected infants but also HIV-exposed but uninfected infants who become infected by the pathogen because of transmission from HIV-infected mothers or family members with coinfections. These guidelines for treating OIs in children therefore consider treatment of infections among all children, both HIV-infected and uninfected, born to HIV-infected women. Additionally, HIV infection is increasingly seen among adolescents with perinatal infection now surviving into their teens and among youth with behaviorally acquired HIV infection. Although guidelines for postpubertal adolescents can be found in the adult OI guidelines, drug pharmacokinetics and response to treatment may differ for younger prepubertal or pubertal adolescents. Therefore, these guidelines also apply to treatment of HIV-infected youth who have not yet completed pubertal development. Major changes in the guidelines include 1) greater emphasis on the importance of antiretroviral therapy for p

Mofenson, Lynne M.; Brady, Michael T.; Danner, Susie P.; Dominguez, Kenneth L.; Hazra, Rohan; Handelsman, Edward; Havens, Peter; Nesheim, Steve; Read, Jennifer S.; Serchuck, Leslie; Van Dyke, Russell

2010-01-01

45

Updated national and international hypertension guidelines: a review of current recommendations.  

PubMed

Despite the availability of effective pharmacological treatments to aid the control of blood pressure, the global rate of uncontrolled blood pressure remains high. As such, further measures are required to improve blood pressure control. Recently, several national and international guidelines for the management of hypertension have been published. These aim to provide easily accessible information for healthcare professionals and patients to aid the diagnosis and treatment of hypertension. In this review, we have compared new and current guidelines from the American and International Societies of Hypertension; the American Heart Association, American College of Cardiology and the US Center for Disease Control and Prevention; the panel appointed to the Eighth Joint National Committee; the European Societies of Hypertension and Cardiology; the French Society of Hypertension; the Canadian Hypertension Education Program; the National Institute for Health and Clinical Excellence (UK); the Taiwan Society of Cardiology and the Chinese Hypertension League. We have identified consensus opinion regarding best practises for the management of hypertension and have highlighted any discrepancies between the recommendations. In general there is good agreement between the guidelines, however, in some areas, such as target blood pressure ranges for the elderly, further trials are required to provide sufficient high-quality evidence to form the basis of recommendations. PMID:25315030

Kjeldsen, Sverre; Feldman, Ross D; Lisheng, Liu; Mourad, Jean-Jacques; Chiang, Chern-En; Zhang, Weizhong; Wu, Zhaosu; Li, Wei; Williams, Bryan

2014-11-01

46

Guidelines to Career Development for Wastewater Treatment Plant Personnel.  

ERIC Educational Resources Information Center

The guidelines were written to promote job growth and improvement in the personnel who manage, operate, and maintain wastewater treatment plants. Trained operators and technicians are the key components in any water pollution control facility. The approach is to move from employment to training through specific modules for 21 standard job…

Environmental Protection Agency, Washington, DC. Office of Education and Manpower Planning.

47

[Brazilian guidelines for the treatment of narcolepsy].  

PubMed

This manuscript contains the conclusion of the consensus meeting of the Brazilian Sleep Association with Brazilian sleep specialists on the treatment of narcolepsy based on the review of medical literature from 1980 to 2010. The manuscript objectives were to reinforce the use of agents evaluated in randomized placebo-controlled trials and to issue consensus opinions on the use of other available medications as well as to inform about safety and adverse effects of these medications. Management of narcolepsy relies on several classes of drugs, namely, stimulants for excessive sleepiness, antidepressants for cataplexy and hypnotics for disturbed nocturnal sleep. Behavioral measures are likewise valuable and universally recommended. All therapeutic trials were analyzed according to their class of evidence. Recommendations concerning the treatment of each single symptom of narcolepsy as well as general recommendations were made. Modafinil is the first-line pharmacological treatment of excessive sleepiness. Second-line choices for the treatment of excessive sleepiness are slow-release metylphenidate followed by mazindol. The first-line treatments of cataplexy are the antidepressants, reboxetine, clomipramine, venlafaxine, desvenlafaxine or high doses of selective serotonin reuptake inibitors antidepressants. As for disturbed nocturnal sleep the best option is still hypnotics. Antidepressants and hypnotics are used to treat hypnagogic hallucinations and sleep paralysis. PMID:20945021

Alóe, Flávio; Alves, Rosana Cardoso; Araújo, John F; Azevedo, Alexandre; Bacelar, Andrea; Bezerra, Márcio; Bittencourt, Lia Rita Azeredo; Bustamante, Guilherme; Cardoso, Tania Aparecida Marchiori de Oliveira; Eckeli, Alan L; Fernandes, Regina Maria França; Goulart, Leonardo; Pradella-Hallinan, Márcia; Hasan, Rosa; Sander, Heidi Haueisen; Pinto Jr, Luciano Ribeiro; Cecília Lopes, Maria; Minhoto, Gisele Richter; Moraes, Walter; Moreira, Gustavo Antônio; Pachito, Daniela; Pedrazolli, Mário; Poyares, Dalva; Prado, Lucila; Rizzo, Geraldo; Nonato Rodrigues, R; Roitman, Israel; Ademir Baptista, Silva; Tavares, Stella Márcia Azevedo

2010-09-01

48

Treatment guidelines for depression in pregnancy  

Microsoft Academic Search

Depression is a ubiquitous disorder in childbearing women with up to 10% of women experiencing depression in pregnancy. Postpartum depression occurs in 12–16% of pregnancies making it a common complication. Moreover, these illnesses are frequently underdiagnosed in obstetric settings, and a recent report of the Surgeon General's Office confirms that many women do not access services, or receive treatment of

S. M Marcus; K. L Barry; H. A Flynn; R Tandon; J. F Greden

2001-01-01

49

Tuberculosis in childhood: a systematic review of national and international guidelines  

PubMed Central

Background Paediatric tuberculosis (TB) represents a major public health concern worldwide. About 1 million children aged less than 15 years develop TB each year, contributing to 3-25% of the total TB caseload. The aim of this review is to evaluate national and international guidelines concerning tuberculosis in childhood and compare them in terms of diagnosis and treatment strategies. Methods A literature search of the Pubmed database was performed from January 2000 to August 2013, using the terms “tuberculosis” and “children”. The search was limited to guidelines and consensus conferences, human species and full text availability, with no language restrictions. Results Twenty-seven national and international guidelines are identified. Several discrepancies on the diagnosis workup of TB are underlined. The main points of disagreement are represented by the interpretation of tuberculin skin test (TST) result and the recommendations on the use of TST and/or interferon-gamma release assay (IGRA) for the diagnosis of TB infection. Otherwise, all guidelines are in agreement that a microbiological confirmation should always be sought. Similarly, susceptibility drug testing and genotyping should be performed whenever it is possible on the basis of resources availability. On the contrary, the use of nucleic acid amplification tests (NAATs) for the M. tuberculosis detection is still controversial. A general consensus exists, otherwise, on TB treatment and only minor discrepancies are evidenced, such as the recommendations on daily or intermittent treatment regimens. Conclusions Despite advances in TB diagnostic tools have been reached during the last decade, a lack of uniformity in their availability, indication and interpretation has relevant consequences for clinical practice. Further studies need to be performed to clarify this issue and identify a reliable and reproducible diagnostic workup. Moreover, future studies should analyze the drug metabolism and the efficacy of intermittent dosing regimes in childhood, as well as new treatment regimens in order to improve the therapy compliance. PMID:24564378

2014-01-01

50

National Synchrotron Light Source guidelines for the conduct of operations  

SciTech Connect

To improve the quality and uniformity of operations at the Department of Energy`s facilities, the DOE issued Order 5480.19 ``Conduct of Operations Requirements at DOE facilities.`` This order recognizes that the success of a facilities mission critically depends upon a high level of performance by its personnel and equipment. This performance can be severely impaired if the facility`s Conduct of Operations pays inadequate attention to issues of organization, safety, health, and the environment. These guidelines are Brookhaven National Laboratory`s and the National Synchrotron Light Source`s acknowledgement of the principles of Conduct of Operations and the response to DOE Order 5480.19. These guidelines cover the following areas: (1) operations organization and administration; (2) shift routines and operating practices; (3) control area activities; (4) communications; (5) control of on-shift training; (6) investigation of abnormal events; (7) notifications; (8) control of equipment and system studies; (9) lockouts and tagouts; (10) independent verification; (11) log-keeping; (12) operations turnover; (13) operations aspects of facility process control (14) required reading; (15) timely orders to operators; (16) operations procedures; (17) operator aid posting; and (18) equipment sizing and labeling.

Buckley, M. [Brookhaven National Lab., Upton, NY (United States). National Synchrotron Light Source

1998-01-01

51

Haemophilia care - beyond the treatment guidelines.  

PubMed

Care for people with haemophilia (PWH) has improved much over the last two decades leading to near normal lives for those receiving early regular prophylaxis with clotting factor concentrates (CFC). Yet, there are significant limitations of those practices. In the absence of a well-defined optimal prophylaxis protocol, there are wide variations in practices with a two to threefold difference in doses. In those parts of the world where there are constraints on the availability of CFC, episodic replacement remains the norm for most patients even though it is evident that this does not change the natural history of the disease over a wide range of doses. Suitable prophylactic protocols therefore need to be developed wherever possible at these doses. Finally, there are only limited data on long-term outcomes in haemophilia from anywhere in the world. The practice of documenting specific outcomes as part of the regular evaluation of PWH needs to be established and the appropriate instruments used to assess them. Definitions of clinical events and endpoints of interventions in clinical studies are being developed to help such data collection. The correlations between different replacement therapy protocols and specific outcomes will help define what is best at different dose levels. Such data will allow better health planning and treatment choices throughout the world. PMID:24762268

Srivastava, A

2014-05-01

52

Community adherence to schizophrenia treatment and safety monitoring guidelines.  

PubMed

The 2003 Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations and the Mount Sinai Conference Safety Monitoring recommendations generated guidelines for pharmacological treatment of schizophrenia and monitoring of antipsychotic side effects. This study examined rate of recommendation adherence and impact of adherence on outcomes of outpatients with schizophrenia or schizoaffective disorder in community mental health centers. Clinical practice was assessed as conformant, nonconformant, or not applicable. Treatment practices were conformant for antipsychotic dose (83%); use of antiparkinsonian (97%), antidepressant (100%), and antianxiety agents (90%) but not clozapine for residual positive symptoms (31%); and monitoring weight gain (48%), glucose dysregulation (53%), hyperlipidemia (34%), or extrapyramidal symptoms (11%). Community mental health center treatment practices were largely conformant with the 2003 Schizophrenia PORT treatment recommendations. There is less evidence that patients who receive treatment in the community are adequately monitored for antipsychotic side effects per the Mount Sinai recommendations. PMID:24375205

Keller, William R; Fischer, Bernard A; McMahon, Robert; Meyer, Walter; Blake, Melissa; Buchanan, Robert W

2014-01-01

53

[Guidelines for the diagnosis and treatment of spontaneous pneumothorax].  

PubMed

This is the fourth update of the guidelines for the diagnosis and treatment of pneumothorax published by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Spontaneous pneumothorax, or the presence of air in the pleural space not caused by injury or medical intervention, is a significant clinical problem. We propose a method for classifying cases into 3 categories: partial, complete, and complete with total lung collapse. This classification, together with a clinical assessment, would provide sufficient information to enable physicians to decide on an approach to treatment. This update introduces simple aspiration in an outpatient setting as a treatment option that has yielded results comparable to conventional drainage in the management of uncomplicated primary spontaneous pneumothorax; this technique is not, as yet, widely used in Spain. For the definitive treatment of primary spontaneous pneumothorax, the technique most often used by thoracic surgeons is video-assisted thoracoscopic bullectomy and pleural abrasion. Hospitalization and conventional tube drainage is recommended for the treatment of secondary spontaneous pneumothorax. This update also has a new section on catamenial pneumothorax, a condition that is probably underdiagnosed. The definitive treatment for a recurring or persistent air leak is usually surgery or the application of talc through the drainage tube when surgery is contraindicated. Our aim in proposing algorithms for the management of pneumothorax in these guidelines was to provide a useful tool for clinicians involved in the diagnosis and treatment of this disease. PMID:18775256

Rivas de Andrés, Juan J; Jiménez López, Marcelo F; Molins López-Rodó, Laureano; Pérez Trullén, Alfonso; Torres Lanzas, Juan

2008-08-01

54

Consensus Guidelines for the Management and Treatment of Neuroendocrine Tumors  

PubMed Central

Neuroendocrine tumors (NETs) are a heterogeneous group of tumors originating in various anatomic locations. The management of this disease poses a significant challenge because of the heterogeneous clinical presentations and varying degree of aggressiveness. The recent completion of several phase III trials, including those evaluating octreotide, sunitinib, and everolimus, demonstrate that rigorous evaluation of novel agents in this disease is possible and can lead to practice-changing outcomes. Nevertheless, there are many aspects to the treatment of NETs that remain unclear and controversial. The North American Neuroendocrine Tumor Society (NANETS) published a set of consensus guidelines in 2010 which provided an overview for the treatment of patients with these malignancies. Here, we present a set of consensus tables intended to complement these guidelines and serve as a quick, accessible reference for the practicing physician. PMID:23591432

Kunz, Pamela L.; Reidy-Lagunes, Diane; Anthony, Lowell B.; Bertino, Erin M.; Brendtro, Kari; Chan, Jennifer A.; Chen, Herbert; Jensen, Robert T.; Kim, Michelle Kang; Klimstra, David S.; Kulke, Matthew H.; Liu, Eric H.; Metz, David C.; Phan, Alexandria T.; Sippel, Rebecca S.; Strosberg, Jonathan R.; Yao, James C.

2014-01-01

55

SEOM clinical guidelines for the treatment of advanced colorectal cancer  

Microsoft Academic Search

Colorectal cancer is the first cause of cancer diagnosis in Spain. Over half of the patients are diagnosed with or will eventually\\u000a develop distant metastasis. The current manuscript aims to provide synthetic practical guidelines for the therapeutic approaches\\u000a in advanced disease. Available systemic therapeutic options, and integration and sequencing of chemotherapy with surgical\\u000a procedures are discussed. Extent of disease, treatment

Rocío García-Carbonero; M. Auxiliadora Gómez España; Enrique Casado Sáenz; Vicente Alonso Orduña; Andrés Cervantes Ruipérez; Javier Gallego Plazas; Pilar García Alfonso; Ignacio Juez Martel; Encarnación González Flores; María Lomas Garrido; Dolores Isla Casado

2010-01-01

56

Guidelines for Antimicrobial Treatment of Uncomplicated Acute Bacterial Cystitis and Acute Pyelonephritis in Women  

Microsoft Academic Search

This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America (IDSA) through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians in the diagnosis and treatment of two specific types of urinary tract infections (UTIs): uncomplicated, acute, symptomatic bacterial cystitis and acute pyelonephritis in women. The guideline

John W. Warren; Elias Abrutyn; J. Richard Hebel; James R. Johnson; Anthony J. Schaeffer; Walter E. Stamm

1999-01-01

57

[NCCN Asian consensus statement - can Asian patients with cancer accept treatment modalities from NCCN guidelines ?].  

PubMed

To spread the National Comprehensive Cancer Network(NCCN)guidelines widely in Asia, committee members from Asian countries have been preparing an Asia Consensus Statement(ACS)along the NCCN guidelines. The ACS for Kidney Cancer guidelines and Prostate Cancer guidelines were issued in 2009 and in 2011, respectively. In addition, second versions of both these guidelines were issued in 2011 and 2013, respectively. In this review, the process and contents of NCCN ACS have been described. PMID:25129079

Ozono, Seiichiro; Hinotsu, Shiro; Namiki, Mikio; Akaza, Hideyuki

2014-06-01

58

A Canadian Evidence-Based Guideline for the First-Line Treatment of Follicular Lymphoma: Joint Consensus of the Lymphoma Canada Scientific Advisory Board.  

PubMed

Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma (NHL) in North America. Because of the heterogeneity of the disease, treatment options vary from observation to aggressive therapies or stem cell transplantation, or both. Although advances in treatment have improved outcomes, the disease remains largely incurable. In Canada, no unified national guideline exists for the front-line treatment of FL; provincial guidelines vary and are largely based on funding. There is therefore a need for evidence-based national treatment guidelines that are supported by Canadian hematologists to ensure that patients with FL have equitable access to the best available care. A group of experts from across Canada developed a national evidence-based treatment guideline to provide health care professionals with clear guidance on the first-line management of FL. Results of a systematic review of the literature are presented with consensus recommendations based on available evidence. PMID:25195028

Kuruvilla, John; Assouline, Sarit; Hodgson, David; MacDonald, David; Stewart, Doug; Christofides, Anna; Komolova, Marina; Connors, Joseph

2014-08-01

59

Primary care guidelines: Senior executives’ views on changing health centre practices in hypertension treatment  

PubMed Central

Objective To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. Design A cross-sectional telephone survey. Setting All municipal health centres in Finland. Subjects Health centres where both the head physician and the senior nursing officer responded. Main outcome measures Agreement in views of the senior executives on the adoption of clinical practices as recommended in the Hypertension Guideline. Results Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p < 0.001) reported that no agreements on recording target blood pressure in patient records existed. A similar discrepancy was seen in recording cardiovascular risk (64% vs. 44%, p < 0.001). Senior executives agreed best on the calibration of sphygmomanometers and the provision of weight-control group counselling. Conclusions Hypertension Guideline recommendations that require joint agreements between professionals are less often adopted than simple, precise recommendations. More emphasis on effective multidisciplinary collaboration is needed. PMID:19929184

Ijäs, Jarja; Alanen, Seija; Kaila, Minna; Ketola, Eeva; Nyberg, Solja; Välimäki, Maritta A.; Mäkelä, Marjukka

2009-01-01

60

77 FR 10542 - Revision of the National Preparedness for Response Exercise Program (PREP) Guidelines  

Federal Register 2010, 2011, 2012, 2013

...the National Preparedness for Response Exercise Program (PREP) Guidelines AGENCY...The National Preparedness for Response Exercise Program (PREP) is designed to facilitate...among other things, that periodic exercises take place to test oil spill...

2012-02-22

61

Emergency treatment of anaphylactic reactions--guidelines for healthcare providers.  

PubMed

*The UK incidence of anaphylactic reactions is increasing. *Patients who have an anaphylactic reaction have life-threatening airway and, or breathing and, or circulation problems usually associated with skin or mucosal changes. *Patients having an anaphylactic reaction should be treated using the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. *Anaphylactic reactions are not easy to study with randomised controlled trials. There are, however, systematic reviews of the available evidence and a wealth of clinical experience to help formulate guidelines. *The exact treatment will depend on the patient's location, the equipment and drugs available, and the skills of those treating the anaphylactic reaction. *Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction. *Despite previous guidelines, there is still confusion about the indications, dose and route of adrenaline. *Intravenous adrenaline must only be used in certain specialist settings and only by those skilled and experienced in its use. *All those who are suspected of having had an anaphylactic reaction should be referred to a specialist in allergy. *Individuals who are at high risk of an anaphylactic reaction should carry an adrenaline auto-injector and receive training and support in its use. *There is a need for further research about the diagnosis, treatment and prevention of anaphylactic reactions. PMID:18358585

Soar, Jasmeet; Pumphrey, Richard; Cant, Andrew; Clarke, Sue; Corbett, Allison; Dawson, Peter; Ewan, Pamela; Foëx, Bernard; Gabbott, David; Griffiths, Matt; Hall, Judith; Harper, Nigel; Jewkes, Fiona; Maconochie, Ian; Mitchell, Sarah; Nasser, Shuaib; Nolan, Jerry; Rylance, George; Sheikh, Aziz; Unsworth, David Joseph; Warrell, David

2008-05-01

62

Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder  

Microsoft Academic Search

Over the past 2 ? 3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental

David Forbes; Mark Creamer; Andrea Phelps; Richard Bryant; Alexander McFarlane; Grant J. Devilly; Lynda Matthews; Beverley Raphael; Chris Doran; Tracy Merlin; Skye Newton

2007-01-01

63

Low Compliance with National Guidelines for Preventing Transmission of Group 1 Nationally Notifiable Infectious Diseases in Korea  

PubMed Central

Purpose This study was performed to evaluate the compliance with, and adequacy of, the Korean national guidelines which had been recommended until 2011 for isolation of patients with group 1 nationally notifiable infectious diseases (NNIDs), namely cholera, typhoid fever, paratyphoid fever, shigellosis, and enterohemorrhagic Escherichia coli (EHEC) infection. Materials and Methods We evaluated the clinical and microbiological characteristics of confirmed cases of group 1 NNIDs and compliance with the guidelines in 20 Korean hospitals nationwide in 2000-2010. We also compared the Korean guidelines with international guidelines. Results Among 528 confirmed cases (8 cases of cholera, 232 of typhoid fever, 81 of paratyphoid fever, 175 of shigellosis, and 32 EHEC infections), strict compliance with the Korean guideline was achieved in only 2.6% to 50.0%, depending on the disease. While the Korean guidelines recommend isolation of all patients with group 1 NNIDs, international guidelines recommend selective patient isolation and screening for fecal shedding, depending on the type of disease and patient status. Conclusion Compliance with the previous national guidelines for group 1 NNIDs in Korea was generally very low. Further studies are needed to evaluate whether compliance was improved after implementation of the new guideline in 2012. PMID:24532515

Kim, Eu Suk; Song, Kyoung-Ho; Kim, Baek-Nam; Kwak, Yee Gyung; Lee, Chang-Seop; Park, Sang Won; Moon, Chisook; Park, Kyung Hwa; Jang, Hee-Chang; Yeom, Joon-Sup; Oh, Won Sup; Kim, Chung-Jong

2014-01-01

64

The German guidelines for the treatment of anxiety disorders.  

PubMed

A consensus group consisting of 36 experts representing 20 leading German specialist societies and patient self-help organizations developed evidence-based recommendations for the treatment of anxiety disorders in Germany. These were based on a systematic review of randomized controlled trials on anxiety disorders (n = 403) and on preexisting German and international guidelines. According to the consensus committee, anxiety disorders should be treated with psychotherapy or pharmacological drugs or a combination of both. Cognitive behavioral therapy (CBT) was regarded as the psychological treatment with the highest level of evidence. Psychodynamic therapy (PDT) was recommended for cases in which CBT was not effective or not available or in which PDT was the informed patient's preferred option. First-line drugs for anxiety disorders include selective serotonin reuptake inhibitors and serotonin-noradrenaline reuptake inhibitors. After remission, medications should be continued for 6-12 months. When either drug or psychotherapy was not effective, treatment should be switched to the other approach or to a combination of both. For patients non-responsive to standard treatments, alternative strategies are suggested. When developing a treatment plan, efficacy, side effects, costs and the preference of the patient should be considered. A large amount of data available from randomized controlled trials permit the formulation of robust evidence-based recommendations for the treatment of anxiety disorders. The recommendations were not only developed for the special situation in Germany, but may also be helpful for developing treatment plans in other countries. PMID:25404200

Bandelow, Borwin; Lichte, Thomas; Rudolf, Sebastian; Wiltink, Jörg; Beutel, Manfred E

2014-11-18

65

Proposal for Guidelines for the Treatment of Vitiligo in Croatia  

E-print Network

Abstract: Vitiligo, an acquired depigmentation disorder, because of its impressive clinical presentation has a large impact on psychosocial life of patients. Although the exact etiopathogenesis still remains uncertain, several therapeutic options are available for treatment of this condition. Unfortunately, patients are often confronted with difficulties regarding to receiving suitable therapy. Because of the fact that vitiligo is not contagious and not life-threatening disease, physicians usually do not recognize patients ’ problems and consider vitiligo as only a cosmetic problem, which should be treated only by camouflage and sun protection products. On the other hand, because of the lack of the accurate information for patients, a widely open market for different kind of alternative questionable therapies occurs so patients are often experimenting with different types of unproven medications. The need for widely accepted consensus concerning vitiligo treatment and establishment of the therapeutic guidelines exists worldwide. Our aim was to introduce

Andrija Stanimirovi; Vedrana Bulat; Neira Puizina-ivi

66

Evidence-Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition  

PubMed Central

This paper aims to introduce, summarize, and emphasize the importance of the 'Evidence-Based, Pharmacological Treatment Guideline for Depression in Korea, Revised Edition'. The guideline broadly covers most aspects of the pharmacological treatment of patients in Korea diagnosed with moderate to severe major depression according to the DSM-IV TR. The guideline establishment process involved determining and answering a number of key questions, searching and selecting publications, evaluating recommendations, preparing guideline drafts, undergoing external expert reviews, and obtaining approval. A guideline adaptation process was conducted for the revised edition. The guideline strongly recommends pharmacological treatment considered appropriate to the current clinical situation in Korea, and should be considered helpful when selecting the appropriate pharmacological treatment of patients diagnosed with major depressive disorder. Therefore, the wide distribution of this guideline is recommended. PMID:24753693

2014-01-01

67

S3-Guidelines for the Treatment of Inflammatory Breast Disease during the Lactation Period  

PubMed Central

Breastfeeding is widely acknowledged to be the best and most complete form of nutrition for healthy infants born at term and is associated with numerous benefits in terms of infants? health, growth, immunity and development. However, breastfeeding problems often result in early weaning. Standardized treatment recommendations for breastfeeding-related diseases are necessary to optimize the care offered to breastfeeding women. Evidence and consensus based guidelines for the treatment of puerperal mastitis, sore nipples, engorgement and blocked ducts were developed on the initiative of the National Breastfeeding Committee. These guidelines were developed in accordance with the criteria set up by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), the Association of Scientific Medical Societies in Germany. The recommendations were drawn up by an interdisciplinary group of experts and were based on a systematic search and evaluation of the literature but also took clinical experience into account. Additionally good clinical practice (GCP) in terms of expert opinion was formulated in cases where scientific investigations could not be performed or were not aimed for. This article presents a summary of the recommendations of the S3-guidelines. PMID:24771901

Jacobs, A.; Abou-Dakn, M.; Becker, K.; Both, D.; Gatermann, S.; Gresens, R.; Groß, M.; Jochum, F.; Kühnert, M.; Rouw, E.; Scheele, M.; Strauss, A.; Strempel, A.-K.; Vetter, K.; Wöckel, A.

2013-01-01

68

Development of national health care guidelines in Austria. Gesundheit Österreich GmbH/BIQG  

PubMed Central

Context The Austrian health system is characterized by fragmentation of policy and financing. Therefore, an institute for quality in the health system was founded to bridge the gap between different interests and to bring forward quality work in the whole health system. One of the first tasks of this institute is the development and implementation of so-called ‘Bundesqualitätsleitlinien’, which mean national transsectoral and transdisciplinal health care guidelines. Purpose The main aim is the implementation of evidence-based integrated health care guidelines on a national level and the improvement of efficiency and effectiveness of the health care system. Description The guideline work follows national and international evidence and experience under the principle of transparence and consensual multidisciplinary development. Established evidence, such as medical, social and other guidelines may be integrated in the development process and can be declared as part of the final guidelines. Each guideline is developed, discussed and finally accepted by a panel of experts who represent main stakeholders of health system as well as health professionals and patients. While there are fix members, such as federal ministries and patient representatives, the different health professionals are invited as required referring to the topic of the guideline. Conclusions At the moment four national quality guidelines for chronic diseases are under development: COPD, diabetes, dementia and Parkinson's disease. Furthermore, a guideline for hospital admission and discharge management is in progress. As the utilization of these guidelines in practice is not predictable yet, the implementation in some regional pilot projects is planned. Discussion The multidisciplinary and consensual approach leads to the challenge of achieving necessary compromises as well as high quality results. Furthermore, there is no possibility to create and finance new structures any improvements have to be gained through optimized processes which limits the options and possibilities of the guidelines.

Gleichweit, Sonja; Baumer, Eva

2009-01-01

69

Rating evidence in treatment guidelines: a case example of when to initiate combination antiretroviral therapy (cART) in HIV-positive asymptomatic persons.  

PubMed

Guidelines for the initiation of combination antiretroviral therapy (cART) in those living with HIV are provided by several national and international treatment guidelines committees. Following recent changes to some of these guidelines, there is now considerable variation between the guidelines in terms of the recommendations for initiation of cART among asymptomatic individuals with high (>350 cells/µl) CD4 cell counts. In this review we compare the schemes used for rating evidence by the various committees and assess the strengths and weaknesses of the available evidence for initiating cART at higher CD4 cell counts. PMID:24179998

Sabin, Caroline A; Cooper, David A; Collins, Simon; Schechter, Mauro

2013-07-31

70

Chronic hepatitis B therapy: available drugs and treatment guidelines.  

PubMed

Currently, there are several drugs approved for the treatment of chronic hepatitis B including recombinant interferons, such as Interferon--? and its pegylated formulation, and the nucleos(t)ide analogues, such as Lamivudine, Adefovir, Telbivudine, Entecavir and Tenofovir. Pegylated--Interferon is an immune--modulatory agent that works mainly by enhancing the innate immune response while nucleos(t)ide analogues are oral drugs with direct inhibition of viral replication. Each agent has its own advantages and drawbacks. Pegylated--Interferon treatment has a finite duration without induction of drug resistance but only a limited number of patients achieve a sustained virological response to therapy. On the other hand, the care with nucleos(t)ide analogues requires a long--term treatment with a potential risk of induction of drug resistance, but higher rates of viral replication suppression are achieved. Nevertheless, second generation nucleos(t)ide analogues, such as Entecavir and Tenofovir, have both high genetic barrier to resistance and potent antiviral action. This review describes the mechanisms of antiviral activity and the efficacy of viral suppression of the different available drugs for chronic hepatitis B treatment, considering the recent clinical guidelines for an optimal management of chronic HBV infection. PMID:25323305

Caviglia, G P; Abate, M L; Pellicano, R; Smedile, A

2014-10-17

71

Guideline for diagnosis and treatment of subacromial pain syndrome  

PubMed Central

Treatment of “subacromial impingement syndrome” of the shoulder has changed drastically in the past decade. The anatomical explanation as “impingement” of the rotator cuff is not sufficient to cover the pathology. “Subacromial pain syndrome”, SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows: (1) The diagnosis SAPS can only be made using a combination of clinical tests. (2) SAPS should preferably be treated non-operatively. (3) Acute pain should be treated with analgetics if necessary. (4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. (5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture. (6) Occupational interventions are useful when complaints persist for longer than 6 weeks. (7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered. (8) Strict immobilization and mobilization techniques are not recommended. (9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage). (10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management. (12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears. PMID:24847788

Diercks, Ron; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

2014-01-01

72

Revisions Recommended to Bulletin 17B - US National Flood Frequency Guidelines  

NASA Astrophysics Data System (ADS)

The Hydrologic Frequency Analysis Work Group (HFAWG) has synthesized recent research and completed its own studies to support proposed revisions to the current the US national flood frequency guidelines (Bulletin 17B). Bulletin 17 was originally issued in 1976; Bulletin 17B, the last revision, was published in 1982, over 30 years ago. To reflect advances that have occurred since 1982, the HFAWG has proposed revisions in four main areas: (1) use of historical information; (2) the motivation for low outlier identification and their statistical definition and treatment; (3) procedures for estimating generalized/regional skew; and (4) procedures for estimating confidence intervals for estimated quantiles. We present overviews of the HFAWG process and technical studies that led us to these revisions. The focus is on the use of the Expected Moments Algorithm (EMA) with the log-Pearson Type III distribution. A new Multiple Grubbs-Beck low outlier test and improved EMA confidence intervals are important parts of the revision.

England, J. F.; Cohn, T. A.; Faber, B. A.; Stedinger, J. R.; Thomas, W. O.; Mason, R. R.

2013-12-01

73

Guideline adherence for the treatment of advanced schistosomiasis japonica in Hubei, China.  

PubMed

This study compared physicians' practices on three treatment procedures and hospitalization days with guideline recommendations to assess guideline adherence in the treatment of advanced schistosomiasis japonica. Descriptive statistics were used to estimate patients' characteristics and rate of guideline adherence. And chi-square tests were used to assess influences of severity of the disease on guideline adherence. The study found no one (0/173) adhered to adequate diagnosis, treatment regimens, and discharge criteria of guidelines completely. And 2.23% of patients in group 1 and 4.23% in group 2 were totally conforming to adequate diagnosis. 91.91% of patients were conforming to adequate treatment regimens among which group 1 and group 2 were 90.32 and 92.25%, respectively. And one (2.23%) patient in group 1 and zero (0%) in group 2 were conforming to discharge criteria of guidelines, and most of the patients left hospital without symptom checks (151/173), liver function and biochemical tests (169/173), and complication checks (91/173). Among 173 inpatients, rate of adequate hospitalization days was 36.42% (63/173). And chi-square test suggested no significant difference (P?>?0.05) on guideline adherence in two groups, which implied both of critical and general patients' treatments should be stressed to comply with guidelines. There existed a large gap between guidelines and practices of the treatment of advanced schistosomiasis japonica. PMID:25270234

Zhong, Fangying; Liu, Chenxi; Zhang, Xinping

2014-12-01

74

Treatment deviating from guidelines does not influence status epilepticus prognosis.  

PubMed

Status epilepticus (SE) prognosis is related to nonmodifiable factors (age, etiology), but the exact role of drug treatment is unclear. This study was undertaken to address the prognostic role of treatment adherence to guidelines (TAG). We prospectively studied over 26 months a cohort of adults with incident SE (excluding postanoxic). TAG was assessed in terms of drug doses (± 30 % of recommendations) and medication sequence; its prognostic impact on mortality and return to baseline conditions was adjusted for etiology, SE severity [Status Epilepticus Severity Score (STESS)], and comorbidities. Of 225 patients, 26 (12 %) died and 82 (36 %) were discharged with a new handicap; TAG was observed in 142 (63 %). On univariate analysis, age, etiology, SE severity, and comorbidities were significantly related to outcome, while TAG was associated with neither outcome nor likelihood of SE control. Logistic regression for mortality identified etiology [odds ratio (OR) 18.8, 95 % confidence interval (CI) 4.3-82.8] and SE severity (STESS ? 3; OR 1.7, 95 % CI 1.2-2.4) as independent predictors, and for lack of return to baseline, again etiology (OR 7.4, 95 % CI 3.9-14.0) and STESS ? 3 (OR 1.7, 95 % CI 1.4-2.2). Similar results were found for the subgroup of 116 patients with generalized-convulsive SE. Receiver operator characteristic (ROC) analyses confirmed that TAG did not improve outcome prediction. This study of a large SE cohort suggests that treatment adherence to recommendations using current medications seems to play a negligible prognostic role (class III), confirming the importance of the biological background. Awaiting further treatment trials, it appears mandatory to apply resources towards identification of new therapeutic approaches. PMID:22899399

Rossetti, Andrea O; Alvarez, Vincent; Januel, Jean-Marie; Burnand, Bernard

2013-02-01

75

ARE THE 'NATIONAL GUIDELINES' BASED ON SOUND JUDGMENTS  

EPA Science Inventory

Until recently, procedures used to derive water quality criteria for aquatic life were not well defined and few principles were identified. On November 28, 1980, the United States Environmental Protection Agency published 'Guidelines for Deriving Water Quality Criteria for the Pr...

76

The National Career Development Guidelines: Progress and Possibilities. NOICC Occasional Papers/3.  

ERIC Educational Resources Information Center

This monograph reports on the progress made in implementing the National Career Development Guidelines and explores some possibilities for their future use. The "Introduction" (Mary Beth McCormac) summarizes activities at the national level and provides an overview of the project. "Lessons from the Local Pilot Sites" (Juliet Miller) reviews the…

Miller, Juliet; And Others

77

Dermatofibrosarcoma protuberans: clinical series, national Danish incidence data and suggested guidelines.  

PubMed

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma that frequently recurs locally, but rarely metastasizes. The purpose of this work is to present a clinical series of DFSP patients and national Danish incidence data in the period 2000-2012. Furthermore, the aim is to present guidelines on the management based on a review of the literature. Medical records of 26 consecutively treated patients at the Department of Plastic Surgery in Health Care Region Zealand were reviewed and histological specimens were reassessed. To investigate national Danish incidence in the period 2000-2012, data were extracted from the national pathology registry. Finally, a literature search was performed in Pubmed and Cochrane, and 23 major publications were reviewed. Studies on Mohs Micrographic surgery were excluded. All patients were treated with wide local excision (WLE) with a median margin of 2.8 cem and a median follow-up time of 36 months. We found a local recurrence rate of 4%. Our national incidence data were based on 374 patients. The overall incidence was 0.53 per 100,000 persons. The prevalence of DFSP in the age group 20-50 years was significantly higher than the group below 20 years (p < 0.0001). Surgery is the treatment of choice for primary DFSP, local recurrences, and metastases. If clear margins cannot be obtained by WLE or surgery is not an option because of unacceptable functional or cosmetic outcome, adjuvant radiotherapy or imatinib can be considered. Chemotherapy can be a final option if other treatments fail. PMID:23837507

Akram, Javed; Wooler, Gitte; Lock-Andersen, Jørgen

2014-02-01

78

Derived concentration guideline levels for Argonne National Laboratory's building 310 area.  

SciTech Connect

The derived concentration guideline level (DCGL) is the allowable residual radionuclide concentration that can remain in soil after remediation of the site without radiological restrictions on the use of the site. It is sometimes called the single radionuclide soil guideline or the soil cleanup criteria. This report documents the methodology, scenarios, and parameters used in the analysis to support establishing radionuclide DCGLs for Argonne National Laboratory's Building 310 area.

Kamboj, S., Dr.; Yu, C ., Dr. (Environmental Science Division)

2011-08-12

79

Federal Guidelines - Operation and Maintenance of Wastewater Treatment Facilities.  

ERIC Educational Resources Information Center

This document contains the federal guidelines for meeting the specific requirements of the Federal Water Pollution Control Act Amendments of 1972. These guidelines are also intended to assist in meeting the regulations for grant assisted facility construction and to provide information on the key elements to be included in the operation plans for…

Environmental Protection Agency, Washington, DC. Office of Water Programs.

80

European brain death codes: a comparison of national guidelines  

Microsoft Academic Search

The majority of European countries have published recommendations for the diagnosis of brain death as a necessary prerequisite\\u000a for organ donation. The concept of brain death as defining the death of the individual is accepted in all European countries;\\u000a however, the guidelines for determining the total and irreversible loss of all brain functions differ somewhat in the various\\u000a countries. While

Walter F. Haupt; Jobst Rudolf

1999-01-01

81

Nutrition practices of nurseries in England: Comparison with national guidelines  

E-print Network

populations of children and establish healthy behaviors early in life. References Benjamin, S. E., Cradock, A., Walker, E., Slining, M., & Gillman, M. W. (2008). Obesity prevention in child care. A review of U.S. state regulations. BMC Public Health, 8, 188... Years Settings. Last accessed 13.12.28. Crawley, H. (2006) Eating well for under-5s in child care. Practical nutritional guidelines, 2nd ed. St Austell: Caroline Walter Trust pdf...

Neelon, Sara E. Benjamin; Burgoine, Thomas; Hesketh, Kathryn R.; Monsivais, Pablo

2014-11-06

82

Wound Healing Society (WHS) venous ulcer treatment guidelines: what's new in five years?  

PubMed

Since the establishment of the guidelines for the treatment of venous ulcers by the Wound Healing Society in 2006, there has been an abundance of new literature, both in accord and discord with the guidelines. The goal of this update is to highlight new findings since the publication of these guidelines to assist practitioner and patient in appropriate health care decisions, as well as to drive future research endeavors. PMID:22805581

Tang, Jennifer C; Marston, William A; Kirsner, Robert S

2012-01-01

83

National Guidelines Not Always Followed When Diagnosing Smear-Negative Pulmonary Tuberculosis in Patients with HIV in Botswana  

PubMed Central

Background Diagnosis of smear negative pulmonary tuberculosis (SNPTB) is challenging, especially in patients with HIV. The Botswana National Tuberculosis Program (BNTP) guidelines give guidance in diagnosing and treating SNPTB. Patients with chronic cough should be screened for TB by 3 sputum smear investigations. If negative, a chest x-ray (CXR) should be performed. If negative for TB, antimicrobial treatment for other infections should be started. We investigated the clinicians’ use of the guidelines in clinical practice. Methods Data regarding the medical history (coughing period), requested and conducted investigations concerning tuberculosis diagnosis (sputum smear or culture or CXR) or alternative diagnoses (sputum microscopy or blood or sputum culture for diagnosis of other organisms), in SNPTB HIV-positive patients (outpatients and admitted patients) from 2006–2009 in a district hospital in Botswana were extracted from all available hospital medical records. Additionally, a survey was done in all doctors diagnosing SNPTB in this hospital using a self-administered questionnaire with questions regarding the application of the BNTP guidelines in practice. Descriptive analyses of collected data were performed to test the compliance to the guidelines. Results Data from medical records showed that in 47.0% (132/281) of patients, TB treatment was started without microbiological results from sputum smears. Other methods to rule out or confirm PTB were used in 2.1% (6/281); and 99.6% (280/281) of SNPTB patients had received a CXR. The survey in 7 clinicians found that all always used CXR, and all clinicians requested three sputum results only sometimes. Six out of 7 clinicians started antibiotics before starting TB treatment. Reasons clinicians gave for difficulties in following the guidelines included inability of patients to produce sputum; and laboratory delays in releasing sputum results. Conclusion Between 2006 and 2009 a high proportion of SNPTB diagnoses in a district hospital in Botswana were not supported by laboratory investigation. PMID:24551128

Tafuma, Taurayi A.; Burnett, Rosemary J.; Huis in 't Veld, Diana

2014-01-01

84

[Clinical practice guideline. Diagnosis and treatment of dyslipidemia.  

PubMed

Non-communicable diseases are a public health problem in México. Coronary heart disease and diabetes mellitus are the first and second cause of death in the country, followed by thrombotic cerebrovascular events. Cardiovascular diseases are the leading cause of death; one primary risk factor is hypercholesterolemia. The detection and treatment of lipid abnormalities is the key to the prevention and management of chronic non-communicable diseases. Two nationally representative surveys have shown that lipid abnormalities are the most common risk factors in Mexican adults. The purpose of this guide is to provide a basis for identifying dyslipidemia in a timely manner, and to systematize the criteria for diagnosis and treatment in the first and second level of care. PMID:24290026

Canalizo-Miranda, Elvia; Favela-Pérez, Eddie Alberto; Salas-Anaya, Javier Alejandro; Gómez-Díaz, Rita; Jara-Espino, Ricardo; Del Pilar Torres-Arreola, Laura; Viniegra-Osorio, Arturo

2013-01-01

85

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40  

ERIC Educational Resources Information Center

This Treatment Improvement Protocol (TIP) addresses the clinical use of buprenorphine in the treatment of opioid addiction. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts…

Boone, Margaret; Brown, Nancy J.; Moon, Mary A.; Schuman, Deborah J.; Thomas, Josephine; Wright, Denise L.

2004-01-01

86

The "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)": Expectations, Strategies, and Significance  

ERIC Educational Resources Information Center

This paper starts out by describing the research and drafting processes of the "National Medium- and Long-Term Educational Reform and Development Guideline" (2010-20) (hereafter abbreviated as the "Guideline") and analyzes a series of core concepts that ran through the entire process of researching and drafting the "Guideline". It expounds on the…

Xiaobing, Sun

2012-01-01

87

Wilderness medical society practice guidelines for the prevention and treatment of lightning injuries: 2014 update.  

PubMed

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260-269. PMID:25498265

Davis, Chris; Engeln, Anna; Johnson, Eric L; McIntosh, Scott E; Zafren, Ken; Islas, Arthur A; McStay, Christopher; Smith, William R; Cushing, Tracy

2014-12-01

88

Assessing Conformance to Medication Treatment Guidelines for Schizophrenia in a Community Mental Health Center (CMHC)  

Microsoft Academic Search

The feasibility of implementing current medication treatment guidelines in a community mental health clinic was examined in this cross-sectional and retrospective study. Specifically, two issues were addressed: 1) could we identify a set of clinical guidelines whose utilization could be monitored with a routine medical chart review; and 2) were the requisite data for such a review available in the

Mona Goldman; Daniel J. Healy; Timothy Florence; Lorelei Simpson; Karen K. Milner

2003-01-01

89

Swiss national guideline for reimbursement of enzyme replacement therapy in late-onset Pompe disease.  

PubMed

Glycogen storage disease type II is a rare multi-systemic disorder characterised by an intracellular accumulation of glycogen due a mutation in the acid alpha glucosidase (GAA) gene. The level of residual enzyme activity, the genotype and other yet unknown factors account for the broad variation of the clinical phenotype. The classical infantile form is characterised by severe muscle hypotonia and cardiomyopathy leading to early death. The late-onset form presents as a limb girdle myopathy with or without pulmonary dysfunction. Enzyme replacement therapy (ERT) with recombinant human GAA (rhGAA) in infants is life saving. In contrast, therapeutic efficacy of rhGAA in the late-onset form is modest. High expenses of rhGAA, on-going infusions and poor pharmacokinetic efficacy raised a discussion of the cost effectiveness of ERT in late-onset Pompe disease in Switzerland. This discussion was triggered by a Swiss federal court ruling which confirmed the reluctance of a health care insurer not to reimburse treatment costs in a 67-year-old female suffering from Pompe disease. As a consequence of this judgement ERT was stopped by all insurance companies in late-onset Pompe patients in Switzerland regardless of their clinical condition. Subsequent negotiations lead to the release of a national guideline of the management of late-onset Pompe disease. Initiation and limitation of ERT is outlined in a national Pompe registry. Reimbursement criteria are defined and individual efficacy of ERT with rhGAA is continuously monitored. PMID:23749294

Hundsberger, Thomas; Rohrbach, Marianne; Kern, Lukas; Rösler, Kai M

2013-09-01

90

Operating cost guidelines for benchmarking DOE thermal treatment systems for low-level mixed waste  

SciTech Connect

This report presents guidelines for estimating operating costs for use in benchmarking US Department of Energy (DOE) low-level mixed waste thermal treatment systems. The guidelines are based on operating cost experience at the DOE Toxic Substances Control Act (TSCA) mixed waste incinerator at the K-25 Site at Oak Ridge. In presenting these guidelines, it should be made clear at the outset that it is not the intention of this report to present operating cost estimates for new technologies, but only guidelines for estimating such costs.

Salmon, R.; Loghry, S.L.; Hermes, W.H.

1994-11-01

91

Preventive treatment in migraine and the new US guidelines  

PubMed Central

Migraine headaches are among the most common headache disorders seen in various practices. The prevalence of migraine headaches is 18% in women and 6% in men. While millions of Americans suffer from migraine headaches, roughly 3%–13% of identified migraine patients are on preventive therapy, while an estimated 38% actually need a preventive agent. The challenge among physicians is not only when to start a daily preventive agent but which preventive agent to choose. Circumstances warranting prevention have been described in the past, and in 2012, a new set of guidelines with an evidence review on preventive medications was published. A second set of guidelines provided evidence on nonsteroidal anti-inflammatory drugs, herbs, minerals, and vitamins for prevention of episodic migraine. This article describes the updated US guidelines for the prevention of migraines and also outlines the major studies from which these guidelines were derived. PMID:23717045

Estemalik, E; Tepper, S

2013-01-01

92

Recentralizing healthcare through evidence-based guidelines ¿ striving for national equity in Sweden.  

PubMed

BackgroundThe Swedish government has increasingly begun to rely on so called informative governance when regulating healthcare. The question this article sets out to answer is: considered to be ¿the backbone¿ of the Swedish state¿s strategy for informative governance in healthcare, what kind of regulatory arrangement is the evidence-based National Guidelines? Together with national medical registries and an extensive system of quality and efficiency indicators, the National Guidelines constitutes Sweden¿s quality management system.MethodsA framework for evaluating and comparing regulatory arrangements was used. It asks for instance: what is the purpose of the regulation and are regulation methods oriented towards deterrence or compliance?ResultsThe Swedish National Guidelines is a regulatory arrangement intended to govern the prioritizations of all decision makers ¿ politicians and administrators in the self-governing county councils as well as healthcare professionals ¿ through a compliance model backed up by top-down benchmarking and built-in mechanisms for monitoring. It is thus an instrument for the central state to steer local political authorities. The purpose is to achieve equitable and cost-effective healthcare.ConclusionsThis article suggests that the use of evidence-based guidelines in Swedish healthcare should be seen in the light of Sweden¿s constitutional setting, with several autonomous levels of political authority negotiating the scope for their decision-making power. As decision-making capacity is relocated to the central government ¿ from the democratically elected county councils responsible for financing and provision of healthcare ¿ the Swedish National Guidelines is part of an ongoing process of healthcare recentralization in Sweden, reducing the scope for local decision-making. This represents a new aspect of evidence-based medicine (EBM) and clinical practice guidelines (CPGs). PMID:25370710

Fredriksson, Mio; Blomqvist, Paula; Winblad, Ulrika

2014-11-01

93

76 FR 30308 - National Standard 10 Guidelines; Public Meetings  

Federal Register 2010, 2011, 2012, 2013

...Councils' agenda. FOR FURTHER INFORMATION CONTACT: Debra Lambert, National Marine Fisheries Service, 301-713-2341. SUPPLEMENTARY...interpretation or other auxiliary aids should be directed to Debra Lambert (301-713-2341), at least 5 days before the...

2011-05-25

94

Physiotherapy in hip and knee osteoarthritis: development of a practice guideline concerning initial assessment, treatment and evaluation  

Microsoft Academic Search

BACKGROUND: An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice. METHODS: A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence

W. F. H. Peter; M. J. Jansen; E. J. Hurkmans; H. Bloo; L. M. M. C. J. Dekker-Bakker; R. G. Dilling; W. K. H. A. Hilberdink; C. Kersten-Smit; M. de Rooij; C. Veenhof; H. M. Vermeulen; R. J. de Vos; J. W. Schoones; T. P. M. Vliet Vlieland

2011-01-01

95

1998 Guidelines for the Treatment of Sexually Transmitted Disease  

NSDL National Science Digital Library

The Division of STD Prevention of the US Centers for Disease Control has recently released this update (MMWR 1998;47(No. RR-1)) to the 1993 set of guidelines with the same title. The guidelines were developed by CDC staff after consultation with a "group of invited experts" in early 1997. Included are sections on various sexually transmitted diseases, including HIV, Genital Ulcers, Epididymitis, Human Papillomavirus Infection, and vaccine preventable STDs, among others. Guideline evidence is briefly discussed in each section of the report, and the CDC is committed to providing "more comprehensive, annotated discussions of such evidence...in background papers that will be published in 1998." Note that in the HTML version of the report, some of the interior links within chapters are inaccurate. In those cases, it is prudent to click on the section headings to find the relevant information.

1998-01-01

96

Safety & Security Guidelines Annual U.S. National School on Neutron and X-ray Scattering  

E-print Network

in the experiment areas. However, you cannot take photos of security-related areas (such as surveillance camerasSafety & Security Guidelines 14th Annual U.S. National School on Neutron and X-ray Scattering access orientation during your training. o Cameras are allowed on site, and you may take photos

Pennycook, Steve

97

Safety & Security Guidelines Annual U.S. National School on Neutron and X-ray Scattering  

E-print Network

in the experiment areas. However, you cannot take photos of security-related areas (such as surveillance camerasSafety & Security Guidelines 15th Annual U.S. National School on Neutron and X-ray Scattering access orientation during your training. o Cameras are allowed on site, and you may take photos

98

Guidelines for Conducting the Follow-Up Survey. National Reporting System for Adult Education.  

ERIC Educational Resources Information Center

The National Reporting System (NRS) established reporting requirements for the adult education program required by Title II of the Workforce Investment Act. The NRS defines the measures local programs must collect, the methodologies for collecting them, and state reporting requirements. This document presents the guidelines for conducting the NRS…

American Institutes for Research in the Behavioral Sciences, Washington, DC.

99

National Wildlife Health Center Bat White-Nose Syndrome (WNS)/Pd Surveillance Submission Guidelines  

E-print Network

National Wildlife Health Center Bat White-Nose Syndrome (WNS)/Pd Surveillance Submission Guidelines Winter 2013/2014 (November ­ April) TABLE OF CONTENTS PAGE Winter 2013/2014 NWHC Bat Submission Quick Within the WNS Endemic Area(See Map in Appendix A).....................................................7

Torgersen, Christian

100

Implementation of National Guidelines for Healthy School Meals: The Relationship between Process and Outcome  

ERIC Educational Resources Information Center

The implementation of policy interventions at the school level is often considered an organizational change process. The main goal of the present study was to examine the degree of implementation of Norwegian national guidelines for healthy school meals and how organizational capacity at the school level contributed to the degree of…

Holthe, Asle; Larsen, Torill; Samdal, Oddrun

2011-01-01

101

The Process of Developing National Standards That Meet ANSI Guidelines.  

ERIC Educational Resources Information Center

American national standards for the evaluation of educational programs were developed by the Joint Committee on Standards for Educational Evaluation in 1994. This paper describes the Joint Committee's standard setting process. The Joint Committee is a coalition of professional organizations concerned with the quality of evaluations in education.…

Sanders, James R.

102

From Physical Activity Guidelines to a National Activity Plan  

ERIC Educational Resources Information Center

The U.S. National Physical Activity Plan (NPAP) is a comprehensive strategic plan aimed at increasing physical activity levels in all segments of the American population. The purpose of this paper is to summarize the development of the NPAP, provide an update on the status of the NPAP, and comment on the future of the NPAP. The NPAP was released…

Bornstein, Daniel B.; Pate, Russell R.

2014-01-01

103

Canadian Consensus Guidelines for the Treatment of Seasonal Affective Disorder  

Microsoft Academic Search

Seasonal affective disorder (SAD) is a subtype of major depression that is characterized by onset at a certain time of year, usually the winter. These guidelines were arrived at by consensus, and have undergone both internal review by the 14 members of the consensus group and by external, international consultants. The executive summary format was chosen to provide a quick

Raymond W. Lam; Anthony J. Levitt

104

epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England.  

PubMed

National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001. These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters. The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence). A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines. These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations. Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of healthcare in NHS hospitals in England can be minimised. PMID:17307562

Pratt, R J; Pellowe, C M; Wilson, J A; Loveday, H P; Harper, P J; Jones, S R L J; McDougall, C; Wilcox, M H

2007-02-01

105

[Comparison of American and European (Czech) guidelines for diagnosis and treatment of chronic heart failure].  

PubMed

The new Czech and European recommendations for diagnosis and treatment of heart failure were published in 2012. The American guidelines ACCF/AHA were published in 2013. Main difference between them is presentation of acute and chronic heart failure in the European guidelines while the American and the Czech guidelines include only chronic heart failure. The American recommendations distinguish heart failure with reduced ejection fraction and with remained ejection fraction. In the beginning, the American guidelines introduce A-D classification which doesn´t figure in the European neither Czech guidelines. Class A patients are ill with risk factors, but without heart failure. In contrast, class D patients are decompensated with symptoms in the rest. Epidemiologic data shows interesting results with prevalence about 0.2% in 60-69 years old subjects and 80% in subjects older than 85 years. 5 year mortality is 50%. The American guidelines start to treat class A which is in fact prevention and treatment of risk factors. There is mentioned inevitably treatment of hypertension, both systolic and diastolic which decrease risk of heart failure up to 50%. There is almost no difference in pharmacotherapy. Noteworthy, the American guidelines introduce also ACE inhibitors - fosinopril and quinapril, on the other hand beta-blockers don´t involve nebivolol. Wide range of diuretics are mentioned, some of them aren´t registered in the Czech Republic. European and Czech guidelines involve ivabradin. Neither nesiritid nor levosimendan for inpatients aren´t involved. There is briefly mentioned surgery and cardiac mechanical support, moreover there are references for guidelines for heart transplantation. PMID:24986000

Spinar, Jind?ich; Spinarová, Lenka; Vítovec, Ji?í; Ludka, Ond?ej

2014-04-01

106

Practice guidelines for acupuncturists using acupuncture as an adjunctive treatment for anorexia nervosa.  

PubMed

Anorexia nervosa is a potentially life-threatening eating disorder where people intentionally refuse to eat sufficient amounts to maintain a healthy body-weight for fear of becoming fat. The intense preoccupation with restriction of food and control of body weight makes this one of the most complex and confusing conditions for practitioners to treat. While no single treatment has been found to be superior to another in the treatment of anorexia nervosa, general practice guidelines are available to guide mainstream treatment, however there are no guidelines for practitioners of complementary therapies. Complementary therapies such as acupuncture show promise as an adjunctive therapy in improving co-morbidities such as depression and anxiety levels among people with anorexia nervosa, by strengthening mind, body and overall well-being. The aim of this guideline is to assist and support acupuncture practitioners to deliver effective and safe adjunctive acupuncture treatments to people with anorexia nervosa, by providing a practice guideline that is underpinned by an ethical and evidence-based framework. The use of complementary therapies and specifically acupuncture in the treatment of anorexia nervosa may provide important adjunctive care to allow a comprehensive treatment approach that potentially improves quality of life, reduces anxiety and instils hope for recovery. It is hoped that acupuncture practitioners treating patients with anorexia nervosa will refer to these guidelines and apply the guidance (as deemed appropriate). PMID:25637148

Fogarty, Sarah; Ramjan, Lucie Michelle

2015-02-01

107

A consensus statement for safety monitoring guidelines of treatments for major depressive disorder  

PubMed Central

Objective This paper aims to present an overview of screening and safety considerations for the treatment of clinical depressive disorders and make recommendations for safety monitoring. Method Data were sourced by a literature search using MEDLINE and a manual search of scientific journals to identify relevant articles. Draft guidelines were prepared and serially revised in an iterative manner until all co-authors gave final approval of content. Results Screening and monitoring can detect medical causes of depression. Specific adverse effects associated with antidepressant treatments may be reduced or identified earlier by baseline screening and agent-specific monitoring after commencing treatment. Conclusion The adoption of safety monitoring guidelines when treating clinical depression is likely to improve overall physical health status and treatment outcome. It is important to implement these guidelines in the routine management of clinical depression. PMID:21888608

Dodd, Seetal; Malhi, Gin S; Tiller, John; Schweitzer, Isaac; Hickie, Ian; Khoo, Jon Paul; Bassett, Darryl L; Lyndon, Bill; Mitchell, Philip B; Parker, Gordon; Fitzgerald, Paul B; Udina, Marc; Singh, Ajeet; Moylan, Steven; Giorlando, Francesco; Doughty, Carolyn; Davey, Christopher G; Theodoras, Michael; Berk, Michael

2011-01-01

108

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and  

E-print Network

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected to the care of HIV-infected infants, children, adolescents, and pregnant women whose work and advocacy saved for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children: Panel

Bandettini, Peter A.

109

UVA Department of Student Health Medical Guideline for Outpatient Treatment of Eating Disorders  

E-print Network

UVA Department of Student Health Medical Guideline for Outpatient Treatment of Eating Disorders In recognition of the complex and intensive treatment often required for individuals with an eating disorder to assist UVA staff in providing excellent outpatient care for students with eating disorders

Acton, Scott

110

Treatment and Prevention of Acute Diarrhoea. Guidelines for the Trainers of Health Workers.  

ERIC Educational Resources Information Center

This booklet, intended primarily for the trainers of middle-level community health workers in underdeveloped countries, is designed to help such workers present the topic of diarrhea treatment and prevention in training courses. Divided into five sections, the booklet gives guidelines on treatment and prevention, with particular emphasis on the…

World Health Organization, Geneva (Switzerland).

111

Adoption of practice guidelines and assessment tools in substance abuse treatment  

Microsoft Academic Search

BACKGROUND: The gap between research and practice limits utilization of relevant, progressive and empirically validated strategies in substance abuse treatment. METHODS: Participants included substance abuse treatment programs from the Northeastern United States. Structural equation models were constructed with agency level data to explore two outcome variables: adoption of practice guidelines and assessment tools at two points in time; models also

Traci Rieckmann; Bret E Fuller; Dennis McCarty

2010-01-01

112

Treatment guidelines for Attention Deficit and Hyperactivity Disorder: A critical review.  

PubMed

A series of clinical guidelines for Attention Deficit and Hyperactivity Disorder throughout life have been published in recent years. The aim is to provide a synthesis of the best available scientific knowledge and facilitate clinical work as well as to make a critical review of the latest clinical guidelines based on treatment and recommendations. Searches of the following databases were performed: MEDLINE/ PubMed/ Index Medicus, PsycINFO/ PsyLIT and the Science Citation Index at Web of Science (ISI). The indexed MeSH terms “ADHD,” “guideline,” “therapeutics” were used for the search, and a total of 10 articles and 9 guides were selected. The guidelines indicate that the diagnosis of ADHD is made by clinical assessment and must be performed by a health professional with training and experience in the disorder. Multimodal treatment is ideal for the integral management of ADHD. Pharmacotherapy remains the first choice treatment for ADHD throughout life, particularly stimulant medication and among them, highlighting treatment with methylphenidate and all guidelines agree that psychological therapy increases the effectiveness of treatment as co-adjuncts to pharmacotherapy. PMID:25388773

Rabito-Alcón, María F; Correas-Lauffer, Javier

2014-01-01

113

Hepatitis B virus treatment beyond the guidelines: special populations and consideration of treatment withdrawal  

PubMed Central

The goal of chronic hepatitis B (CHB) treatment is to improve survival by preventing disease progression to decompensated cirrhosis and hepatocellular carcinoma which is the cause of over 1 million deaths annually. The risk of disease progression is reduced when a sustained reduction of hepatitis B virus (HBV) DNA to undetectable levels and suppression of HBV replication are obtained which can result in regression of liver fibrosis and may even reverse cirrhosis. However, even if HBsAg loss occurs, HBV is not completely eradicated by treatment, and long-term therapy is required in patients who are HBeAg– and HBeAg+ who do not maintain off-treatment virological suppression and in those with advanced liver disease. The recently updated European Association of the Study of the Liver (EASL) clinical practical guidelines for HBV have clarified, first, how to treat HBV (interferon or the most potent oral drugs with optimal resistance profiles, i.e. entecavir and tenofovir disoproxil fumarate, should be used as first-line monotherapies); second, who should be treated (CHB in patients with significant liver disease but also patients who are HBsAg+ and are receiving immunosuppressive treatment, patients coinfected with HBV and human immunodeficiency virus, mothers who are HBsAg+ with high viral load in late pregnancy associated with sero vaccination to reduce the risk of vertical transmission of HBV; and third, when to stop antiviral therapies. The aim of this review was to clarify how to treat HBV and who should be treated, as well as when to stop treatment. Although the answer to these questions is clear for pegylated interferon, it is more debatable for nucleos(t)ide analogues (anti-HBe seroconversion, HBsAg loss or anti-HBs seroconversion with undetectable HBV DNA are clear indications to discontinue treatment but sustained undetectable HBV DNA in patients who are anti-HBe+ without significant fibrosis might be another indication). PMID:25057295

Vallet-Pichard, Anais

2014-01-01

114

Impact of the New ACC/AHA Guidelines on the Treatment of High Blood Cholesterol in a Managed Care Setting  

PubMed Central

Background In November 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) together issued new guidelines for the treatment of patients with high cholesterol, providing a new paradigm for the management of cholesterol in the primary and secondary prevention of coronary artery disease. Objective To examine the impact of the 2013 ACC/AHA cholesterol treatment guidelines on pharmacy utilization of cholesterol-lowering drugs in a real-world managed care setting. Methods Pharmacy claims from OptumRx, a national pharmacy benefit management provider, for the period between January 1, 2013, and December 31, 2013 (baseline period), were used to identify candidates for cholesterol-lowering therapy and to estimate the number of potential patients who will be starting or intensifying statin therapy based on the updated cholesterol treatment guidelines. Potential candidates for cholesterol-lowering treatments included patients with diabetes or hypertension aged 40 to 75 years who were not already receiving a cholesterol-lowering medication, as well as patients receiving cholesterol-lowering therapies during the baseline period. The baseline cholesterol-lowering medication market share was used to project changes in pharmacy utilization over the next 3 years. Results Based on the 2013 ACC/AHA cholesterol treatment guidelines, there will be a 25% increase in the proportion of the overall population that is treated with statins over the next 3 years, increasing from 3,909,407 (27.7%) patients to 4,892,668 (34.7%) patients. The largest proportion of the increase in statin utilization is projected to be for primary prevention in patients aged 40 to 75 years who were not receiving any cholesterol-lowering treatment at baseline. These projected changes will increase the overall number of statin prescriptions by 25% and will decrease the number of nonstatin cholesterol-lowering medication prescriptions by 68% during the next 3 years. Conclusion The new 2013 ACC/AHA cholesterol treatment guidelines are projected to have a significant impact on the utilization of cholesterol-lowering drugs by increasing the overall proportion of the population receiving statin therapy and by decreasing the utilization of nonstatin cholesterol-lowering medications.

Tran, Josephine N.; Caglar, Toros; Stockl, Karen M.; Lew, Heidi C.; Solow, Brian K.; Chan, Paul S.

2014-01-01

115

LANDFILLS EFFLUENT LIMITATIONS GUIDELINES DATABASE  

EPA Science Inventory

Resource Purpose: This resource served as the main information source for national characteristics of landfills for the landfills effluent guidelines. The database was developed based on responses to the "1994 Waste Treatment Industry Questionnaire: Phase II Landfills" and...

116

The Relationship between National Heart, Lung, and Blood Institute Weight Guidelines and Concurrent Medical Costs in a Manufacturing Population.  

ERIC Educational Resources Information Center

Explored the relationship between the 1998 National Heart, Lung, and Blood Institute (NHLBI) weight guidelines and concurrent medical costs among 177,971 employees, retirees, and adult dependents from a nationwide manufacturing corporation. Results indicated that the six weight groups defined by the NHLBI guidelines were consistent with concurrent…

Wang, Feifei; Schultz, Alyssa B.; Musich, Shirley; McDonald, Tim; Hirschland, David; Edington, Dee W.

2003-01-01

117

Evidence-based Danish Guidelines for the Treatment of Malassezia-related Skin Diseases.  

PubMed

Internationally approved guidelines for the diagnosis and management of Malassezia-related skin diseases are lacking. Therefore, a panel of experts consisting of dermatologists and a microbiologist under the auspices of the Danish Society of Dermatology undertook a data review and compiled guidelines for the diagnostic procedures and management of pityriasis versicolor, seborrhoeic dermatitis and Malassezia folliculitis. Main recommendations in most cases of pityriasis versicolor and seborrhoeic dermatitis include topical treatment which has been shown to be sufficient. As first choice, treatment should be based on topical antifungal medication. A short course of topical corticosteroid or topical calcineurin inhibitors has an anti-inflammatory effect in seborrhoeic dermatitis. Systemic antifungal therapy may be indicated for widespread lesions or lesions refractory to topical treatment. Maintenance therapy is often necessary to prevent relapses. In the treatment of Malassezia folliculitis systemic antifungal treatment is probably more effective than topical treatment but a combination may be favourable. PMID:24556907

Hald, Marianne; Arendrup, Maiken C; Svejgaard, Else L; Lindskov, Rune; Foged, Erik K; Saunte, Ditte Marie L

2014-02-20

118

2013 ACC/AHA cholesterol treatment guideline: Paradigm shifts in managing atherosclerotic cardiovascular disease risk.  

PubMed

The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults represents a major shift from prior cholesterol management guidelines. The new guidelines include data from individual randomized trials as well as the most comprehensive meta-analyses, and introduce several major paradigm shifts, which include: aiming for ASCVD risk reduction as opposed to targeting LDL-C levels, advocating for the use of evidence-based doses of statins as first line therapy, and utilizing a new risk calculator and risk cut point to guide initiation of statin therapy. These major changes have created controversy and confusion among the medical community, with some clinicians hesitant to embrace the shift. We review the evidence that forms the basis for these major changes, compare them to other major lipid guidelines, and recommend an integrated approach to managing dyslipidemia to decrease atherosclerotic cardiovascular disease risk. PMID:25435519

Finkel, Jonathan B; Duffy, Danielle

2014-10-28

119

Wilderness medical society practice guidelines for the prevention and treatment of frostbite: 2014 update.  

PubMed

The Wilderness Medical Society convened an expert panel to develop a set of evidence-based guidelines for the prevention and treatment of frostbite. We present a review of pertinent pathophysiology. We then discuss primary and secondary prevention measures and therapeutic management. Recommendations are made regarding each treatment and its role in management. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each modality according to methodology stipulated by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2011;22(2):156-166. PMID:25498262

McIntosh, Scott E; Opacic, Matthew; Freer, Luanne; Grissom, Colin K; Auerbach, Paul S; Rodway, George W; Cochran, Amalia; Giesbrecht, Gordon G; McDevitt, Marion; Imray, Christopher H; Johnson, Eric L; Dow, Jennifer; Hackett, Peter H

2014-12-01

120

Dutch Hospital Drug Formularies: pharmacotherapeutic variation and conservatism, but concurrence with national pharmacotherapeutic guidelines  

PubMed Central

Aims This research examines current hospital drug formularies (HDFs) of all Dutch general hospitals. It assesses the extent to which they recommend the same drugs, the breadth of their coverage in terms of therapeutic areas, drug groups incorporated and individuals drugs included, and their extent of conservatism by considering the year of introduction of the drugs included within groups. Furthermore, it considers the extent to which their recommendations concur and comply with those of national pharmacotherapeutic guidelines and the WHO Essential Drugs List (EDL). Methods Seventy-eight (81%) out of all 96 current Dutch HDFs were received of which 62 were suitable for study. Differences between HDFs and eventual associations with hospital characteristics were researched by statistical testing and case-control studies. To evaluate HDFs' concurrence with national guidelines and compliance with the WHO EDL, nine drug groups were studied in detail: benzodiazepines, calcium channel blockers, ?-adrenoceptor blocking agents, ACE-inhibitors, angiotensin-II inhibitors, NSAIDs, H2-receptor antagonists, 5HT3-antagonists, and H+-pump inhibitors. Concurrence and compliance with national guidelines and the WHO EDL was defined as inclusion of recommended drugs. Non-concurrence was defined as inclusion of nonrecommended drugs. Results The total number of indications addressed and drug groups incorporated within HDFs varied from 28 to 72 (median 56) and from 30 to 123 (median 97), respectively. The total number of individual drug entities (pharmacological substances) included ranged from 239 to 658 (median 430) and the total number of drug products, including all different dosage forms, from 412 to 1121 (median 655). Within drug groups, drug entities first marketed were most frequently included. Teaching hospitals were most likely to include recently marketed drugs. Depending on the drug group, HDFs' concurrence and compliance with national guidelines and the WHO EDL ranged from 35% to 100%. Conclusions Findings indicate that Dutch HDFs are rather uniform in the indications addressed and the drug groups incorporated. However, the number of individual drug entities and drug products included within groups varies considerably. Furthermore, Dutch HDFs are considered rather conservative, as older drugs are favoured over more recent drugs. Generally, with some drug exceptions, Dutch HDFs concur and comply with recommendations in national pharmacotherapeutic guidelines and with the WHO EDL over 90%. PMID:10718781

Fijn, R; Engels, S A G; Brouwers, J R B J; Knaap, R J; De Jong-Van den Berg, L T W

2000-01-01

121

Mortality benefits of population-wide adherence to national physical activity guidelines: a prospective cohort study.  

PubMed

We quantified the mortality benefits and attributable fractions associated with engaging in physical activity across a range of levels, including those recommended by national guidelines. Data were from the Allied Dunbar National Fitness Survey, a population-based prospective cohort comprising 1,796 male and 2,122 female participants aged 16-96 years, randomly selected from 30 English constituencies in 1990. Participants were tagged for mortality at the Office for National Statistics. Cox multivariable regression quantified the association between self-reported achievement of activity guidelines-150 min of at least moderate activity per week, equivalent here to 30 or more 20-min episodes of at least moderate activity per month-and mortality adjusting for age, sex, smoking status, social class, geographical area, anxiety/depression and interview season. There were 1,175 deaths over a median (IQR) of 22.9 (3.9) years follow-up; a mortality rate of 15.2, 95 % confidence interval (CI) 14.4-16.1 per 1,000 person years. Compared with being inactive (no 20-min bouts per month), meeting activity guidelines (30+ bouts) was associated with a 25 % lower mortality rate, adjusting for measured confounders. If everyone adhered to recommended-, or even low-activity levels, a substantial proportion of premature mortality might be avoided (PAF, 95 % CI 20.6, 6.9-32.3 and 8.9, 4.2-13.4 %, respectively). Among a representative English population, adherence to activity guidelines was associated with significantly reduced mortality. Efforts to increase population-wide activity levels could produce large public health benefits and should remain a focus of health promotion efforts. PMID:25377532

Long, Gráinne; Watkinson, Clare; Brage, Søren; Morris, Jerry; Tuxworth, Bill; Fentem, Peter; Griffin, Simon; Simmons, Rebecca; Wareham, Nicholas

2014-11-01

122

Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment  

ERIC Educational Resources Information Center

The purpose of this article is to provide counselors with an overview of best practices for the treatment of women who experience prenatal depression (PND). The authors first discuss issues in the screening and diagnosis of PND. Next, the 2 most common treatments, antidepressants and psychotherapy, are reviewed and discussed in relation to current…

Choate, Laura H.; Gintner, Gary G.

2011-01-01

123

Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action  

PubMed Central

Purpose Venous thromboembolism (VTE) is an increasingly frequent complication of cancer and its treatments, and is associated with worsened mortality and morbidity in patients with cancer. Design The Italian Association of Medical Oncology, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, the French National Federation of the League of Centers Against Cancer, and the European Society of Medical Oncology have recently published guidelines regarding VTE in patients with cancer. This review, authored by a working group of members from these panels, focuses on the methodology and areas of consensus and disagreement in the various clinical guidelines as well as directions for future research. Results There is broad consensus regarding the importance of thromboprophylaxis in hospitalized patients with cancer, including prolonged prophylaxis in high-risk surgical patients. Prophylaxis is not currently recommended for ambulatory patients with cancer (with exceptions) or for central venous catheters. All of the panels agree that low molecular weight heparins are preferred for the long-term treatment of VTE in cancer. Areas that warrant further research include the benefit of prophylaxis in the ambulatory setting, the risk/benefit ratio of prophylaxis for hospitalized patients with cancer, an understanding of incidental VTE, and the impact of anticoagulation on survival. Conclusion We call for a sustained research effort to investigate the clinical issues identified here to reduce the burden of VTE and its consequences in patients with cancer. PMID:19720907

Khorana, Alok A.; Streiff, Michael B.; Farge, Dominique; Mandala, Mario; Debourdeau, Philippe; Cajfinger, Francis; Marty, Michel; Falanga, Anna; Lyman, Gary H.

2009-01-01

124

Treatment of urinary tract infection in persons with spinal cord injury: guidelines, evidence, and clinical practice  

PubMed Central

Objectives To investigate current clinical practice in the treatment of urinary tract infections (UTIs) in persons with spinal cord injury (SCI) in SCI centers where German is spoken and to compare it with current guidelines and evidence-based standards evaluated by a literature review. Methods A standardized questionnaire was mailed to 16 SCI rehabilitation centers. The results were compared with a literature review Results Of the 16 centers, 13 responded. Indications for UTI treatment, medications, and treatment duration differed substantially among the individual centers and from the existing guidelines. Antibiotic treatment is regarded as the method of choice. Compared with the existing literature, patients in two center were undertreated, whereas they were overtreated in seven centers. Conclusion Even in specialized centers, treatment of UTI in patients with SCI is based more on personal experience of the treating physicians than on published evidence. This may at least partly be due to the paucity of evidence-based data. The observed tendency toward overtreatment with antibiotics carries substantial future risks, as this strategy may well lead to the induction of multiresistant bacterial strains. Therefore, developing guidelines would be an important step toward a unification of the different treatment strategies, thus reducing unnecessary antibiotic treatment. Furthermore, evidence-based studies evaluating the success of antibiotic treatment as well as the usefulness of alternative strategies are urgently needed. PMID:21528621

Pannek, Juergen

2011-01-01

125

Commentary: Treatment Guidelines for Child and Adolescent Bipolar Disorder  

ERIC Educational Resources Information Center

Once considered rare in children, pediatric bipolar disorder is now widely diagnosed in the United States. The illness has become a cultural phenomenon, adorning the cover of Time magazine and headlining national news broadcasts. Kowatch and colleagues, in compiling consensus recommendations for bipolar disorder in children and adolescents, have…

McClellan, Jon

2005-01-01

126

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

PubMed Central

AIM: To compare program costs of chronic hepatitis B (CHB) screening and treatment using Australian and other published CHB treatment guidelines. METHODS: Economic modeling demonstrated that in Australia a strategy of hepatocellular cancer (HCC) prevention in patients with CHB is more cost-effective than current standard care, or HCC screening. Based upon this model, we developed the B positive program to optimize CHB management of Australians born in countries of high CHB prevalence. We estimated CHB program costs using the B positive program algorithm and compared them to estimated costs of using the CHB treatment guidelines published by the Asian-Pacific, American and European Associations for the Study of Liver Disease (APASL, AASLD, EASL) and those suggested by an independent United States hepatology panel. We used a Markov model that factored in the costs of CHB screening and treatment, individualized by viral load and alanine aminotransferase levels, and calculated the relative costs of program components. Costs were discounted by 5% and calculated in Australian dollars (AUD). RESULTS: Using the B positive algorithm, total program costs amount to 13?979?224 AUD, or 9634 AUD per patient. The least costly strategy is based upon using the AASLD guidelines, which would cost 34% less than our B positive algorithm. Using the EASL and the United States Expert Group guidelines would increase program costs by 46%. The largest expenditure relates to the cost of drug treatment (66.9% of total program costs). The contribution of CHB surveillance (20.2%) and HCC screening and surveillance (6.6%) is small - and together they represent only approximately a quarter of the total program costs. CONCLUSION: The significant cost variations in CHB screening and treatment using different guidelines are relevant for clinicians and policy makers involved in designing population-based disease control programs. PMID:23155339

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

2012-01-01

127

Concordance With ASCO Guidelines for Surveillance After Colorectal Cancer Treatment: A Population-Based Analysis  

PubMed Central

Purpose: Intensive surveillance after curative treatment of colorectal cancer (CRC) is associated with improved overall survival. This study examined concordance with the 2005 ASCO surveillance guidelines at the population level. Methods: A cohort of 250 patients diagnosed with stage II or III CRC in 2004 and alive 42 months after diagnosis was identified from health administrative data in Manitoba, Canada. Colonoscopy, liver imaging, and carcinoembryonic antigen (CEA) testing were assessed over 3 years. Guidelines were met if patients had at least one colonoscopy in 3 years and at least one liver imaging test and three CEA tests annually. Multivariate logistic regression assessed the effect of patient and physician characteristics and disease and treatment factors on guideline concordance. Results: Guidelines for colonoscopy, liver imaging, and CEA were met by 80.4%, 47.2%, and 22% of patients, respectively. Guideline concordance for colonoscopy was predicted by annual contact with a surgeon, higher income, and the diagnosis of colon (rather than rectal) cancer. Adherence was lower in those older than 70 years and with higher comorbidity. For liver imaging, significant predictors were annual contact with an oncologist, receipt of chemotherapy, and diagnosis of colon cancer. Concordance with CEA guidelines was higher with annual contact with an oncologist and high levels of family physician contact, and lower in urban residents, in those older than 70, and in those with stage II disease. Conclusion: Completion of recommended liver imaging and CEA testing fall well below guidelines in Manitoba, whereas colonoscopy is better provided. Addressing this gap should improve outcomes for CRC survivors. PMID:23181004

Sisler, Jeffrey J.; Seo, Bosu; Katz, Alan; Shu, Emma; Chateau, Daniel; Czaykowski, Piotr; Wirtzfeld, Debrah; Singh, Harminder; Turner, Donna; Martens, Patricia

2012-01-01

128

Development and maintenance of guideline-based decision support for pharmacological treatment of hypertension.  

PubMed

The objective was to build a computer-based decision support system (DSS), which could apply the formal rules embedded in guidelines regarding pharmacological treatment of hypertension. The aim was also to test VISUAL BASIC as a development tool for DSS's in health care. From the Swedish guidelines for treatment of hypertension, the most widely accepted and scientifically best proved treatment strategies were chosen and implemented as rules. A DSS that is capable of applying the evidence-based rules extracted from guidelines regarding drug treatment of hypertension, to any patient's medical profile, was constructed. The output consists of a recommendation regarding preferred generic drug class and also a written report, reflecting decision steps provided by the rule-base and inference engine. We also provide methods for formalising an implementable language of guidelines. A mainstream programming language like VISUAL BASIC can be an alternative when building complicated decision support systems. A logic formal notation can facilitate communication between the expert and the programmer. The program is a stand-alone product independent of computerized medical records and thereby easy to install and maintain. PMID:10710183

Persson, M; Bohlin, J; Eklund, P

2000-03-01

129

A survey of practitioner adoption and implementation of practice guidelines and evidence-based treatments 1  

Microsoft Academic Search

This paper addresses the challenges associated with practitioner adoption and implementation of practice guidelines and evidence-based effective treatments. The paper presents results from a recent survey of practitioners about awareness of and attitudes about standards of care, including preference for use of intervention knowledge statements developed through expert consensus and through empirical research findings. Evidence based practice and the associated

Edward J. Mullen; William F. Bacon

130

German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version)  

PubMed Central

Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1–S126, 2006; or http://www.psoriasis-leitlinie.de). PMID:17497162

Kopp, I.; Augustin, M.; Banditt, K. B.; Boehncke, W. H.; Follmann, M.; Friedrich, M.; Huber, M.; Kahl, C.; Klaus, J.; Koza, J.; Kreiselmaier, I.; Mohr, J.; Mrowietz, U.; Ockenfels, H. M.; Orzechowski, H. D.; Prinz, J.; Reich, K.; Rosenbach, T.; Rosumeck, S.; Schlaeger, M.; Schmid-Ott, G.; Sebastian, M.; Streit, V.; Weberschock, T.; Rzany, B.

2007-01-01

131

SEOM clinical guidelines for the treatment of renal cell carcinoma.  

PubMed

The purpose of this article was to provide updated recommendations for the diagnosis and treatment of renal cell carcinoma. Pathological confirmation is mandatory before treatment with ablative or focal therapies before any type of systemic therapy. Renal cell cancer should be staged according to the TNM classification system. A laparoscopic nephron-sparing surgery should be the approach for tumors <4 cm if technically feasible. Otherwise, radical (or partial in selected cases) nephrectomy is the treatment of choice, with lymph node dissection only performed in patients with clinically detected lymph node involvement. Some retrospective evidence for a cytoreductive nephrectomy in the postimmunotherapy era suggests a benefit in patients with good or intermediate risk or for patients with a symptomatic primary lesion. Adjuvant treatment with chemotherapy or with targeted agents is not recommended and studies are ongoing today. Patients with metastatic disease should be staged by computed tomography scans of the chest, abdomen and pelvis. The efficacy of sunitinib, bevacizumab plus interferon-?, and pazopanib is well established in patients with good and intermediate risk as well for temsirolimus in poor-risk patients. These four agents are considered standard of care in first-line treatment. Sorafenib, axitinib and everolimus are standard of care in second line in different settings based on their benefit in PFS. Besides some benefit described for IL-2 in highly selected patients in first line, there is a promising and emerging role for the new immunotherapeutic approaches in metastatic renal cell carcinoma. PMID:25274276

Bellmunt, J; Puente, J; Garcia de Muro, J; Lainez, N; Rodríguez, C; Duran, I

2014-12-01

132

The use of vertical flow constructed wetlands for on-site treatment of domestic wastewater: New Danish guidelines  

Microsoft Academic Search

Official guidelines for the on-site treatment of domestic sewage have recently been published by the Danish Ministry of Environment as a consequence of new treatment requirements for single houses and dwellings in rural areas. This paper summarises the guidelines for vertical constructed wetland systems (planted filter beds) that will fulfil demands of 95% removal of BOD and 90% nitrification. The

Hans Brix; Carlos A. Arias

2005-01-01

133

Physician Peer Assessments for Compliance with Methadone Maintenance Treatment Guidelines  

ERIC Educational Resources Information Center

Introduction: Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer…

Strike, Carol; Wenghofer, Elizabeth; Gnam, William; Hillier, Wade; Veldhuizen, Scott; Millson, Margaret

2007-01-01

134

[Lyme borreliosis--guidelines of treatment and expectations of patients].  

PubMed

Clinical and patophysiological aspects of Lyme borreliosis influencing effectives of treatments are introduced. European recommendations--results of EUCALB export group (regarding European multistrains specificity), AAN-American Academy Neurology as well ILADS Working Group based on experience from North America supported of some important studies connected with duration of therapy are described. Expectations of patients are introduced. PMID:22320049

Zajkowska, Joanna

2008-01-01

135

Quality Improvement Guidelines for Imaging Detection and Treatment of Endoleaks following Endovascular Aneurysm Repair (EVAR)  

SciTech Connect

Major concerns after aortic aneurysm repair are caused by the presence of endoleaks, which are defined as persistent perigraft flow within the aortic aneurysm sac. Diagnosis of endoleaks can be performed with various imaging modalities, and indications for treatment are based on further subclassifications. Early detection and correct classification of endoleaks are crucial for planning patient management. The vast majority of endoleaks can be treated successfully by interventional means. Guidelines for Imaging Detection and Treatment of endoleaks are described in this article.

Rand, T., E-mail: Thomas.Rand@wienkav.at [General Hospital Hietzing, Department of Radiology (Austria); Uberoi, R. [John Radcliffe Hospital, Department of Radiology (United Kingdom)] [John Radcliffe Hospital, Department of Radiology (United Kingdom); Cil, B. [Hacettepe University Hospitals, Department of Interventional Radiology (Turkey)] [Hacettepe University Hospitals, Department of Interventional Radiology (Turkey); Munneke, G. [St George's Hospital, Department of Interventional Radiology (United Kingdom)] [St George's Hospital, Department of Interventional Radiology (United Kingdom); Tsetis, D. [University Hospital of Heraklion, Medical School of Crete, Department of Radiology (Greece)] [University Hospital of Heraklion, Medical School of Crete, Department of Radiology (Greece)

2013-02-15

136

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review  

Microsoft Academic Search

Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide treatments that are effective\\u000a and cost-effective. The purpose of this systematic review was to investigate the cost-effectiveness of guideline-endorsed\\u000a treatments for LBP. We searched nine clinical and economic electronic databases and the reference list of relevant systematic\\u000a reviews and included studies for eligible studies.

Chung-Wei Christine Lin; Marion Haas; Chris G. Maher; Luciana A. C. Machado; Maurits W. van Tulder

137

Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases  

PubMed Central

Urinary tract disease is a common reason for use (and likely misuse, improper use, and overuse) of antimicrobials in dogs and cats. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, guidelines for diagnosis and management of urinary tract infections were created by a Working Group of the International Society for Companion Animal Infectious Diseases. While objective data are currently limited, these guidelines provide information to assist in the diagnosis and management of upper and lower urinary tract infections in dogs and cats. PMID:21776346

Weese, J. Scott; Blondeau, Joseph M.; Boothe, Dawn; Breitschwerdt, Edward B.; Guardabassi, Luca; Hillier, Andrew; Lloyd, David H.; Papich, Mark G.; Rankin, Shelley C.; Turnidge, John D.; Sykes, Jane E.

2011-01-01

138

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

PubMed Central

Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS). First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM) treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin) and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran) were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques). PMID:24348701

Fitzcharles, Mary-Ann; Buskila, Dan; Shir, Yoram; Sommer, Claudia

2013-01-01

139

Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies.  

PubMed

Objective. Current evidence indicates that there is no single ideal treatment for fibromyalgia syndrome (FMS). First choice treatment options remain debatable, especially concerning the importance of complementary and alternative medicine (CAM) treatments. Methods. Three evidence-based interdisciplinary guidelines on FMS in Canada, Germany, and Israel were compared for their first choice and CAM-recommendations. Results. All three guidelines emphasized a patient-tailored approach according to the key symptoms. Aerobic exercise, cognitive behavioral therapy, and multicomponent therapy were first choice treatments. The guidelines differed in the grade of recommendation for drug treatment. Anticonvulsants (gabapentin, pregabalin) and serotonin noradrenaline reuptake inhibitors (duloxetine, milnacipran) were strongly recommended by the Canadian and the Israeli guidelines. These drugs received only a weak recommendation by the German guideline. In consideration of CAM-treatments, acupuncture, hypnosis/guided imagery, and Tai Chi were recommended by the German and Israeli guidelines. The Canadian guidelines did not recommend any CAM therapy. Discussion. Recent evidence-based interdisciplinary guidelines concur on the importance of treatment tailored to the individual patient and further emphasize the need of self-management strategies (exercise, and psychological techniques). PMID:24348701

Ablin, Jacob; Fitzcharles, Mary-Ann; Buskila, Dan; Shir, Yoram; Sommer, Claudia; Häuser, Winfried

2013-01-01

140

[The National Programme for Disease Management Guidelines. Goals, contents, patient involvement].  

PubMed

The Programme for National Disease Management Guidelines (German DM-CPG Programme) aims at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. The programme, focussing on high priority healthcare topics, has been sponsored since 2003 by the German Medical Association (BAEK), the Association of the Scientific Medical Societies (AWMF), and by the National Association of Statutory Health Insurance Physicians (KBV). It is organised by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network (G-I-N). The main objective of the programme is to establish consensus of the medical professions on evidence-based key recommendations covering all sectors of health care provision and facilitating the coordination of care for the individual patient through time and across disciplines. Within this framework experts from national patient self-help groups have been developing patient guidance based upon the recommendations for healthcare providers. The article describes goals, topics and selected contents of the DM-CPG programme - using asthma as an example. PMID:17334883

Ollenschläger, G; Kopp, I; Lelgemann, M; Sänger, S; Klakow-Franck, R; Gibis, B; Gramsch, E; Jonitz, G

2007-03-01

141

Parkinson's Disease Treatment Guidelines 2002 issued by Societas Neurologica Japonica  

Microsoft Academic Search

\\u000a Abstract\\u000a   To relieve the problems of the progressively aging population in Japan, the Ministry of Health, Labor and Welfare decided\\u000a to focus on the treatment of high-incidence diseases and the establishment of effective medical technologies. As a result\\u000a of these shifts in policy, the Societas Neurologica Japonica formed several ad hoc committees to collect materials in order\\u000a to establish evidence-based

Kazuko Hasegawa

2007-01-01

142

Evidence-based guideline: Treatment of parenchymal neurocysticercosis  

PubMed Central

Objective: To review the evidence base for different treatment strategies in intraparenchymal neurocysticercosis in adults and children. Method: A literature search of Medline, EMBASE, LILACS, and the Cochrane Database from 1980 to 2008, updated in 2012, resulted in the identification of 10 Class I or Class II trials of cysticidal drugs administered with or without corticosteroids in the treatment of neurocysticercosis. Results: The available data demonstrate that albendazole therapy, administered with or without corticosteroids, is probably effective in decreasing both long-term seizure frequency and the number of cysts demonstrable radiologically in adults and children with neurocysticercosis, and is well-tolerated. There is insufficient information to assess the efficacy of praziquantel. Recommendations: Albendazole plus either dexamethasone or prednisolone should be considered for adults and children with neurocysticercosis, both to decrease the number of active lesions on brain imaging studies (Level B) and to reduce long-term seizure frequency (Level B). The evidence is insufficient to support or refute the use of steroid treatment alone in patients with intraparenchymal neurocysticercosis (Level U). PMID:23568997

Baird, Ruth Ann; Wiebe, Sam; Zunt, Joseph R.; Halperin, John J.; Gronseth, Gary; Roos, Karen L.

2013-01-01

143

Guidelines for the treatment of bacterial vaginosis: focus on tinidazole  

PubMed Central

Bacterial vaginosis (BV) is a complex vaginal infection most commonly associated with women of child-bearing age. Risk factors for BV are numerous. There are currently multiple clinical and laboratory tests for diagnosis of BV, including the most commonly used diagnostic methods: Amsel’s criteria or Nugent’s Gram stain scale. The mainstay of BV therapy is metronidazole, but tinidazole as well as a few other agents have also been used successfully. Tinidazole is the second nitroimidazole antiprotozoal agent and a structural derivative of metronidazole. With a favorable pharmacokinetic profile and reduced side effects, tinidazole is an alternative agent for BV treatment. There are minimal head-to-head comparative data to establish tinidazole’s superiority to metronidazole or other therapeutic agents. Available data suggest tinidazole has a role in special populations particularly for refractory or relapsing BV. PMID:19707258

Dickey, Laura J; Nailor, Michael D; Sobel, Jack D

2009-01-01

144

[Guidelines for the diagnosis and treatment of the fibromyalgia syndrome].  

PubMed

Over the past years, considerable progress has been made in understanding the pathogenesis of the fibromyatgia syndrome and the evidence based approach to the diagnosis and management has been significantty extended. The purpose of the current project is to develop practicat and evidence based guidetine recommendations for the Israeli health care system. A panet of physicians with clinical and research experience in the fibromyalgia field was convened under the auspices of the Israeli Rheumatology Association. A systematic review was performed on the current literature regarding the diagnosis and treatment of fibromyalgia. Using an interactive discussion procedure, recommendations were reached and expert opinion was introduced where evidence was considered incomplete. The panel recommendations underline the importance of concomitant and integrated medical therapy, such as serotonin and noradrenaline reuptake inhibitor (SNRI) anti-depressants or gamma-aminobutyric acid (GABA) related anti-epileptics, with regular aerobic physical exercise. PMID:24483001

Ablin, Jacob N; Amital, Howard; Ehrenfeld, Michael; Aloush, Valerie; Elkayam, Ori; Langevitz, Pnina; Mevorach, Dror; Mader, Reuven; Sachar, Tali; Amital, Daniela; Buskila, Dan

2013-12-01

145

[Guidelines for diagnostics and treatment of arterial hypertension. Practical recommendations of the Croatian Working Group for Hypertension. Consideration on the ESH-ESC 2007 guidelines].  

PubMed

ESH/ECS guidelines for diagnostics and treatment of arterial hypertension 2007 is a basic paper for all physicians who treat hypertensive patients. Since publishing, this article has been the most cited medical paper. According to ESH/ECS guidelines some local peculiarities in each country should be considered when diagnosing and treating hypertensive patients. Practical recommendations of the Croatian working group for the diagnostics and treatment of hypertension are in agreement with ESH/ECS guidelines. However, few additional issues are added and further discussed in this paper (hypertensive crisis, treatment of hypertension in patients undergoing dialysis and in renal transplanted patients, role of family physicians, role of nurse). We believe that this paper will contribute better control of hypertension in Croatia. All medical societies and institutions that took part in writing this document, have to consider this paper as an official statement. PMID:18792559

Jelakovi?, Bojan; Kuzmani?, Dusko; Milici?, Davor; Reiner, Zeljko; Aganovi?, Izet; Basi?-Juki?, Nikolina; Bozikov, Jadranka; Cikes, Maja; Dika, Zivka; Delmis, Josip; Galesi?, Kresimir; Hrabak-Zerjavi?, Vlasta; Ivanusa, Mario; Juresa, Vesna; Kati?, Milica; Kern, Josipa; Kes, Petar; Laganovi?, Mario; Pavlovi?, Drasko; Pe?in, Ivan; Pocani?, Darko; Racki, Sanjin; Sabljar-Matovinovi?, Mirjana; Sonicki, Zdenko; Vrci?-Keglevi?, Mladenka; Vuleti?, Silvije; Zaputovi?, Luka

2008-01-01

146

Management of chronic hepatitis B infection: Current treatment guidelines, challenges, and new developments  

PubMed Central

Chronic hepatitis B (CHB) virus infection is a global public health problem, affecting more than 400 million people worldwide. The clinical spectrum is wide, ranging from a subclinical inactive carrier state, to progressive chronic hepatitis, cirrhosis, decompensation, and hepatocellular carcinoma. However, complications of hepatitis B virus (HBV)-related chronic liver disease may be reduced by viral suppression. Current international guidelines recommend first-line treatment of CHB infection with pegylated interferon, entecavir, or tenofovir, but the optimal treatment for an individual patient is controversial. The indications for treatment are contentious, and increasing evidence suggests that HBV genotyping, as well as serial on-treatment measurements of hepatitis B surface antigen and HBV DNA kinetics should be used to predict antiviral treatment response. The likelihood of achieving a sustained virological response is also increased by extending treatment duration, and using combination therapy. Hence the paradigm for treatment of CHB is constantly evolving. This article summarizes the different indications for treatment, and systematically reviews the evidence for the efficacy of various antiviral agents. It further discusses the shortcomings of current guidelines, use of rescue therapy in drug-resistant strains of HBV, and highlights the promising clinical trials for emerging therapies in the pipeline. This concise overview presents an updated practical approach to guide the clinical management of CHB. PMID:24876747

Tang, Ceen-Ming; Yau, Tung On; Yu, Jun

2014-01-01

147

Wet-wrap treatment in children with atopic dermatitis: a practical guideline.  

PubMed

Treatment of children with severe atopic dermatitis (AD) can be especially challenging because several possible intervention treatments have (relative) contraindications in childhood. In recent years, wet-wrap treatment (WWT) has been advocated as a relatively safe and efficacious intervention in children with severe or refractory AD. The goal of this article is to provide a practical guideline as a starting point for clinicians who are interested in using WWT in their own clinical practice. We will address several practical issues surrounding the use of WWT by describing our own experiences, supplemented with data from the literature. PMID:22256990

Devillers, Arjan C A; Oranje, Arnold P

2012-01-01

148

Patient Factors Associated with Guideline-concordant Treatment of Anxiety and Depression in Primary Care  

PubMed Central

Objective To identify associations of patient characteristics (predisposing, enabling and need factors) with guideline-concordant care for anxiety and depression in primary care. Design Analysis of data from the Netherlands Study of Depression and Anxiety (NESDA). Participants Seven hundred and twenty-one patients with a current anxiety or depressive disorder, recruited from 67 general practitioners (GPs), were included. Measures Diagnoses according to the Diagnostic and Statistic Manual of Mental Disorders, fourth edition (DSM-IV) were made using a structured and widely validated assessment. Socio-demographic and enabling characteristics, severity of symptoms, disability, (under treatment for) chronic somatic conditions, perceived need for care, beliefs and evaluations of care were measured by questionnaires. Actual care data were derived from electronic medical records. Criteria for guideline-concordant care were based on general practice guidelines, issued by the Dutch College of General Practitioners. Results Two hundred and eighty-one (39%) patients received guideline-concordant care. High education level, accessibility of care, comorbidity of anxiety and depression, and severity and disability scores were positively associated with receiving guideline-concordant care in univariate analyses. In multivariate multi-level logistic regression models, significant associations with the clinical need factors disappeared. Positive evaluations of accessibility of care increased the chance (OR?=?1.31; 95%?CI?=?1.05–1.65; p?=?0.02) of receiving guideline-concordant care, as well as perceiving any need for medication (OR?=?2.99; 95%?CI?=?1.84–4.85; p?guideline-concordant care. Conclusions This study shows that education level, accessibility of care and patients’ perceived needs for care are more strongly associated with the delivery of guideline-concordant care for anxiety or depression than clinical need factors. Initiatives to improve GPs’ communication skills around mental health issues, and to improve recognition of people suffering from anxiety disorders, could increase the number of patients receiving treatment for depression and anxiety in primary care. PMID:20049547

Verhaak, Peter F. M.; Smolders, Mirrian; Laurant, Miranda G. H.; van der Meer, Klaas; Spreeuwenberg, Peter; van Marwijk, Harm W. J.; Penninx, Brenda W. J. H.; Bensing, Jozien M.

2010-01-01

149

Quality Control Guidelines for National Committee for Clinical Laboratory Standards-Recommended Broth Macrodilution Testing of Ketoconazole and Itraconazole  

Microsoft Academic Search

Ketoconazole and itraconazole were tested in a multilaboratory study to establish quality control (QC) guidelines for yeast antifungal susceptibility testing. Two isolates that had been previously identified as QC isolates for amphotericin B,fluconazole, andflucytosine (Candida parapsilosisATCC 22019 andCandida krusei ATCC 6258) were tested in accordance with the National Committee for Clinical Laboratory Standards M27-P guidelines. Each isolate was tested 20

JOHN H. REX; MICHAEL A. PFALLER; MICHAEL LANCASTER; FRANK C. ODDS; ANNE BOLMSTROM; ANDMICHAEL G. RINALDI

1996-01-01

150

Adoption of practice guidelines and assessment tools in substance abuse treatment  

PubMed Central

Background The gap between research and practice limits utilization of relevant, progressive and empirically validated strategies in substance abuse treatment. Methods Participants included substance abuse treatment programs from the Northeastern United States. Structural equation models were constructed with agency level data to explore two outcome variables: adoption of practice guidelines and assessment tools at two points in time; models also included organizational, staffing and service variables. Results In 1997, managed care involvement and provision of primary care services had the strongest association with increased use of assessment tools, which, along with provision of counseling services, were associated with a greater use of practice guidelines. In 2001, managed care involvement, counseling services and being a stand-alone drug treatment agency were associated with a greater use of assessment tools, which was in turn related to an increase in the use of practice guidelines. Conclusions This study provides managers, clinicians and policy-makers with a framework for understanding factors related to the adoption of new technologies in substance abuse treatment. PMID:20346158

2010-01-01

151

Clinical trial data in support of changing guidelines in osteoarthritis treatment.  

PubMed

Goals for the management of osteoarthritis (OA) emphasize pain relief, reduction of inflammation, and improvement in functioning. Among pharmacological pain management interventions, nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently recommended as the most effective treatment option for OA. However, the use of traditional oral NSAIDs is associated with risk of serious adverse events involving the gastrointestinal, cardiovascular, and renal systems. Topical NSAIDs are an alternative with well-established tolerability and efficacy in the treatment of OA of the knee or hand. While the management of OA pain is evolving toward the more widespread use of topical NSAIDs, some OA management guidelines have yet to incorporate these agents in their recommendations. This review examines the efficacy and tolerability of topical NSAIDs, their current placement in OA management guidelines, and their potential role in enabling pain specialists to provide individualized care for their patients with OA. PMID:24748817

Balmaceda, Casilda M

2014-01-01

152

Clinical trial data in support of changing guidelines in osteoarthritis treatment  

PubMed Central

Goals for the management of osteoarthritis (OA) emphasize pain relief, reduction of inflammation, and improvement in functioning. Among pharmacological pain management interventions, nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently recommended as the most effective treatment option for OA. However, the use of traditional oral NSAIDs is associated with risk of serious adverse events involving the gastrointestinal, cardiovascular, and renal systems. Topical NSAIDs are an alternative with well-established tolerability and efficacy in the treatment of OA of the knee or hand. While the management of OA pain is evolving toward the more widespread use of topical NSAIDs, some OA management guidelines have yet to incorporate these agents in their recommendations. This review examines the efficacy and tolerability of topical NSAIDs, their current placement in OA management guidelines, and their potential role in enabling pain specialists to provide individualized care for their patients with OA. PMID:24748817

Balmaceda, Casilda M

2014-01-01

153

Drivers for change in the management of prostate cancer - guidelines and new treatment techniques.  

PubMed

Clinical practice guidelines and new treatment techniques are of particular importance for the effective management of prostate cancer. In Europe, the European Association of Urology guidelines offer a regularly updated evidence-based source of recommendations for the optimal treatment of prostate cancer. This review examines recent changes to guidelines highlighting developments in diagnosis, hormonal therapy in advanced and metastatic disease, bone protection, the definition of new terminology such as castrate-resistant prostate cancer, treatment of relapse after hormonal therapy, and cytotoxic therapy for castrate-resistant prostate cancer. The review also examines new surgical and radiotherapeutic developments in prostate cancer. This includes minimally invasive techniques such as robot-assisted radical prostatectomy, which is becoming the surgical gold standard for clinically localized disease in many countries. Other promising techniques reviewed include cryosurgical ablation of the prostate, laser-induced interstitial thermotherapy, vascular-targeted photodynamic therapy, and high-intensity focused ultrasound; with the exception of cryotherapy, these approaches are not currently recommended for routine clinical use. Finally, we will review the evidence supporting intensity modulated radiotherapy, an optimized high-precision form of three-dimensional conformal radiotherapy which aims to allow homogeneously increased radiation doses, without increased toxicity to healthy at-risk organs. Novel techniques such as proton beam or carbon ion radiotherapy, which may offer improved and more localized dose distribution with reduced damage to normal tissue, are also examined. PMID:22672123

Wolff, J M; Mason, M

2012-06-01

154

Compliance of Disease Awareness Campaigns in Printed Dutch Media with National and International Regulatory Guidelines  

PubMed Central

Background The European legislation prohibits prescription-only medicines' advertising but allows pharmaceutical companies to provide information to the public on health and diseases, provided there is no direct or indirect reference to a pharmaceutical product. Various forms of promotion have become increasingly common in Europe including “disease-oriented” campaigns. Objectives To explore examples of disease awareness campaigns by pharmaceutical companies in the Netherlands, by assessing their compliance with the World Health Organization (WHO) Ethical Criteria for medicinal drug promotion and the Dutch guidelines for provision of information by pharmaceutical companies. Methods Materials referring to health/disease and treatments published in the most widely circulated newspapers and magazines were collected from March to May 2012. An evaluation tool was developed based on relevant underlying principles from the WHO ethical criteria and Dutch self-regulation guidelines. Collected disease awareness advertisements were used to pilot the evaluation tool and to explore the consistency of information provided with the WHO and Dutch criteria. Findings Eighty materials met our inclusion criteria; 71 were published in newspapers and 9 in magazines. The large majority were news items but 21 were disease awareness advertisements, of which 5 were duplicates. Fifteen out of the 16 disease awareness campaigns were non-compliant with current guidelines mainly due to lack of balance (n?=?12), absence of listed author and/or sponsor (n?=?8), use of misleading or incomplete information (n?=?5) and use of promotional information (n?=?5). None mentioned a pharmaceutical product directly. Conclusion Disease Awareness Campaigns are present in Dutch printed media. Although no brand names were mentioned, the lack of compliance of disease awareness campaigns with the current regulations is alarming. There were information deficiencies and evidence of information bias. A key concern is that the context in which the information is provided, mostly through indirect referral, is likely to support treatment with the sponsor's product. PMID:25198776

Leonardo Alves, Teresa; Martins de Freitas, Auramarina F.; van Eijk, Martine E. C.; Mantel-Teeuwisse, Aukje K.

2014-01-01

155

Guidelines Disconcordance in Acute Bipolar Depression: Data from the National Bipolar Mania Pathway Survey (BIPAS) in Mainland China  

PubMed Central

With the recent attention to the importance of evidence-based medicine in psychiatry, a number of treatment guidelines have been published. This survey investigated prescribing pattern and predictors for guideline disconcordance in the acute treatment of bipolar depression across mainland China. Pharmacological treatments of 1078 patients with bipolar depression were examined. Guidelines disconcordance was determined by comparing the medication(s) patients were prescribed with the recommendation(s) in the guidelines of the Canadian Network for Mood and Anxiety Treatments. Predictors for guidelines discordance were analyzed with logistic regression. Of the 1078 patients, 50.2% patients were treated against treatment guidelines recommendations. The patients who were treated in general hospitals (OR?=?1.53, 95% CI 1.18–1.97), with a depressive episode (OR?=?1.67, 95% CI 1.27–2.19) and an older age at first onset (OR?=?1.62, 95% CI 1.15–2.28) were more likely to receive guideline-disconcordant treatment than their counterparts. In contrast, the patients with current mental comorbidity, an older age at study entry, a longer duration of disease, and more frequent episodes in past year were less likely to receive guideline-disconcordant treatments than their counterparts with an OR of 0.43 (95% CI 0.24–0.77), 0.52 (95CI% 0.36–0.75), 0.48 (95% CI 0.36–0.65), and 0.50 (95% CI 0.38–0.64), respectively. Our finding suggested the disconcordance with treatment guidelines in patients with an acute bipolar depression is common under naturalistic conditions in mainland China, and the predicting factors correlated with guidelines disconcordance include both psychiatrist-specific (clinicians from general hospitals) and patient-specific features (a depressive episode at first onset, no current co-morbidity with mental disorders, a younger age at study entry, an older age at first onset, shorter duration of disease, and non-frequent episodes in past year). PMID:24763748

Wang, Zuowei; Gao, Keming; Hong, Wu; Xing, Mengjuan; Wu, Zhiguo; Chen, Jun; Zhang, Chen; Yuan, Chengmei; Huang, Jia; Peng, Daihui; Wang, Yong; Lu, Weihong; Yi, Zhenghui; Yu, Xin; Zhao, Jingping; Fang, Yiru

2014-01-01

156

Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash  

PubMed Central

OBJECTIVE To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. OPTIONS Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. OUTCOMES The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. EVIDENCE An “extraction” team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. VALUES To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of “conservative” care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to, or better than the published evidence. REPORTED BENEFITS, HARMS AND COSTS The expected benefits from the recommendations include more rapid recovery from pain, impairment and disability (improved pain and ROM). The GDC identified evidence-based pain benefits from 10 unimodal treatments and more than 7 multimodal treatments. There were no pain benefits from magnets in necklaces, education or relaxation alone, occipital release alone, or head retraction-extension exercise combinations alone. The specificity of the studied treatments meant few studies could be generalized to more than a minority of patients. Adverse events were not addressed in most studies, but where they were, there were none or they were minor. The theoretic harm of vertebral artery dissection (VAD) was not reported, but an analysis suggested that 1 VAD may occur subsequent to 1 million cervical manipulations. Costs were not analyzed in this guideline, but it is the understanding of the GDC that recommendations limiting ineffective care and promoting a more rapid return of patients to full functional capacity will reduce patient costs, as well as increase patient safety and satisfaction. For simplicity, this version of the guideline includes primarily data synthesized across studies (evidence syntheses), whereas the technical and the interactive versions of this guideline (http://ccachiro.org/cpg) also include relevant data from individual studies (evidence extractions). RECOMMENDATIONS The GDC developed treatment, risk-management and research recommendations using the available evidence. Treatment recommendations addressing 13 treatment modalities revolved around a decision algorithm comprising diagnosis (or assessment leading to diagnosis), treatment and reassessment. Several specific variations of modalities of treatment were not recommended. For adverse events not associated with a treatment modality, but that occur in the clinical setting, there was evidence to recommend reconsideration of treatment options or referral to the appropriate health services. For adverse eve

Anderson-Peacock, Elizabeth; Blouin, Jean-Sébastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Gross Stein, Janice; White, Eleanor

2005-01-01

157

Quality Assessment of Clinical Practice Guidelines on the Treatment of Hepatocellular Carcinoma or Metastatic Liver Cancer  

PubMed Central

Objectives To assess the quality of the currently available clinical practice guidelines (CPGs) for hepatocellular carcinoma, and provide a reference for clinicians in selecting the best available clinical protocols. Methods The databases of PubMed, MEDLINE, Web of Science, Chinese Biomedical Literature database (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and relevant CPGs websites were systematically searched through March 2014. CPGs quality was appraised using the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument, and data analysis was performed using SPSS 13.0 software. Results A total of 20 evidence-based and 20 expert consensus-based guidelines were included. The mean percentage of the domain scores were: scope and purpose 83% (95% confidence interval (CI), 81% to 86%), clarity of presentation 79% (95% CI, 73% to 86%), stakeholder involvement 39% (95% CI, 30% to 49%), editorial independence 58% (95% CI, 52% to 64%), rigor of development 39% (95% CI, 31% to 46%), and applicability 16% (95% CI, 10% to 23%). Evidence-based guidelines were superior to those established by consensus for the domains of rigor of development (p<0.001), clarity of presentation (p?=?0.01) and applicability (p?=?0.021). Conclusions The overall methodological quality of CPGs for hepatocellular carcinoma and metastatic liver cancer is moderate, with poor applicability and potential conflict of interest issues. The evidence-based guidelines has become mainstream for high quality CPGs development; however, there is still need to further increase the transparency and quality of evidence rating, as well as the recommendation process, and to address potential conflict of interest. PMID:25105961

Wang, Yingqiang; Luo, Qianqian; Li, Youping; Wang, Haiqing; Deng, Shaolin; Wei, Shiyou; Li, Xianglian

2014-01-01

158

A comparison between reported therapy staffing levels and the department of health therapy staffing guidelines for stroke rehabilitation: a national survey  

PubMed Central

Background This study compared reported staffing levels for stroke care within UK in-patient stroke units to stroke strategy staffing guidelines published by the UK Department of Health and the Royal College of Physicians. The purpose was to explore the extent to which stroke teams are meeting recommended staffing levels. Method The data analyzed in this report consisted of the detailed therapist staffing levels reported in the demographic section of our national survey to determine upper limb treatment in stroke units (the ATRAS survey). A contact list of stroke practitioners was therefore compiled primarily in collaboration with the 28 National Stroke Improvement Networks. Geographic representation of the network areas was obtained by applying the straight-forward systematic sampling method and the Nth name selection technique to each Network list. In total 192 surveys were emailed to stroke care providers around England. This included multiple contacts within stroke teams (e.g. a stroke consultant and a stroke co-coordinator) to increase awareness of the survey. Results A total of 53 surveys were returned from stroke teams and represented 20 of the 28 network areas providing 71% national coverage. To compare reported staffing levels to suggested DoH guidelines, analysis was conducted on 19 of the 37 inpatient hospital care units that had no missing data for staff numbers, unit bed numbers, number of stroke patients treated per annum, average unit length-of-stay, and average unit occupancy rates. Only 42% of units analyzed reached the DoH guideline for physiotherapy and fewer than 16% of the units reached the guideline for speech & language therapy. By contrast, 84% of units surveyed reached the staffing guideline for occupational therapy. However, a post-hoc analysis highlights this as an irregularity in the DoH guidelines, revealing that all therapies are challenged to provide the recommended therapy time. Conclusions Most in-patient stroke units are operating below the DoH guidelines and are therefore challenged in providing the recommended amount of therapy and patient time to facilitate optimal functional recovery for stroke patients. PMID:24884979

2014-01-01

159

Five Year Outcomes of the China National Free Antiretroviral Treatment Program  

PubMed Central

Background China's National Free Antiretroviral Treatment Program began in 2002 and, by August 2008, included over 52,000 patients. Objective To report five year outcomes on adult mortality and immunological treatment failure rates and risk factors. Design Open cohort analysis of prospectively collected observational database. Patients All patients in national treatment database from June 2002-August 2008. Patients excluded if not started on triple therapy or had missing treatment regimen information. Intervention Antiretroviral therapy per Chinese national treatment guidelines. Measurements Mortality rate and immunologic treatment failure rate using World Health Organization criteria. Results Of 52,191 total patients, 48,785 were included. Median age was 38 years, 58% were male, 53% were infected through plasma/blood, and median baseline CD4 cell count was 118/?L. Mortality was greatest during the first three months of treatment (22.6/100 person-years) but declined to a steady rate of 4-5/100 person-years after six months and maintained over the subsequent 4½ years. Baseline CD4 cell count <50/?L (adjusted hazard ratio [HR] 3.3, 95% confidence interval [CI] 2.9-3.8, compared to ?200/?L) and having 4-5 baseline symptom categories (adjusted HR 3.4, 95% CI 2.9-4.0, compared to no baseline symptoms) were the strongest mortality risk factors. Treatment failure was determined among 31,070 with ?1 follow-up CD4 cell count. Overall, 25% (12.0/100 person-years) failed treatment with the cumulative treatment failure rate increasing to 50% at five years. Limitation Immunologic treatment failure does not necessarily correlate well with virologic treatment failure. Conclusions The National Free Antiretroviral Treatment Program reduced mortality among adult AIDS patients in China to rates comparable to other low or middle-income countries. A cumulative immunological treatment failure rate of 50% after five years, with limited availability of second-line regimens, is of great concern. PMID:19687476

Zhang, Fujie; Dou, Zhihui; Ma, Ye; Zhao, Yan; Liu, Zhongfu; Bulterys, Marc; Chen, Ray Y.

2009-01-01

160

Factors Associated With Guideline-Concordant Use of Radiotherapy After Mastectomy in the National Comprehensive Cancer Network  

SciTech Connect

Purpose: We examined the rates and determinants of appropriate and inappropriate use of postmastectomy radiotherapy (PMRT), as defined by the National Comprehensive Cancer Network (NCCN) practice guidelines, among women with Stage I-II breast cancer (American Joint Committee on Cancer, 5th edition). Methods and Materials: Using clinical characteristics, 1,620 consecutive patients at eight NCCN institutions who had undergone mastectomy between July 1997 and June 2002 were classified into three cohorts according to whether the guidelines (1) recommended PMRT, (2) recommended against PMRT, or (3) made no definitive PMRT recommendation. We defined the absence of PMRT in the first cohort as underuse and receipt of PMRT in the second cohort as overuse. Multivariate logistic regression analysis was applied to investigate the association of clinical and sociodemographic factors with PMRT. Results: Overall, 23.8% of patients received PMRT. This included 199 (83.6%) of 238 in the 'recommend PMRT' cohort, 58 (5.6%) of 1,029 in the 'recommend against PMRT' cohort, and 127 (38.6%) of 329 in the 'consider PMRT' cohort. The only factor associated with underuse in the 'recommend PMRT' cohort was nonreceipt of chemotherapy (odds ratio [OR], 0.08; p <0.0001). In addition to tumor characteristics, the factors associated with overuse in the 'recommend against PMRT' cohort included age <50 years (OR, 2.28; p = 0.048), NCCN institution (OR, 1.04-8.29; p = 0.026), higher education (OR, 3.49; p = 0.001), and no reconstructive surgery (OR, 2.44; p = 0.019). The factors associated with PMRT in the 'consider PMRT' cohort included NCCN institution (OR, 1.1-9.01; p <0.0001), age <50 years (OR, 2.26; p = 0.041), and tumor characteristics. Conclusion: The results of our study have shown that concordance with definitive treatment guidelines was high. However, when current evidence does not support a definitive recommendation for PMRT, treatment decisions appear to be influenced, not only by patient age and clinical characteristics, but also by institution-specific patterns of care.

Punglia, Rinaa S. [Dana-Farber Cancer Institute, Boston, MA (United States)], E-mail: rpunglia@partners.org; Hughes, Melissa E. [Dana-Farber Cancer Institute, Boston, MA (United States); Edge, Stephen B. [Roswell Park Cancer Institute, Buffalo, NY (United States); Theriault, Richard L. [M. D. Anderson Cancer Center, Houston, TX (United States); Bookman, Michael A. [Fox Chase Cancer Center, Philadelphia, PA (United States); Wilson, John L. [Arthur G. James Cancer Hospital and Richard Solove Research Institute, Ohio State University, Columbus, OH (United States); Ottesen, Rebecca A.; Niland, Joyce C. [City of Hope National Medical Center, Duarte, CA (United States); Weeks, Jane C. [Dana-Farber Cancer Institute, Boston, MA (United States)

2008-12-01

161

Wilderness Medical Society practice guidelines for treatment of exercise-associated hyponatremia: 2014 update.  

PubMed

Exercise-associated hyponatremia (EAH) is defined by a serum or plasma sodium concentration below the normal reference range of 135 mmol/L that occurs during or up to 24 hours after prolonged physical activity. It is reported to occur in individual physical activities or during organized endurance events conducted in austere environments in which medical care is limited and often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to ensure a positive outcome. Failure in this regard is a recognized cause of event-related fatality. In an effort to produce best practice guidelines for EAH in the austere environment, the Wilderness Medical Society convened an expert panel. The panel was charged with the development of evidence-based guidelines for management of EAH. Recommendations are made regarding the situations when sodium concentration can be assessed in the field and when these values are not known. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Treatment of Exercise-Associated Hyponatremia published in Wilderness & Environmental Medicine 2013;24(3):228-240. PMID:25498260

Bennett, Brad L; Hew-Butler, Tamara; Hoffman, Martin D; Rogers, Ian R; Rosner, Mitchell H

2014-12-01

162

Starting treatment according to guidelines evaluation: a multicentre audit of HIV patients in the UK.  

PubMed

The aim of this audit was to assess whether HIV patients are being started on antiretroviral therapy (ART) according to British and European guidelines. Data were collected from the Survey of Prevalent HIV Infections Diagnosed (SOPHID) return for 2010 at five major HIV management centres in the UK. Data from this 3873 patient cohort revealed 52 patients who should have been receiving ART according to the guidelines but were not. Of these, 23 patients elected not to start ART despite clinical advice to the contrary. Information required to assist in the decision for earlier ART initiation (CD4 count 350–500 cells/mL) was missing for some patients. Clinicians must pay attention to the regular assessment of patients with a CD4 count of 351–500 cells/mL so that all those who may benefit from earlier treatment are identified. Future research should investigate patient barriers to initiating therapy following recommendation by a clinician. PMID:24400349

Reeves, I; Premchand, N; Schwenk, A; Brennan-Benson, P; Cumming, S; Lee, V; Whitehead, T

2013-03-01

163

International Guidelines for the Management and Treatment of Morquio A Syndrome  

PubMed Central

Morquio A syndrome (mucopolysaccharidosis IVA) is a lysosomal storage disorder associated with skeletal and joint abnormalities and significant non-skeletal manifestations including respiratory disease, spinal cord compression, cardiac disease, impaired vision, hearing loss, and dental problems. The clinical presentation, onset, severity and progression rate of clinical manifestations of Morquio A syndrome vary widely between patients. Because of the heterogeneous and progressive nature of the disease, the management of patients with Morquio A syndrome is challenging and requires a multidisciplinary approach, involving an array of specialists. The current paper presents international guidelines for the evaluation, treatment and symptom-based management of Morquio A syndrome. These guidelines were developed during two expert meetings by an international panel of specialists in pediatrics, genetics, orthopedics, pulmonology, cardiology, and anesthesia with extensive experience in managing Morquio A syndrome. © 2014 The Authors. American Journal of Medical Genetics Part A published by Wiley Periodicals, Inc. PMID:25346323

Hendriksz, Christian J; Berger, Kenneth I; Giugliani, Roberto; Harmatz, Paul; Kampmann, Christoph; Mackenzie, William G; Raiman, Julian; Villarreal, Martha Solano; Savarirayan, Ravi

2015-01-01

164

International guidelines for the management and treatment of Morquio A syndrome.  

PubMed

Morquio A syndrome (mucopolysaccharidosis IVA) is a lysosomal storage disorder associated with skeletal and joint abnormalities and significant non-skeletal manifestations including respiratory disease, spinal cord compression, cardiac disease, impaired vision, hearing loss, and dental problems. The clinical presentation, onset, severity and progression rate of clinical manifestations of Morquio A syndrome vary widely between patients. Because of the heterogeneous and progressive nature of the disease, the management of patients with Morquio A syndrome is challenging and requires a multidisciplinary approach, involving an array of specialists. The current paper presents international guidelines for the evaluation, treatment and symptom-based management of Morquio A syndrome. These guidelines were developed during two expert meetings by an international panel of specialists in pediatrics, genetics, orthopedics, pulmonology, cardiology, and anesthesia with extensive experience in managing Morquio A syndrome. © 2014 The Authors. American Journal of Medical Genetics Part A published by Wiley Periodicals, Inc. PMID:25346323

Hendriksz, Christian J; Berger, Kenneth I; Giugliani, Roberto; Harmatz, Paul; Kampmann, Christoph; Mackenzie, William G; Raiman, Julian; Villarreal, Martha Solano; Savarirayan, Ravi

2015-01-01

165

A practice guideline from the American College of Medical Genetics and Genomics and the National Society of Genetic Counselors: referral indications for cancer predisposition assessment.  

PubMed

Disclaimer: The practice guidelines of the American College of Medical Genetics and Genomics (ACMG) and the National Society of Genetic Counselors (NSGC) are developed by members of the ACMG and NSGC to assist medical geneticists, genetic counselors, and other health-care providers in making decisions about appropriate management of genetic concerns, including access to and/or delivery of services. Each practice guideline focuses on a clinical or practice-based issue and is the result of a review and analysis of current professional literature believed to be reliable. As such, information and recommendations within the ACMG and NSGC joint practice guidelines reflect the current scientific and clinical knowledge at the time of publication, are current only as of their publication date, and are subject to change without notice as advances emerge. In addition, variations in practice, which take into account the needs of the individual patient and the resources and limitations unique to the institution or type of practice, may warrant approaches, treatments, and/or procedures that differ from the recommendations outlined in this guideline. Therefore, these recommendations should not be construed as dictating an exclusive course of management, nor does the use of such recommendations guarantee a particular outcome. Genetic counseling practice guidelines are never intended to displace a health-care provider's best medical judgment based on the clinical circumstances of a particular patient or patient population. Practice guidelines are published by the ACMG or the NSGC for educational and informational purposes only, and neither the ACMG nor the NSGC "approve" or "endorse" any specific methods, practices, or sources of information.Cancer genetic consultation is an important aspect of the care of individuals at increased risk of a hereditary cancer syndrome. Yet several patient, clinician, and system-level barriers hinder identification of individuals appropriate for cancer genetics referral. Thus, the purpose of this practice guideline is to present a single set of comprehensive personal and family history criteria to facilitate identification and maximize appropriate referral of at-risk individuals for cancer genetic consultation. To develop this guideline, a literature search for hereditary cancer susceptibility syndromes was conducted using PubMed. In addition, GeneReviews and the National Comprehensive Cancer Network guidelines were reviewed when applicable. When conflicting guidelines were identified, the evidence was ranked as follows: position papers from national and professional organizations ranked highest, followed by consortium guidelines, and then peer-reviewed publications from single institutions. The criteria for cancer genetic consultation referral are provided in two formats: (i) tables that list the tumor type along with the criteria that, if met, would warrant a referral for a cancer genetic consultation and (ii) an alphabetical list of the syndromes, including a brief summary of each and the rationale for the referral criteria that were selected. Consider referral for a cancer genetic consultation if your patient or any of their first-degree relatives meet any of these referral criteria.Genet Med advance online publication 13 November 2014Genetics in Medicine (2014); doi:10.1038/gim.2014.147. PMID:25394175

Hampel, Heather; Bennett, Robin L; Buchanan, Adam; Pearlman, Rachel; Wiesner, Georgia L

2014-11-13

166

Results of new statin trials: Should the low-density lipoprotein cholesterol treatment guidelines be revised?  

Microsoft Academic Search

In December 2002, the National Cholesterol Education Program published its third expert panel report on the detection, evaluation,\\u000a and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Since then, many new studies suggest that a\\u000a more aggressive approach should be taken in cholesterol therapy. Based on these new clinical trials, the National Cholesterol\\u000a Education Program published recommended

Allison M. J. Ross; Theodore G. Ganiats

2005-01-01

167

S3-Guidelines for the Treatment of Inflammatory Breast Disease during the Lactation Period: AWMF Guidelines, Registry No.?015/071 (short version) AWMF Leitlinien-Register Nr.?015/071 (Kurzfassung).  

PubMed

Breastfeeding is widely acknowledged to be the best and most complete form of nutrition for healthy infants born at term and is associated with numerous benefits in terms of infants' health, growth, immunity and development. However, breastfeeding problems often result in early weaning. Standardized treatment recommendations for breastfeeding-related diseases are necessary to optimize the care offered to breastfeeding women. Evidence and consensus based guidelines for the treatment of puerperal mastitis, sore nipples, engorgement and blocked ducts were developed on the initiative of the National Breastfeeding Committee. These guidelines were developed in accordance with the criteria set up by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), the Association of Scientific Medical Societies in Germany. The recommendations were drawn up by an interdisciplinary group of experts and were based on a systematic search and evaluation of the literature but also took clinical experience into account. Additionally good clinical practice (GCP) in terms of expert opinion was formulated in cases where scientific investigations could not be performed or were not aimed for. This article presents a summary of the recommendations of the S3-guidelines. PMID:24771901

Jacobs, A; Abou-Dakn, M; Becker, K; Both, D; Gatermann, S; Gresens, R; Groß, M; Jochum, F; Kühnert, M; Rouw, E; Scheele, M; Strauss, A; Strempel, A-K; Vetter, K; Wöckel, A

2013-12-01

168

The 2013 Clinical Guidelines for the Diagnosis and Treatment of HIV/AIDS in HIV-Infected Koreans  

PubMed Central

While a variety of clinical guidelines for the diagnosis and treatment of HIV/AIDS are used extensively around the world, the implementation of such guidelines is not assured in Korea due to constraints with respect to the diagnostic tests and antiretroviral drugs currently available in the country. Consequently, the Committee for Clinical Guidelines for the Diagnosis and Treatment of HIV/AIDS of the Korean Society for AIDS was founded in 2010, and the first edition of the Korean guidelines was published a year later. However, due to the rapid discovery of new data in the field of HIV and the evolution of the clinical environment in Korea in the last few years, it has become necessary to revise the first set of guidelines. This guideline aims to provide comprehensive information regarding the diagnosis and management of HIV/AIDS in Korea. The recommendations contain important information for physicians working with HIV/AIDS in the clinical field. A brief summary of the revised guidelines and key changes to the original version of the guidelines are summarized below. PMID:24475362

2013-01-01

169

Direct nitrous oxide emissions from agricultural fields in China estimated by the revised 1996 IPPC guidelines for national greenhouse gases  

Microsoft Academic Search

Using revised 1996 IPCC guidelines for national greenhouse gases and statistic data in China Agricultural Yearbook, we estimated the direct nitrous oxide (N2O) emissions from agricultural fields in China for the following years: 1949, 1954, 1960, 1965, 1970, 1975, 1980, 1985, 1990 and 1995. Direct N2O emissions have been increasing continuously, from 26 Gg N in 1949 to 336 Gg

G. X. Xing; X. Y. Yan

1999-01-01

170

National Regulations and Guidelines and the Local Follow-Up in the Chain of Actions in Special Education  

ERIC Educational Resources Information Center

The topic of this article is the chain of actions in special education in Norwegian compulsory schooling. The main research question is: how do local practise concur with national regulations and guidelines in different phases of the chain of actions in special education? The study is carried out as an evaluation study. The criteria on which the…

Nilsen, Sven; Herlofsen, Camilla

2012-01-01

171

Guidelines for Reporting Case Studies on Extracorporeal Treatments in Poisonings: Methodology  

PubMed Central

A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup highlighted deficiencies in the existing literature, especially the reporting of case studies. Although general reporting guidelines exist for case studies, there are none in the specific field of extracorporeal treatments in toxicology. Our goal was to construct and propose a checklist that systematically outlines the minimum essential items to be reported in a case study of poisoned patients undergoing extracorporeal treatments. Through a modified two-round Delphi technique, panelists (mostly chosen from the EXTRIP workgroup) were asked to vote on the pertinence of a set of items to identify those considered minimally essential for reporting complete and accurate case reports. Furthermore, independent raters validated the clarity of each selected items between each round of voting. All case reports containing data on extracorporeal treatments in poisoning published in Medline in 2011 were reviewed during the external validation rounds. Twenty-one panelists (20 from the EXTRIP workgroup and an invited expert on pharmacology reporting guidelines) participated in the modified Delphi technique. This group included journal editors and experts in nephrology, clinical toxicology, critical care medicine, emergency medicine, and clinical pharmacology. Three independent raters participated in the validation rounds. Panelists voted on a total of 144 items in the first round and 137 items in the second round, with response rates of 96.3% and 98.3%, respectively. Twenty case reports were evaluated at each validation round and the independent raters' response rate was 99.6% and 98.8% per validation round. The final checklist consists of 114 items considered essential for case study reporting. This methodology of alternate voting and external validation rounds was useful in developing the first reporting guideline for case studies in the field of extracorporeal treatments in poisoning. We believe that this guideline will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports may provide early signals of effectiveness and/or harm, thereby improving healthcare decision-making. PMID:24890576

Lavergne, Valéry; Ouellet, Georges; Bouchard, Josée; Galvao, Tais; Kielstein, Jan T; Roberts, Darren M; Kanji, Salmaan; Mowry, James B; Calello, Diane P; Hoffman, Robert S; Gosselin, Sophie; Nolin, Thomas D; Goldfarb, David S; Burdmann, Emmanuel A; Dargan, Paul I; Decker, Brian Scott; Hoegberg, Lotte C; Maclaren, Robert; Megarbane, Bruno; Sowinski, Kevin M; Yates, Christopher; Mactier, Robert; Wiegand, Timothy; Ghannoum, Marc

2014-01-01

172

Clinical practice guidelines for treatment of acne vulgaris: a critical appraisal using the AGREE II instrument.  

PubMed

A significant number of clinical practice guidelines (CPGs) about the treatment of acne vulgaris in adolescents and adults have been published worldwide. However, little is known about the quality of CPGs in this field. The aim of this study was to appraise the methodological quality of published acne vulgaris CPGs. We performed a systematic review of published CPGs on acne vulgaris therapy from July 2002 to July 2012. Three reviewers independently assessed each CPG using the AGREE II instrument. A standardized score was calculated for each of the six domains. Our search strategy identified 103 citations but just six met our inclusion criteria. Agreement among reviewers was very good: 0.981. The domains that scored better were: "scope and purpose" and "clarity and presentation". Those that scored worse were "stakeholder involvement", "rigor of development", and "applicability". The European and the Malaysian CPGs were the only recommended with no further modifications. In addition, the Mexican, Colombian and the United States guidelines were recommended with provisos, with lower scores regarding stakeholder involvement, rigor of development and applicability. Only two guidelines clearly reported outcome measures for evaluating efficacy or included quality of life outcomes. CPGs varied regarding the consideration of light/laser therapy or consideration of complementary/alternative medicines. None of them included cost considerations of drugs such as systemic isotretinoin. In conclusion, published acne vulgaris CPGs for acne therapy vary in quality with a clear need to improve their methodological rigor. This could be achieved with the adherence to current CPGs development standards. PMID:23925586

Sanclemente, Gloria; Acosta, Jorge-Luis; Tamayo, Maria-Eulalia; Bonfill, Xavier; Alonso-Coello, Pablo

2014-04-01

173

Evolving guidelines in the use of topical nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis  

PubMed Central

Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are a standard treatment for osteoarthritis (OA), but the use of oral NSAIDs has been linked to an elevated risk for cardiovascular and gastrointestinal adverse events and renal toxicity. Topical NSAIDs are thought to afford efficacy that is comparable to oral formulations while reducing widespread systemic drug exposure, which may provide a benefit in terms of safety and tolerability. As a result, European treatment guidelines have, for many years, recommended the use of topical NSAIDs as a safe and effective treatment option for OA. Following the recent approval of several topical NSAID formulations by the US Food and Drug Administration, US treatment guidelines are increasingly recommending the use of topical NSAIDs as an alternative therapy and, in some cases, as a first-line option for OA. This commentary summarizes OA treatment guidelines that are currently available and discusses their potential evolution with regard to the increased inclusion of topical NSAIDs. PMID:24444047

2014-01-01

174

Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs  

SciTech Connect

Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

Kelekis, Alexis D., E-mail: akelekis@med.uoa.gr; Filippiadis, Dimitris K., E-mail: dfilippiadis@yahoo.g [Attikon University Hospital, 2nd Radiology Department (Greece); Martin, Jean-Baptiste, E-mail: jbmartin@cird.c [Geneva University Hospital, Service d'Imagerie Medicale (Switzerland); Brountzos, Elias, E-mail: ebrountz@med.uoa.g [Attikon University Hospital, 2nd Radiology Department (Greece)

2010-10-15

175

Implementation of the NICE guideline - recommendations from the British Fertility Society for national criteria for NHS funding of assisted conception.  

PubMed

Assisted conception providers in England were surveyed to establish the uptake of NICE guideline for infertility particularly in respect of assisted conception and the criteria used to accept patients for NHS funded treatment. Detailed information on selection criteria was obtained from a group of commissioning consortia at an advanced stage in their arrangements. While there was an overall increase in the number of NHS IVF cycles purchased in England, implementation is stalled at one fresh cycle in the vast majority of Primary Care Trusts (PCTs). There is little consensus about the criteria used for acceptance into an NHS programme. This is particularly so in respect of social criteria which are often arbitrary and used as a rationing tool. This information complements that provided by the survey of Primary Care Trusts performed in March 2005 by the All Party Parliamentary Group on Infertility (APPGI) in partnership with the National Infertility Awareness Campaign (NIAC) which together provide a basis for recommendations for NHS funding. The recommendations presented should be applied across England and Wales to ensure consistency, fairness and equity of access. PMID:17008271

Kennedy, R; Kingsland, C; Rutherford, A; Hamilton, M; Ledger, W

2006-09-01

176

Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies.  

PubMed

Since the previous publication of Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines in 1997, there has been a substantial increase in evidence-based treatment options for bipolar disorder. The present guidelines review the new evidence and use criteria to rate strength of evidence and incorporate effectiveness, safety, and tolerability data to determine global clinical recommendations for treatment of various phases of bipolar disorder. The guidelines suggest that although pharmacotherapy forms the cornerstone of management, utilization of adjunctive psychosocial treatments and incorporation of chronic disease management model involving a healthcare team are required in providing optimal management for patients with bipolar disorder. Lithium, valproate and several atypical antipsychotics are first-line treatments for acute mania. Bipolar depression and mixed states are frequently associated with suicidal acts; therefore assessment for suicide should always be an integral part of managing any bipolar patient. Lithium, lamotrigine or various combinations of antidepressant and mood-stabilizing agents are first-line treatments for bipolar depression. First-line options in the maintenance treatment of bipolar disorder are lithium, lamotrigine, valproate and olanzapine. Historical and symptom profiles help with treatment selection. With the growing recognition of bipolar II disorders, it is anticipated that a larger body of evidence will become available to guide treatment of this common and disabling condition. These guidelines also discuss issues related to bipolar disorder in women and those with comorbidity and include a section on safety and monitoring. PMID:15952957

Yatham, Lakshmi N; Kennedy, Sidney H; O'Donovan, Claire; Parikh, Sagar; MacQueen, Glenda; McIntyre, Roger; Sharma, Verinder; Silverstone, Peter; Alda, Martin; Baruch, Philippe; Beaulieu, Serge; Daigneault, Andree; Milev, Roumen; Young, L Trevor; Ravindran, Arun; Schaffer, Ayal; Connolly, Mary; Gorman, Chris P

2005-01-01

177

Wilderness medical society practice guidelines for treatment of eye injuries and illnesses in the wilderness: 2014 update.  

PubMed

A panel convened to develop an evidence-based set of guidelines for the recognition and treatment of eye injuries and illnesses that may occur in the wilderness. These guidelines are meant to serve as a tool to help wilderness providers accurately identify and subsequently treat or evacuate for a variety of ophthalmologic complaints. Recommendations are graded on the basis of the quality of their supporting evidence and the balance between risks and benefits according to criteria developed by the American College of Chest Physicians. This is an updated version of the original guidelines published in Wilderness & Environmental Medicine 2012;23(4):325-336. PMID:25498259

Paterson, Ryan; Drake, Brandy; Tabin, Geoffrey; Butler, Frank K; Cushing, Tracy

2014-12-01

178

Criminal Justice and Alcohol Treatment: Results from a National Sample  

PubMed Central

This study investigates the associations of recent criminal justice involvement with perceived need for alcohol treatment and alcohol treatment utilization, adjusting for demographic and clinical characteristics. We examined a national sample of adults with alcohol use disorders (AUD, N=4,390) from the 2006 National Survey on Drug Use and Health (NSDUH). Almost 15% reported criminal justice involvement in the past year. Generalized logit models regressed perceived need for alcohol or drug treatment and past year treatment utilization (versus neither) on past year legal involvement, demographic, and clinical information. In general, results found stronger associations between frequency of criminal justice involvement for treatment utilization compared to perceived need for treatment alone. Treatment utilization was also associated with being on probation, arrests for drug possession/sale and DUI but perceived need was not. Study results suggest opportunities for interventions to increase treatment rates or treatment need, a major correlate of treatment utilization. PMID:22954511

Booth, Brenda M.; Curran, Geoffrey M.; Han, Xiaotong; Edlund, Mark J.

2012-01-01

179

[French Society of Vascular Medicine good medical practice guidelines on safety and environment in vascular medicine: Treatment of varicose veins].  

PubMed

These guidelines proposed by the French Society of Vascular Medicine define the optimal environment for vascular medicine practice: outpatient clinic; equipment, layout and maintenance of the care center; infection risk prevention (hand hygiene, individual protective measures, exposure to blood, ultrasound apparatus, etc.); common interventions and techniques (liquid and foam sclerotherapy, endovenous thermal treatments). These guidelines do not include phlebectomy and use of ultrasound contrast agents. PMID:25451022

Giordana, P; Miserey, G

2014-12-01

180

Profile of lacosamide and its role in the long-term treatment of epilepsy: a perspective from the updated NICE guideline  

PubMed Central

Aim The goal of antiepileptic treatment is to achieve seizure freedom or seizure control. The aim of this paper is to review the evidence for the use of lacosamide for adjunctive treatment of refractory focal seizures with or without secondary generalization, within the scope of the 2012 update of the Clinical Guideline published by the National Institute for Health and Clinical Excellence (NICE). Methods Clinical evidence for the use of lacosamide and other antiepileptic drugs (AEDs) was systematically reviewed, evaluated, and presented to the Guideline Development Group. Only randomized clinical trials were included. Outcomes of clinical efficacy (seizure freedom, 50% reduction in seizure frequency, time to first seizure, time to 12-month remission, treatment withdrawal, and time to treatment withdrawal), experience of adverse events, and cognitive and quality of life outcomes were reviewed. A decision model was built to weigh the clinical benefits of each adjunctive AED, measured by seizure control and seizure reduction, compared with the harm from adverse events, as measured by withdrawals from treatment due to adverse events. Results Lacosamide was included as part of the recommended AEDS to be used in tertiary epilepsy centers. The evidence review showed that more participants who received lacosamide as an adjunctive treatment had at least a 50% reduction in seizure frequency compared with those taking placebo. However, more participants on lacosamide were found to experience adverse events and withdrawal from treatment compared with those on placebo. The cost-effectiveness analysis showed that compared with placebo, the benefits gained from adjunctive lacosamide were modest and uncertain, whereas the costs were significantly high. Compared with other AEDs licensed for adjunctive therapy in focal seizures, lacosamide was associated with fewer quality-adjusted life years and higher costs. Therefore, the Guideline Development Group noted that the balance of benefit and harm needs to be carefully monitored in all patients. PMID:23630422

Nunes, Vanessa Delgado; Sawyer, Laura; Neilson, Julie; Sarri, Grammati; Cross, J Helen

2013-01-01

181

76 FR 18713 - Malheur National Forest; Oregon; Malheur National Forest Site-Specific Invasive Plants Treatment...  

Federal Register 2010, 2011, 2012, 2013

...to eradicate, control, or contain...Malheur National Forest. The Proposed...methods including chemical (herbicides...and biological controls. These treatments...methods including chemical (herbicides...and biological controls. Treatment could be anywhere on Forest Service...

2011-04-05

182

Health impact assessment: A comparison of 45 local, national, and international guidelines  

SciTech Connect

This article provides a comparison of health impact assessment (HIA) guidelines from around the world and for multiple geographic scales. We identify commonalities and differences within HIA guides to discuss the plausibility of consensus guidelines and to inform guideline development. The practice of HIA has grown over the last two decades with a concurrent growth of HIA guides. This study expands on earlier review work and includes guides published since 2007 (Mindell, Boltong and Forde, 2008). From April 2010 to October 2011, 45 HIA guides were identified through an internet search and review of previous research. Common characteristics, key features, and the HIA process were analyzed. The 45 documents recommended similar but not identical processes for conducting HIAs. These analyses suggest that guidelines for HIAs are similar in many areas of the world and that new HIA practitioners can use these findings to inform their approach. Further discussion is needed to determine if the approaches established in these guidelines are followed and if one set of common guidelines could be written for use in numerous countries and regions. - Highlights: Black-Right-Pointing-Pointer We analyze 45 health impact assessment (HIA) guidelines worldwide. Black-Right-Pointing-Pointer We examine similarities and unique attributes of each guideline. Black-Right-Pointing-Pointer We discuss the advantages and disadvantages of developing consensus guidelines. Black-Right-Pointing-Pointer Identifying additional guidelines aides in future HIA work and evaluation.

Hebert, Katherine A., E-mail: jsx3@cdc.gov; Wendel, Arthur M., E-mail: dvq6@cdc.gov; Kennedy, Sarah K., E-mail: heaton.sarah@gmail.com; Dannenberg, Andrew L., E-mail: adannenberg2@gmail.com

2012-04-15

183

A National Evaluation of Treatment Outcomes for Cocaine Dependence  

Microsoft Academic Search

Background: This national study focused on posttreat- ment outcomes of community treatments of cocaine de- pendence. Relapse to weekly (or more frequent) co- caine use in the first year after discharge from 3 major treatment modalities was examined in relation to pa- tient problem severity at admission to the treatment pro- gram and length of stay. Methods: We studied 1605

D. Dwayne Simpson; George W. Joe; Bennett W. Fletcher; Robert L. Hubbard; M. Douglas Anglin

1999-01-01

184

European guidelines for the diagnosis and treatment of pelvic girdle pain  

PubMed Central

A guideline on pelvic girdle pain (PGP) was developed by “Working Group 4” within the framework of the COST ACTION B13 “Low back pain: guidelines for its management”, issued by the European Commission, Research Directorate-General, Department of Policy, Coordination and Strategy. To ensure an evidence-based approach, three subgroups were formed to explore: (a) basic information, (b) diagnostics and epidemiology, and (c) therapeutical interventions. The progress of the subgroups was discussed at each meeting and the final report is based on group consensus. A grading system was used to denote the strength of the evidence, based on the AHCPR Guidelines (1994) and levels of evidence recommended in the method guidelines of the Cochrane Back Review group. It is concluded that PGP is a specific form of low back pain (LBP) that can occur separately or in conjunction with LBP. PGP generally arises in relation to pregnancy, trauma, arthritis and/or osteoarthritis. Uniform definitions are proposed for PGP as well as for joint stability. The point prevalence of pregnant women suffering from PGP is about 20%. Risk factors for developing PGP during pregnancy are most probably a history of previous LBP, and previous trauma to the pelvis. There is agreement that non risk factors are: contraceptive pills, time interval since last pregnancy, height, weight, smoking, and most probably age. PGP can be diagnosed by pain provocation tests (P4/thigh thrust, Patrick’s Faber, Gaenslen’s test, and modified Trendelenburg’s test) and pain palpation tests (long dorsal ligament test and palpation of the symphysis). As a functional test, the active straight leg raise (ASLR) test is recommended. Mobility (palpation) tests, X-rays, CT, scintigraphy, diagnostic injections and diagnostic external pelvic fixation are not recommended. MRI may be used to exclude ankylosing spondylitis and in the case of positive red flags. The recommended treatment includes adequate information and reassurance of the patient, individualized exercises for pregnant women and an individualized multifactorial treatment program for other patients. We recommend medication (excluding pregnant women), if necessary, for pain relief. Recommendations are made for future research on PGP. PMID:18259783

Albert, Hanne B.; Östgaard, Hans Christian; Sturesson, Bengt; Stuge, Britt

2008-01-01

185

[Teaching psychiatric nursing/mental health: its interface with the Brazilian psychiatric reform and national curriculum guidelines].  

PubMed

This theoretical study addresses the education system for Psychiatric Nursing in an increasingly changing world of accelerated scientific and technological modernization. The objective is to discuss the pedagogy in Psychiatric Nursing, and its interface with the principles of the Brazilian psychiatric reform and national curriculum guidelines of nursing undergraduate courses. The theoretical foundation of the study consisted of constructs of the Brazilian psychiatric reform and national curriculum guidelines of nursing undergraduate courses and their relationship to factors constituting the pedagogy in psychiatric nursing. The study shows that it is not enough to identify technical issues regarding contents and teaching, didactic procedures, methods and pedagogical techniques; it is necessary to implement changes, using a new perspective and by daring to question the nature of knowledge and institutional psychiatric practices. PMID:20085170

Fernandes, Josicelia Dumêt; Sadigursky, Dora; Silva, Rosana Maria de Oliveira; Amorim, Aclair Bastos; Teixeira, Giselle Alves da Silva; de Araújo, Maria da Conceição Filgueiras

2009-12-01

186

Spanish Society of Nephrology document on KDIGO guidelines for the assessment and treatment of chronic kidney disease.  

PubMed

The new Kidney Disease: Improving Global Outcomes (KDIGO) international guidelines on chronic kidney disease (CKD) and the management of blood pressure (BP) in CKD patients are an update of the corresponding 2002 and 2004 KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines. The documents aim to provide updated guidelines on the assessment, management and treatment of patients with CKD. The first guidelines retain the 2002 definition of CKD but present an improved prognosis classification. Furthermore, concepts about prognosis of CKD, recommendations for management of patients, and criteria for referral to the nephrologist have been updated. The second guideline retains the <130/80 mm Hg-goal for management of BP in patients with CKD presenting increased albuminuria or proteinuria (albumin-to-creatinine ratio 30-300 mg/g, and >300 mg/g, respectively) but recommends a less-strict goal of <140/90 mm Hg in patients with normoalbuminuria. The development of the guidelines followed a predetermined process in which the evidence available was reviewed and assessed. Recommendations on management and treatment are based on the systematic review of relevant studies. The GRADE system (Grading of Recommendations Assessment, Development and Evaluation) was used to assess the quality of evidence and issue the grade of recommendation. Areas of uncertainty are also discussed for the different aspects addressed. PMID:24798565

Gorostidi, Manuel; Santamaría, Rafael; Alcázar, Roberto; Fernández-Fresnedo, Gema; Galcerán, Josep M; Goicoechea, Marián; Oliveras, Anna; Portolés, José; Rubio, Esther; Segura, Julián; Aranda, Pedro; de Francisco, Angel L M; Del Pino, M Dolores; Fernández-Vega, Francisco; Górriz, José L; Luño, José; Marín, Rafael; Martínez, Isabel; Martínez-Castelao, Alberto; Orte, Luis M; Quereda, Carlos; Rodríguez-Pérez, José C; Rodríguez, Mariano; Ruilope, Luis M

2014-05-21

187

Assessment, behavioral treatment, and prevention of pica: clinical guidelines and recommendations for practitioners.  

PubMed

Pica is a dangerous form of self-injurious behavior that occurs in people with developmental disabilities who are institutionalized. Studies also indicate that pica has led to the death of people with developmental disabilities. While a number of published studies have demonstrated that pica behavior can be decreased substantially with behavioral treatment, few of these studies incorporated strategies for generalization and maintenance outside of brief sessions. A second limitation of current research is that some studies reduced pica substantially, but pica responses still occurred at rates that are problematic in terms of prevention of adverse consequences, which leaves practitioners with the task of further decreasing pica to protect people exhibiting pica from harm. We make recommendations for assessment, treatment, and prevention of pica for practitioners. These recommendations are based on two extensive reviews of the literature and our extensive experience as practitioners in the treatment of pica. Our hope is that administrators, professionals and practitioners will consider our guidelines and recommendations as they attempt to protect people with pica and developmental disabilities from harm by developing standards for assessment, treatment and prevention for this difficult-to-treat population. Our hope is that children with pica will receive early intervention to prevent pica from developing into life-threatening behavior. PMID:22750361

Williams, Don E; McAdam, David

2012-01-01

188

Treatment guidelines for temporomandibular joint ankylosis with secondary dentofacial deformities in adults.  

PubMed

Temporomandibular joint (TMJ) ankylosis with secondary dentofacial deformities in adult patients is a severely disfiguring condition and surgical treatment of this disease remains a great clinical challenge. Treatment goals are to restore the joint function, to improve facial appearances and to correct malocclusion, as well as to re-establishing harmony among them. Currently, various surgical techniques, such as arthroplasty with or without interpositional material, orthognathic surgery, distraction osteogenesis, autologous bone or bone replacement materials graft and plastic surgery, have been described in the literature. In most cases these techniques should be used in combination to achieve satisfactory outcomes. The biggest difficulty for most clinicians is to determine the proper sequence of these procedures because no uniform treatment protocol has been established. Based on the published literature and our own clinical experiences, we have prepared this review article to provide some guidelines for the surgical management of TMJ ankylosis with dentofacial deformities in adults, which will be modified and updated periodically to provide the best treatment options to benefit our patients. PMID:23321052

Zhu, Songsong; Wang, Dazhang; Yin, Qiudan; Hu, Jing

2013-10-01

189

Prevention and treatment of venous thromboembolism with low-molecular-weight heparins: Clinical implications of the recent European guidelines  

PubMed Central

Venous thromboembolism (VTE) is an important cause of avoidable morbidity and mortality. However, routine prophylaxis for at-risk patients is underused. Recent guidelines issued by an international consensus group, including the International Union of Angiology (IUA), recommend use of low-molecular-weight heparins (LMWHs) for the treatment of acute VTE and prevention of recurrence, and for prophylaxis in surgical and medical patients. This review highlights current inadequacies in the provision of thromboprophylaxis, and considers the clinical implications of the European guidelines on the prevention and treatment of VTE. PMID:18782432

Prandoni, Paolo

2008-01-01

190

Improving Quality: Core Mission for Developing Higher Education in the "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)"  

ERIC Educational Resources Information Center

The "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)" (hereafter abbreviated as the "Guideline") has pointed out that the core mission for the development of China's higher education in the next decade is to improve quality. This development mission was put forward against the background of China's higher…

Kai, Jiang

2012-01-01

191

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders. Part 2: Maintenance Treatment of Major Depressive Disorder-Update 2015.  

PubMed

Abstract These guidelines for the treatment of unipolar depressive disorders systematically review available evidence pertaining to the biological treatment of patients with major depression and produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians assessing and treating patients with these conditions. The relevant data have been extracted primarily from various treatment guidelines and panels for depressive disorders, as well as from meta-analyses/reviews on the efficacy of antidepressant medications and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and was then categorized into five levels of evidence (CE A-F) and five levels of recommendation grades (RG 1-5). This second part of the WFSBP guidelines on depressive disorders covers the management of the maintenance phase treatment, and is primarily concerned with the biological treatment (including pharmacological and hormonal medications, electroconvulsive therapy and other brain stimulation treatments) of adults and also, albeit to a lesser extent, children, adolescents and older adults. PMID:25677972

Bauer, Michael; Severus, Emanuel; Köhler, Stephan; Whybrow, Peter C; Angst, Jules; Möller, Hans-Jürgen

2015-02-01

192

Developing Guidelines on the Assessment and Treatment of Delirium in Older Adults at the End of Life  

PubMed Central

Background and Purpose Delirium at the end of life is common and can have serious consequences on an older person’s quality of life and death. In spite of the importance of detecting, diagnosing, and managing delirium at the end of life, comprehensive clinical practice guidelines (CPG) are lacking. Our objective was to develop CPG for the assessment and treatment of delirium that would be applicable to seniors receiving end-of-life care in diverse settings. Methods Using as a starting point the 2006 Canadian Coalition for Seniors’ Mental Health CPG on the assessment and treatment of delirium, a team of palliative care researchers and clinicians partnered with members of the original guideline development group to adapt the guidelines for an end-of-life care context. This process was supported by an extensive literature review. The final guidelines were reviewed by external experts. Results Comprehensive CPG on the assessment and treatment of delirium in older adults at the end of life were developed and can be downloaded from http://www.ccsmh.ca. Conclusions Further research is needed on the implementation and evaluation of these adapted delirium guidelines for older patients receiving end-of-life care in various palliative care settings. PMID:23251311

Brajtman, Susan; Wright, David; Hogan, David B.; Allard, Pierre; Bruto, Venera; Burne, Deborah; Gage, Laura; Gagnon, Pierre R.; Sadowski, Cheryl A.; Helsdingen, Sherri; Wilson, Kimberley

2011-01-01

193

MANAGEMENT OF ASTHMA EXACERBATIONS: School Treatment National Asthma Education and  

E-print Network

MANAGEMENT OF ASTHMA EXACERBATIONS: School Treatment National Asthma Education and Prevention Program National Asthma Education and Prevention Program Steps to Follow for an Asthma Episode in the School Setting When a Nurse is Not Available Be prepared. Know which students have asthma and where

Bandettini, Peter A.

194

MANAGEMENT OF ASTHMA EXACERBATIONS: School Treatment National Asthma Education and  

E-print Network

MANAGEMENT OF ASTHMA EXACERBATIONS: School Treatment National Asthma Education and Prevention Program Suggested Emergency Nursing Protocol for Students with Asthma Symptoms Who Don't Have a Personal Asthma Action Plan National Asthma Education and Prevention Program A student with asthma symptoms should

Bandettini, Peter A.

195

Version 4.2014, 08/22/14 National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN . NCCN Guidelines Index  

E-print Network

Version 4.2014, 08/22/14 © National Comprehensive Cancer Network, Inc. 2014, All rights reserved permission of NCCN . ®® NCCN Guidelines Index NHL Table of Contents Discussion Continue NCCN Clinical;Version 4.2014, 08/22/14 © National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN

Bogyo, Matthew

196

[Diagnosis and treatment of aortic diseases : new guidelines of the European Society of Cardiology 2014].  

PubMed

In September 2014 the European Society of Cardiology issued guidelines for the diagnosis and treatment of aortic diseases in adults. Contrast-enhanced computed tomography (CT) represents the imaging modality of first choice as it is rapidly and almost ubiquitously available and can evaluate the entire aorta in a single-step examination. In patients with a high clinical suspicion of an acute aortic syndrome based on (family) history and symptoms, CT should be performed without further delay to confirm or refute the diagnosis. Diseases involving the ascending aorta remain a domain of open surgery, be it on an emergency basis in an acute type A dissection or electively in asymptomatic aneurysms with an aortic diameter >5.5 cm. The presence of risk factors (e. g. bicuspid aortic valve, Marfan syndrome and aortic dissection/rupture in the family history) may prompt earlier surgical repair at a lower threshold diameter. The treatment of descending aortic disease is primarily conservative including modification of cardiovascular risk factors. If indicated, endovascular aortic stent graft repair appears to be superior to open surgery for descending thoracic aortic disease or equivalent in the treatment of infrarenal abdominal aortic aneurysms. The management of aortic diseases related to genetic connective tissue diseases (e. g. Marfan syndrome, Loeys-Dietz syndrome and Ehlers-Danlos syndrome) is complex and requires special multidisciplinary expertise. PMID:25406331

Eggebrecht, H

2014-12-01

197

Technology for Water Treatment (National Water Management)  

NASA Technical Reports Server (NTRS)

The buildup of scale and corrosion is the most costly maintenance problem in cooling tower operation. Jet Propulsion Laboratory successfully developed a non-chemical system that not only curbed scale and corrosion, but also offered advantages in water conservation, cost savings and the elimination of toxic chemical discharge. In the system, ozone is produced by an on-site generator and introduced to the cooling tower water. Organic impurities are oxidized, and the dissolved ozone removes bacteria and scale. National Water Management, a NASA licensee, has installed its ozone advantage systems at some 200 cooling towers. Customers have saved money and eliminated chemical storage and discharge.

1992-01-01

198

75 FR 32191 - National Health and Nutrition Examination Survey (NHANES) DNA Samples: Guidelines for Proposals...  

Federal Register 2010, 2011, 2012, 2013

...and Nutrition Examination Survey (NHANES) DNA Samples: Guidelines for Proposals To Use Samples...of describing the health of the population, DNA specimens were collected during three NHANES surveys. DNA is available in the form of crude lysates...

2010-06-07

199

Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy.  

PubMed

Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this fifth of 6 sections of the guidelines of care for psoriasis, we discuss the use of ultraviolet (UV) light therapy for the treatment of patients with psoriasis. Treatment should be tailored to meet individual patients' needs. We will discuss in detail the efficacy and safety as well as offer recommendations for the use of phototherapy, including narrowband and broadband UVB and photochemotherapy using psoralen plus UVA, alone and in combination with topical and systemic agents. We will also discuss the available data for the use of the excimer laser in the targeted treatment of psoriasis. Finally, where available, we will summarize the available data that compare the safety and efficacy of the different forms of UV light therapy. PMID:19811850

Menter, Alan; Korman, Neil J; Elmets, Craig A; Feldman, Steven R; Gelfand, Joel M; Gordon, Kenneth B; Gottlieb, Alice; Koo, John Y M; Lebwohl, Mark; Lim, Henry W; Van Voorhees, Abby S; Beutner, Karl R; Bhushan, Reva

2010-01-01

200

Antibiotic prescribing in nursing homes in an area with low prevalence of antibiotic resistance: Compliance with national guidelines  

PubMed Central

Objective To examine antibiotic prescribing in nursing homes and determine to what degree the prescribing was in accordance with the national guidelines for antibiotic prescribing. Design Retrospective examination of patients’ records who were prescribed antibiotics in the period 1 March 2007 to 28 February 2008. Setting and patients Patients residing in the nursing homes of Arendal, Norway. Main outcome measures Choice of antibiotic in respect of the recommendations in the national guidelines for antibiotic prescribing. Results A total of 714 antibiotic courses were prescribed to 327 patients yielding a prevalence of 6.6%. Compliant prescribing was 77% for urinary tract infections (UTI), 79% for respiratory tract infections (RTI), and 76% for skin and soft tissue infections (SSTI). Ciprofloxacin was responsible for 63% of non-compliant prescribing. On the respite wards there was a higher rate of total prescribing, non-compliant prescribing, and prescribing by physicians employed at the local hospital. Conclusion Guidelines for antibiotic use must be implemented actively and efforts to improve antibiotic prescribing in nursing homes must be aimed at both nursing home and hospital physicians. PMID:22188479

Fagan, Mark; Mæhlen, Marthe; Lindbæk, Morten; Berild, Dag

2012-01-01

201

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

Microsoft Academic Search

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

David S. Baldwin; Ian M. Anderson; David J. Nutt; Borwin Bandelow; A. Bond; Jonathan R. T. Davidson; J. A. den Boer; Naomi A. Fineberg; Martin Knapp; J. Scott; H.-U. Wittchen

2005-01-01

202

Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up.  

PubMed

Squamous cell carcinoma of the anus (SCCA) is a rare cancer but its incidence is increasing throughout the world, and is particularly high in the human immunodeficiency virus positive (HIV+) population. A multidisciplinary approach is mandatory (involving radiation therapists, medical oncologists, surgeons, radiologists and pathologists). SCCA usually spreads in a loco-regional manner within and outside the anal canal. Lymph node involvement at diagnosis is observed in 30%-40% of cases while systemic spread is uncommon with distant extrapelvic metastases recorded in 5%-8% at onset, and rates of metastatic progression after primary treatment between 10 and 20%. SCCA is strongly associated with human papilloma virus (HPV, types 16-18) infection. The primary aim of treatment is to achieve cure with loco-regional control and preservation of anal function, with the best possible quality of life. Treatment dramatically differs from adenocarcinomas of the lower rectum. Combinations of 5FU-based chemoradiation and other cytotoxic agents (mitomycin C) have been established as the standard of care, leading to complete tumour regression in 80%-90% of patients with locoregional failures in the region of 15%. There is an accepted role for surgical salvage. Assessment and treatment should be carried out in specialised centres treating a high number of patients as early as possible in the clinical diagnosis. To date, the limited evidence from only 6 randomised trials [1,2,3,4,5,6,7], the rarity of the cancer, and the different behaviour/natural history depending on the predominant site of origin, (the anal margin, anal canal or above the dentate line) provide scanty direction for any individual oncologist. Here we aim to provide guidelines which can assist medical, radiation and surgical oncologists in the practical management of this unusual cancer. PMID:25239441

Glynne-Jones, R; Nilsson, P J; Aschele, C; Goh, V; Peiffert, D; Cervantes, A; Arnold, D

2014-10-01

203

Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up.  

PubMed

Squamous cell carcinoma of the anus (SCCA) is a rare cancer but its incidence is increasing throughout the world, and is particularly high in the human immunodeficiency virus positive (HIV+) population. A multidisciplinary approach is mandatory (involving radiation therapists, medical oncologists, surgeons, radiologists and pathologists). SCCA usually spreads in a loco-regional manner within and outside the anal canal. Lymph node involvement at diagnosis is observed in 30-40% of cases while systemic spread is uncommon with distant extrapelvic metastases recorded in 5-8% at onset, and rates of metastatic progression after primary treatment between 10% and 20%. SCCA is strongly associated with human papilloma virus (HPV, types 16-18) infection. The primary aim of treatment is to achieve cure with loco-regional control and preservation of anal function, with the best possible quality of life. Treatment dramatically differs from adenocarcinomas of the lower rectum. Combinations of 5FU-based chemoradiation and other cytotoxic agents (mitomycin C) have been established as the standard of care, leading to complete tumour regression in 80-90% of patients with locoregional failures in the region of 15%. There is an accepted role for surgical salvage. Assessment and treatment should be carried out in specialised centres treating a high number of patients as early as possible in the clinical diagnosis. To date, the limited evidence from only 6 randomised trials [1,2,3,4,5,6,7], the rarity of the cancer, and the different behaviour/natural history depending on the predominant site of origin, (the anal margin, anal canal or above the dentate line) provide scanty direction for any individual oncologist. Here we aim to provide guidelines which can assist medical, radiation and surgical oncologists in the practical management of this unusual cancer. PMID:24947004

Glynne-Jones, Robert; Nilsson, Per J; Aschele, Carlo; Goh, Vicky; Peiffert, Didier; Cervantes, Andrés; Arnold, Dirk

2014-06-01

204

Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents.  

PubMed

Atopic dermatitis is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in atopic dermatitis management and care, providing recommendations based on the available evidence. In this third of 4 sections, treatment of atopic dermatitis with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option. PMID:24813298

Sidbury, Robert; Davis, Dawn M; Cohen, David E; Cordoro, Kelly M; Berger, Timothy G; Bergman, James N; Chamlin, Sarah L; Cooper, Kevin D; Feldman, Steven R; Hanifin, Jon M; Krol, Alfons; Margolis, David J; Paller, Amy S; Schwarzenberger, Kathryn; Silverman, Robert A; Simpson, Eric L; Tom, Wynnis L; Williams, Hywel C; Elmets, Craig A; Block, Julie; Harrod, Christopher G; Begolka, Wendy Smith; Eichenfield, Lawrence F

2014-08-01

205

Guidelines for Survival Bleeding of Mice and Rats These guidelines have been developed to assist investigators and National Institutes of Health (NIH)  

E-print Network

1 Guidelines for Survival Bleeding of Mice and Rats These guidelines have been developed to assist) in their choice and application of survival rodent bleeding techniques. The guidelines are based on peer institutions recommend the use of retro-orbital bleeding only for specific applications and encourage

Bandettini, Peter A.

206

NCI Digital Media Guidelines  

Cancer.gov

NCI Digital Media Guidelines The NCI Digital Media Guidelines provide developers and content managers guidance on the visual and content standards, as well as policies and procedures, in effect for National Cancer Institute (NCI) digital media – including

207

The Pragmatist in Context of a National Science Foundation Supported Grant Program Evaluation: Guidelines and Paradigms  

ERIC Educational Resources Information Center

Background: The philosophical underpinnings of evaluation guidelines set forth by a funding agency can sometimes seem inconsistent with that of the intervention. Purpose: Our purpose is to introduce questions pertaining to the contrast between the instructional program's underlying philosophical beliefs and assumptions and those underlying our…

Ross, Margaret E.; Narayanan, N. Hari; Hendrix, Theron Dean; Myneni, Lakshman Sundeep

2011-01-01

208

Guidelines in context of evidence  

PubMed Central

Objective In clinical practice guidelines, the quality of the available evidence is graded according to its reliability and quality. This study aimed to evaluate the quality of the available research evidence, using the levels of evidence, in the evidence summaries of 64 Finnish national evidence?based Current Care guidelines. Design Descriptive assessment. Setting Electronic web?based guidelines in Finland. Main outcome measures The proportions of evidence summaries with different levels of evidence (A–D). Results The 64 guidelines had a total of 2419 evidence summaries. Of these, 532 (22.0%) were evidence level A, 891 (36.8%) were evidence level B, 808 (33.4%) were evidence level C, and 188 (7.8%) were evidence level D. Most—that is, 81% of the level C and D evidence summaries dealt with diagnosis and treatment. Most of the evidence summaries pertained to treatment (58.2%) and diagnosis (22.4%). The sections on diagnosis and treatment represented 80% of all the level A and level B evidence, and 81% of all the level C and level D evidence. Conclusions There is adequate high?quality evidence (level A) to support only a fifth of the main statements of the 64 guidelines. This is most likely an optimistic estimate, since level D evidence often does not have an evidence summary. The guideline development groups find it easier to agree on recommendations based on level A and level B evidence. PMID:17693681

Ketola, Eeva; Kaila, Minna; Honkanen, Mari

2007-01-01

209

World Federation of Societies of Biological Psychiatry guidelines for the pharmacological treatment of dementias in primary care.  

PubMed

Objective. To define a practice guideline for biological treatment of dementias for general practitioners in primary care. Methods. TThis paper is a short and practical summary of the World Federation of Biological Psychiatry (WFSBP) guidelines for the Biological treatment of Alzheimer's disease and other dementias for treatment in primary care ( Ihl et al. 2011 ). The recommendations were developed by a task force of international experts in the field and are based on randomized controlled studies. Results. Anti-dementia medications neither cure, nor arrest, or alter the course of the disease. The type of dementia, the individual symptom constellation and the tolerability and evidence for efficacy should determine what medications should be used. In treating neuropsychiatric symptoms, psychosocial intervention should be the treatment of first choice. For neuropsychiatric symptoms, medications should only be considered when psychosocial interventions are not adequate and after cautious risk-benefit analysis. Conclusions. Depending on the diagnostic entity and clinical presentation different anti-dementia drugs can be recommended. These guidelines provide a practical approach for general practitioners managing dementias. PMID:25195764

Ihl, Ralf; Bunevicius, Robertas; Frölich, Lutz; Winblad, Bengt; Schneider, Lon S; Dubois, Bruno; Burns, Alistair; Thibaut, Florence; Kasper, Siegfried; Möller, Hans-Jürgen

2014-10-18

210

NATIONAL CONFERENCE ON MANAGEMENT AND TREATMENT OF CONTAMINATED SEDIMENTS: PROCEEDINGS  

EPA Science Inventory

The National Conference on Management and Treatment of Contaminated Sediment was held in Cincinnati, OH, May 13 to 14, 1997. This technology transfer meeting was held for 213 professionals from various EPA divisions and other organizations, including Environment Canada, the U.S. ...

211

Version 1.2014, 12/20/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN . NCCN Guidelines Index  

E-print Network

Version 1.2014, 12/20/13 © National Comprehensive Cancer Network, Inc. 2013, All rights reserved permission of NCCN . ®® NCCN Guidelines Index NHL Table of Contents Discussion Note: All recommendations cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. CUTB-1

Kay, Mark A.

212

[Russian experts' clinical guidelines for acute myeloid leukemia treatment in patients less than 60 years of age].  

PubMed

The purpose of the paper is to present Russian experts' consolidated opinion about acute myeloid leukemia (AML) treatment in adult patients aged less than 60 years. The guidelines have been elaborated having regard to foreign publications and Russian experience, on the basis of global and Russian clinical trials to treat AML and to define indications for allogeneic bone marrow transplantation in patients during first complete remission. PMID:25314772

Savchenko, V G; Parovichnikova, E N; Afanas'ev, B V; Gritsaev, S V; Semochkin, S V; Bondarenko, S N; Troitskaia, V V; Sokolov, A N; Kuz'mina, L A; Kliasova, G A; Baranova, O Iu; Lapin, V A; Konstantinova, T S; Samo?lova, O S; Kaporskaia, T S; Shatokhin, S V

2014-01-01

213

Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies.  

PubMed

Atopic dermatitis is a common and chronic, pruritic inflammatory skin condition that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this second of 4 sections, treatment of atopic dermatitis with nonpharmacologic interventions and pharmacologic topical therapies are reviewed. Where possible, suggestions on dosing and monitoring are given based on available evidence. PMID:24813302

Eichenfield, Lawrence F; Tom, Wynnis L; Berger, Timothy G; Krol, Alfons; Paller, Amy S; Schwarzenberger, Kathryn; Bergman, James N; Chamlin, Sarah L; Cohen, David E; Cooper, Kevin D; Cordoro, Kelly M; Davis, Dawn M; Feldman, Steven R; Hanifin, Jon M; Margolis, David J; Silverman, Robert A; Simpson, Eric L; Williams, Hywel C; Elmets, Craig A; Block, Julie; Harrod, Christopher G; Smith Begolka, Wendy; Sidbury, Robert

2014-07-01

214

Scoliosis Research Society (SRS) Criteria and Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2008 Guidelines in Non-Operative Treatment of Idiopathic Scoliosis.  

PubMed

According to the Scoliosis Research Society (SRS), idiopathic scoliosis (IS) is a curvature of more than 10° Cobb angle, affecting 2-3% of pediatric population. Idiopathic scoliosis accounts for 80% of all scoliosis cases. Non-operative principles in the therapy of idiopathic scoliosis, including Scoliosis Research Society (SRS) criteria and guidelines proposed by the experts of the Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORTS) were presented. The possibility to carry out quality of life assessments in a conservative procedure was also demonstrated. Based on the natural history of idiopathic scoliosis, SRS criteria, SOSORT 2008 experts' opinion and the knowledge of the possibilities of psychological assessment of conservative IS treatment, rules were proposed regarding nonsurgical IS therapy procedures, with special consideration being paid to the proper treatment start time (age, Risser test, biological maturity, Cobb angle), possibility of curvature progression, the importance of physiotherapy and psychological assessment. The knowledge of SRS criteria and SOSORT guidelines regarding the conservative treatment of IS are essential for proper treatment (the right time to start treatment), and supports establishment of interdisciplinary treatment teams, consisting of a physician, a physiotherapist, an orthopedic technician and a psychologist. PMID:25066033

Korbel, Krzysztof; Kozinoga, Mateusz; Stoli?ski, ?ukasz; Kotwicki, Tomasz

2014-01-01

215

[Spanish evidence-based guidelines on the treatment of moderate-to-severe psoriasis with biologic agents].  

PubMed

Psoriasis vulgaris is an inflammatory skin disease that is generally chronic and that affects between 1 % and 2 % of the population in industrialized Western countries. It is associated with a marked decline in quality of life. A wide range of treatments are currently available, although surveys conducted before the advent of biologic agents reflected a strong degree of dissatisfaction with the treatments then available. Extensive scientific evidence has been gathered on the safety of biologic agents, and this has led to a review of the role of systemic treatment in general and has allowed new therapeutic goals and strategies to be contemplated in patients with moderate-to-severe psoriasis. In this new situation, there is a need for Spanish guidelines on the treatment of moderate-to-severe psoriasis with biologic agents, drafted by consensus among specialists and ratified by the Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology (AEDV). These guidelines should be evidence-based with regard to the pharmacologic characteristics, mechanism of action, administration route and regimen, efficacy, contraindications, adverse effects, and cost estimates of biologic agents approved for the treatment of moderate-to severe psoriasis in Spain. PMID:19558918

Puig, L; Carrascosa, J M; Daudén, E; Sánchez-Carazo, J L; Ferrándiz, C; Sánchez-Regaña, M; García-Bustinduy, M; Bordas, X; Moreno, J C; Hernanz, J M; Laguarda, S; García-Patos, V

2009-06-01

216

Guidelines for the pharmacological treatment of peripheral neuropathic pain: expert panel recommendations for the middle East region.  

PubMed

Neuropathic pain (NeP) has been the focus of extensive basic and clinical research over the past 20 years. This has led to an increased understanding of underlying pathophysiological mechanisms and the development of new therapeutic agents, as well as a clearer definition of the role of established medications. To date there are no published treatment guidelines for NeP in the Middle East. A multidisciplinary panel of Middle East and international experts met to review critically and reach a consensus on how best to apply evidence-based guidelines for the treatment of NeP (mainly peripheral NeP) in the Middle East. The expert panel recommended pregabalin, gabapentin and secondary amine tricyclic antidepressants (nortriptyline and desipramine) as first-line treatments for peripheral NeP. Serotonin-norepinephrine reuptake inhibitor antidepressants, tramadol and controlled-release opioid analgesics were recommended as second-line treatments. There is a need to increase diagnostic awareness of NeP, use validated screening questionnaires and undertake more treatment research in the Middle East region. PMID:20515552

Bohlega, S; Alsaadi, T; Amir, A; Hosny, H; Karawagh, A M; Moulin, D; Riachi, N; Salti, A; Shelbaya, S

2010-01-01

217

Practical Guidelines for the Prevention, Diagnosis, and Treatment of Osteonecrosis of the Jaw in Patients With Cancer  

PubMed Central

Purpose This article discusses osteonecrosis of the jaw (ONJ) and offers health care professionals practical guidelines and recommendations for the prevention, diagnosis, and management of ONJ in cancer patients receiving bisphosphonate treatment. Methods A panel of experts representing oral and maxillofacial surgery, oral medicine, endocrinology, and medical oncology was convened to review the literature and clinical evidence, identify risk factors for ONJ, and develop clinical guidelines for the prevention, early diagnosis, and multidisciplinary treatment of ONJ in patients with cancer. The guidelines are based on experience and have not been evaluated within the context of controlled clinical trials. Results ONJ is a clinical entity with many possible etiologies; historically identified risk factors include corticosteroids, chemotherapy, radiotherapy, trauma, infection, and cancer. With emerging concern for potential development of ONJ in patients receiving bisphosphonates, the panel recommends a dental examination before patients begin therapy with intravenous bisphosphonates. Dental treatments and procedures that require bone healing should be completed before initiating intravenous bisphosphonate therapy. Patients should be instructed on the importance of maintaining good oral hygiene and having regular dental assessments. For patients currently receiving bisphosphonates who require dental procedures, there is no evidence to suggest that interrupting bisphosphonate therapy will prevent or lower the risk of ONJ. Frequent clinical assessments and conservative dental management are suggested for these patients. For treatment of patients who develop ONJ, a conservative, nonsurgical approach is strongly recommended. Conclusion An increased awareness of the potential risk of ONJ in patients receiving bisphosphonate therapy is needed. Close coordination between the treating physician and oral surgeon and/or a dental specialist is strongly recommended in making treatment decisions. PMID:20871729

Ruggiero, Salvatore; Gralow, Julie; Marx, Robert E.; Hoff, Ana O.; Schubert, Mark M.; Huryn, Joseph M.; Toth, Bela; Damato, Kathryn; Valero, Vicente

2006-01-01

218

Conformance to schizophrenia treatment guidelines in North West-Bank, Palestine: focus on antipsychotic dosing and polytherapy  

PubMed Central

Background Analysis of the prescribing patterns of antipsychotic drugs can improve therapeutic outcomes. The purpose of this study was to evaluate the prescribing pattern of antipsychotics and its conformance to international treatment guidelines. Methods A cross sectional study at primary psychiatric centers was carried out. Patients’ medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. All statistical analyses were conducted using Statistical Package for Social Sciences. Results 250 patients were included in this study. A total of 406 antipsychotic agents were used; 348 (85.7%) were first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n=126). There was no significant difference in positive (p=0.3), negative (p=0.06) and psychopathology (p=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose of (300 – 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Analysis showed that use of depot, use of anticholinergic agents and increasing amount of total CPZeq were significant factors associated with antipsychotic combination. Conclusions This study indicated that antipsychotic prescribing was not in conformance with international guidelines with respect to maintenance dose and combination therapy. Type of antipsychotic treatment regimen, combination versus monotherapy, was not associated with better clinical or economic outcome. PMID:23816223

2013-01-01

219

Evidence-based guidelines for the treatment of lower urinary tract symptoms related to uncomplicated benign prostatic hyperplasia in Italy: updated summary from AURO.it  

PubMed Central

Background: The first Italian national guidelines were developed by the Italian Association of Urologists and published in 2007. Since then, a number of new drugs or classes of drugs have emerged for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH), new data have emerged on medical therapy (monotherapies and combination therapies), new surgical techniques have come into practice, and our understanding of disease pathogenesis has increased. Consequently, a new update of the guidelines has become necessary. Methods: A structured literature review was conducted to identify relevant papers published between 1 August 2006 and 12 December 2010. Publications before or after this timeframe were considered only if they were recognised as important milestones in the field or if the literature search did not identify publications within this timeframe. The quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation framework. Main findings: Decisions on therapeutic intervention should be based on the impact of symptoms on quality of life (QoL) rather than the severity of symptoms (International Prostate Symptom Score (IPSS) score). A threshold for intervention was therefore based on the IPSS Q8, with intervention recommended for patients with a score of at least 4. Several differences in clinical recommendations have emerged. For example, combination therapy with a 5?-reductase inhibitor plus ? blocker is now the recommended option for the treatment of patients at risk of BPH progression. Other differences include the warning of potential worsening of cognitive disturbances with use of anticholinergics in older patients, the distinction between Serenoa repens preparations (according to the method of extraction), and the clearly defined threshold of prostate size for performing open surgery (>80 g). While the recommendations included in these guidelines are evidence based, clinical decisions should also be informed by patients’ clinical and physical circumstances, as well as patients’ preferences and actions. Conclusions: These guidelines are intended to assist physicians and patients in the decision-making process regarding the management of LUTS/BPH, and support the process of continuous improvement of the quality of care and services to patients. PMID:23205056

Casarico, Antonio; Fandella, Andrea; Galetti, Caterina; Hurle, Rodolfo; Mazzini, Elisa; Niro, Ciro; Perachino, Massimo; Sanseverino, Roberto; Pappagallo, Giovanni Luigi

2012-01-01

220

Carcinoma of unknown primary: key radiological issues from the recent National Institute for Health and Clinical Excellence guidelines  

PubMed Central

Carcinoma of unknown primary origin (CUP) accounts for 3–5% of cancer cases and is the fourth most common cause of cancer death in the UK. CUP management is challenging, partly owing to the heterogeneity of the condition and its presentation, but also owing to the lack of dedicated clinical services for these patients. The recent National Institute for Health and Clinical Excellence (NICE) guidelines on metastatic malignancy of unknown primary origin were developed to improve the co-ordination of diagnostic and clinical services at hospitals treating cancer patients in England and Wales, in particular by the setting up of CUP teams to manage these patients. Radiologists have a vital role in the diagnosis of these patients and should work closely with the CUP team to streamline the diagnostic pathway. This article summarises areas of the NICE guidelines relevant to radiology and discusses the radiological management of patients with CUP, including initial investigation, the importance of biopsy, the management of specific presentations, special investigations and organisational issues. PMID:22374278

Taylor, M B; Bromham, N R; Arnold, S E

2012-01-01

221

Residential Treatment: A Review of the National Literature  

E-print Network

– December 2003, “Juveniles with Sexual Offending Behaviors” Report # 10 – February 2004, “Attendant Care for Children and Youth with EBD/SED Part I National Literature Review” Report # 11 – June 2004, “Reactive Attachment Disorder: Concepts, Treatment..., “Co-Occurring Disorders of Substance Abuse and SED in Children and Adolescents” Report # 15 – October 2005, “Therapeutic Foster Care” – Update of recent literature Report # 16 - March 2006, “Therapeutic Alliance with Children and Families” Report...

Walter, Uta M.; Petr, Chris

2007-08-01

222

Guidelines for the diagnosis and treatment of cobalamin and folate disorders.  

PubMed

The clinical picture is the most important factor in assessing the significance of test results assessing cobalamin status because there is no 'gold standard' test to define deficiency. Serum cobalamin currently remains the first-line test, with additional second-line plasma methylmalonic acid to help clarify uncertainties of underlying biochemical/functional deficiencies. Serum holotranscobalamin has the potential as a first-line test, but an indeterminate 'grey area' may still exist. Plasma homocysteine may be helpful as a second-line test, but is less specific than methylmalonic acid. The availability of these second-line tests is currently limited. Definitive cut-off points to define clinical and subclinical deficiency states are not possible, given the variety of methodologies used and technical issues, and local reference ranges should be established. In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment. Treatment of cobalamin deficiency is recommended in line with the British National Formulary. Oral therapy may be suitable and acceptable provided appropriate doses are taken and compliance is not an issue. Serum folate offers equivalent diagnostic capability to red cell folate and is the first-line test of choice to assess folate status. PMID:24942828

Devalia, Vinod; Hamilton, Malcolm S; Molloy, Anne M

2014-08-01

223

Australian consensus guidelines for the safe handling of monoclonal antibodies for cancer treatment by healthcare personnel.  

PubMed

These consensus guidelines provide recommendations for the safe handling of monoclonal antibodies. Definitive recommendations are given for the minimum safe handling requirements to protect healthcare personnel. The seven recommendations cover: (i) appropriate determinants for evaluating occupational exposure risk; (ii) occupational risk level compared with other hazardous and non-hazardous drugs; (iii) stratification of risk based on healthcare personnel factors; (iv) waste products; (v) interventions and safeguards; (vi) operational and clinical factors and (vii) handling recommendations. The seventh recommendation includes a risk assessment model and flow chart for institutions to consider and evaluate clinical and operational factors unique to individual healthcare services. These guidelines specifically evaluated monoclonal antibodies used in the Australian cancer clinical practice setting; however, the principles may be applicable to monoclonal antibodies used in non-cancer settings. The guidelines are only applicable to parenterally administered agents. PMID:25302720

Alexander, M; King, J; Bajel, A; Doecke, C; Fox, P; Lingaratnam, S; Mellor, J D; Nicholson, L; Roos, I; Saunders, T; Wilkes, J; Zielinski, R; Byrne, J; MacMillan, K; Mollo, A; Kirsa, S; Green, M

2014-10-01

224

Results of the National Cholesterol Education (NCEP) Program Evaluation Project Utilizing Novel E-Technology (NEPTUNE) II Survey and Implications for Treatment Under the Recent NCEP Writing Group Recommendations  

Microsoft Academic Search

The most recent national survey of compliance with the National Cholesterol Edu- cation Program (NCEP) Adult Treatment Panel (ATP) guidelines was completed before ATP III and showed significant underachievement of low-density lipoprotein (LDL) cholesterol goals. The NCEP Evaluation ProjecT Utilizing Novel E-Technol- ogy (NEPTUNE) II was a national survey conducted in 2003. Of the 4,885 patients, 67% achieved their LDL

Michael H. Davidson; Kevin C. Maki; Thomas A. Pearson; Richard C. Pasternak; Prakash C. Deedwania; James M. McKenney; Gregg C. Fonarow; David J. Maron; Benjamin J. Ansell; Luther T. Clark; Christie M. Ballantyne

225

Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden  

PubMed Central

Background: The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases. Methods: A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions. Results: This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies. Conclusion: Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit. PMID:25396208

Eckard, Nathalie; Janzon, Magnus; Levin, Lars-Åke

2014-01-01

226

Magnetic resonance imaging in monitoring the treatment of multiple sclerosis: concerted action guidelines  

Microsoft Academic Search

Serial gadolinium enhanced MRI of the brain detects much clinically silent disease activity in early relapsing-remitting and secondary progressive multiple sclerosis (MS), and thus has an important role in monitoring the effects of therapy. Based on the proceedings of a recent Commission of the European Communities (CEC) workshop and a review of the literature, guidelines are presented for using MRI

D H Miller; F Barkhof; I Berry; L Kappos; G Scotti; A J Thompson

1991-01-01

227

Increasing Physicians' and Nurses' Compliance with Treatment Guidelines in Cancer Care Program.  

ERIC Educational Resources Information Center

The effect of the use of guidelines on the care of patients with breast, colon, and non-small-cell lung cancers is reported. Audits of patient records revealed an increase over time in the percentage of recommended cancer care procedures that were complied with. (Author/MLW)

Slenker, Suzanne E.; And Others

1985-01-01

228

Community Rehabilitation: "Home versus Centre" Guidelines for Choosing the Optimal Treatment Location  

ERIC Educational Resources Information Center

This study aimed to produce indicators and guidelines for clinician use in determining whether individual therapy sessions for community rehabilitation services should be delivered in a home/community-based setting or centre-based setting within a flexible service delivery model. Concept mapping techniques as described by Tochrim and Kane (2005)…

Barker, Lauren N.; Ziino, Carlo

2010-01-01

229

Directrices para la Creacion del Centro Nacional de Informacion y Documentacion (Guidelines for the Creation of a National Information and Documentation Center).  

ERIC Educational Resources Information Center

This document discusses background information and guidelines for the creation of a national information and documentation center for the dissemination of scientific and technological information. The study first reports on information services in several other countries and the need for an information center in Venezuela; included are…

Menda Behrens, Eduardo

230

Survey of policy for MRSA screening in English cataract surgical units and changes to practice after updated National guidelines  

PubMed Central

Background National guidelines on MRSA (methicillin-resistant Staphylococcus aureus) screening policy in England have changed on a number of occasions, but there is limited data on its influence at a local level. The aim of this study was to determine if changes in National policy influenced preoperative screening of cataract patients for MRSA. Methods A structured telephone survey was conducted on all 133 ophthalmology units in England in 2004 and again in 2007 for the initial responders, after a change in national policy. Results A total of 74 units (56%) responded in 2004 and 71 units (96% of initial respondents) in 2007. In 2004, 57% of units screened for MRSA. They screened groups at high risk of carriage, including patients with previous MRSA (93%) and patients from Nursing homes (21%). Swab sites included the nose (100%), eyes (31%) and perineum (62%). In 2007, there was no significant change in the number of units that screened for MRSA (57% vs 66%; p?=?0.118; McNemar test). However, more units screened for MRSA in patients from nursing/residential homes (21% vs 51%; p?=?0.004, McNemar test), and in patients who had recent admission to hospital (12% vs 36%; p?=?0.003). In the second survey, 3 units (6%) now screened patients who were close relatives of MRSA carriers. Conclusion This survey has highlighted inconsistences in MRSA screening practice of day-case cataract surgery patients across England after 2 major national policy changes. A change in DoH policy only led to more units screening patients for MRSA from high risk groups. PMID:24341357

2013-01-01

231

Hypertension guidelines in elderly patients: is anybody listening?  

Microsoft Academic Search

PurposePrevious guidelines for the management of uncomplicated hypertension in elderly patients have recommended diuretic agents and then beta-blockers. We examined trends in the initial treatment choice for elderly people with hypertension and the effects of a government-sponsored program to publish and disseminate a simplified version of the national guidelines for the treatment of hypertension to all physicians in Ontario, Canada.

Karen Tu; Muhammad M Mamdani; Jack V Tu

2002-01-01

232

A Wiki Collaboration to Create National Guidelines: Tips for Professional Practice  

ERIC Educational Resources Information Center

In 2006, technology directors from independent schools across the country had banded together and created "Principles of Good Practice" for technology in independent schools. These principles "define high standards and ethical behavior in key areas of independent school operations" (NAIS 2006). This author decided that it was time for the National

Moser, Patt

2009-01-01

233

Guidelines for compliance with the National Environmental Policy Act and the California Environmental Quality Act  

SciTech Connect

The National Environmental Policy Act of 1969 (NEPA) sets forth national policy for the protection of the environment. The NEPA process is intended to help officials of the federal government make decisions that are based on an understanding of environmental consequences, and take actions that protect, restore, and enhance the environment. The California Environmental Quality Act of 1970 (CEQA) is similar to NEPA. The California legislature established CEQA to inform both state and local governmental decision-makers and the public about potential significant environmental effects of proposed activities, to identify ways to avoid or reduce environmental impacts, and to disclose to the public the reasons why a project is approved if significant environmental effects are involved. Lawrence Berkeley Laboratory (LBL), complies with the provisions of both NEPA and CEQA. This document defines the responsibilities and authorities for NEPA/CEQA compliance at LBL.

Kielusiak, C.

1993-02-01

234

National General Aviation Design Competition Guidelines 1999-2000 Academic Year  

NASA Technical Reports Server (NTRS)

The National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA) and the Air Force Research Laboratory are sponsoring a National General Aviation Design Competition for students at U.S. aeronautical and engineering universities for the 1999-2000 academic year. The competition challenges individuals and teams of undergraduates and/ or graduate students, working with faculty advisors, to address design challenges for general aviation aircraft. Now in its sixth year, the competition seeks to increase the involvement of the academic community in the revitalization of the U.S. general aviation industry while providing real-world design and development experiences for students. It allows university students to participate in a major national effort to rebuild the U.S. general aviation sector while raising student awareness of the value of general aviation for business and personal use , and its economic relevance. Faculty and student participants have indicated that the open-ended design challenges offered by the competition have provided the basis for quality educational experiences.

1999-01-01

235

Update on guidelines for selecting appropriate patients to receive treatment with dental implants: priorities for the NHS--the position after 15 years.  

PubMed

In 1997 the Faculty of Dental Surgery (Royal College of Surgeons, England) as part of a wider publication produced guidance on prioritisation for the selection of patients to receive treatment with dental implants within the NHS in the UK (http://www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/index.html). This update considers eight main groups who may benefit from treatment with osseointegrated implants. Where patients are being considered for implant-based rehabilitation, treatment plans must be weighed up against the risks, benefits and outcomes outlined in evidence-based research. PMID:25146811

Alani, A; Bishop, K; Renton, T; Djemal, S

2014-08-01

236

National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification  

Microsoft Academic Search

Chronic kidney disease is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of chronic kidney disease include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Current evidence suggests that some of these adverse outcomes can be prevented or delayed by early detection and treatment. Unfortunately,

Andrew S. Levey; Josef Coresh; Ethan Balk; Annamaria T. Kausz; Adeera Levin; Michael W. Steffes; Ronald J. Hogg; Ronald D. Perrone; Joseph Lau; Garabed Eknoyan

237

[Total abstinence or harm reduction--different strategies of alcohol treatment in research studies and international guidelines].  

PubMed

Alcohol use is considered to be one of the major factors contributing to global health burden as well as social and economic harm. Only about 16% of alcohol dependent individuals enter addiction treatment programs in Poland, with only a few more in Western Europe. The aim of the paper was to present two main treatment strategies of alcohol dependence: total abstinence and harm reduction. The advantages and disadvantages of both treatment goals are presented, pointing to a possibility of treating them as complementary strategies. A need to choose a proper, personalised patient-oriented aim of a treatment program is emphasised, with an option to revise the objective during long-term therapy. The paper describes implications from investigating the problem of alcohol dependence from a population health perspective. The surprisingly high amount of individuals remitting spontaneously from alcohol dependence without treatment is also discussed, and a possible bias resulting from analysing data on alcoholic subjects coming only from addiction centres, not from general population is taken into consideration. In the second part of the paper, American as well as British alcohol treatment guidelines are presented. PMID:23045891

Jakubczyk, Andrzej; Wojnar, Marcin

2012-01-01

238

Promotion of Standard Treatment Guidelines and Building Referral System for Management of Common Noncommunicable Diseases in India  

PubMed Central

Treatment services constitute one of the five priority actions to face the global crisis due to noncommunicable diseases (NCDs). It is important to formulate standard treatment guidelines (STGs) for an effective management, particularly at the primary and secondary levels of health care. Dissemination and implementation of STGs for NCDs on a country-wide scale involves difficult and complex issues. The management of NCDs and the associated costs are highly variable and huge. Besides the educational strategies for promotion of STGs, the scientific and administrative sanctions and sanctity are important for purposes of reimbursements, insurance, availability of facilities, and legal protection. An effective and functional referral- system needs to be built to ensure availability of appropriate care at all levels of health- services. The patient-friendly “to and fro” referral system will help to distribute the burden, lower the costs, and maintain the sustainability of services. PMID:22628909

Jindal, SK

2011-01-01

239

Implementation of the NICE guideline – Recommendations from the British Fertility Society for national criteria for NHS funding of assisted conception  

Microsoft Academic Search

Summary Assisted conception providers in England were surveyed to establish the uptake of NICE Guidelines for Infertility particularly in respect of assisted conception and the criteria used to accept patients for NHS funded treatment. Detailed information on selection criteria was obtained from a group of commissioning consortia at an advanced stage in their arrangements. While there was an overall increase

R. Kennedy; C. Kingsland; A. Rutherford; W. Ledger

2006-01-01

240

[Treatment of rhabdomyosarcoma at the National Cancer Center Hospital].  

PubMed

Seventy-nine patients with rhabdomyosarcoma (RMS) received treatment at the National Cancer Center Hospital between 1962 and 1985. The patients ranged in age from 4 months to 74 years with a median age of 6 years. Forty-six patients were male and 33 were female. The primary tumor site of RMS was the same as in the previous report. The head and neck region was the most frequent site (40.5%), followed by the extremities (34.1%), genitourinary region (15.2%), trunk (5.1%) and retroperitoneum (5.1%). Histologic types were embryonal RMS in 45 patients, alveolar RMS in 23 patients, pleomorphic RMS in 8 patients and unclassified RMS in 3 patients. As of October 1985, 14 of the 79 patients were still alive. Between 1962 and 1971, 38 patients were not treated by any protocol. After 1972, 41 patients received treatment using a 3 stage-related, multiple-modality program. In the first protocol, chemotherapy consisted of Vincristine, Cyclophosphamide, and Actinomycin-D, and 1 of 18 patients have survived more than 5 years. The cumulative 5-year survival rate of the first protocol was 11.1%. In the second treatment program, which involved Adriamycin in addition to the 3 drugs cited above, 4 of 23 patients have survived more than 5 years. The cumulative 5-year survival rate, 33.2%, was very improved. PMID:3592704

Beppu, Y; Fukuma, H; Chuma, H; Ise, T; Ohira, M

1987-05-01

241

The ACC/AHA 2013 guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: the good the bad and the uncertain: a comparison with ESC/EAS guidelines for the management of dyslipidaemias 2011.  

PubMed

Atherosclerotic cardiovascular disease is the most important public health problem of our time in both Europe and the rest of the world, accounting for the greatest expenditure in most healthcare budgets. Achieving consistency of clinical care, incorporating new evidence and their synthesis into practical recommendations for clinicians is the task of various guideline committees throughout the world. Any change in a set of guidelines therefore can have far reaching consequences, particularly if they appear to be at variance with the existing guidelines. The present article discusses the recent American College of Cardiology (ACC)/American Heart Association (AHA) guidelines 2013 on the control of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults. When compared with the ESC/EAS guidelines on lipid modification in 2011, the ACC/AHA guidelines of 2013 differ markedly. Specifically, (i) the scope is limited to randomized trials only, which excludes a significant body of data and promotes essentially a statin centric approach only; (ii) the abolition of low-density lipoprotein cholesterol (LDL-C) targets in favour of specific statin regimens that produce a 30-50% reduction in LDL-C we believe will confuse many physicians and miss the opportunity for medication adherence and patient engagement in self-management; (iii) the absence of target LDL-C levels in very high-risk patients with high absolute risk or residual risk factors will discourage clinicians to consider the addition of lipid modification treatments and individualize patient care; (iv) a reduction in the threshold for treatment in primary prevention will result in a greater number of patients being prescribed statin therapy, which is potentially good in young patients with high life time risk, but will result in a very large number of older patients offered therapy; and (v) the mixed pool risk calculator used to asses CVD risk in the guidelines for primary prevention has not been fully evaluated. This article discusses the potential implications of adopting the ACC/AHA guidelines on patient care in Europe and beyond and concludes with the opinion that the ESC/EAS guidelines from 2011 seem to be the most wide ranging, pragmatic and appropriate choice for European countries. PMID:24639424

Ray, Kausik K; Kastelein, John J P; Boekholdt, S Matthijs; Nicholls, Stephen J; Khaw, Kay-Tee; Ballantyne, Christie M; Catapano, Alberico L; Reiner, Željko; Lüscher, Thomas F

2014-04-01

242

The Role of Optimal Healing Environments in Patients Undergoing Cancer Treatment: Clinical Research Protocol Guidelines  

Microsoft Academic Search

Integrative cancer care (ICC) is the treatment of patients with cancer, under physician supervision, with ap- propriate conventional treatments in a healing context based on insights from research on nutrition, biochem- istry, exercise, and psycho-oncology. It uses validated techniques and practitioners of complementary and al- ternative medicine (CAM), and strategies for enhancing treatment and side-effect management such as chronomodulated chemotherapy,

Keith I. Block; Penny Block; Charlotte Gyllenhaal

2004-01-01

243

The effectiveness of national strategic guidelines at a local level: a case study of the UK general aviation industry  

NASA Astrophysics Data System (ADS)

The thesis is concerned with the prospects for reducing strategic-local tensions in the British planning process. It examines the conflicts surrounding small general aviation aerodromes as a means of understanding these tensions, why they have evolved, and if they might be reconciled through planning reform. The only prior academic research to have touched upon this issue through general aviation has been an ESRC funded project undertaken by Gallent and colleagues (1999), who found aerodromes provided a microcosm of planning's issues. Building on this work, the thesis develops what is meant by strategic-local tensions, which in broad terms are described as differences between national and regional guidance/plans and what actually takes place locally. Moving from a basic research question it develops a wide planning perspective based on the literature by discussing the meaning of planning, its history and issues for example, how conflicts in planning might be influenced by the broader socio-political environment. The thesis then arrives at three hypotheses which question the effectiveness of the existing strategic guideline implementation process, develops a local planning authority framework and addresses issues of reflectivity and bias. Results from three national surveys of pilots, aerodromes and manufacturers, plus longitudinal analysis of government and other datasets, are then used to detail a comprehensive and unique description of general aviation, which includes a costing based account of the direct expenditure of flying activity. This provides a substantive foundation for a local planning authority survey which both extends previous boundaries and enables the process of implementing strategic objectives to be disaggregated and evaluated. Field visits to twenty six aerodromes and five local authorities are subsequently used to explore gaps within the strategic implementation process and to develop conclusions, within the wider landscape of planning, about the nature of strategic local tensions and implications for planning reform.

Lober, Terence

244

Current Fat Guidelines and Recommendations  

Technology Transfer Automated Retrieval System (TEKTRAN)

Current dietary guidelines, including those of the US government [Dietary Guidelines (USDA/DHHS, 2005), Dietary Reference Intakes [reference DRI macronutrient book], National Cholesterol Education Program (NCEP, 2001)], American Heart Association (AHA, 2206), American Diabetes Association (2006) and...

245

Guidelines for Hanford Site implementation of the National Environmental Policy Act  

SciTech Connect

The National Environmental Policy Act (NEPA) environmental review process is mandatory for federal agencies. Understanding and complying with NEPA is extremely important to successfully planning and implementing programs at the Hanford Site. This report is intended to help planners and decision makers understand NEPA by describing the NEPA process as it is outlined in NEPA, in regulations, and in guidance information. The requirements and guidance documents that set forth the NEPA process are discussed. Some of the major NEPA concepts and issues are also addressed. This report is intended to be used as a general road map through the maze of NEPA requirements and guidance to ensure that Hanford Site activities are conducted in compliance with NEPA. Enhanced knowledge of the NEPA process is expected to increase the ability of the Hanford Site to work with regulators, interested parties and the public to ensure that the potential environmental impacts of DOE activities are fully considered at the Hanford Site. In addition, an enhanced understanding of NEPA will help project and program managers to integrate NEPA compliance requirements with program planning. 43 refs., 6 figs., 3 tabs.

King, S.E.

1989-03-01

246

The consequences of failure to achieve targets of guidelines for prevention and treatment of diabetic complications in patients with type 1 diabetes.  

PubMed

To study how the targets of glycemic, blood pressure (BP) and lipid control based on the American Diabetes Association (ADA) guidelines have been implemented, and to assess the risk of cardiovascular events (CVD) and mortality in patients with type 1 diabetes stratified by nephropathy (DN) status. A nationally representative cohort of patients with type 1 diabetes (N = 3,151) from the FinnDiane Study were included. CVD and deaths were identified from the national registers. The treatment targets were HbA1C <7 %, BP <140/80 mmHg and LDL cholesterol <2.6 mmol/l. About 63 % of the patients with DN and 34 % of the patients without DN reached none of the targets. With DN, the 10-year cumulative risk of CVD was 17.4 % (95 % CI 11.1-23.2) if BP was on target, 29.9 % (23.0-36.2, P = 0.03) if BP was not on target and 28.4 % (24.9-31.8, P = 0.009) in those who reached none of the targets. The corresponding figures were 3.8 % (2.7-4.8), 4.4 % (2.7-6.2, P = 0.3) and 8.1 % (6.4-9.8, P < 0.0001) for those without DN. In those with DN, the risk of CVD was higher if BP was not on target [hazard ratio (HR) 1.9 (1.1-3.3)], or none of the three targets [HR 2.2 (1.4-3.6)] were reached than if BP was on target. Although the risk of death without DN was higher in those who reached none of the targets (P = 0.003), after adjustment, no differences were observed between the groups. Failure to reach ADA treatment targets is associated with increased risk of mortality and CVD in patients with type 1 diabetes. PMID:24849006

Lithovius, Raija; Harjutsalo, Valma; Forsblom, Carol; Saraheimo, Markku; Groop, Per-Henrik

2015-02-01

247

Current Recommendations for the Diagnosis and Treatment of Concussion in Sport: A Comparison of Three New Guidelines  

PubMed Central

Abstract Currently, there is considerable debate within the sports medicine community about the role of concussion and the risk of chronic neurological sequelae. This concern has led to significant confusion among primary care providers and athletic trainers about how to best identify those athletes at risk and how to treat those with concussion. During the first quarter of 2013, several new or updated clinical practice guidelines and position statements were published on the diagnosis, treatment, and management of mild traumatic brain injury/concussion in sports. Three of these guidelines were produced by the American Medical Society for Sports Medicine, The American Academy of Neurology, and the Zurich Consensus working group. The goal of each group was to clearly define current best practices for the definition, diagnosis, and acute and post-acute management of sports-related concussion, including specific recommendations for return to play. In this article, we compare the recommendations of each of the three groups, and highlight those topics for which there is consensus regarding the definition of concussion, diagnosis, and acute care of athletes suspected of having a concussion, as well as return-to-play recommendations. PMID:23879529

Marion, Donald W.

2014-01-01

248

Defining ‘elderly’ in clinical practice guidelines for pharmacotherapy  

PubMed Central

Objective: To identify how ‘elderly’ patients are defined and considered within Australian clinical guidelines for the use of pharmacotherapy. Method: Guidelines pertaining to the use of pharmacotherapy, focusing on conditions described in National Health Priority Areas, were identified using databases (Medline, Google Scholar) and organisation websites (Department of Health and Ageing, National Heart Foundation, National Health and Medical Research Council). Guidelines were reviewed and qualitatively analysed to identify any references or definitions of ‘elderly’ persons. Results: Among the 20 guidelines reviewed, 3 defined ‘elderly’ by chronological age (i.e., years since birth) while the remaining 17 guidelines did not define ‘elderly’ in any way. All 20 guidelines used the term ‘elderly’, whilst some guidelines provided age (chronological)-based dosage recommendations suggesting an ageist or generalist approach in their representation of ‘elderly’, for which rationale was seldom provided. Thematic analysis of the statements revealed five key themes regarding how ‘elderly’ was considered within the guidelines, broadly describing ‘elderly’ persons as being frail and with altered pharmacology. Some guidelines also highlighted the limited evidence base to direct clinical decision-making. A continuum of perceptions of ageing also emerged out of the identified themes. Conclusion: Clinical practice guidelines currently do not adequately define ‘elderly’ persons and provide limited guidance on how to apply treatment recommendations to older persons. The representation of ‘elderly’ in guidelines needs to be less based on chronological age or generic definitions focusing more on establishing a direct link between an individual patient’s characteristics and the pharmacology of their prescribed medication. Clinical guidelines that do not offer any practical descriptions of the features of ageing that are specifically related to the use of pharmacotherapy, or how to assess these in individual patients, render decision-making challenging.

Singh, Shamsher; Bajorek., Beata

2014-01-01

249

Treatment of mixed radioactive liquid wastes at Argonne National Laboratory  

SciTech Connect

Aqueous mixed waste at Argonne National Laboratory (ANL) is traditionally generated in small volumes with a wide variety of compositions. A cooperative effort at ANL between Waste Management (WM) and the Chemical Technology Division (CMT) was established, to develop, install, and implement a robust treatment operation to handle the majority of such wastes. For this treatment, toxic metals in mixed-waste solutions are precipitated in a semiautomated system using Ca(OH){sub 2} and, for some metals, Na{sub 2}S additions. This step is followed by filtration to remove the precipitated solids. A filtration skid was built that contains several filter types which can be used, as appropriate, for a variety of suspended solids. When supernatant liquid is separated from the toxic-metal solids by decantation and filtration, it will be a low-level waste (LLW) rather than a mixed waste. After passing a Toxicity Characteristic Leaching Procedure (TCLP) test, the solids may also be treated as LLW.

Vandegrift, G.F.; Chamberlain, D.B.; Conner, C. [and others

1994-03-01

250

Strategic Planning for Deepening the All-Around Structural Reform of Education: Issues of Structural Reform in the "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)"  

ERIC Educational Resources Information Center

The "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)" (hereafter abbreviated as the "Guideline") posits that the development of education must be driven by reform and innovation. It devotes six chapters to mapping out the targets, tasks, and major policy measures for reforming the educational system. Focusing…

Songhua, Tan; Wang, Catherine Yan

2012-01-01

251

Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association.  

PubMed

Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows: (1) The diagnosis SAPS can only be made using a combination of clinical tests. (2) SAPS should preferably be treated non-operatively. (3) Acute pain should be treated with analgetics if necessary. (4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. (5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture. (6) Occupational interventions are useful when complaints persist for longer than 6 weeks. (7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered. (8) Strict immobilization and mobilization techniques are not recommended. (9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage). (10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management. (12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears. PMID:24847788

Diercks, Ron; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

2014-06-01

252

Focus on anorexia nervosa: modern psychological treatment and guidelines for the adolescent patient.  

PubMed

Anorexia nervosa is a serious condition associated with high mortality. Incidence is highest for female adolescents, and prevalence data highlight a pressing unmet need for treatment. While there is evidence that adolescent-onset anorexia has relatively high rates of eventual recovery, the illness is often protracted, and even after recovery from the eating disorder there is an ongoing vulnerability to psychosocial problems in later life. Family therapy for anorexia in adolescence has evolved from a generic systemic treatment into an eating disorder-specific format (family therapy for anorexia nervosa), and this approach has been evidenced as an effective treatment. Individual treatments, including cognitive behavioral therapy, also have some evidence of effectiveness. Most adolescents can be effectively and safely managed as outpatients. Day-patient treatment holds promise as an alternative to inpatient treatment or as an intensive program following a brief medical admission. Evidence is emerging of advantages in detecting and treating adolescent anorexia nervosa in specialist community-based child and adolescent eating-disorder services accessible directly from primary care. Limitations and future directions for modern treatment are considered. PMID:25678834

Espie, Jonathan; Eisler, Ivan

2015-01-01

253

Focus on anorexia nervosa: modern psychological treatment and guidelines for the adolescent patient  

PubMed Central

Anorexia nervosa is a serious condition associated with high mortality. Incidence is highest for female adolescents, and prevalence data highlight a pressing unmet need for treatment. While there is evidence that adolescent-onset anorexia has relatively high rates of eventual recovery, the illness is often protracted, and even after recovery from the eating disorder there is an ongoing vulnerability to psychosocial problems in later life. Family therapy for anorexia in adolescence has evolved from a generic systemic treatment into an eating disorder-specific format (family therapy for anorexia nervosa), and this approach has been evidenced as an effective treatment. Individual treatments, including cognitive behavioral therapy, also have some evidence of effectiveness. Most adolescents can be effectively and safely managed as outpatients. Day-patient treatment holds promise as an alternative to inpatient treatment or as an intensive program following a brief medical admission. Evidence is emerging of advantages in detecting and treating adolescent anorexia nervosa in specialist community-based child and adolescent eating-disorder services accessible directly from primary care. Limitations and future directions for modern treatment are considered.

Espie, Jonathan; Eisler, Ivan

2015-01-01

254

Optimizing outcomes in multiple sclerosis: consensus guidelines for the diagnosis and treatment of multiple sclerosis in Latin America  

PubMed Central

Objective: The prevalence of multiple sclerosis (MS) in Latin America varies across different studies but an intermediate risk and increased frequency of the disease have been reported in recent years. The circumstances of Latin American countries are different from those of Europe and North America, both in terms of differential diagnoses and disease management. Methods: An online survey on MS was sent to 855 neurologists in nine Latin American countries. A panel of nine experts in MS analyzed the results. Results: Diagnostic and therapeutic recommendations were outlined with special emphasis on the specific needs and circumstances of Latin America. The experts proposed guidelines for MS diagnosis, treatment, and follow up, highlighting the importance of considering endemic infectious diseases in the differential diagnoses of MS, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, early treatment initiation, and cost-effective control of treatment efficacy, as well as global assessment of disability. Conclusions: The experts recommended that healthcare systems allocate a longer consultation time for patients with MS, which must be conducted by neurologists trained in the management of the disease. All drugs currently approved must be available in all Latin American countries and must be covered by healthcare plans. The expert panel supported the creation of a permanent forum to discuss future clinical and therapeutic recommendations that may be useful in Latin American countries. PMID:22164189

Macías-Islas, Miguel Ángel; Gabbai, Alberto Alan; Correale, Jorge; Bolaña, Carlos; Sotelo, Eduardo Duriez; Bonitto, Juan García; Vergara-Edwards, Fernando; Vizcarra-Escobar, Darwin

2011-01-01

255

A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients  

SciTech Connect

Purpose: To develop a clinical staging system for maxillary osteoradionecrosis (ORN) in irradiated nasopharyngeal carcinoma (NPC) patients. Methods and Materials: The data of maxillary ORN cases among 1,758 irradiated NPC patients were analyzed. A staging system based on the degrees of bone exposure (E), infection (I), and bleeding (B) was developed. Correlations between various clinical parameters and stages of maxillary ORN and relationships between treatment modalities and outcomes at each stage were evaluated. Cumulative success of treatment and risk factors that affect treatment outcomes were analyzed. Results: The incidence of maxillary ORN was 2.7% (48/1,758). TNM stage of NPC (p < 0.001), radiation dose (p = 0.029), and tooth extraction (p < 0.001) appeared to have significant influences on disease severity. Success rates between conservative therapy and surgical treatment were not significantly different for Stage I ORN but differed significantly for Stage II (p = 0.013) and Stage III (p = 0.008) lesions. Grade 3 infection and bleeding significantly jeopardized treatment success (p = 0.043 and 0.015, respectively). The risk ratios of treatment failure for Grade 3 infection and bleeding were 2.523 (p = 0.034) and 3.141 (p = 0.027), respectively. Conclusions: More serious maxillary ORN tended to occur in cases with more advanced NPC, higher radiation dose, and history of tooth extraction. Surgical treatment was usually required in Stage II and III ORN. The grades of infection and bleeding are important factors in guidance of treatment and prediction of outcomes.

Cheng, S.-J. [Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan (China); Department of Dentistry, Sun-Yat-San Cancer Center, Taipei, Taiwan (China); Lee, J.-J. [Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan (China); School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Ting, L.-L. [Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (China); Tseng, I.-Y. [Department of Dentistry, Cathay General Hospital, Taipei, Taiwan (China); Chang, H.-H. [Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan (China); School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Chen, H.-M. [Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan (China); School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Kuo, Y.-S. [Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan (China); School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Hahn, L.-J. [Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan (China); School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan (China); Kok, S.-H. [Division of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan (China) and School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan (China)]. E-mail: kok@ha.mc.ntu.edu.tw

2006-01-01

256

Guideline for benchmarking thermal treatment systems for low-level mixed waste  

SciTech Connect

A process for benchmarking low-level mixed waste (LLMW) treatment technologies has been developed. When used in conjunction with the identification and preparation of surrogate waste mixtures, and with defined quality assurance and quality control procedures, the benchmarking process will effectively streamline the selection of treatment technologies being considered by the US Department of Energy (DOE) for LLMW cleanup and management. Following the quantitative template provided in the benchmarking process will greatly increase the technical information available for the decision-making process. The additional technical information will remove a large part of the uncertainty in the selection of treatment technologies. It is anticipated that the use of the benchmarking process will minimize technology development costs and overall treatment costs. In addition, the benchmarking process will enhance development of the most promising LLMW treatment processes and aid in transferring the technology to the private sector. To instill inherent quality, the benchmarking process is based on defined criteria and a structured evaluation format, which are independent of any specific conventional treatment or emerging process technology. Five categories of benchmarking criteria have been developed for the evaluation: operation/design; personnel health and safety; economics; product quality; and environmental quality. This benchmarking document gives specific guidance on what information should be included and how it should be presented. A standard format for reporting is included in Appendix A and B of this document. Special considerations for LLMW are presented and included in each of the benchmarking categories.

Hoffman, D.P.; Gibson, L.V. Jr.; Hermes, W.H. [Martin Marietta Energy Systems, Inc., Oak Ridge, TN (United States); Bastian, R.E. [Focus Environmental, Inc., Knoxville, TN (United States); Davis, W.T. [Tennessee Univ., Knoxville, TN (United States)

1994-01-01

257

[Guidelines for the treatment of Hansen's disease in Japan (third edition)].  

PubMed

ad hoc committee of Japanese Leprosy Association recommends revised standard treatment protocol of leprosy in Japan, which is a modification of World Health Organization's multidrug therapy (WHO/MDT, 2010). For paucibacillary (PB) leprosy, 6 months treatment by rifampicin and dapsone (MDT/PB) is enough. However, for high bacterial load multibacillary (MB) leprosy, 12 months treatment seems insufficient. Thus, (A) For MB with bacterial index (BI) > 3 before treatment, 2 years treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. When BI becomes negative and active lesion is lost within 2 years, no maintenance therapy is necessary. When BI is still positive, one year of MDT/MB is added (3 years in total), followed by maintenance therapy by dapsone and clofazimine until BI negativity and loss of active lesions. (B) For MB with BI < 3 or fresh MB (less than 6 months after the onset of the disease) with BI > 3, 1 year treatment by MDT/MB is necessary. When BI becomes negative and active lesion is lost within one year, no maintenance therapy is necessary. When BI is still positive or active lesion is remaining, additional therapy with MDT/MB for one more year is recommended. Brief summary of diagnosis, purpose of therapy, character of drugs, and prevention of deformity is also described. PMID:24579462

Goto, Masamichi; Nogam, Reiko; Okano, Yoshiko; Gidoh, Masaichi; Yotsu, Rie; Ishida, Yutaka; Kitajima, Shinichi; Kai, Masanori; Ishii, Norihisa; Ozaki, Motoaki; Hatano, Kentaro

2013-12-01

258

Field guidelines for collection, treatment, and analysis of water samples, Montana district  

USGS Publications Warehouse

This manual provides a set of standardized guidelines and quality-control procedures for the collection and preservation of water samples and defines procedures for field analyses of unstable constituents or properties. Seldom is the water being samples of such uniformity that a single grab sample is representative of the whole. For this reason a variety of sampler types and sampling methods have been devised. Descriptions and procedures for field use are given for a number of sampler types. Several methods of sampling are described for which these samplers can be used. Sample-processing devices such as sample splitters and filtration apparatus are discussed along with methods of cleaning. Depending on the type of analysis to be performed in the laboratory, samples may need to be preserved shortly after collection. Various types of preservation are described in detail. Analyses for unstable constituents or properties are of necessity accomplished in the field. This manual addresses analytical techniques and quality assurance for: (1) Water temperature, (2) specific conductance, (3) pH, (4) alkalinity, (5) dissolved oxygen, and (6) bacteria. Examples of field report forms are given as attachments. Information pertinent to certain field calculations is also presented. (USGS)

Knapton, J.R.

1985-01-01

259

Time at Treatment of Severe Retinopathy of Prematurity in China: Recommendations for Guidelines in More Mature Infants  

PubMed Central

Purpose To investigate the postmenstrual (PMA) age at treatment of severe retinopathy of prematurity (i.e. Type 1 prethreshold or threshold) in infants in a tertiary referral center in China. Principal Findings 76.6% (359/469) of infants were treated for threshold disease. 67.5% (317/469) of infants had a birth weight (BW) of 1250g or above and almost 30% (126) had a gestational age (GA) of 32 weeks or above. There was little difference in the characteristics of infants treated for Type 1 prethreshold or threshold ROP. After controlling for GA, PMA age at treatment was highest in infants with BW ?2000g (mean PMA 40.3±4.4 weeks, p<0.001); after controlling for BW, higher GA was associated with higher PMA at treatment (mean PMA 41.5 weeks for gestational age >34 weeks, p<0.001). For every three weeks increase in GA there was a two-week increase in PMA at treatment (R2 = 0.20, p<0.001). The time at treatment of Type 1 prethreshold disease was similar to that for threshold disease i.e. chronological age 5.6?7.4 weeks, or PMA 34.1?40.2 weeks but the lower end of the 95% confidence interval for chronological age for Type 1 prethreshold disease among infants with BW ?2000g was 3.7 weeks (i.e. before the recommended interval of 4?6 weeks after birth). Significance The Chinese guidelines regarding timing of the first examination are appropriate for infants with BW <2000g, but more mature infants should be examined a little earlier, at 3 weeks after birth, in order to detect Type 1 prethreshold disease which has a better prognosis than threshold. PMID:25664992

Chen, Yi; Feng, Jing; Gilbert, Clare; Yin, Hong; Liang, Jianhong; Li, Xiaoxin

2015-01-01

260

Cost-Effectiveness of Antiretroviral Regimens in the World Health Organization's Treatment Guidelines: A South African Analysis  

PubMed Central

Objective The World Health Organization (WHO) recently changed its first-line antiretroviral treatment guidelines in resource-limited settings. The cost-effectiveness of the new guidelines are unknown. Design Comparative effectiveness and cost-effectiveness analysis using a model of HIV disease progression and treatment. Methods Using a simulation of HIV disease and treatment in South Africa, we compared the life expectancy, quality-adjusted life expectancy, lifetime costs, and cost-effectiveness of five initial regimens. Four are currently recommended by the WHO: tenofovir/lamivudine/efavirenz; tenofovir/lamivudine/nevirapine; zidovudine/lamivudine/efavirenz; and zidovudine/lamivudine/nevirapine. The fifth is the most common regimen in current use: stavudine/lamivudine/nevirapine. Virologic suppression and toxicities determine regimen effectiveness and cost-effectiveness. Results Choice of first-line regimen is associated with a difference of nearly 12 months of quality-adjusted life expectancy, from 135.2 months (tenofovir/lamivudine/efavirenz) to 123.7 months (stavudine/lamivudine/nevirapine). Stavudine/lamivudine/nevirapine is more costly and less effective than zidovudine/lamivudine/nevirapine. Initiating treatment with a regimen containing tenofovir/lamivudine/nevirapine is associated with an incremental cost-effectiveness ratio of $1,045 per quality-adjusted life year compared with zidovudine/lamivudine/nevirapine. Using tenofovir/lamivudine/efavirenz was associated with the highest survival, fewest opportunistic diseases, lowest rate of regimen substitution, and an incremental cost-effectiveness ratio of $5,949 per quality-adjusted life year gained compared with tenofovir/lamivudine/nevirapine. Zidovudine/lamivudine/efavirenz was more costly and less effective than tenofovir/lamivudine/nevirapine. Results were sensitive to the rates of toxicities and the disutility associated with each toxicity. Conclusion Among the options recommended by WHO, we estimate only three should be considered under normal circumstances. Choice among those depends on available resources and willingness to pay. Stavudine/lamivudine/nevirapine is associated with the poorest quality-adjusted survival and higher costs than zidovudine/lamivudine/nevirapine. PMID:21124202

Bendavid, Eran; Grant, Philip; Talbot, Annie; Owens, Douglas K.; Zolopa, Andrew

2010-01-01

261

Description of local adaptation of national guidelines and of active feedback for rationalising preoperative screening in patients at low risk from anaesthetics in a French university hospital  

PubMed Central

OBJECTIVE: To describe the effect of local adaptation of national guidelines combined with active feedback and organisational analysis on the ordering of preoperative investigations for patients at low risk from anaesthetics. DESIGN: Assessment of preoperative tests ordered over one month, before and after local adaptation of guidelines and feedback of results, combined with an organisational analysis. SETTING: Motivated anaesthetists in 15 surgical wards of Bordeaux University Hospital, Region Aquitain, France. SUBJECTS: 42 anaesthetists, 60 surgeons, and their teams. MAIN OUTCOME MEASURES: Number and type of preoperative tests ordered in June 1993 and 1994, and the estimated savings. RESULTS: Of 536 patients at low risk from anaesthetics studied in 1993 before the intervention 80% had at least one preoperative test. Most (70%) tests were ordered by anaesthetists. Twice the number of preoperative tests were ordered than recommended by national guidelines. Organisational analysis indicated lack of organised consultations and communication within teams. Changes implemented included scheduling of anaesthetic consultations; regular formal multidisciplinary meetings for all staff; preoperative ordering decision charts. Of 516 low risk patients studied in 1994 after the intervention only 48% had one or more preoperative tests ordered (p < 0.05). Estimated mean (SD) saving for one year if changes were applied to all patients at low risk from anaesthesia in the hospital 3.04 (1.23) mFF. CONCLUSIONS: A sharp decrease in tests ordered in low risk patients was found. The likely cause was the package of changes that included local adaptation of national guidelines, feedback, and organisational change. PMID:10178152

Capdenat Saint-Martin, S; Michel, P.; Raymond, J. M.; Iskandar, H.; Chevalier, C.; Petitpierre, M. N.; Daubech, L.; Amouretti, M.; Maurette, P.

1998-01-01

262

76 FR 36896 - Salmon-Challis National Forest, ID; Forestwide Invasive Plant Treatment Environmental Impact...  

Federal Register 2010, 2011, 2012, 2013

...DEPARTMENT OF AGRICULTURE Forest Service Salmon-Challis National Forest, ID; Forestwide Invasive Plant Treatment Environmental Impact Statement AGENCY: Forest Service, USDA. ACTION: Notice of intent...

2011-06-23

263

Evaluation of the Definitions of “High-Risk” Cutaneous Squamous Cell Carcinoma Using the American Joint Committee on Cancer Staging Criteria and National Comprehensive Cancer Network Guidelines  

PubMed Central

Recent guidelines from the American Joint Committee on Cancer (AJCC) and National Comprehensive Cancer Network (NCCN) have been proposed for the assessment of “high-risk” cutaneous squamous cell carcinomas (cSCCs). Though different in perspective, both guidelines share the common goals of trying to identify “high-risk” cSCCs and improving patient outcomes. Thus, in theory, both definitions should identify a similar proportion of “high-risk” tumors. We sought to evaluate the AJCC and NCCN definitions of “high-risk” cSCCs and to assess their concordance. Methods. A retrospective review of head and neck cSCCs seen by an academic dermatology department from July 2010 to November 2011 was performed. Results. By AJCC criteria, most tumors (n = 211,82.1%) were of Stage 1; 46 tumors (13.9%) were of Stage 2. Almost all were of Stage 2 due to size alone (?2?cm); one tumor was “upstaged” due to “high-risk features.” Using the NCCN taxonomy, 231 (87%) of tumors were “high-risk.” Discussion. This analysis demonstrates discordance between AJCC and NCCN definitions of “high-risk” cSCC. Few cSCCs are of Stage 2 by AJCC criteria, while most are “high-risk” by the NCCN guidelines. While the current guidelines represent significant progress, further studies are needed to generate a unified definition of “high-risk” cSCC to optimize management. PMID:25309755

Chu, Melinda B.; Slutsky, Jordan B.; Dhandha, Maulik M.; Beal, Brandon T.; Armbrecht, Eric S.; Walker, Ronald J.; Varvares, Mark A.; Fosko, Scott W.

2014-01-01

264

Derivation of residual radioactive material guidelines for 13 radionuclides present in Operable Unit IV at Brookhaven National Laboratory, Upton, New York  

SciTech Connect

Residual radioactive material guidelines for 13 radionuclides (americium-241; cobalt-60; cesium-137; europium-152, -154, and -155; plutonium-238, -239, and -240; strontium-90; and uranium-234, -235, and -238) were derived for Operable Unit (OU) IV at Brookhaven National Laboratory. This site has been identified for remedial action under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as amended by the Superfund Amendments and Reauthorization Act of 1986. Single-nuclide guidelines were derived on the basis of the requirement that the 50-year committed effective dose equivalent to a hypothetical individual who lives or works in the immediate vicinity of OU IV should not exceed a dose constraint of 30 mrem/yr following remedial action for the current use and plausible future use scenarios or a dose limit of 100 mrem/yr for plausible but less likely future use scenarios. The US Department of Energy (DOE) residual radioactive material guideline computer code, RESRAD, was used in this evaluation; RESRAD implements the methodology described in the DOE manual for determining residual radioactive material guidelines. Four potential scenarios were considered; each assumed that, for a period of 1,000 years following remedial action, the site would be used without radiological restrictions. The four scenarios varied with regard to the type of site use, time spent at the site, and sources of food consumed.

Faillace, E.; Nimmagadda, M.; Yu, C.

1994-12-01

265

Symptoms during cancer pain treatment following WHO-guidelines: a longitudinal follow-up study of symptom prevalence, severity and etiology  

Microsoft Academic Search

Most patients with advanced cancer develop diverse symptoms that can limit the efficacy of pain treatment and undermine their quality of life. The present study surveys symptom prevalence, etiology and severity in 593 cancer patients treated by a pain service. Non-opioid analgesics, opioids and adjuvants were administered following the WHO-guidelines for cancer pain relief. Other symptoms were systematically treated by

Thomas Meuser; Christian Pietruck; Lukas Radbruch; Petra Stute; Klaus A Lehmann; Stefan Grond

2001-01-01

266

Do HIV-Positive Women Receive Depression Treatment that Meets Best Practice Guidelines?  

PubMed Central

This study addressed whether psychopharmacologic and psychotherapeutic treatment of depressed HIV+ women met standards defined in the best practice literature, and tested hypothesized predictors of standard-concordant care. 1,352 HIV-positive women in the multi-center Women’s Interagency HIV Study were queried about depressive symptoms and mental health service utilization using standards published by the American Psychiatric Association and the Agency for Healthcare Quality and Research to define adequate depression treatment. We identified those who: 1) reported clinically significant depressive symptoms (CSDS) using Centers for Epidemiological Studies – Depression Scale (CES-D) scores of ? 16; or 2) had lifetime diagnoses of major depressive disorder (MDD) assessed by World Mental Health Composite International Diagnostic Interviews plus concurrent elevated depressive symptoms in the past 12 months. Adequate treatment prevalence was 46.2% (n=84) for MDD and 37.9% (n=211) for CSDS. Multivariable logistic regression analysis found that adequate treatment was more likely among women who saw the same primary care provider consistently, who had poorer role functioning, who paid out-of-pocket for healthcare, and who were not African American or Hispanic/Latina. This suggests that adequate depression treatment may be increased by promoting healthcare provider continuity, outreaching individuals with lower levels of role impairment, and addressing the specific needs and concerns of African American and Hispanic/Latina women. PMID:24402689

Cook, Judith A.; Burke-Miller, Jane K.; Grey, Dennis D.; Cocohoba, Jennifer; Liu, Chenlong; Schwartz, Rebecca; Golub, Elizabeth T.; Anastos, Kathryn; Steigman, Pamela J.; Cohen, Mardge H.

2014-01-01

267

Do HIV-positive women receive depression treatment that meets best practice guidelines?  

PubMed

This study addressed whether psychopharmacologic and psychotherapeutic treatment of depressed HIV+ women met standards defined in the best practice literature, and tested hypothesized predictors of standard-concordant care. 1,352 HIV-positive women in the multi-center Women's Interagency HIV Study were queried about depressive symptoms and mental health service utilization using standards published by the American Psychiatric Association and the Agency for Healthcare Research and Quality to define adequate depression treatment. We identified those who: (1) reported clinically significant depressive symptoms (CSDS) using Centers for Epidemiological Studies-Depression Scale scores of ?16; or (2) had lifetime diagnoses of major depressive disorder (MDD) assessed by World Mental Health Composite International Diagnostic Interviews plus concurrent elevated depressive symptoms in the past 12 months. Adequate treatment prevalence was 46.2 % (n = 84) for MDD and 37.9 % (n = 211) for CSDS. Multivariable logistic regression analysis found that adequate treatment was more likely among women who saw the same primary care provider consistently, who had poorer self-rated role functioning, who paid out-of-pocket for healthcare, and who were not African American or Hispanic/Latina. This suggests that adequate depression treatment may be increased by promoting healthcare provider continuity, outreaching individuals with lower levels of reported role impairment, and addressing the specific needs and concerns of African American and Hispanic/Latina women. PMID:24402689

Cook, Judith A; Burke-Miller, Jane K; Grey, Dennis D; Cocohoba, Jennifer; Liu, Chenlong; Schwartz, Rebecca M; Golub, Elizabeth T; Anastos, Kathryn; Steigman, Pamela J; Cohen, Mardge H

2014-06-01

268

Management of suspected viral encephalitis in children - Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group national guidelines.  

PubMed

In the 1980s the outcome of patients with herpes simplex encephalitis was shown to be dramatically improved with aciclovir treatment. Delays in starting treatment, particularly beyond 48 h after hospital admission, are associated with a worse prognosis. Several comprehensive reviews of the investigation and management of encephalitis have been published. However, their impact on day-to-day clinical practice appears to be limited. The emergency management of meningitis in children and adults was revolutionised by the introduction of a simple algorithm as part of management guidelines. In February 2008 a group of clinicians met in Liverpool to begin the development process for clinical care guidelines based around a similar simple algorithm, supported by an evidence base, whose implementation is hoped would improve the management of patients with suspected encephalitis. PMID:22120594

Kneen, R; Michael, B D; Menson, E; Mehta, B; Easton, A; Hemingway, C; Klapper, P E; Vincent, A; Lim, M; Carrol, E; Solomon, T

2012-05-01

269

Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development  

PubMed Central

Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this third paper we discuss the issues of: reviewing, reporting, and publishing guidelines; updating guidelines; and the two emerging issues of enhancing guideline implementability and how guideline developers should approach dealing with the issue of patients who will be the subject of guidelines having co-morbid conditions. PMID:22762242

2012-01-01

270

PREVENTION GUIDELINES SYSTEM/DATABASE  

EPA Science Inventory

The Prevention Guidelines System gives public health practitioners quick access to the most current CDC recommendations and guidelines for the prevention, control, treatment and detection of infectious and chronic diseases, environmental hazards, natural or human-generated disast...

271

Evaluation of rationality in prescribing, adherence to treatment guidelines, and direct cost of treatment in intensive cardiac care unit: A prospective observational study  

PubMed Central

Background: Cardiovascular diseases (CVDs) remain the most common cause of sudden death. Hence, appropriate drug therapy in intensive cardiac care unit (ICCU) is crucial in managing cardiovascular emergencies and to decrease morbidity and mortality. Objective: To evaluate prescribing pattern of drugs and direct cost of therapy in patients admitted in ICCU. Materials and Methods: Patients admitted in ICCU of a tertiary care teaching hospital were enrolled. Demographic data, clinical history, and complete drug therapy received during their stay in ICCU were noted. Data were analyzed for drug utilization pattern and direct cost of treatment calculated using patient's hospital and pharmacy bills. Rationality of therapy was evaluated based on American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Result: Data of 170 patients were collected over 2 months. Mean age of patients was 54.67 ± 13.42 years. Male to female ratio was 2.33:1. Most common comorbid condition was hypertension 76 (44.7%). Most common diagnosis was acute coronary syndrome (ACS) 49.4%. Mean stay in ICCU was 4.42 ± 1.9 days. Mean number of drugs prescribed per patient was 11.43 ± 2.85. Antiplatelet drugs were the most frequently prescribed drug group (86.5%). Mean cost of pharmacotherapy per patient was ‘2701.24 ± 3111.94. Mean direct cost of treatment per patient was ‘10564.74 ± 14968.70. Parenteral drugs constituted 42% of total drugs and 90% of total cost of pharmacotherapy. Cost of pharmacotherapy was positively correlated with number of drugs (P = 0.000) and duration of stay (P = 0.027). Conclusion: Antiplatelet drugs were the most frequently prescribed drug group. Mean number of drugs per encounter were high, which contributed to the higher cost of pharmacotherapy. ACC/AHA guidelines were followed in majority of the cases. PMID:24914255

Christian, Rohan P.; Rana, Devang A.; Malhotra, Supriya D.; Patel, Varsha J.

2014-01-01

272

National Youth Court Guidelines.  

ERIC Educational Resources Information Center

Youth courts provide communities with an opportunity to impose immediate consequences for first time youthful offenders, while providing a peer operated disposition mechanism that constructively allows young people to take responsibility, be held accountable, and make amends for violating the law. Dispositions hold youth accountable in part…

Godwin, Tracy M.

273

Department of Transportation (DOT) National Highway Traffic Safety Administration and the American Medical Association Commission on Emergency Medical Services air ambulance guidelines.  

PubMed

These guidelines were developed as national EMS voluntary standards to: 1) Establish standard nomenclature for levels of aeromedical crew members; 2) Define the training requirements for each level; 3) Define the medical control requirements for aeromedical crew members; 4) Describe the application of the standards; and 5) Describe the general content areas of the training of aeromedical crew members. The AMA Commission on EMS has reviewed the current draft of the proposed national EMS voluntary standards and decided to accept them for inclusion in this second edition of the Air Ambulance Guidelines with the expectation that the final version of the ASTM Committee F-30 standard will be essentially the same as the current draft standard. The guidelines are designed to acquaint practicing physicians, especially those practicing in rural and remote areas, with the following factors which affect the transportation of patients by air ambulance: 1) Risks to the patient flying at high altitudes; 2) Equipment, both general and specific, required to render anticipated care; 3) Qualifications of personnel aboard the air ambulance, and the level of care required in transit; 4) Care required for specific medical and surgical conditions during flight. PMID:10108218

1990-12-01

274

Department of Transportation (DOT) National Highway Traffic Safety Administration and the American Medical Association Commission on Emergency Medical Services air ambulance guidelines.  

PubMed

These guidelines were developed as national EMS voluntary standards to: 1) Establish standard nomenclature for levels of aeromedical crew members; 2) Define the training requirements for each level; 3) Define the medical control requirements for aeromedical crew members; 4) Describe the application of the standards; and 5) Describe the general content areas of the training of aeromedical crew members. The AMA Commission on EMS has reviewed the current draft of the proposed national EMS voluntary standards and decided to accept them for inclusion in this second edition of the Air Ambulance Guidelines with the expectation that the final version of the ASTM Committee F-30 standard will be essentially the same as the current draft standard. The guidelines are designed to acquaint practicing physicians, especially those practicing in rural and remote areas, with the following factors which affect the transportation of patients by air ambulance: 1) Risks to the patient flying at high altitudes; 2) Equipment, both general and specific, required to render anticipated care; 3) Qualifications of personnel aboard the air ambulance, and the level of care required in transit; 4) Care required for specific medical and surgical conditions during flight. PMID:10296315

1989-12-01

275

Partial breast irradiation. Patient selection, guidelines for treatment, and current results.  

PubMed

Studies evaluating selected patients treated with partial breast irradiation (PBI) in accelerated fractionation schemes have demonstrated the equivalence of PBI with traditional whole-breast irradiation. The major advantage of PBI is the time compression of treatment down to less than 1 week compared with 6.5 weeks for whole-breast external beam treatments. Four techniques are available to deliver PBI. These include interstitial brachytherapy multicatheter systems, the Mammosite Radiation Therapy System applicator, external beam three-dimensional conformal radiation therapy and intraoperative radiation therapy. For the two brachytherapy techniques of multicatheter implantation and the Mammosite, accurate placement is achieved with image guidance via intraoperative ultrasonography, mammography, and/or CT scanning. Technologies such as image-guided cone beam CT assure accurate delivery of PBI with external beam three-dimensional conformal radiation therapy. Results of PBI show excellent control rates with mild toxicities; cosmetic outcomes are good to excellent in the vast majority of patients. PMID:17641514

Chen, Peter Y; Vicini, Frank A

2007-01-01

276

Environmental assessment of proposed effluent guidelines for the centralized waste treatment industry  

SciTech Connect

The purpose of the report is to present an assessment of the water quality benefits of controlling the discharge of priority and nonconventional pollutants from centralized waste treatment facilities to surface waters and publicly-owned treatment works (POTWs). Potential aquatic life and human health impacts of direct discharges on receiving stream water quality and of indirect discharges on POTWs and their receiving streams are projected at current, proposed BPT/BAT (Best Practicable Control Technology/Best Available Technology) and proposed PSES (Pretreatment Standards for Existing Sources) levels by quantifying pollutant releases and by using stream modeling techniques. In addition, EPA Regional and State Pretreatment Coordinators were contacted and State 304(1) Short Lists are reviewed for evidence of documented environmental impacts on aquatic life, human health, and POTW operations and for impacts on the quality of receiving water.

NONE

1995-01-01

277

ATC Guidelines for use of IMRT for intra-thoracic treatments  

Cancer.gov

ICRU Report 62 introduced the concept of the planning organ-at-risk volume (PRV), in which a margin is added around the organ at risk (OAR) to account for that organ’s geometric uncertainties. The PRV margin around the critical structure that must be spared is analogous to the PTV margin around the CTV. The use of PRV concept is particularly important for those cases involving IMRT because of the increased sensitivity of this type of treatment to geometric uncertainties.

278

A hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of catheter-associated asymptomatic bacteriuria  

PubMed Central

Background Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. However, many cases treated as hospital-acquired CAUTI are actually asymptomatic bacteriuria (ABU). Evidence-based guidelines recommend that providers neither screen for nor treat ABU in most catheterized patients, but there is a significant gap between these guidelines and clinical practice. Our objectives are (1) to evaluate the effectiveness of an audit and feedback intervention for increasing guideline-concordant care concerning catheter-associated ABU and (2) to measure improvements in healthcare providers' knowledge of and attitudes toward the practice guidelines associated with the intervention. Methods/Design The study uses a controlled pre/post design to test an intervention using audit and feedback of healthcare providers to improve their compliance with ABU guidelines. The intervention and the control sites are two VA hospitals. For objective 1 we will review medical records to measure the clinical outcomes of inappropriate screening for and treatment of catheter-associated ABU. For objective 2 we will survey providers' knowledge and attitudes. Three phases of our protocol are proposed: the first 12-month phase will involve observation of the baseline incidence of inappropriate screening for and treatment of ABU at both sites. This surveillance for clinical outcomes will continue at both sites throughout the study. Phase 2 consists of 12 months of individualized audit and feedback at the intervention site and guidelines distribution at both sites. The third phase, also over 12 months, will provide unit-level feedback at the intervention site to assess sustainability. Healthcare providers at the intervention site during phase 2 and at both sites during phase 3 will complete pre/post surveys of awareness and familiarity (knowledge), as well as of acceptance and outcome expectancy (attitudes) regarding the relevant practice guidelines. Discussion Our proposal to bring clinical practice in line with published guidelines has significant potential to decrease overdiagnosis of CAUTI and associated inappropriate antibiotic use. Our study will also provide information about how to maximize effectiveness of audit and feedback to achieve guideline adherence in the inpatient setting. Trial Registration NCT01052545 PMID:21513539

2011-01-01

279

National Drug and Alcoholism Treatment Unit Survey (NDATUS). 1987 Final Report.  

ERIC Educational Resources Information Center

This report presents the findings of the 1987 National Drug and Alcoholism Treatment Unit Survey, a national survey designed to measure the location, scope, and characteristics of drug abuse and alcoholism treatment and prevention facilities, services, and activities throughout the United States, including the District of Columbia, and the U.S.…

National Inst. on Drug Abuse (DHHS/PHS), Rockville, MD.

280

Treatment Research in Mental Illness: Improving the Nation's Public Mental Health Care  

E-print Network

Treatment Research in Mental Illness: Improving the Nation's Public Mental Health Care through NIMH Funded Interventions Research Report of the National Advisory Mental Health Council's Workgroup on Clinical Trials EXECUTIVE SUMMARY The mission of the National Institute of Mental Health (NIMH

Baker, Chris I.

281

Mucopolysaccharidosis I, II, and VI: Brief review and guidelines for treatment  

PubMed Central

Mucopolysaccharidoses (MPS) are rare genetic diseases caused by the deficiency of one of the lysosomal enzymes involved in the glycosaminoglycan (GAG) breakdown pathway. This metabolic block leads to the accumulation of GAG in various organs and tissues of the affected patients, resulting in a multisystemic clinical picture, sometimes including cognitive impairment. Until the beginning of the XXI century, treatment was mainly supportive. Bone marrow transplantation improved the natural course of the disease in some types of MPS, but the morbidity and mortality restricted its use to selected cases. The identification of the genes involved, the new molecular biology tools and the availability of animal models made it possible to develop specific enzyme replacement therapies (ERT) for these diseases. At present, a great number of Brazilian medical centers from all regions of the country have experience with ERT for MPS I, II, and VI, acquired not only through patient treatment but also in clinical trials. Taking the three types of MPS together, over 200 patients have been treated with ERT in our country. This document summarizes the experience of the professionals involved, along with the data available in the international literature, bringing together and harmonizing the information available on the management of these severe and progressive diseases, thus disclosing new prospects for Brazilian patients affected by these conditions. PMID:21637564

2010-01-01

282

How could depression guidelines be made more relevant and applicable to primary care?  

PubMed Central

Background Many guidelines have been developed in the area of depression but there has been no systematic assessment of their relevance to general practice. Aim To assess national guidelines on general practice management of depression using two complementary approaches to identify specific ways in which guidance could be made more relevant and applicable to the nature of general practice and the patients who seek help in this context. Design of study Review of national guidelines. Setting Seven English speaking countries: UK, US, Australia, New Zealand, Ireland, Canada, and Singapore. Method Seven guidelines were independently reviewed quantitatively using the Appraisal of Guidelines for Research and Evaluation (AGREE) scores and qualitatively using thematic coding. Results The quantitative assessment highlights that most of the guidelines fail to meet the criteria on rigour of development, applicability, and editorial independence. The qualitative assessment shows that the majority of guidelines do not address associated risk factors sufficiently and the dilemma of diagnostic uncertainty flows over into management recommendations. Management strategies for depression (antidepressants and psychological strategies) are supported by all of the guidelines, with several listing drugs before psychological therapies; there is limited attention paid to the different types of psychological therapies. Moreover, the guidelines in the main fail to acknowledge individual patient circumstances, in particular the influence on response to treatment of social issues such as adverse life events or social support. Conclusion Assessments of current national guidelines on depression management in general practice suggest significant limitations in their relevance to general practice. PMID:19401008

Hegarty, Kelsey; Gunn, Jane; Blashki, Grant; Griffiths, Frances; Dowell, Tony; Kendrick, Tony

2009-01-01

283

Guideline 2: Informed Consent.  

ERIC Educational Resources Information Center

The second in seven sets of guidelines based on the consensus of experts in the treatment of psychiatric and behavioral problems in mental retardation (MR) focuses on informed consent. Guidelines cover underlying concepts, usual components, informed consent as a process, information to include, what to provide, when to obtain informed consent, and…

American Journal on Mental Retardation, 2000

2000-01-01

284

Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults  

PubMed Central

Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: What pharmacologic therapies are proven effective for migraine prevention? Methods: The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications available in the United States for migraine prevention. Results and Recommendations: The author panel reviewed 284 abstracts, which ultimately yielded 29 Class I or Class II articles that are reviewed herein. Divalproex sodium, sodium valproate, topiramate, metoprolol, propranolol, and timolol are effective for migraine prevention and should be offered to patients with migraine to reduce migraine attack frequency and severity (Level A). Frovatriptan is effective for prevention of menstrual migraine (Level A). Lamotrigine is ineffective for migraine prevention (Level A). PMID:22529202

Silberstein, S.D.; Holland, S.; Freitag, F.; Dodick, D.W.; Argoff, C.; Ashman, E.

2012-01-01

285

Treatment Services in Adult Drug Courts: Report on the 1999 National Drug Court Treatment Survey. Drug Courts Resource Series.  

ERIC Educational Resources Information Center

In October 1999, National Treatment Accountability for Safer Communities (TASC), in cooperation with the Office of Justice Programs, Drug Courts Program Office and the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, developed and distributed a questionnaire designed to describe substance abuse…

Pexton, Elizabeth A.; Gossweiler, Robert

286

[The Spanish Society of Pediatric Infectious Diseases Guidelines for the diagnosis and treatment of congenital toxoplasmosis].  

PubMed

Congenital toxoplasmosis is the result of transplacental fetal infection by Toxoplasma gondii after the primary maternal infection. The severity of the disease depends on the gestational age at transmission. First trimester infections are more severe, but less frequent, than third trimester infections. Acute maternal infection is diagnosed by seroconversion or by the detection of IgM antibodies and a low IgG avidity test. In these cases, spiramycin should be initiated to prevent transmission to the fetus. For identification of fetal infection, polymerase chain reaction (PCR) testing of amniotic fluid after 18 weeks gestation should be performed. If fetal infection is confirmed, the mothers should be treated with pyrimethamine, sulfadiazine and folinic acid. Most infants infected in utero are born with no obvious signs of toxoplasmosis, but up to 80% developed learning and visual disabilities later in life. Neonatal diagnosis with IgM/IgA antibodies or blood/cerebrospinal fluid PCR may be difficult because false-negative results frequently occur. In these cases diagnosis is possible by demonstrating a rise in IgG titers during follow-up or by the detection of antibodies beyond one year of age. Early treatment with pyrimethamine and sulfadiazine may improve the ophthalmologic and neurological outcome. Congenital toxoplasmosis is a preventable disease. Pre-pregnancy screening and appropriate counseling regarding prevention measures in seronegative women may prevent fetal infection. PMID:23352717

Baquero-Artigao, F; del Castillo Martín, F; Fuentes Corripio, I; Goncé Mellgren, A; Fortuny Guasch, C; de la Calle Fernández-Miranda, M; González-Tomé, M I; Couceiro Gianzo, J A; Neth, O; Ramos Amador, J T

2013-08-01

287

Speech pathologists’ experiences with stroke clinical practice guidelines and the barriers and facilitators influencing their use: a national descriptive study  

PubMed Central

Background Communication and swallowing disorders are a common consequence of stroke. Clinical practice guidelines (CPGs) have been created to assist health professionals to put research evidence into clinical practice and can improve stroke care outcomes. However, CPGs are often not successfully implemented in clinical practice and research is needed to explore the factors that influence speech pathologists’ implementation of stroke CPGs. This study aimed to describe speech pathologists’ experiences and current use of guidelines, and to identify what factors influence speech pathologists’ implementation of stroke CPGs. Methods Speech pathologists working in stroke rehabilitation who had used a stroke CPG were invited to complete a 39-item online survey. Content analysis and descriptive and inferential statistics were used to analyse the data. Results 320 participants from all states and territories of Australia were surveyed. Almost all speech pathologists had used a stroke CPG and had found the guideline “somewhat useful” or “very useful”. Factors that speech pathologists perceived influenced CPG implementation included the: (a) guideline itself, (b) work environment, (c) aspects related to the speech pathologist themselves, (d) patient characteristics, and (e) types of implementation strategies provided. Conclusions There are many different factors that can influence speech pathologists’ implementation of CPGs. The factors that influenced the implementation of CPGs can be understood in terms of knowledge creation and implementation frameworks. Speech pathologists should continue to adapt the stroke CPG to their local work environment and evaluate their use. To enhance guideline implementation, they may benefit from a combination of educational meetings and resources, outreach visits, support from senior colleagues, and audit and feedback strategies. PMID:24602148

2014-01-01

288

Thyroid Coding Guidelines  

Cancer.gov

Coding Guidelines THYROID GLAND C739 Coding Hormone Therapy Code Hormone Therapy as 01 for follicular and/or papillary thyroid cancer when thyroid hormone therapy is given. Do not code replacement therapy as treatment unless the tumor is papillary

289

Guidelines for the diagnosis and treatment of idiopathic pulmonary fibrosis. Sociedad Española de Neumología y Cirugía Torácica (SEPAR) Research Group on Diffuse Pulmonary Diseases.  

PubMed

Idiopathic pulmonary fibrosis is defined as a chronic fibrosing interstitial pneumonia limited to the lung, of unknown cause, with poor prognosis and few treatment options. In recent years there has been an increase in their prevalence, probably due to the optimization of diagnostic methods and increased life expectancy. The ATS/ERS Consensus (2000) established the diagnostic criteria and recommendations for the assessment of the disease course and treatment. Later studies have helped to redefine diagnostic criteria and treatment options. In 2011, an international consensus was published, establishing diagnostic criteria and new treatment strategies. These guidelines have been updated with the newest aspects of diagnosis and treatment of idiopathic pulmonary fibrosis. A level of evidence has been identified for the most relevant questions, particularly with regard to treatment options. PMID:23742884

Xaubet, Antoni; Ancochea, Julio; Bollo, Elena; Fernández-Fabrellas, Estrella; Franquet, Tomás; Molina-Molina, Maria; Montero, Maria Angeles; Serrano-Mollar, Anna

2013-08-01

290

7 CFR 611.10 - Standards, guidelines, and plans.  

...DEPARTMENT OF AGRICULTURE CONSERVATION OPERATIONS SOIL SURVEYS Soil Survey Operations § 611.10 Standards, guidelines, and plans. (a) NRCS conducts soil surveys under national standards and guidelines...

2014-01-01

291

7 CFR 611.10 - Standards, guidelines, and plans.  

Code of Federal Regulations, 2012 CFR

...DEPARTMENT OF AGRICULTURE CONSERVATION OPERATIONS SOIL SURVEYS Soil Survey Operations § 611.10 Standards, guidelines, and plans. (a) NRCS conducts soil surveys under national standards and guidelines...

2012-01-01

292

7 CFR 611.10 - Standards, guidelines, and plans.  

Code of Federal Regulations, 2013 CFR

...DEPARTMENT OF AGRICULTURE CONSERVATION OPERATIONS SOIL SURVEYS Soil Survey Operations § 611.10 Standards, guidelines, and plans. (a) NRCS conducts soil surveys under national standards and guidelines...

2013-01-01

293

7 CFR 611.10 - Standards, guidelines, and plans.  

Code of Federal Regulations, 2010 CFR

...DEPARTMENT OF AGRICULTURE CONSERVATION OPERATIONS SOIL SURVEYS Soil Survey Operations § 611.10 Standards, guidelines, and plans. (a) NRCS conducts soil surveys under national standards and guidelines...

2010-01-01

294

7 CFR 611.10 - Standards, guidelines, and plans.  

Code of Federal Regulations, 2011 CFR

...DEPARTMENT OF AGRICULTURE CONSERVATION OPERATIONS SOIL SURVEYS Soil Survey Operations § 611.10 Standards, guidelines, and plans. (a) NRCS conducts soil surveys under national standards and guidelines...

2011-01-01

295

Contributors to primary care guidelines  

PubMed Central

Objective To determine the professions of those who contribute to guidelines, guideline variables associated with differing contributor participation, and whether conflict of interest statements are provided in primary care guidelines. Design Retrospective analysis of the primary care guidelines from the Canadian Medical Association website. Two independent data extractors reviewed the guidelines and extracted relevant data. Setting Canada. Main outcome measures Sponsors of guidelines, jurisdiction (national or provincial) of guidelines, the professions of those who contribute to guidelines, and the reported conflict of interest statements within guidelines. Results Of the 296 guidelines in the family medicine section of the CMA Infobase, 65 were duplicates and 35 had limited relevance to family medicine. Twenty did not provide contributor information, leaving 176 guidelines for analysis. In total, there were 2495 contributors (authors and committee members): 1343 (53.8%) non–family physician specialists, 423 (17.0%) family physicians, 141 (5.7%) nurses, 75 (3.0%) pharmacists, 269 (10.8%) other clinicians, 203 (8.1%) nonclinician scientists, and 41 (1.6%) unknown professions. The proportion of contributors from the various professions differed significantly between provincial and national guidelines, as well as between industry-funded and non–industry-funded guidelines (both P < .001). For provincial guidelines, 30.8% of contributors were family physicians and 37.3% were other specialists compared with 13.9% and 57.4%, respectively, for national guidelines. Of industry-funded guidelines, 7.8% of contributors were family physicians and 68.6% were other specialists compared with 19.4% and 49.9%, respectively, for non–industry-funded guidelines. Conflicts of interest were not reported in 68.9% of guidelines. When reported, conflict of interest statements were present for 48.6% of non–family physician specialists, 30.0% of pharmacists, 27.7% of family physicians, and 10.0% or less of the remaining groups; differences were statistically significant (P < .001). Conclusion Non–family physician specialists outnumber all other health care providers combined and are more than 3 times more likely to contribute to primary care guidelines than family physicians are. Conflict of interest statements were provided in the minority of guidelines, and for guidelines in which conflict of interest statements were included, non–family physician specialists were most likely to report them. Guidelines targeted to primary care should have much more primary care and family medicine representation and include fewer contributors who have conflicts of interest. PMID:25609522

Allan, G. Michael; Kraut, Roni; Crawshay, Aven; Korownyk, Christina; Vandermeer, Ben; Kolber, Michael R.

2015-01-01

296

Radiation Therapy Oncology Group Consensus Panel Guidelines for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Head Cancer  

SciTech Connect

Purpose: To develop contouring guidelines to be used in the Radiation Therapy Oncology Group protocol 0848, a Phase III randomized trial evaluating the benefit of adjuvant chemoradiation in patients with resected head of pancreas cancer. Methods and Materials: A consensus committee of six radiation oncologists with expertise in gastrointestinal radiotherapy developed stepwise contouring guidelines and an atlas for the delineation of the clinical target volume (CTV) in the postoperative treatment of pancreas cancer, based on identifiable regions of interest and margin expansions. Areas at risk for subclinical disease to be included in the CTV were defined, including nodal regions, anastomoses, and the preoperative primary tumor location. Regions of interest that could be reproducibly contoured on postoperative imaging after a pancreaticoduodenectomy were identified. Standardized expansion margins to encompass areas at risk were developed after multiple iterations to determine the optimal margin expansions. Results: New contouring recommendations based on CT anatomy were established. Written guidelines for the delineation of the postoperative CTV and normal tissues, as well as a Web-based atlas, were developed. Conclusions: The postoperative abdomen has been a difficult area for effective radiotherapy. These new guidelines will help physicians create fields that better encompass areas at risk and minimize dose to normal tissues.

Goodman, Karyn A., E-mail: goodmank@mskcc.org [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Regine, William F. [University of Maryland School of Medicine, Baltimore, Maryland (United States); Dawson, Laura A. [Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Ben-Josef, Edgar [University of Michigan Medical School, Ann Arbor, Michigan (United States); Haustermans, Karin [University Hospital Leuven, Leuven (Belgium); Bosch, Walter R. [Image-Guided Therapy QA Center, Washington University, St. Louis, Missouri (United States); Turian, Julius; Abrams, Ross A. [Rush University Medical College, Chicago, Illinois (United States)

2012-07-01

297

Consensus Guidelines for Delineation of Clinical Target Volume for Intensity-Modulated Pelvic Radiotherapy for the Definitive Treatment of Cervix Cancer  

SciTech Connect

Purpose: Accurate target definition is vitally important for definitive treatment of cervix cancer with intensity-modulated radiotherapy (IMRT), yet a definition of clinical target volume (CTV) remains variable within the literature. The aim of this study was to develop a consensus CTV definition in preparation for a Phase 2 clinical trial being planned by the Radiation Therapy Oncology Group. Methods and Materials: A guidelines consensus working group meeting was convened in June 2008 for the purposes of developing target definition guidelines for IMRT for the intact cervix. A draft document of recommendations for CTV definition was created and used to aid in contouring a clinical case. The clinical case was then analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. Results: Nineteen experts in gynecological radiation oncology generated contours on axial magnetic resonance images of the pelvis. Substantial STAPLE agreement sensitivity and specificity values were seen for gross tumor volume (GTV) delineation (0.84 and 0.96, respectively) with a kappa statistic of 0.68 (p < 0.0001). Agreement for delineation of cervix, uterus, vagina, and parametria was moderate. Conclusions: This report provides guidelines for CTV definition in the definitive cervix cancer setting for the purposes of IMRT, building on previously published guidelines for IMRT in the postoperative setting.

Lim, Karen [Radiation Medicine Program, Princess Margaret Hospital/ Ontario Cancer Institute, University Health Network, Toronto, Ontario (Canada); Small, William [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois (United States); Portelance, Lorraine [Department of Radiation Oncology, McGill University Health Center, Montreal, Quebec (Canada); Creutzberg, Carien [Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands); Juergenliemk-Schulz, Ina M. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Mundt, Arno; Mell, Loren K. [Department of Radiation Oncology, University of California, San Diego, School of Medicine, La Jolla, California (United States); Mayr, Nina [Department of Radiation Medicine, Ohio State University, Columbus, Ohio (United States); Viswanathan, Akila [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States); Jhingran, Anuja [Department of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX (United States); Erickson, Beth [Dept. of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); De Los Santos, Jennifer [Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL (United States); Gaffney, David [Dept. of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT (United States); Yashar, Catheryn [Dept. of Radiation Oncology, Univ. of California, San Diego, School of Medicine, La Jolla, CA (United States); Beriwal, Sushil [Dept. of Radiation Oncology, Magee-Women's Hospital of Univ. of Pittsburgh Medical Center, Pittsburgh, PA (United States); Wolfson, Aaron [Dept. of Radiation Oncology, Univ. of Miami Miller School of Medicine, Miami, FL (United States)

2011-02-01

298

World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision.  

PubMed

In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, World J Biol Psychiatry 3:171), recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo- or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines. PMID:18949648

Bandelow, Borwin; Zohar, Joseph; Hollander, Eric; Kasper, Siegfried; Möller, Hans-Jürgen; Zohar, Joseph; Hollander, Eric; Kasper, Siegfried; Möller, Hans-Jürgen; Bandelow, Borwin; Allgulander, Christer; Ayuso-Gutierrez, José; Baldwin, David S; Buenvicius, Robertas; Cassano, Giovanni; Fineberg, Naomi; Gabriels, Loes; Hindmarch, Ian; Kaiya, Hisanobu; Klein, Donald F; Lader, Malcolm; Lecrubier, Yves; Lépine, Jean-Pierre; Liebowitz, Michael R; Lopez-Ibor, Juan José; Marazziti, Donatella; Miguel, Euripedes C; Oh, Kang Seob; Preter, Maurice; Rupprecht, Rainer; Sato, Mitsumoto; Starcevic, Vladan; Stein, Dan J; van Ameringen, Michael; Vega, Johann

2008-01-01

299

78 FR 45544 - Center for Substance Abuse Treatment (CSAT) National Advisory Council; Notice of Meeting  

Federal Register 2010, 2011, 2012, 2013

...OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (CSAT) National Advisory Council...notice is hereby given that the Substance Abuse and Mental Health Services...

2013-07-29

300

78 FR 15961 - Center for Substance Abuse Treatment National Advisory Council; Meeting  

Federal Register 2010, 2011, 2012, 2013

...OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment National Advisory Council; Meeting...hereby given of the meeting of the Substance Abuse and Mental Health Services...

2013-03-13

301

Treatment Services for Children With ADHD: A National Perspective  

Microsoft Academic Search

ObjectiveTo summarize knowledge on treatment services for children and adolescents with attention-deficit hyperactivity disorder (ADHD), trends in services from 1989 to 1996, types of services provided, service mix, and barriers to care.

KIMBERLY HOAGWOOD; KELLY J. KELLEHER; MICHAEL FEIL; DIANE M. COMER

2000-01-01

302

Forms & Guidelines  

Cancer.gov

2003 DCP Consortia for Early Phase Prevention Trials 2003 Step 1: Developing a Cancer Prevention Clinical Trial Forms & Guidelines General Guidelines for Consortia Lead Organization to add Participating to Consortium (doc, 63kb) NCI Request for Proposals,

303

76 FR 70954 - Idaho Panhandle National Forests, Idaho; Idaho Panhandle National Forest Noxious Weed Treatment...  

Federal Register 2010, 2011, 2012, 2013

...Panhandle National Forests, 3815 Schreiber Way...public comments, the Forest Supervisor will make...several methods of control including mechanical, chemical, or biological methods...and conditions the Forest Service would...

2011-11-16

304

Implementation of national guidelines, incorporated within structured diabetes and hypertension records at primary level care in Cape Town, South Africa: a randomised controlled trial  

PubMed Central

Background and objectives Many clinical management guidelines for chronic diseases have been published, but they have not been put into practice by busy clinicians at primary care levels. This study evaluates the implementation of national guidelines incorporated within a structured diabetes and hypertension clinical record (SR) in Cape Town in a randomised controlled trial (RCT). Methods Eighteen public sector community health centres (CHC) were randomly selected and allocated as intervention or control CHC. At each clinic, 25 patients with diabetes and 35 patients with hypertension were enrolled at baseline. Questionnaires were completed, blood samples were collected, blood pressure (BP) and anthropometric measures were taken and patient records were audited. SR with clinical guideline prompts were introduced at the intervention clinics after training doctors in their use and suggestions to incorporate them in regular patient records. Contact was maintained during the year of intervention with the clinic staff. A follow-up survey was conducted 1 year later to assess BP and HbA1c, and the patient records were examined to ascertain the extent of use of the SR in the intervention clinics. In-depth interviews were conducted with doctors and nurses to record their response to the intervention. Results The intervention evaluated in this RCT had no impact on either diabetes or hypertension control. In the intervention clinics, less than 60% of the patient folders contained the SR and when present was seldom used. Although the staff were well disposed to the research team, their workload prohibited them from undertaking a true evaluation of the SR, and overall they did not perceive the SR as supporting their current process of patient care. Conclusions No benefit to diabetes of hypertension care by introducing and availability of the staff in the use of the SR was shown in this RCT. The process measures suggest that the SR was not widely used by the healthcare provided in the primary care clinics. PMID:24070181

Steyn, Krisela; Lombard, Carl; Gwebushe, Nomonde; Fourie, Jean M.; Everett-Murphy, Katherine; Zwarenstein, Merrick; Levitt, Naomi S.

2013-01-01

305

SBRT for the Primary Treatment of Localized Prostate Cancer: The Effect of Gleason Score, Dose and Heterogeneity of Intermediate Risk on Outcome Utilizing 2.2014 NCCN Risk Stratification Guidelines  

PubMed Central

Purpose: To report an update of our previous experience using stereotactic body radiation therapy (SBRT) for the primary treatment of prostate cancer, risk stratified by the updated National Comprehensive Cancer Network (NCCN) version 2.2014, reporting efficacy and toxicity in a community hospital setting. Methods: From 2007 to 2012, 142 localized prostate cancer patients were treated with SBRT using CyberKnife. NCCN guidelines Version 2.2014 risk groups analyzed included very low (20%), low (23%), intermediate (35%), and high (22%) risk. To further explore group heterogeneity and to comply with new guidelines, we separated our prior intermediate risk group into favorable intermediate and unfavorable intermediate groups depending on how many intermediate risk factors were present (one vs.?>?one). The unfavorable intermediate group was further analyzed in combination with the high risk group as per NCCN guidelines Version 2.2014. Various dose levels were used over the years of treatment, and have been categorized into low dose (35?Gy, n?=?5 or 36.25?Gy, n?=?107) and high dose (37.5?Gy, n?=?30). All treatments were delivered in five fractions. Toxicity was assessed using radiation therapy oncology group criteria. Results: Five-year actuarial freedom from biochemical failure (FFBF) was 100, 91.7, 95.2, 90.0, and 86.7% for very low, low, intermediate and high risk patients, respectively. A significant difference in 5?year FFBF was noted for patients with Gleason score (GS) ?8 vs. 7 vs. 5/6 (p?=?0.03) and low vs. high dose (p?=?0.05). T-stage, pretreatment PSA, age, risk stratification group, and use of ADT did not affect 5-year FFBF. Multivariate analysis revealed GS and dose to be the most predictive factors for 5-year FFBF. Conclusion: Our experience with SBRT for the primary treatment of localized prostate cancer demonstrates favorable efficacy and toxicity comparable to the results reported for IMRT in literature. GS remains the single most important pretreatment predictor of outcome. PMID:25426447

Bernetich, Matthew; Oliai, Caspian; Lanciano, Rachelle; Hanlon, Alexandra; Lamond, John; Arrigo, Stephen; Yang, Jun; Good, Michael; Feng, Jing; Brown, Royce; Garber, Bruce; Mooreville, Michael; Brady, Luther W.

2014-01-01

306

Substance Dependence, Abuse and Treatment: Findings from the 2000 National Household Survey on Drug Abuse.  

ERIC Educational Resources Information Center

This report provides the first information on substance dependence, abuse, and treatment obtained from the 2000 National Household Survey on Drug Abuse (NHSDA). Several important changes to the NHSDA in 1999 and 2000 affected the estimates of drug use, as well as the estimates for dependence, abuse, and needing and receiving treatment. Following…

Epstein, Joan F.

307

[Integrated headache care network. Kiel Migraine and Headache Center and German National Headache Treatment Network].  

PubMed

Migraine and other headaches affect 54 million people in Germany. They rank among the ten most severely disabling complaints and the three most expensive neurological disorders. Nevertheless, they are not adequately recognized in the healthcare system with sketchy diagnoses and inadequate treatment. This inadequate care is not primarily due to a lack of medical and scientific knowledge on the development and treatment of headaches but is predominantly due to organizational deficits in the healthcare system and in the implementation of current knowledge. To overcome the organizational barriers the national headache treatment network was initiated in Germany. For the first time it allows national cross-sectoral and multidisciplinary links between inpatient and outpatient care. A hand in hand treatment programme, better education, better information exchange between all partners and combined efforts using clearly defined treatment pathways and goals are the basis for state of the art and efficient treatment results. The treatment network is geared towards the specialized treatment of severely affected patients with chronic headache disorders. A national network of outpatient and inpatient pain therapists in both practices and hospitals works hand in hand to optimally alleviate pain in a comprehensive cross-sectoral and multidisciplinary manner. For therapy refractive disorders, a high-intensive supraregional fully inpatient treatment can be arranged. This concept offers for the first time a nationwide coordinated treatment without limitation by specialization and bureaucratic remuneration sectors. PMID:23549863

Göbel, H; Heinze-Kuhn, K; Petersen, I; Göbel, A; Heinze, A

2013-04-01

308

The disconnect between a national tuberculosis drug resistance survey and treatment outcomes: a lost opportunity.  

PubMed

We linked results from the Fourth Botswana National Drug Resistance Survey (DRS), 2007-2008, to patient records from the national Electronic Tuberculosis Registry to determine treatment outcomes. Of 915 new patients, 651 (71%) had treatment data available. Completion or cure was achieved for 10/15 (67%, 95%CI 42-85) with isoniazid monoresistance, (6/16, 38%, 95%CI 18-61) with multidrug resistance, while 73% (391/537, 95%CI 69-76) were susceptible to first-line drugs. The analysis was limited because of unavailable treatment records and undocumented outcomes. Prospective analyses following DRSs should be considered to ensure adequate outcome data. PMID:25299864

Click, E S; Chirenda, J; Kibias, S; Menzies, H J; Oeltmann, J E; Sentle, C; Muribe, T; Lere, T D; Makombe, R; Bamrah, S; Moore, B K; Cain, K P

2014-11-01

309

Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part IIClinical Applications and Guidelines  

Microsoft Academic Search

Yogic breathing is a unique method for balancing the autonomic nervous system and influencing psycho- logic and stress-related disorders. Part I of this series presented a neurophysiologic theory of the effects of Su- darshan Kriya Yoga (SKY). Part II will review clinical studies, our own clinical observations, and guidelines for the safe and effective use of yoga breath techniques in

Richard P. Brown; Patricia L. Gerbarg

2005-01-01

310

CIHR Canadian HIV Trials Network Co-Infection and Concurrent Diseases Core: Updated Canadian guidelines for the treatment of hepatitis C infection in HIV-hepatitis C coinfected adults  

PubMed Central

BACKGROUND: Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV and is responsible for a heavy burden of morbidity and mortality. Management of HIV-HCV coinfection is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug-drug interactions between new HCV direct-acting antiviral therapies and antiretroviral regimens. OBJECTIVE: To update national standards for the management of HCV-HIV coinfected adults in the Canadian context. METHODS: A standing working group with specific clinical expertise in HIV-HCV coinfection was convened by The Canadian Institute of Health Research HIV Trials Network to review recently published data regarding HCV antiviral treatments and to update the Canadian HIV-HCV coinfection guidelines. RESULTS: Recent data suggest that the gap in sustained virological response rates between HCV monoinfection and HIV-HCV coinfection has been eliminated with newer HCV antiviral regimens. All HIV-HCV coinfected individuals should be assessed for HCV therapy. First-line treatment for genotypes 1 through 6 includes pegylated interferon and weight-based ribavirin dosing plus the nucleotide sofosbuvir for 12 weeks. Sofosbuvir in combination with the protease inhibitor simeprevir is another first-line consideration for genotype 1 infection. Sofosbuvir with ribavirin for 12 weeks (genotype 2) and 24 weeks (genotype 3) is also recommended as first-line treatment. DISCUSSION: Recommendations may not supersede individual clinical judgement.

Hull, Mark; Shafran, Stephen; Tseng, Alice; Giguère, Pierre; Klein, Marina B; Cooper, Curtis

2014-01-01

311

Guideline-concordant administration of prothrombin complex concentrate and vitamin K is associated with decreased mortality in patients with severe bleeding under vitamin K antagonist treatment (EPAHK study)  

PubMed Central

Introduction In vitamin K antagonist (VKA)-treated patients with severe hemorrhage, guidelines recommend prompt VKA reversal with prothrombin complex concentrate (PCC) and vitamin K. The aim of this observational cohort study was to evaluate the impact of guideline concordant administration of PCC and vitamin K on seven-day mortality. Methods Data from consecutive patients treated with PCC were prospectively collected in 44 emergency departments. Type of hemorrhage, coagulation parameters, type of treatment and seven-day mortality mortality were recorded. Guideline-concordant administration of PCC and vitamin K (GC-PCC-K) were defined by at least 20 IU/kg factor IX equivalent PCC and at least 5 mg of vitamin K performed within a predefined time frame of eight hours after admission. Multivariate analysis was used to assess the effect of appropriate reversal on seven-day mortality in all patients and in those with intracranial hemorrhage (ICH). Results Data from 822 VKA-treated patients with severe hemorrhage were collected over 14 months. Bleeding was gastrointestinal (32%), intracranial (32%), muscular (13%), and “other” (23%). In the whole cohort, seven-day mortality was 13% and 33% in patients with ICH. GC-PCC-K was performed in 38% of all patients and 44% of ICH patients. Multivariate analysis showed a two-fold decrease in seven-day mortality in patients with GC-PCC-K (odds ratio (OR)?=?2.15 (1.20 to 3.88); P?=?0.011); this mortality reduction was also observed when only ICH was considered (OR?=?3.23 (1.53 to 6.79); P?=?0.002). Conclusions Guideline-concordant VKA reversal with PCC and vitamin K within eight hours after admission was associated with a significant decrease in seven-day mortality. PMID:24762166

2014-01-01

312

Research Fellowships Program of the National Center for Health Services Research and Development. Policies and Guidelines for Applicants.  

ERIC Educational Resources Information Center

The National Center for Health Services Research and Development supports individual research training in an institutional setting for the development of competence in research techniques relevant to the organization, delivery, quality, financing, utilization, and evaluation of health delivery systems. The evolution of health services science…

Health Services and Mental Health Administration (DHEW), Bethesda, MD.

313

Atmospherically deposited PBDEs, pesticides, PCBs, and PAHs in Western US National Park fish: Concentrations and consumption guidelines  

EPA Science Inventory

Concentrations of polybrominated diphenyl ethers (PBDEs), pesticides, polychlorinated biphenyls (PCBs), and polycyclic aromatic hydrocarbons were measured in 136 fish from 14 remote lakes in 8 western U.S. National Parks/Preserves between 2003 and 2005 and compared to human and w...

314

Characteristics and treatment responses of patients satisfying the BSR guidelines for anti-TNF in ankylosing spondylitis  

Microsoft Academic Search

Objective. We present the results of the response to anti-tumour necrosis factor (anti-TNF) of 30 ankylosing spondylitis (AS) patients where we have complied with the BSR guidelines. Method. All patients had pre-assessments of Bath AS Disease Activity Index (BASDAIs) at two points a month apart prior to commencing anti-TNF. They then had 2 week and 2 month assessments followed by

K. Gadsby; C. Deighton

2007-01-01

315

Physician adherence to hypertension treatment guidelines and drug acquisition costs of antihypertensive drugs at the cardiac clinic: a pilot study  

PubMed Central

Prescribing pattern surveys are one of the pharmacoepidemiological techniques that provide an unbiased picture of prescribing habits. Prescription surveys permit the identification of suboptimal prescribing patterns for further evaluation. The aims of this study were to determine the prescribing trend, adherence of the prescribers to the guideline, and the impact of drug expenditure on drug utilization at the cardiac clinic of Penang Hospital, Malaysia. This was a cross-sectional study. Demographic data of the patients, diagnoses and the drugs prescribed were recorded. The average drug acquisition costs (ADAC) were calculated for each antihypertensive drug class on a daily and annual basis. Adherence to the guideline was calculated as a percentage of the total number of patients. A total of 313 individuals fulfilled the inclusion criteria. The average age of the study population was 59.30 ± 10.35 years. The mean number of drugs per prescription in the study was 2.09 ± 0.78. There were no significant differences in the demographic data. Antihypertensive drugs were used in monotherapy and polytherapy in 20.8% and 79.2% of the patients, respectively. Adherence to the guideline regarding prescription occurred in 85.30% of the patients. The lowest priced drug class was diuretics and the highest was angiotensin-receptor blockers. In conclusion, the total adherence to the guideline was good; the adherence percentage only slightly decreased with a co-existing comorbidity (such as diabetes mellitus). The use of thiazide diuretics was encouraged because they are well tolerated and inexpensive, and perindopril was still prescribed for diabetic patients since it is relatively cheap (generic drug) and its daily dosage is beneficial. PMID:22346346

Abdulameer, Shaymaa Abdalwahed; Sahib, Mohanad Naji; Aziz, Noorizan Abd; Hassan, Yahaya; AlRazzaq, Hadeer Akram Abdul; Ismail, Omar

2012-01-01

316

A guideline management system.  

PubMed

This paper describes the architecture of NewGuide, a guide-line management system for handling the whole life cycle of a computerized clinical practice guideline. NewGuide components are organized in a distributed architecture: an editor to formalize guidelines, a repository to store them, an inference engine to implement guidelines instances in a multi-user environment, and a reporting system storing the guidelines logs in order to be able to completely trace any individual physician guideline-based decision process. There is a system "central level" that maintains official versions of the guidelines, and local Healthcare Organizations may download and implement them according to their needs. The architecture has been implemented using the Java 2 Enterprise Edition (J2EE) platform. Simple Object Access Protocol (SOAP) and a set of con-tracts are the key factors for the integration of NewGuide with healthcare legacy systems. They allow maintaining unchanged legacy user interfaces and connecting the system with what-ever electronic patient record. The system functionality will be illustrated in three different contexts: homecare-based pressure ulcer prevention, acute ischemic stroke treatment and heart failure management by general practitioners. PMID:15360768

Ciccarese, Paolo; Caffi, Ezio; Boiocchi, Lorenzo; Quaglini, Silvana; Stefanelli, Mario

2004-01-01

317

Current clinical practice guidelines on chemotherapy and radiotherapy for the treatment of non-metastatic muscle-invasive urothelial cancer: a systematic review and critical evaluation by the Hellenic Genito-Urinary Cancer Group (HGUCG).  

PubMed

Radical cystectomy is the treatment of choice in localized muscle-invasive urothelial cancer. Nevertheless, relapses are frequent and systemic chemotherapy has been employed in order to reduce this risk. In addition, bladder preservation strategies are appealing. During the last decade, there has been a difficulty in conducting and completing large-scale trials in urothelial cancer. This has resulted in relatively few changes in the existing guidelines. Recent studies have created renewed interest in certain fields, such as the role of chemo-radiotherapy and management of unfit patients. In addition, application of certain guidelines has been limited in everyday practice. We conducted a systematic review of the existing guidelines and recent randomized trials not included in these guidelines, and developed a treatment algorithm, regarding non-surgical therapies for non-metastatic, muscle-invasive urothelial cancer based predominantly on patients' fitness for the available therapeutic modalities. PMID:25205597

Zagouri, F; Peroukidis, S; Tzannis, K; Kouloulias, V; Bamias, A

2015-01-01

318

Quality of Care Measures for the Treatment of Bipolar Disorder  

Microsoft Academic Search

The staff of the American Psychiatric Assocition (APA), the American Psychiatric Institute for Research and Education (APIRE), and a national panel of experts in bipolar disorder and practice guideline development have collaborated to generate a set of quality of care indicators for the pharmacologic and psychosocial treatment of bipolar disorder. The indicators were derived from APA’s evidence-based Practice Guideline for

Farifteh Firoozmand Duffy; William Narrow; Joyce C. West; Laura J. Fochtmann; David A. Kahn; Trisha Suppes; John M. Oldham; John S. McIntyre; Ronald W. Manderscheid; Paul Sirovatka; Darrel Regier

2005-01-01

319

Consensus Recommendations for the Diagnosis and Management of Pancreatic Neuroendocrine Tumors: Guidelines from a Canadian National Expert Group.  

PubMed

Pancreatic neuroendocrine tumors (pNETs) are rare heterogeneous tumors that have been steadily increasing in both incidence and prevalence during the past few decades. Pancreatic NETs are categorized as functional (F) or nonfunctional (NF) based on their ability to secrete hormones that elicit clinically relevant symptoms. Specialized diagnostic tests are required for diagnosis. Treatment options are diverse and include surgical resection, intraarterial hepatic therapy, and peptide receptor radionuclide therapy (PRRT). Systemic therapy options include targeted agents as well as chemotherapy when indicated. Diagnosis and management should occur through a collaborative team of health care practitioners well-experienced in managing pNETs. Recent advances in pNET treatment options have led to the development of the Canadian consensus document described in this report. The discussion includes the epidemiology, classification, pathology, clinical presentation and prognosis, imaging and laboratory testing, medical and surgical management, and recommended treatment algorithms for pancreatic neuroendocrine cancers. PMID:25366583

Singh, Simron; Dey, Chris; Kennecke, Hagen; Kocha, Walter; Maroun, Jean; Metrakos, Peter; Mukhtar, Tariq; Pasieka, Janice; Rayson, Daniel; Rowsell, Corwyn; Sideris, Lucas; Wong, Ralph; Law, Calvin

2014-11-01

320

The impact of national and international guidelines on newborn care in the nurseries of Piedmont and Aosta Valley, Italy  

PubMed Central

Background Care procedures for preventing neonatal diseases are carried out according to nurseries' traditions and may be not consistent with the evidence based medicine issues. Methods A multi-centric survey was conducted in 2 Regions located in NW Italy (Piedmont and Aosta Valley) in order to collect information on some healthy newborn care procedures. During 2001, a questionnaire was sent to the chief pediatrician in charge to the all 33 nurseries of the region asking the methods used during 2000 as prevention of ophthalmia neonatorum, early and late hemorrhagic disease of newborn, umbilical cord care and recommendations of vitamin D administration. Thereafter, during 2004 the same questionnaire was sent to the 34 chief pediatrician of nurseries to evaluate if the procedures were changed during 2003 according to guidelines. The nurseries care for 32,516 newborns in 2000 and 37,414 in 2003. Results Aminoglycoside eyes drops as prevention of ophthalmia neonatorum were the first choice in both periods (23 out 33 nurseries in 2000 and 24 out 34 in 2003 p > 0.05; the corresponding figures for newborns were18,984 out 32,516 newborns vs. 28,180 out of 37,414 p < 0.05). The umbilical cord care was carried out with alcohol in 12/33 centers (13,248 newborns) and dry gauze in 3/33 centers (2,130 newborns) in 2000, the corresponding figures in 2003 were 6/34 centers (p > 0.05), (6,380 newborns, p < 0.05) and 12/34 centers (p < 0.05), (18,123 newborns, p < 0.05). The percentage of newborns receiving of i.m. vitamin K. at birth increased during the study period (15,923/32,104 in 2000 vs. 19,684/37,414 in 2003, p < 0.01), but not the number of nurseries (16 in 2000 and 17 in 2003 p > 0.05). The numbers of parents of newborns who receive the recommendations of oral vitamin K during the first months life decreased from 2000 (25,516/30,606) to 2003 (29,808/37,414, p < 0.01) as well as for Vitamin D recommendation (14,582/30,616 in 2000 vs. 11,051/37,414 in 2003, p < 0.01). Oral vitamin K during the first months of life was recommended by 25 nurseries in 2000 and 27 in 2003 (p > 0.05), the corresponding figures for Vitamin D were 15 and 14 (p > 0.05). Conclusion In the present study a large variability of procedures among the nurseries was observed. During the study periods, guidelines and evidence based medicine issues have only partially modified the neonatal care procedures In Piedmont and Aosta Valley nurseries. These observations suggest to implement local forum/consensus conference to standardized procedures as much as possible. PMID:16329760

Guala, Andrea; Guarino, Roberta; Zaffaroni, Mauro; Martano, Claudio; Fabris, Claudio; Pastore, Guido; Bona, Gianni

2005-01-01

321

Abstinence Versus Harm Reduction: Considering Follow-up and Aftercare in First Nations Addictions Treatment  

Microsoft Academic Search

Research on alcohol and substance use in First Nations populations frequently describes the nature of the problem, and the\\u000a severity of the risk factors, but seldom addresses possible interventions and the effectiveness of the treatments that clients\\u000a do engage in. This paper reviews a participatory evaluation of the 6-week residential ‘Namgis Treatment Centre (NTC) program\\u000a in Alert Bay, British Columbia.

Kimberly A. van der Woerd; David N. Cox; Jeff Reading; Andrew Kmetic

2010-01-01

322

Abstinence versus Harm Reduction: Considering Follow-Up and Aftercare in First Nations Addictions Treatment  

ERIC Educational Resources Information Center

Research on alcohol and substance use in First Nations populations frequently describes the nature of the problem, and the severity of the risk factors, but seldom addresses possible interventions and the effectiveness of the treatments that clients do engage in. This paper reviews a participatory evaluation of the 6-week residential "Namgis…

van der Woerd, Kimberly A.; Cox, David N.; Reading, Jeff; Kmetic, Andrew

2010-01-01

323

Antidepressant Treatment of Veterans With Parkinson's Disease and Depression: Analysis of a National Sample  

Microsoft Academic Search

We examined the impact of comorbid Parkinson's disease (PD) on depression treatment. Using national Veterans Affairs (VA) databases, fiscal year 2002 data were examined for 283 273 elderly males seen for depression. We compared 2 matched depression groups, one with (N = 7868) and one without (N = 7868) PD. In the 12-month period following a depression-related clinic visit, PD

Peijun Chen; Helen C. Kales; Daniel Weintraub; Frederic C. Blow; Lan Jiang; Alan M. Mellow

2007-01-01

324

45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants  

Code of Federal Regulations, 2013 CFR

...reasonable medical judgment, relieve severe pain associated with one of the conditions...palliative treatment to relieve severe pain, corroborates the Department's interpretation...palliative treatment to relieve severe pain, even if the overall prognosis,...

2013-10-01

325

45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants  

Code of Federal Regulations, 2010 CFR

...reasonable medical judgment, relieve severe pain associated with one of the conditions...palliative treatment to relieve severe pain, corroborates the Department's interpretation...palliative treatment to relieve severe pain, even if the overall prognosis,...

2010-10-01

326

45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants  

Code of Federal Regulations, 2011 CFR

...reasonable medical judgment, relieve severe pain associated with one of the conditions...palliative treatment to relieve severe pain, corroborates the Department's interpretation...palliative treatment to relieve severe pain, even if the overall prognosis,...

2011-10-01

327

45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants  

Code of Federal Regulations, 2012 CFR

...reasonable medical judgment, relieve severe pain associated with one of the conditions...palliative treatment to relieve severe pain, corroborates the Department's interpretation...palliative treatment to relieve severe pain, even if the overall prognosis,...

2012-10-01

328

Algal wastewater treatment systems for seasonal climates: application of a simple modelling approach to generate local and regional design guidelines.  

PubMed

Algal waste stabilisation ponds (WSP) provide a means of treating wastewater, and also a potential source of water for re-use in irrigation, aquaculture or algal biomass cultivation. The quantities of treated water available and the periods in which it is suitable for use or discharge are closely linked to climatic factors. This paper describes the application, at a continent-wide scale, of a modelling approach based on the use of readily available climate datasets to provide WSP design and performance guidelines linked to geographical location. Output is presented in regionally-based contour maps covering a wide area of Russia and central Asia and indicating pond area, earliest discharge date, discharge duration, wastewater inflow:outflow ratio and salinity under user-specified conditions. The results confirm that broad-brush discharge guidelines of the type commonly used in North America can safely be applied; but suggest that a more detailed approach is worthwhile to optimise operating regimes for local conditions. The use of long-series climate data can also permit tailoring of designs to specific sites. The work considers a simple 2-pond system, but other configurations and operating regimes should be investigated, especially for the wide range of locations across the world that are intermediate between the 'one short discharge per year' mode and year-round steady-state operation. PMID:22365374

Heaven, Sonia; Salter, Andrew M; Clarke, Derek; Pak, Lyubov N

2012-05-01

329

Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America.  

PubMed

A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion. PMID:24947530

Stevens, Dennis L; Bisno, Alan L; Chambers, Henry F; Dellinger, E Patchen; Goldstein, Ellie J C; Gorbach, Sherwood L; Hirschmann, Jan V; Kaplan, Sheldon L; Montoya, Jose G; Wade, James C

2014-07-15

330

Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America.  

PubMed

A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion. PMID:24973422

Stevens, Dennis L; Bisno, Alan L; Chambers, Henry F; Dellinger, E Patchen; Goldstein, Ellie J C; Gorbach, Sherwood L; Hirschmann, Jan V; Kaplan, Sheldon L; Montoya, Jose G; Wade, James C

2014-07-15

331

Using GRADE methodology for the development of public health guidelines for the prevention and treatment of HIV and other STIs among men who have sex with men and transgender people  

PubMed Central

Background The World Health Organization (WHO) Department of HIV/AIDS led the development of public health guidelines for delivering an evidence-based, essential package of interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender people in the health sector in low- and middle-income countries. The objective of this paper is to review the methodological challenges faced and solutions applied during the development of the guidelines. Methods The development of the guidelines followed the WHO guideline development process, which utilizes the GRADE approach. We identified, categorized and labeled the challenges identified in the guidelines development process and described the solutions through an interactive process of in-person and electronic communication. Results We describe how we dealt with the following challenges: (1) heterogeneous and complex interventions; (2) paucity of trial data; (3) selecting outcomes of interest; (4) using indirect evidence; (5) integrating values and preferences; (6) considering resource use; (7) addressing social and legal barriers; (8) wording of recommendations; and (9) developing global guidelines. Conclusion We were able to successfully apply the GRADE approach for developing recommendations for public health interventions. Applying the general principles of the approach while carefully considering specific challenges can enhance both the process and the outcome of guideline development. PMID:22640260

2012-01-01

332

Development of practice guidelines for hemodialysis in Egypt  

PubMed Central

Although hemodialysis is the main modaility of treatment of end-stage renal disease, no practice guidelines are available in Egypt. Applying international guidelines for hemodialysis would not be suitable or feasible, because of different health system and lack of resources. The aim of this project was the development of evidence- and consensus-based clinical practice guidelines for hemodialysis in Egypt. The Egyptian guidelines were adopted from the standards developed by The College of Physicians and Surgeons of Alberta (Canada), The National Kidney Foundation (USA), The Clinical Standards Board for Scotland (Scotland), and The College of Physicians and Surgeons of Ontario (Canada). In addition, the guidelines published in Oxford Handbook of Dialysis were reviewed. Thereafter, a panel of Egyptian experts in the field of nephrology and hemodialysis was selected and invited to participate in this project. The Delphi technique was applied to build up the consensus among the experts on the formulated guidelines. The final version of the Egyptian Hemodialysis Practice Guidelines included five main sections; personnel, patient care practices, infection prevention and control, facility, and documentation/records. A consensus on practice guidelines for hemodialysis has been successfully produced and is supported by levels of evidence. The 12 Egyptian experts who participated in the Delphi technique and the reviewers assured the completeness and acceptability of the developed practice guidelines. Also, including experts from the university hospitals together with the Directorates of Cairo and Giza Health Affairs of the Egyptian Ministry of Health (MOH) avoided conflicts between clinical recommendations and feasible application in the MOH hemodialysis facilities. PMID:21206681

Ahmed, A. M. A.; Allam, Mohd. F.; Habil, E. S.; Metwally, A. M.; Ibrahiem, N. A.; Radwan, M.; El-Gaafary, M. M.; Afifi, A.; Gadallah, M. A.

2010-01-01

333

The 1996 meeting of the national technical workgroup on mixed waste thermal treatment  

SciTech Connect

The National Technical Workgroup on Mixed Waste Thermal Treatment held its annual meeting in Atlanta Georgia on March 12-14, 1996. The National Technical Workgroup (NTW) and this meeting were sponsored under an interagency agreement between EPA and DOE. The 1996 Annual Meeting was hosted by US DOE Oak Ridge Operations in conjunction with Lockheed Martin Energy Systems - Center for Waste Management. A new feature of the annual meeting was the Permit Writer Panel Session which provided an opportunity for the state and federal permit writers to discuss issues and potential solutions to permitting mixed waste treatment systems. In addition, there was substantial discussion on the impacts of the Waste Combustion Performance Standards on mixed waste thermal treatment which are expected to proposed very soon. The 1996 meeting also focussed on two draft technical resource documents produced by NTW on Waste Analysis Plans and Compliance Test Procedures. Issues discussed included public involvement, waste characterization, and emission issues.

NONE

1996-12-31

334

Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy  

PubMed Central

Background It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL) for breast cancer diagnosis and treatment on quality-of-care indicators in the Northwestern Italian region of Piedmont. Methods We included two samples of women aged 50–69?years with incident breast cancer treated in Piedmont before and after the introduction of PGL: 600 in 2002 (pre-PGL) and 621 in 2004 (post-PGL). Patients were randomly selected among all incident breast cancer cases identified through the hospital discharge records database. We extracted clinical data on breast cancer cases from medical charts and ascertained vital status through linkage with town offices. We assessed compliance with 14 quality-of-care indicators from PGL recommendations, before and after their introduction in clinical practice. Results Among patients with invasive lesions, 77.1% (N = 368) and 77.5% (N = 383) in the pre-PGL and post-PGL groups, respectively, received breast conservative surgery (BCS) as a first-line treatment. Following BCS, 87.7% received radiotherapy in 2002, compared to 87.9% in 2004. Of all patients at medium-to-high risk of distant metastasis, 65.5% (N = 268) and 63.6% (N = 252) received chemotherapy in 2002 and in 2004, respectively. Among the 117 patients with invasive lesions and negative estrogen receptor status in 2002, hormonal therapy was prescribed in 23 of them (19.6%). The incorrect prescription of hormonal therapy decreased to 10.8% (N = 10) among the 92 estrogen receptor-negative patients in 2004 (p < 0.01). Compliance with PGL recommendations was already high in the pre-PGL group, although some quality-of-care indicators did not reach the standard. In the pre/post analysis, 8 out of 14 quality-of-care indicators showed an improvement from 2002 to 2004, but only 4 out of 14 reached statistical significance. We did not find any change in the risk of mortality in the post-PGL versus the pre-PGL group (adjusted hazard ratio 0.94, 95%CI 0.56–1.56). Conclusions These results highlight the need to continue to improve breast cancer care and to measure adherence to PGL. PMID:23351327

2013-01-01

335

Guidelines for dementia-related health advocacy for adults with intellectual disability and dementia: national task group on intellectual disabilities and dementia practices.  

PubMed

Increasing numbers of adults with intellectual disabilities (ID) are living into old age. Though this indicates the positive effects of improved health care and quality of life, the end result is that more adults with ID are and will be experiencing age-related health problems and also exhibiting symptoms of cognitive impairment and decline, some attributable to dementia. Early symptoms of dementia can be subtle and in adults with ID are often masked by their lifelong cognitive impairment, combined with the benign effects of aging. A challenge for caregivers is to recognize and communicate symptoms, as well as find appropriate practitioners familiar with the medical issues presented by aging adults with lifelong disabilities. Noting changes in behavior and function and raising suspicions with a healthcare practitioner, during routine or ad hoc visits, can help focus the examination and potentially validate that the decline is the result of the onset or progression of dementia. It can also help in ruling out reversible conditions that may have similar presentation of symptoms typical for Alzheimer's disease and related dementias. To enable caregivers, whether family members or staff, to prepare for and advocate during health visits, the National Task Group on Intellectual Disabilities and Dementia Practices has developed guidelines and recommendations for dementia-related health advocacy preparation and assistance that can be undertaken by provider and advocacy organizations. PMID:25633379

Bishop, Kathleen M; Hogan, Mary; Janicki, Matthew P; Keller, Seth M; Lucchino, Ronald; Mughal, Dawna T; Perkins, Elizabeth A; Singh, Baldev K; Service, Kathy; Wolfson, Sarah

2015-02-01

336

Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level  

PubMed Central

Physical disorders are, compared to the general population, more prevalent in people with severe mental illness (SMI). Although this excess morbidity and mortality is largely due to modifiable lifestyle risk factors, the screening and assessment of physical health aspects remains poor, even in developed countries. Moreover, specific patient, provider, treatment and system factors act as barriers to the recognition and to the management of physical diseases in people with SMI. Psychiatrists can play a pivotal role in the improvement of the physical health of these patients by expanding their task from clinical psychiatric care to the monitoring and treatment of crucial physical parameters. At a system level, actions are not easy to realize, especially for developing countries. However, at an individual level, even simple and very basic monitoring and treatment actions, undertaken by the treating clinician, can already improve the problem of suboptimal medical care in this population. Adhering to monitoring and treatment guidelines will result in a substantial enhancement of physical health outcomes. Furthermore, psychiatrists can help educate and motivate people with SMI to address their suboptimal lifestyle, including smoking, unhealthy diet and lack of exercise. The adoption of the recommendations presented in this paper across health care systems throughout the world will contribute to a significant improvement in the medical and related psychiatric health outcomes of patients with SMI. PMID:21633691

DE HERT, MARC; COHEN, DAN; BOBES, JULIO; CETKOVICH-BAKMAS, MARCELO; LEUCHT, STEFAN; M. NDETEI, DAVID; W. NEWCOMER, JOHN; UWAKWE, RICHARD; ASAI, ITSUO; MÖLLER, HANS-JURGEN; GAUTAM, SHIV; DETRAUX, JOHAN; U. CORRELL, CHRISTOPH

2011-01-01

337

WSAVA Nutritional Assessment Guidelines  

Microsoft Academic Search

Objectives Careful assessment of the nutritional needs of cats and dogs must be taken into consideration in order to maintain optimum health, be part of a treatment regimen for a diseased state, or to maximize the quality of life in all animals. The goal of these World Small Animal Veterinary Association (WSAVA) Guidelines is that a nutritional assessment and specific

Lisa Freeman; Iveta Becvarova; Nick Cave; Clayton MacKay; Patrick Nguyen; Betina Rama; Gregg Takashima; Ross Tiffin; Peter van Beukelen; S Yathiraj

2011-01-01

338

Curricular Guidelines for Endodontics.  

ERIC Educational Resources Information Center

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

Journal of Dental Education, 1981

1981-01-01

339

Guidelines on Urolithiasis1  

Microsoft Academic Search

Objectives: A project was initiated by the Health Care Office of the European Association of Urology in order to formulate common recommendations and guidelines for the treatment of patients with urolithiasis. The basic task for the working group therefore was to extract and evaluate evidence from the literature in order to reach a consensus on how these patients could best

H.-G. Tiselius; D. Ackermann; P. Alken; C. Buck; P. Conort; M. Gallucci

2001-01-01

340

2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association task force on practice guidelines  

Technology Transfer Automated Retrieval System (TEKTRAN)

This guideline is based on the Full Panel Report which is provided as a data supplement to the guideline. The Full Panel Report contains background and additional material related to content, methodology, evidence synthesis, rationale and references and is supported by the NHLBI Systematic Evidence ...

341

The 2013 American College of Cardiology/American Heart Association guidelines for the treatment of dyslipidemia: mind the gaps!  

PubMed

Abstract The ACC/AHA lipid guidelines need to be reconsidered before full implementation. A new cardiovascular disease (CVD) risk estimation, preferably based in interventional multiethnic studies, will be ideal. Specific LDL-C targets may also be necessary because there are data pointing out that they are useful and pragmatic. The risk/benefit ratio should be a key issue because medicine is all about this concept (Hippocrates 460 - c. 370 BC: "first do not harm"; and then in the Hippocratic Oath: "I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous"). PMID:24827374

Athyros, Vasilios G; Katsiki, Niki; Karagiannis, Asterios; Mikhailidis, Dimitri P

2014-09-01

342

Atmospherically Deposited PBDEs, Pesticides, PCBs, and PAHs in Western US National Park Fish: Concentrations and Consumption Guidelines  

PubMed Central

Concentrations of polybrominated diphenyl ethers (PBDEs), pesticides, polychlorinated biphenyls (PCBs), and polycyclic aromatic hydrocarbons were measured in 136 fish from 14 remote lakes in 8 western US National Parks/Preserves between 2003 and 2005 and compared to human and wildlife contaminant health thresholds. A sensitive (median detection limit ?18 pg/g wet weight), efficient (61% recovery at 8 ng/g), reproducible (4.1 %RSD), and accurate (7 % deviation from SRM) analytical method was developed and validated for these analyses. Concentrations of PCBs, hexachlorobenzene, hexachlorocyclohexanes, DDTs and chlordanes in western US fish were comparable to or lower than mountain fish recently collected from Europe, Canada, and Asia. Dieldrin and PBDE concentrations were higher than recent measurements in mountain fish and Pacific Ocean salmon. Concentrations of most contaminants in western US fish were 1–6 orders of magnitude below calculated recreational fishing contaminant health thresholds. However, contaminant concentrations exceeded subsistence fishing cancer screening values in 8 of 14 lakes. Average contaminant concentrations in fish exceeded wildlife contaminant health thresholds for piscivorous mammals in 5 lakes, and piscivorous birds in all 14 lakes. These results indicate that atmospherically deposited organic contaminants can accumulate in high elevation fish, reaching concentrations relevant to human and wildlife health. PMID:18504962

Ackerman, Luke K.; Schwindt, Adam R.; Simonich, Staci L.; Koch, Dan C.; Blett, Tamara F.; Schreck, Carl B.; Kent, Michael L.; Landers, Dixon H.

2014-01-01

343

Atmospherically deposited PBDEs, pesticides, PCBs, and PAHs in western U.S. National Park fish: Concentrations and consumption guidelines  

USGS Publications Warehouse

Concentrations of polybrominated diphenyl ethers (PBDEs), pesticides, polychlorinated biphenyls (PCBs), and polycyclic aromatic hydrocarbons were measured in 136 fish from 14 remote lakes in 8 western U.S. National Parks/Preserves between 2003 and 2005 and compared to human and wildlife contaminant health thresholds. A sensitive (median detection limit, -18 pg/g wet weight), efficient (61% recovery at 8 ng/g), reproducible (4.1% relative standard deviation (RSD)), and accurate (7% deviation from standard reference material (SRM)) analytical method was developed and validated for these analyses. Concentrations of PCBs, hexachlorobenzene, hexachlorocyclohexanes, DDTs, and chlordanes in western U.S. fish were comparable to or lower than mountain fish recently collected from Europe, Canada, and Asia. Dieldrin and PBDE concentrations were higher than recent measurements in mountain fish and Pacific Ocean salmon. Concentrations of most contaminants in western U.S. fish were 1-6 orders of magnitude below calculated recreational fishing contaminant health thresholds. However, lake average contaminant concentrations in fish exceeded subsistence fishing cancer thresholds in 8 of 14 lakes and wildlife contaminant health thresholds for piscivorous birds in 1of 14 lakes. These results indicate that atmospherically deposited organic contaminants can accumulate in high elevation fish, reaching concentrations relevant to human and wildlife health. ?? 2008 American Chemical Society.

Ackerman, L.K.; Schwindt, A.R.; Simonich, S.L.M.; Koch, D.C.; Blett, T.F.; Schreck, C.B.; Kent, M.L.; Landers, D.H.

2008-01-01

344

[Application of guidelines in clinical practice: a multicenter analysis of the treatment of membranous glomerulonephritis in Piedmont, Italy].  

PubMed

The treatment of membranous glomerulonephritis (MGN) is controversial, especially in cases of no response to first-line treatment or multiple relapses. The Clinical Nephrology Group of Piedmont carried out a multicenter analysis of the treatment of patients affected by MGN in 15 nephrology units in Piedmont. The first treatment is usually started after a waiting period of 3-6 months in case of proteinuria in the nephrotic range but normal or slightly impaired renal function. A history of cancer, the presence of infectious disease, and secondary forms of MGN are criteria for exclusion from treatment. As first-line treatment, Piedmont nephrologists prescribe corticosteroids alternated with immunosuppressive drugs, generally preferring cyclophosphamide to chlorambucil. Only one nephrology unit uses cyclosporin A (CyA) as the first choice. In case of no response to treatment, a second therapeutic approach is undertaken after 2-12 months. Second-line treatment consists of CyA if immunosuppressive drugs were given before, and corticosteroids/ immunosuppressive drugs if CyA was the first treatment. A further choice may be ACTH or rituximab. In case of multiple relapses the treatment options are the same but previous immunosuppressive treatment, patient age, and the duration of kidney disease with a greater probability of renal failure and progression towards sclerosis require careful attention. Concern has been expressed regarding the potentially severe side effects of ACTH including myopathy, cataract and diabetes. In conclusion, the applied therapeutic approaches in Piedmont reflect the difficulty reported in the literature in identifying simple recommendations. ACTH and rituximab are increasingly preferred for the treatment of MGN and there is a need for prospective studies to determine the best protocol for rituximab and the safety profile of ACTH. PMID:21132646

Rollino, Cristiana; Coppo, Rosanna; Giacchino, Franca; Savoldi, Silvana; Manganaro, Marco; Amore, Alessandro; Colla, Loredana; Ferro, Michela; Demicheli, Giovanni; Berutti, Silvia; Burdese, Manuel; Paternoster, Giuseppe; Cravero, Raffaella; Benozzi, Luisa; Vagelli, Giuseppe; Messuerotti, Alessandra; Licata, Carolina; Bainotti, Serena; Patti, Rosaria Rita; Quaglia, Marco; Costantini, Luigia; Stratta, Piero; Segoloni, Giuseppe

2010-01-01

345

Management of asthma: the current US and European guidelines.  

PubMed

Asthma management guidelines aim to improve the implementation of current knowledge into daily clinical practice by establishing a consensus of scientific practices for the management of asthma. Initial guidelines were based on consensus of expert opinion in order to employ a severity-based classification system as a guide to treatment. However, advances in asthma research led to the development of evidence-based guidelines and a major paradigm shift to control-based asthma management. Control-based management is central to the published guidelines developed by The National Heart, Lung, and Blood Institute (NHLBI), The Global Initiative for Asthma (GINA), and The British Thoracic Society (BTS), each one using the same volume of evidence but emphasizing aspects particular to their specific patient populations and socioeconomic needs. This chapter summarizes the evolution of these guidelines and summarizes the key points and evidence used in the recommendations for the assessment, monitoring, and management of asthma in all ages, with particular emphasis on the NHLBI guidelines. PMID:24162904

Reddy, Ashwini P; Gupta, Meera R

2014-01-01

346

Clinical nutrition guidelines of the French Speaking Society of Clinical Nutrition and Metabolism (SFNEP): Summary of recommendations for adults undergoing non-surgical anticancer treatment.  

PubMed

Up to 50% of patients with cancer suffer from weight loss and undernutrition (as called cachexia) even though it is rarely screened or properly handled. Patients' prognosis and quality of life could be greatly improved by simple and inexpensive means encompassing nutritional status assessment and effective nutritional care. These guidelines aim to give health professionals and patients practical and up-to-date advice to manage nutrition in the principal situations encountered during the cancer course according to the type of tumour and treatment (i.e. radio and/or chemotherapy). Specific suggestions are made for palliative and elderly patients because of specific risks of undernutrition and related comorbidities in this subset. Levels of evidence and grades of recommendations are detailed as stated by current literature and consensus opinion of clinical experts in each field. PMID:24794790

2014-08-01

347

COASTAL GUIDELINES  

EPA Science Inventory

Resource Purpose: Developed to support effluent guidelines for the coastal subcategory of the oil and gas extraction industry. Data were used to develop environmental impacts, potential regulatory limits, and the cost of regulation. Legislation/Enabling Authority: ...

348

The relationship between primary care physicians' adherence to guidelines for the treatment of diabetes and patient satisfaction: findings from a pilot study  

Microsoft Academic Search

Background. Adherence to clinical guidelines improves health care outcomes, reduces expend- iture and prevents the complication of unnecessary interventions. It is uncertain what effect the adherence to guidelines for treating diabetes has on patient satisfaction. Some authors have reported that the use of guidelines does not affect patient satisfaction with care, and have con- cluded that satisfaction is related to

Revital Gross; Hava Tabenkin; Avi Porath; Anthony Heymann; Miriam Greenstein; Boaz Porter; Ronit Matzliach

349

FY 1995 separation studies for liquid low-level waste treatment at Oak Ridge National Laboratory  

SciTech Connect

During FY 1995, studies were continued to develop improved methods for centralized treatment of liquid low-level waste (LLLW) at Oak Ridge National Laboratory (ORNL). Focus in this reporting period was on (1) identifying the parameters that affect the selective removal of {sup 90}Sr and {sup 137}Cs, two of the principal radioactive contaminants expected in the waste; (2) validating the effectiveness of the treatment methods by testing an ac Melton Valley Storage Tank (MVST) supernate; (3) evaluating the optimum solid/liquid separation techniques for the waste; (4) identifying potential treatment methods for removal of technetium from LLLW; and (5) identifying potential methods for stabilizing the high-activity secondary solid wastes generated by the treatment.

Bostick, D.T.; Arnold, W.D.; Burgess, M.W. [and others

1995-01-01

350

National Respite Guidelines: Respite Services for Families of Children with Disabilities, Chronic and Terminal Illnesses, and Children at Risk of Abuse or Neglect.  

ERIC Educational Resources Information Center

These guidelines are intended to assist states and local communities in developing quality respite services that meet the diverse needs of families and children with disabilities, with chronic and terminal illnesses, or at risk of abuse or neglect. The guidelines support the philosophy that all families can benefit from temporary intervals of rest…

Edgar, Maggie; Uhl, Monica

351

Gender Research in the National Institute on Drug Abuse National Treatment Clinical Trials Network: A Summary of Findings  

PubMed Central

Background The NIDA National Drug Abuse Treatment Clinical Trials Network (CTN) was established to foster translation of research into practice in substance abuse treatment settings. The CTN provides a unique opportunity to examine in multi-site, translational clinical trials, the outcomes of treatment interventions targeting vulnerable sub-groups of women; the comparative effectiveness of gender-specific protocols to reduce risk behaviors; and gender differences in clinical outcomes. Objectives To review gender-related findings from published CTN clinical trials and related studies from January, 2000 through March, 2010. Methods CTN studies were selected for review if they focused on treatment outcomes or services for special populations of women with substance use disorders (SUDs) including those with trauma histories, pregnancy, co-occurring eating and other psychiatric disorders and HIV risk behaviors; or implemented gender-specific protocols. Results The CTN has randomized 11,500 participants (41% women) across 200 clinics in 24 randomized clinical trials in community settings, of which 4 have been gender-specific. This paper summarizes gender-related findings from CTN clinical trials and related studies, focusing on trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors. Conclusions These published studies have expanded the evidence base regarding interventions for vulnerable groups of women with SUDs as well as gender-specific interventions to reduce HIV risk behaviors in substance using men and women. The results also underscore the complexity of accounting for gender in the design of clinical trials and analysis of results. Scientific Relevance To fully understand the relevance of gender-specific moderators and mediators of outcome, it is essential that future translational studies adopt more sophisticated approaches to understanding and measuring gender-relevant factors and plan sample sizes that are adequate to support more nuanced analytic methods. PMID:21854272

Greenfield, Shelly F.; Rosa, Carmen; Putnins, Susan I.; Green, Carla A.; Brooks, Audrey J.; Calsyn, Donald A.; Cohen, Lisa R.; Erickson, Sarah; Gordon, Susan M.; Haynes, Louise; Killeen, Therese; Miele, Gloria; Tross, Susan; Winhusen, Theresa

2011-01-01

352

[The Dutch Institute for Health Care Improvement (CBO) guideline for the diagnosis and treatment of aspecific acute and chronic low back complaints].  

PubMed

Under the auspices of the Dutch Institute for Healthcare Improvement (CBO), a guideline has been developed for the diagnosis and treatment of aspecific low-back pain, based on the recent scientific literature. So-called 'red flags' are used to identify physical disorders. To obtain insight into psychosocial factors, 'yellow flags' are used. Acute low-back pain (0-12 weeks) is treated in a time-contingent manner. Staying active is better than bed rest. If chronicity threatens, exercise therapy can be advised. As part of an activating management, manipulation can be used. For pain relief, paracetamol is the drug of choice. The treatment of chronic low-back pain is aimed at the optimisation of the patients' functionality. Staying active is preferred here as well. Varied exercise therapy is advised. Back training may be considered. Manipulation can be used as part of an activating management. Paracetamol is preferred for pain relief. There is a limited role for percutaneous lumbar facet denervation. Behaviour therapy can be employed and there is a place for multidisciplinary programmes if other methods of treatment have proved insufficiently effective. PMID:15015247

Koes, B W; Sanders, R J; Tuut, M K

2004-02-14

353

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

PubMed

Current U.K. guidelines on the management of borderline personality disorder include specific recommendations about the duration of therapy and number of sessions per week that patients should be offered. However, very little research has been conducted to examine the impact of these aspects of treatment process on patient outcomes. We therefore undertook a systematic review to examine the impact of treatment duration, number of sessions per week and access group-based therapy on general mental health, depression, social functioning and deliberate self-harm. We identified 25 randomized trials for possible inclusion in the review. However, differences in outcome measures used meant that only 12 studies could be included in the analysis. Statistically significant reductions in self-harm and depression and improvement in social functioning were found for treatments that include more than one session per week and those that included group-based sessions but were not found for those that deliver in individual sessions or one or fewer sessions per week. Longer term outcomes of short-term interventions have not been examined. Further research is needed to examine the impact of shorter term interventions and to compare the effects of group-based versus individual therapies for people with borderline personality disorder. PMID:24990645

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

2014-08-01

354

Transitioning to highly effective therapies for the treatment of chronic hepatitis C virus infection: a policy statement and implementation guideline.  

PubMed

Chronic hepatitis C virus (HCV) infection increases all-cause mortality, rates of cirrhosis, hepatocellular carcinoma, liver transplantation and overall health care utilization. Morbidity and mortality disproportionately affect individuals born between 1945 and 1975. The recent development of well-tolerated and highly effective therapies for chronic HCV infection represents a unique opportunity to dramatically reduce rates of HCV-related complications and their costs. Critical to the introduction of such therapies will be well-designed provincial programming to ensure immediate treatment access to individuals at highest risk for complication, and well-defined strategies to address the global treatment needs of traditionally high-risk and marginalized populations. HCV practitioners in New Brunswick created a provincial strategy that stratifies treatment according to those at highest need, measures clinical impact, and creates evaluation strategies to demonstrate the significant direct and indirect cost savings anticipated with curative treatments. PMID:25390613

Smyth, Daniel John; Webster, Duncan; Barrett, Lisa; MacMillan, Mark; McKnight, Lisa; Schweiger, Frank

2014-11-01

355

Spanish evidence-based guidelines on the treatment of psoriasis with biologic agents, 2013. Part 1: on efficacy and choice of treatment. Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology.  

PubMed

Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical experience with biologics, and the abundance of literature now available on these agents have made evidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasis treatment is to achieve complete or nearly complete clearing of lesions and to maintain it over time. Failing that ideal, the goal would be to reduce involvement to localized lesions that can be controlled with topical therapy. Although current evidence allows us to directly or indirectly compare the efficacy or risk of primary or secondary failure of available biologics based on objective outcomes, clinical trial findings cannot be directly translated to routine practice. As a result, the prescribing physician must tailor the treatment regimen to the individual patient. This update of the clinical practice guidelines issued by the Spanish Academy of Dermatology and Venereology (AEDV) on biologic therapy for psoriasis incorporates information from the most recent publications on this topic. PMID:24018211

Puig, L; Carrascosa, J M; Carretero, G; de la Cueva, P; Lafuente-Urrez, R F; Belinchón, I; Sánchez-Regaña, M; García-Bustínduy, M; Ribera, M; Alsina, M; Ferrándiz, C; Fonseca, E; García-Patos, V; Herrera, E; López-Estebaranz, J L; Marrón, S E; Moreno, J C; Notario, J; Rivera, R; Rodriguez-Cerdeira, C; Romero, A; Ruiz-Villaverde, R; Taberner, R; Vidal, D

2013-10-01

356

The Red Road to Wellness: Cultural Reclamation in a Native First Nations Community Treatment Center  

Microsoft Academic Search

This article explores how Native American cultural practices were incorporated into the therapeutic activities of a community-controlled\\u000a substance abuse treatment center on a “First Nations” reserve in the Canadian north. Analysis of open-ended interviews with\\u000a nineteen staff and clients—as contextualized by participant observation, program records, and existing ethnographic resources—yielded\\u000a insights concerning local therapeutic practice with outpatients and other community members.

Joseph P. Gone

2011-01-01

357

HIV Testing in the Nation’s Opioid Treatment Programs, 2005–2011: The Role of State Regulations  

PubMed Central

Objective To identify the extent to which clients in a national sample of opioid treatment programs (OTPs) received HIV testing in 2005 and 2011; to examine relationships between state laws for informed consent and pre-test counseling and rates of HIV testing among OTP clients. Data source Data were collected from a nationally-representative sample of OTPs in 2005 (n=171) and 2011 (n=200). Study design Random-effects logit and interval regression analyses were used to examine changes in HIV testing rates and the relationship of state laws to HIV testing among OTPs. Data collection Data on OTP provision of HIV testing were collected in phone surveys from OTP managers; data also were collected on state laws for HIV testing. Principal findings The percentage of OTPs offering HIV testing decreased significantly from 93% in 2005 to 64% in 2011. Similarly, the percentage of clients tested decreased from an average of 41% in 2005 to 17% in 2011. OTPs located in states whose laws do not require pre-test counseling and that use opt-out consent were more likely to provide HIV testing and to test higher percentages of clients. Conclusions The results show the need to increase HIV testing among OTP clients; the results also underscore the beneficial possibilities of dropping pre-test counseling as a requirement for HIV testing and of using the opt-out approach to informed consent for testing. PMID:23855724

D’Aunno, Thomas; Pollack, Harold A.; Jiang, Lan; Metsch, Lisa R.; Friedmann, Peter D.

2013-01-01

358

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary arterial hypertension associated with connective tissue diseases.  

PubMed

The explosive growth of medical literature on pulmonary hypertension (PH) has led to a steady increase in awareness of this disease within the medical community during the past decade. The recent revision of the classification of PH is presented in in the main guidelines. Group 1 PH or pulmonary arterial hypertension (PAH) is a heterogeneous group and includes PH due to inheritable, drug-induced, and toxin-induced causes and to such underlying systemic causes as connective tissue diseases, human immunodeficiency viral infection, portal hypertension, congenital heart disease, and schistosomiasis. Systemic sclerosis (SSc) is an autoimmune multisystem disorder, which affects over 240 persons per million in the United States.[1] Its manifestations are not confined to the skin but may also involve the lungs, kidneys, peripheral circulation, musculoskeletal system, gastrointestinal tract, and heart. The outcome of PAH associated with SSc is worse when compared to other subtypes of PAH. In this review, we summarize available information about the pulmonary vascular and cardiac manifestations of SSc with special emphasis on their prognostic implications as well as the peculiarity of their detection. PMID:25076994

Boueiz, Adel; Hassoun, Paul M

2014-07-01

359

Evaluation of In-Hospital Management for Febrile Illness in Northern Tanzania before and after 2010 World Health Organization Guidelines for the Treatment of Malaria  

PubMed Central

Objective In 2010, the World Health Organization (WHO) published updated guidelines emphasizing and expanding recommendations for a parasitological confirmation of malaria before treating with antimalarials. This study aimed to assess differences in historic (2007–2008) (cohort 1) and recent (2011–2012) (cohort 2) hospital cohorts in the diagnosis and treatment of febrile illness in a low malaria prevalence area of northern Tanzania. Materials and Methods We analyzed data from two prospective cohort studies that enrolled febrile adolescents and adults aged ?13 years. All patients received quality-controlled aerobic blood cultures and malaria smears. We compared patients' discharge diagnoses, treatments, and outcomes to assess changes in the treatment of malaria and bacterial infections. Results In total, 595 febrile inpatients were enrolled from two referral hospitals in Moshi, Tanzania. Laboratory-confirmed malaria was detected in 13 (3.2%) of 402 patients in cohort 1 and 1 (0.5%) of 193 patients in cohort 2 (p?=?0.041). Antimalarials were prescribed to 201 (51.7%) of 389 smear-negative patients in cohort 1 and 97 (50.5%) of 192 smear-negative patients in cohort 2 (p?=?0.794). Bacteremia was diagnosed from standard blood culture in 58 (14.5%) of 401 patients in cohort 1 compared to 18 (9.5%) of 190 patients in cohort 2 (p?=?0.091). In cohort 1, 40 (69.0%) of 58 patients with a positive blood culture received antibacterials compared to 16 (88.9%) of 18 patients in cohort 2 (p?=?0.094). In cohort 1, 43 (10.8%) of the 399 patients with known outcomes died during hospitalization compared with 12 (6.2%) deaths among 193 patients in cohort 2 (p?=?0.073). Discussion In a setting of low malaria transmission, a high proportion of smear-negative patients were diagnosed with malaria and treated with antimalarials despite updated WHO guidelines on malaria treatment. Improved laboratory diagnostics for non-malaria febrile illness might help to curb this practice. PMID:24587056

Moon, Andrew M.; Biggs, Holly M.; Rubach, Matthew P.; Crump, John A.; Maro, Venace P.; Saganda, Wilbrod; Reddy, Elizabeth A.

2014-01-01

360

Guidelines for Guidelines: Are They Up to the Task? A Comparative Assessment of Clinical Practice Guideline Development Handbooks  

PubMed Central

Objectives We conducted a comparative review of clinical practice guideline development handbooks. We aimed to identify the main guideline development tasks, assign weights to the importance of each task using expert opinions and identify the handbooks that provided a comprehensive coverage of the tasks. Methods We systematically searched and included handbooks published (in English language) by national, international or professional bodies responsible for evidenced-based guideline development. We reviewed the handbooks to identify the main guideline development tasks and scored each handbook for each task from 0 (the handbook did not mention the task) to 2 (the task suitably addressed and explained), and calculated a weighted score for each handbook. The tasks included in over 75% of the handbooks were considered as ‘necessary’ tasks. Result Nineteen guideline development handbooks and twenty seven main tasks were identified. The guideline handbooks’ weighted scores ranged from 100 to 220. Four handbooks scored over 80% of the maximum possible score, developed by the National Institute for Health and Clinical Excellence, Swiss Centre for International Health, Scottish Intercollegiate Guidelines Network and World Health Organization. Necessary tasks were: selecting the guideline topic, determining the guideline scope, identifying relevant existing guidelines, involving the consumers, forming guideline development group,, developing clinical questions, systematic search for evidence, selecting relevant evidence, appraising identifies research evidence, making group decision, grading available evidence, creating recommendations, final stakeholder consultation, guideline implementation strategies, updating recommendations and correcting potential errors. Discussion Adequate details for evidence based development of guidelines were still lacking from many handbooks. The tasks relevant to ethical issues and piloting were missing in most handbooks. The findings help decision makers in identifying the necessary tasks for guideline development, provide an updated comparative list of guideline development handbooks, and provide a checklist to assess the comprehensiveness of guideline development processes. PMID:23189167

Ansari, Shabnam; Rashidian, Arash

2012-01-01

361

Guidelines for use of fishes in research  

USGS Publications Warehouse

The 2004 and 2014 Guidelines were developed to provide a structure that advances appropriate attention toward valid experimental designs and procedures with aquatic animals while ensuring humane treatment of the experimental subjects. At a practical level, the Guidelines are intended to provide general recommendations on field and laboratory endeavors, such as sampling, holding, and handling fishes; to offer information on administrative matters, including regulations and permits; and to address typical ethical concerns, such as perceptions of pain or discomfort experienced by experimental subjects. These Guidelines must be recognized as guidelines. They are not intended to provide detailed instructions but rather to alert investigators to a broad array of topics and concerns to consider prior to initiating study. At a comprehensive level, the principles upon which these Guidelines are based are broadly applicable, and many of the described practices and approaches can be adapted to situations involving other aquatic animal species and conditions. Understanding the differences between fishes and other vertebrates, especially mammals, is critically important to conducting scientifically sound research with fishes. Disparities in life histories and mortality rates in fishes versus other vertebrates are critical in designing sustainable sampling levels in fish populations. The UFR Committee points out that (1) compared to mammalian populations, adult populations of many fish species persist despite very high natural mortality rates in juvenile stages by virtue of the fact that most species lay thousands or tens of thousands of eggs; (2) because of these mortality patterns, research on fishes, especially field research or research on early life stages, can involve, and often requires, much larger numbers of research subjects than does research on mammals; and (3) the animal handling and husbandry requirements for fishes are fundamentally different from those for mammals and other vertebrates, in general. Policies, regulations, and recommendations developed for research on mammals, birds, reptiles, or even amphibians are frequently inappropriate for research with fishes. The Guidelines also address some of the ethical concerns that motivate guidelines used for research with other vertebrates, while being mindful of the unique physiology and general nature of fishes. The Guidelines were developed for general use by investigators within the United States; therefore, the roles, responsibilities, and informational needs of Institutional Animal Care and Use Committees (IACUCs) were given specific attention. All United States institutions that use vertebrate animals for research, teaching, research training, and biological testing are required to create an IACUC to oversee and evaluate all aspects of the institution’s animal care and use program. Investigators from other nations who read this document may disregard specific references to U.S. state and federal laws and regulations, as their institutional infrastructure and processes may differ from those of an internal committee such as IACUCs. The principles described herein, however, are applicable to research on fishes regardless of geographic location. Investigators in other nations may benefit by modifying any of the specific provisions pertaining to the United States, thereby adopting guidelines consistent with the laws and regulations of their own government. The UFR Committee urges that the Guidelines be endorsed and adopted (adapted, where necessary) by those state and federal authorities with regulatory responsibilities for fishes, offices with federal oversight (e.g., National Institutes of Health, Office of Laboratory Animal Welfare; http://grants.nih.gov/grants/olaw/olaw.htm) as well as by universities and other institutions and authorities using fishes and aquatic animals within their research and teaching programs.

Use of Fishes in Research Committee (joint committee of the American Fisheries Society, the American Institute of Fishery Research Biologists, and the American Society of Ichthyologists and Herpetologists)

2014-01-01

362

Group prepares guidelines for documenting dam performance  

SciTech Connect

The Association of State Dam Safety Officials and the Center on the Performance of Dams at Stanford University later this summer expect to complete guidelines for reporting the performance of state, federal, and private dams: A working group of state and federal dam safety engineers and consultants is developing the guidelines to identify incidents that should be reported and to establish reporting requirements. The Federal Emergency Management Agency (FEMA) is funding preparation and publication of the guidelines. The guidelines are expected to expedite the process for reporting information on dam incidents in a timely and complete manner. Much the same as the health care industry compiles and evaluates data related to the incidence of disease and the benefits of treatment, a single standard for reporting the performance of dams in the US will help create a national information base on the occurrence and consequence of dam incidents. Currently, incidents involving dam performance are not reported on a regular basis. The guidelines will define dam incidents in terms of events of engineering interest that provide insights to the safety and structural or operational integrity of dams. Examples of incidents include the performance of a dam that experiences ground motion from a large earthquake, extreme spillway or dam overtopping, rehabilitations made to satisfy dam safety requirements, embankment sliding of an earthen dam, and improper operations that leads to damage downstream. When an incident occurs, the satisfactory or unsatisfactory performance of a dam will be reported, either by a state dam safety official, the owner of the dam, or the owner's engineer.

McCann, M.W. Jr. (Stanford Univ., CA (United States))

1993-06-01

363

[Update on current care guidelines. Diagnosis, treatment and follow-up of cytological changes in the cervix, vagina and vulva].  

PubMed

Approximately 150 cervical cancer cases are diagnosed in Finland annually. Both incidence and mortality have decreased by 80% since organised screening began. Recently, screening based on primary HPV-testing with Pap-smear triage has been shown to be more sensitive and more specific among women over 35 years old in randomised studies and thus may be implemented in routine. Abnormal findings in Pap smears indicate management. Confirmed CIN1 lesions are followed up and CIN2 and worse lesions treated. Follow-up after treatment should be reliably arranged, because elevated risk of cancer remains over 20 years after treatment. Quality control is of utmost importance. PMID:20957796

Pekka, Nieminen; Anttila, Ahti; Bützow, Ralf; Heikkilä, Elina; Hiltunen-Back, Eija; Mäenpää, Johanna; Puistola, Ulla; Rantanen, Virpi; Rintala, Marjut; Räisänen, Ilkka; Santalahti, Anne; Talvensaari-Mattila, Anne; Vartiainen, Juhani; Vuento, Maarit; Yliskoski, Merja

2010-01-01

364

Client characteristics within the Chilean National Youth Addiction Treatment Demonstration System.  

PubMed

In the context of an evaluation of a national demonstration program for youth addiction treatment in Chile, a sociodemographic and substance use profile of children and adolescents accessing services through this new program was developed. Information regarding sociodemographic factors, substance use, and problem severity; services used; and unmet needs was retrospectively gathered for all clients (685) admitted between January 1 and June 30, 2006. Thirty-two treatment centers (91.4%) provided data. The client population profile reflected severe psychosocial circumstances (e.g., 61.4% early exit from school). Of the population, 64.9% were classified in the highest substance risk level. The primary drug reported was cocaine-paste-base (52.7%). Comparisons to similar data in other countries illustrate the more severe profile of this Chilean treatment sample. The results suggest the need for increased outreach and comprehensive intersectoral approaches. Monitoring and evaluation should become part of the culture of the national drug treatment system in Chile and other countries. PMID:21111559

Rush, Brian; Sapag, Jaime; Chaim, Gloria; Quinteros, Claudia

2011-03-01

365

Evidence-based treatment for opioid disorders: a 23-year national study of methadone dose levels.  

PubMed

Effective treatment for patients with opioid use problems is as critical as ever given the upsurge in heroin and prescription opioid abuse. Yet, results from prior studies show that the majority of methadone maintenance treatment (MMT) programs in the US have not provided dose levels that meet evidence-based standards. Thus, this paper examines the extent to which US MMT programs have made changes in the past 23 years to provide adequate methadone doses; we also identify factors associated with variation in program performance. Program directors and clinical supervisors of nationally-representative methadone treatment programs were surveyed in 1988 (n=172), 1990 (n=140), 1995 (n=116), 2000 (n=150), 2005 (n=146), and 2011 (n=140). Results show that the proportion of patients who received doses below 60 mg/day-the minimum recommended-declined from 79.5 to 22.8% in a 23-year span. Results from random effects models show that programs that serve a higher proportion of African-American or Hispanic patients were more likely to report low-dose care. Programs with Joint Commission accreditation were more likely to provide higher doses, as were a program that serves a higher proportion of unemployed and older patients. Efforts to improve methadone treatment practices have made substantial progress, but 23% of patients across the nation are still receiving doses that are too low to be effective. PMID:25012549

D'Aunno, Thomas; Pollack, Harold A; Frimpong, Jemima A; Wuchiett, David

2014-10-01

366

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology.  

PubMed

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees. PMID:24713617

Baldwin, David S; Anderson, Ian M; Nutt, David J; Allgulander, Christer; Bandelow, Borwin; den Boer, Johan A; Christmas, David M; Davies, Simon; Fineberg, Naomi; Lidbetter, Nicky; Malizia, Andrea; McCrone, Paul; Nabarro, Daniel; O'Neill, Catherine; Scott, Jan; van der Wee, Nic; Wittchen, Hans-Ulrich

2014-05-01

367

Federal Facility Compliance Act: Conceptual Site Treatment Plan for Lawrence Livermore National Laboratory, Livermore, California  

SciTech Connect

The Department of Energy (DOE) is required by section 3021(b) of the Resource Conservation and Recovery Act (RCRA), as amended by the Federal Facility Compliance Act (the Act), to prepare plans describing the development of treatment capacities and technologies for treating mixed waste. The Act requires site treatment plans (STPs or plans) to be developed for each site at which DOE generates or stores mixed waste and submitted to the State or EPA for approval, approval with modification, or disapproval. The Lawrence Livermore National Laboratory (LLNL) Conceptual Site Treatment Plan (CSTP) is the preliminary version of the plan required by the Act and is being provided to California, the US Environmental Protection Agency (EPA), and others for review. A list of the other DOE sites preparing CSTPs is included in Appendix 1.1 of this document. Please note that Appendix 1.1 appears as Appendix A, pages A-1 and A-2 in this document.

Not Available

1993-10-01

368

Can genotype be used to tailor treatment of obesity? State of the art and guidelines for future studies and applications  

Technology Transfer Automated Retrieval System (TEKTRAN)

Current treatments for losing weight based mainly on diet and exercise are, in general, unsuccessful. So, as an alternative to the general strategy of one-size-fits-all, a more individualized approach is proposed through the so-called Personalized Medicine in which genotype data are used to personal...

369

Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group.  

PubMed

Radiation dermatitis (RD) results from radiotherapy and often occurs within the first 4 weeks of treatment, although late effects also occur. While RD may resolve over time, it can have a profound effect on patients' quality of life and lead to dose modifications. A study group of international, interdisciplinary experts convened to develop RD prevention and treatment guidelines based on evidence from randomized, controlled trials. Evidence-based recommendations were developed after an extensive literature review. Randomized, controlled trials with standardized measurement of outcomes were considered the best evidence, and a majority of the recommendations were formulated from this literature. The adoption of washing with water, with or without a mild soap, and allowing the use of antiperspirants is supported by randomized trials. Use of topical prophylactic corticosteroids (mometasone) is recommended to reduce discomfort and itching. There is some evidence that silver sulfadiazine cream can reduce dermatitis score. There is insufficient evidence to support, and therefore the panel recommends against the use of trolamine, topical sulcrate, hyaluronic acid, ascorbic acid, silver leaf dressing, light-emitting diode lasers, Theta cream, dexpanthenol, calendula, proteolytic enzymes, sulcralfate, oral zinc, and pentoxifylline. Moreover, there is no evidence to support the superiority for any specific intervention in a reactive fashion. For patients with established radiation-induced telangiectasia and fibrosis, the panel suggests the use of pulse dye laser for visual appearance, and the use of pentoxifylline and vitamin E for the reduction of fibrosis. PMID:23942595

Wong, Rebecca K S; Bensadoun, René-Jean; Boers-Doets, Christine B; Bryce, Jane; Chan, Alexandre; Epstein, Joel B; Eaby-Sandy, Beth; Lacouture, Mario E

2013-10-01

370

High-dose donepezil (23 mg/day) for the treatment of moderate and severe Alzheimer's disease: drug profile and clinical guidelines.  

PubMed

To provide healthcare professionals with a comprehensive assessment of donepezil 23 mg and its role in treating Alzheimer's disease (AD), the Donepezil 23 mg Expert Working Group (EWG) convened in June 2011 to critically evaluate the clinical trial database for this higher dose formulation and the members' clinical experience with its use. Discussions were based on a large, 6-month, phase 3 clinical trial in patients with moderate to severe AD that compared continuing donepezil 10 mg/day versus switching to 23 mg/day. In this trial, donepezil 23 mg/day demonstrated significantly greater cognitive benefits (mean change in Severe Impairment Battery score, 2.11 points; P < 0.001). Prespecified analyses showed that benefits were significant irrespective of concomitant memantine use. The EWG considered integrating these new data into clinical practice approaches. Dementia severity, tolerability of the 10 mg dose, and need for additional therapy were key selection criteria, as was monitoring of gastrointestinal side effects, as consideration of titration strategies is an important aspect of implementation. The EWG concluded that donepezil 23 mg is an efficacious therapy for moderate to severe AD, with or without concomitant memantine, extending the treatment opportunities available to manage moderate to severe AD dementia. EWG guidelines offer assistance to clinicians in choosing and implementing treatment options. PMID:23462265

Cummings, Jeffrey L; Geldmacher, David; Farlow, Martin; Sabbagh, Marwan; Christensen, Daniel; Betz, Peter

2013-05-01

371

75 FR 1597 - Western Pacific Crustacean Fisheries; 2010 Northwestern Hawaiian Islands Lobster Harvest Guideline  

Federal Register 2010, 2011, 2012, 2013

...Fisheries; 2010 Northwestern Hawaiian Islands Lobster Harvest Guideline AGENCY: National Marine...Commerce. ACTION: Notification of lobster harvest guideline...annual harvest guideline for the commercial lobster fishery in the Northwestern Hawaiian...

2010-01-12

372

76 FR 3150 - Office of Biotechnology Activities; Recombinant DNA Research: Action Under the NIH Guidelines for...  

Federal Register 2010, 2011, 2012, 2013

...of Biotechnology Activities; Recombinant DNA Research: Action Under the NIH Guidelines for Research Involving Recombinant DNA Molecules (NIH Guidelines) AGENCY: National...Guidelines currently require that recombinant DNA experiments designed to create new...

2011-01-19

373

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Perioperative management in patients with pulmonary hypertension  

PubMed Central

Patients with pulmonary hypertension (PH) are being encountered more commonly in the perioperative period and this trend is likely to increase as improvements in the recognition, management, and treatment of the disease continue to occur. Management of these patients is challenging due to their tenuous hemodynamic status. Recent advances in the understanding of the patho-physiology, risk factors, monitoring, and treatment of the disease provide an opportunity to reduce the morbidity and mortality associated with PH in the peri-operative period. Management of these patients requires a multi-disciplinary approach and meticulous care that is best provided in centers with vast experience in PH. In this review, we provide a detailed discussion about oerioperative strategies in PH patients, and give evidence-based recommendations, when applicable. PMID:25077004

Tonelli, Adriano R.; Minai, Omar A.

2014-01-01

374

American Cancer Society Lung Cancer Screening Guidelines  

PubMed Central

Findings from the National Cancer Institute’s National Lung Screening Trial established that lung cancer mortality in specific high-risk groups can be reduced by annual screening with low-dose computed tomography. These findings indicate that the adoption of lung cancer screening could save many lives. Based on the results of the National Lung Screening Trial, the American Cancer Society is issuing an initial guideline for lung cancer screening. This guideline recommends that clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about screening with apparently healthy patients aged 55 years to 74 years who have at least a 30-pack-year smoking history and who currently smoke or have quit within the past 15 years. A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose computed tomography should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation. PMID:23315954

Wender, Richard; Fontham, Elizabeth T. H.; Barrera, Ermilo; Colditz, Graham A.; Church, Timothy R.; Ettinger, David S.; Etzioni, Ruth; Flowers, Christopher R.; Gazelle, G. Scott; Kelsey, Douglas K.; LaMonte, Samuel J.; Michaelson, James S.; Oeffinger, Kevin C.; Shih, Ya-Chen Tina; Sullivan, Daniel C.; Travis, William; Walter, Louise; Wolf, Andrew M. D.; Brawley, Otis W.; Smith, Robert A.

2013-01-01

375

High-pressure hand injection injuries caused by dry cleaning solvents: case reports, review of the literature, and treatment guidelines.  

PubMed

A previously unreported subset of high-pressure injection injuries, namely those involving solvents used in the garment dry cleaning industry, is presented. Dry cleaning solutions contain isoparaffinic hydrocarbons, methoxypropanol, and dichlorofluoroethane. Although these solvents have limited potential for systemic toxicity, severe local toxicity causing tissue necrosis often results in loss of the injured digit. Proper treatment includes prompt surgical exploration, careful débridement and irrigation, intravenous antibiotics, and in selected cases, high-dose systemic corticosteroids. PMID:12496578

Gutowski, Karol A; Chu, Jason; Choi, Mihye; Friedman, David W

2003-01-01

376

Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Challenges in managing pulmonary hypertension in the developing countries  

PubMed Central

There is scant published data about pulmonary hypertension (PH) from the developing countries. True prevalence of the disease, its biology, etiology and response to treatment are not well known, and they are likely to be somewhat different from that of the developed countries. In this review, we will discuss the main challenges for managing PH in developing countries and propose real-life recommendations to deal with such difficulties. PMID:25076991

Bhagavatula, Sastry K S; Idrees, Majdy M.

2014-01-01

377

Protocol Development — Guidelines Regarding the Inclusion of Pregnant and Breast-Feeding Women on Cancer Clinical Treatment Trials  

Cancer.gov

Pregnant women may not be arbitrarily excluded from participation in clinical cancer treatment trials. Exclusion of pregnant women from a particular trial must be based on a clear and compelling rationale or justification that shows that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research, or other circumstances that offer a clear and compelling reason for exclusion.

378

32 CFR 256.7 - Accident potential zone guidelines.  

Code of Federal Regulations, 2010 CFR

...Defense 2 2010-07-01 2010-07-01 false Accident potential zone guidelines. 256.7 Section 256.7 National Defense...AIR INSTALLATIONS COMPATIBLE USE ZONES § 256.7 Accident potential zone guidelines....

2010-07-01

379

Audit of the radioactive liquid waste treatment facility operations at the Los Alamos National Laboratory  

SciTech Connect

Los Alamos National Laboratory (Los Alamos) generates radioactive and liquid wastes that must be treated before being discharged to the environment. Presently, the liquid wastes are treated in the Radioactive Liquid Waste Treatment Facility (Treatment Facility), which is over 30 years old and in need of repair or replacement. However, there are various ways to satisfy the treatment need. The objective of the audit was to determine whether Los Alamos cost effectively managed its Treatment Facility operations. The audit determined that Los Alamos` treatment costs were significantly higher when compared to similar costs incurred by the private sector. This situation occurred because Los Alamos did not perform a complete analysis of privatization or prepare a {open_quotes}make-or-buy{close_quotes} plan for its treatment operations, although a {open_quotes}make-or-buy{close_quotes} plan requirement was incorporated into the contract in 1996. As a result, Los Alamos may be spending $2.15 million more than necessary each year and could needlessly spend $10.75 million over the next five years to treat its radioactive liquid waste. In addition, Los Alamos has proposed to spend $13 million for a new treatment facility that may not be needed if privatization proves to be a cost effective alternative. We recommended that the Manager, Albuquerque Operations Office (Albuquerque), (1) require Los Alamos to prepare a {open_quotes}make-or-buy{close_quotes} plan for its radioactive liquid waste treatment operations, (2) review the plan for approval, and (3) direct Los Alamos to select the most cost effective method of operations while also considering other factors such as mission support, reliability, and long-term program needs. Albuquerque concurred with the recommendations.

NONE

1997-11-19

380

SBF GUIDELINES  

EPA Science Inventory

Resource Purpose: Developed to support effluent guidelines for the use of synthetic based drilling fluids in the offshore and coastal subcategories of the oil and gas extraction industry. Data were used to develop environmental impacts, potential reg limits, and the cost o...

381

Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status  

PubMed Central

Background We examined Mexican migrants’ perceived barriers to entering substance abuse treatment and potential differences by gender. Methods This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment. Results Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City. Conclusions Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico. PMID:25074067

2014-01-01

382

Reducing patients’ suicide ideation through training mental health teams in the application of the Dutch multidisciplinary practice guideline on assessment and treatment of suicidal behavior: study protocol of a randomized controlled trial  

PubMed Central

Background To strengthen suicide prevention skills in mental health care in The Netherlands, multidisciplinary teams throughout the country are trained in the application of the new Dutch guideline on the assessment and treatment of suicidal behavior. Previous studies have shown beneficial effects of additional efforts for guideline implementation on professionals’ attitude, knowledge, and skills. However, the effects on patients are equally important, but are rarely measured. The main objective of this study is to examine whether patients of multidisciplinary teams who are trained in guideline application show greater recovery from suicide ideation than patients of untrained teams. Methods/Design This is a multicentre cluster randomized controlled trial (RCT), in which multidisciplinary teams from mental health care institutions are matched in pairs, and randomly allocated to either the experimental or control condition. In the experimental condition, next to the usual dissemination of the guideline (internet, newsletter, books, publications, and congresses), teams will be trained in the application of the guideline via a 1-day small interactive group training program supported by e-learning modules. In the control condition, no additional actions next to usual dissemination of the guideline will be undertaken. Assessments at patient level will start when the experimental teams are trained. Assessments will take place upon admission and after 3 months, or earlier if the patient is discharged. The primary outcome is suicide ideation. Secondary outcomes are non-fatal suicide attempts, level of treatment satisfaction, and societal costs. Both a cost-effectiveness and cost-utility analysis will be performed. The effects of the intervention will be examined in multilevel models. Discussion The strengths of this study are the size of the study, RCT design, training of complete multidisciplinary teams, and the willingness of both management and staff to participate. Trial registration Netherlands trial register: NTR3092 PMID:24195781

2013-01-01

383

Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise  

PubMed Central

Background: Although several tools to evaluate the credibility of health care guidelines exist, guidance on practical steps for developing guidelines is lacking. We systematically compiled a comprehensive checklist of items linked to relevant resources and tools that guideline developers could consider, without the expectation that every guideline would address each item. Methods: We searched data sources, including manuals of international guideline developers, literature on guidelines for guidelines (with a focus on methodology reports from international and national agencies, and professional societies) and recent articles providing systematic guidance. We reviewed these sources in duplicate, extracted items for the checklist using a sensitive approach and developed overarching topics relevant to guidelines. In an iterative process, we reviewed items for duplication and omissions and involved experts in guideline development for revisions and suggestions for items to be added. Results: We developed a checklist with 18 topics and 146 items and a webpage to facilitate its use by guideline developers. The topics and included items cover all stages of the guideline enterprise, from the planning and formulation of guidelines, to their implementation and evaluation. The final checklist includes links to training materials as well as resources with suggested methodology for applying the items. Interpretation: The checklist will serve as a resource for guideline developers. Consideration of items on the checklist will support the development, implementation and evaluation of guidelines. We will use crowdsourcing to revise the checklist and keep it up to date. PMID:24344144

Schünemann, Holger J.; Wiercioch, Wojtek; Etxeandia, Itziar; Falavigna, Maicon; Santesso, Nancy; Mustafa, Reem; Ventresca, Matthew; Brignardello-Petersen, Romina; Laisaar, Kaja-Triin; Kowalski, Sérgio; Baldeh, Tejan; Zhang, Yuan; Raid, Ulla; Neumann, Ignacio; Norris, Susan L.; Thornton, Judith; Harbour, Robin; Treweek, Shaun; Guyatt, Gordon; Alonso-Coello, Pablo; Reinap, Marge; Brožek, Jan; Oxman, Andrew; Akl, Elie A.

2014-01-01

384

Guidelines for lowering lipids to reduce coronary artery disease risk: a comparison of rosuvastatin with atorvastatin, pravastatin, and simvastatin for achieving lipid-lowering goals  

Microsoft Academic Search

Both the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III and the Second Joint Task Force of European Societies guidelines have established low-density lipoprotein (LDL) cholesterol goals for lipid-lowering treatment to reduce the risk of coronary artery disease. Data from 3 trials that compared rosuvastatin 10 mg (n = 389) with atorvastatin 10 mg (n = 393) and

James Shepherd; Donald B Hunninghake; Philip Barter; James M McKenney; Howard G Hutchinson

2003-01-01

385

Consensus guidelines for the use of empiric and diagnostic-driven antifungal treatment strategies in haematological malignancy, 2014.  

PubMed

Invasive fungal disease (IFD) causes significant morbidity and mortality in patients undergoing allogeneic haemopoietic stem cell transplantation or chemotherapy for haematological malignancy. Much of these adverse outcomes are due to the limited ability of traditional diagnostic tests (i.e. culture and histology) to make an early and accurate diagnosis. As persistent or recurrent fevers of unknown origin (PFUO) in neutropenic patients despite broad-spectrum antibiotics have been associated with the development of IFD, most centres have traditionally administered empiric antifungal therapy (EAFT) to patients with PFUO. However, use of an EAFT strategy has not been shown to have an overall survival benefit and is associated with excessive antifungal therapy use. As a result, the focus has shifted to developing more sensitive and specific diagnostic tests for early and more targeted antifungal treatment. These tests, including the galactomannan enzyme-linked immunosorbent assay and Aspergillus polymerase chain reaction (PCR), have enabled the development of diagnostic-driven antifungal treatment (DDAT) strategies, which have been shown to be safe and feasible, reducing antifungal usage. In addition, the development of effective antifungal prophylactic strategies has changed the landscape in terms of the incidence and types of IFD that clinicians have encountered. In this review, we examine the current role of EAFT and provide up-to-date data on the newer diagnostic tests and algorithms available for use in EAFT and DDAT strategies, within the context of patient risk and type of antifungal prophylaxis used. PMID:25482742

Morrissey, C O; Gilroy, N M; Macesic, N; Walker, P; Ananda-Rajah, M; May, M; Heath, C H; Grigg, A; Bardy, P G; Kwan, J; Kirsa, S W; Slavin, M; Gottlieb, T; Chen, S

2014-12-01

386

Canadian hereditary angioedema guideline.  

PubMed

Hereditary angioedema (HAE) is a disease which is associated with random and often unpredictable attacks of painful swelling typically affecting the extremities, bowel mucosa, genitals, face and upper airway. Attacks are associated with significant functional impairment, decreased Health Related Quality of Life, and mortality in the case of laryngeal attacks. Caring for patients with HAE can be challenging due to the complexity of this disease. The care of patients with HAE in Canada is neither optimal nor uniform across the country. It lags behind other countries where there are more organized models for HAE management, and where additional therapeutic options are licensed and available for use. The objective of this guideline is to provide graded recommendations for the management of patients in Canada with HAE. This includes the treatment of attacks, short-term prophylaxis, long-term prophylaxis, and recommendations for self-administration, individualized therapy, quality of life, and comprehensive care. It is anticipated that by providing this guideline to caregivers, policy makers, patients and their advocates, that there will be an improved understanding of the current recommendations regarding management of HAE and the factors that need to be considered when choosing therapies and treatment plans for individual patients. The primary target users of this guideline are healthcare providers who are managing patients with HAE. Other healthcare providers who may use this guideline are emergency physicians, gastroenterologists, dentists and otolaryngologists, who will encounter patients with HAE and need to be aware of this condition. Hospital administrators, insurers and policy makers may also find this guideline helpful. PMID:25352908

Betschel, Stephen; Badiou, Jacquie; Binkley, Karen; Hébert, Jacques; Kanani, Amin; Keith, Paul; Lacuesta, Gina; Yang, Bill; Aygören-Pürsün, Emel; Bernstein, Jonathan; Bork, Konrad; Caballero, Teresa; Cicardi, Marco; Craig, Timothy; Farkas, Henriette; Longhurst, Hilary; Zuraw, Bruce; Boysen, Henrik; Borici-Mazi, Rozita; Bowen, Tom; Dallas, Karen; Dean, John; Lang-Robertson, Kelly; Laramée, Benoît; Leith, Eric; Mace, Sean; McCusker, Christine; Moote, Bill; Poon, Man-Chiu; Ritchie, Bruce; Stark, Donald; Sussman, Gordon; Waserman, Susan

2014-01-01

387

Guidelines for sexually transmitted diseases.  

PubMed

These guidelines for treatment of sexually transmitted diseases (STD) were established after careful deliberation by a group of experts and staff of the Centers for Disease Control (CDC). Commentary received after dissemination of preliminary documents to a large group of physicians was also considered. Certain aspects of these guidelines represent the best judgment of experts. The guidelines should not be construed as rules, but rather as a source of guidance within the United States. This is particularly true for topics that are controversial or based on limited data. PMID:6688083

1983-05-01

388

Effect of the UK’s revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment  

PubMed Central

Aims In September 2012 the UK’s Commission on Human Medicines (CHM) recommended changes in the management of paracetamol poisoning: use of a single ‘100 mg l?1’ nomogram treatment line, ceasing risk assessment, treating all staggered/uncertain ingestions and increasing the duration of the initial acetylcysteine (NAC) infusion from 15 to 60 min. We evaluated the effect of this on presentation, admission, treatment, adverse reactions and costs of paracetamol poisoning. Methods Data were prospectively collected from adult patients presenting to three large UK hospitals from 3 September 2011 to 3 September 2013 (year before and after change). Infusion duration effect on vomiting and anaphylactoid reactions was examined in one centre. A cost analysis from an NHS perspective was performed for 90 000 patients/annum with paracetamol overdose. Results There were increases in the numbers presenting to hospital (before 1703, after 1854; increase 8.9% [95% CI 1.9, 16.2], P = 0.011); admitted (1060/1703 [62.2%] vs. 1285/1854 [69.3%]; increase 7.1% [4.0, 10.2], P < 0.001) and proportion treated (626/1703 [36.8%] vs. 926/1854 [50.0%]; increase: 13.2% [95% CI 10.0, 16.4], P < 0.001). Increasing initial NAC infusion did not change the proportion of treated patients developing adverse reactions (15 min 87/323 [26.9%], 60 min 145/514 [28.2%]; increase: 1.3% [95% CI –4.9, 7.5], P = 0.682). Across the UK the estimated cost impact is £8.3 million (6.4 million–10.2 million) annually, with a cost-per-life saved of £17.4 million (13.4 million–21.5 million). Conclusions The changes introduced by the CHM in September 2012 have increased the numbers of patients admitted to hospital and treated with acetylcysteine without reducing adverse reactions. A safety and cost-benefit review of the CHM guidance is warranted, including novel treatment protocols and biomarkers in the assessment of poisoning. PMID:24666324

Bateman, D Nicholas; Carroll, Robert; Pettie, Janice; Yamamoto, Takahiro; Elamin, Muhammad E M O; Peart, Lucy; Dow, Margaret; Coyle, Judy; Cranfield, Kristina R; Hook, Christopher; Sandilands, Euan A; Veiraiah, Aravindan; Webb, David; Gray, Alasdair; Dargan, Paul I; Wood, David M; Thomas, Simon H L; Dear, James W; Eddleston, Michael

2014-01-01

389

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure  

Microsoft Academic Search

The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic

Aram V. Chobanian; George L. Bakris; Henry R. Black; William C. Cushman; Lee A. Green; Joseph L. Izzo; Daniel W. Jones; Barry J. Materson; Jackson T. Wright

390

Oak Ridge National Lebroatory Liquid&Gaseous Waste Treatment System Strategic Plan  

SciTech Connect

Excellence in Laboratory operations is one of the three key goals of the Oak Ridge National Laboratory (ORNL) Agenda. That goal will be met through comprehensive upgrades of facilities and operational approaches over the next few years. Many of ORNL's physical facilities, including the liquid and gaseous waste collection and treatment systems, are quite old, and are reaching the end of their safe operating life. The condition of research facilities and supporting infrastructure, including the waste handling facilities, is a key environmental, safety and health (ES&H) concern. The existing infrastructure will add considerably to the overhead costs of research due to increased maintenance and operating costs as these facilities continue to age. The Liquid Gaseous Waste Treatment System (LGWTS) Reengineering Project is a UT-Battelle, LLC (UT-B) Operations Improvement Program (OIP) project that was undertaken to develop a plan for upgrading the ORNL liquid and gaseous waste systems to support ORNL's research mission.

Van Hoesen, S.D.

2003-09-09

391

Survey of subsurface treatment technologies for environmental restoration sites at Sandia National Laboratories, New Mexico.  

SciTech Connect

This report provides a survey of remediation and treatment technologies for contaminants of concern at environmental restoration (ER) sites at Sandia National Laboratories, New Mexico. The sites that were evaluated include the Tijeras Arroyo Groundwater, Technical Area V, and Canyons sites. The primary contaminants of concern at these sites include trichloroethylene (TCE), tetrachloroethylene (PCE), and nitrate in groundwater. Due to the low contaminant concentrations (close to regulatory limits) and significant depths to groundwater ({approx}500 feet) at these sites, few in-situ remediation technologies are applicable. The most applicable treatment technologies include monitored natural attenuation and enhanced bioremediation/denitrification to reduce the concentrations of TCE, PCE, and nitrate in the groundwater. Stripping technologies to remove chlorinated solvents and other volatile organic compounds from the vadose zone can also be implemented, if needed.

McGrath, Lucas K.; Ho, Clifford Kuofei; Wright, Jerome L.

2003-08-01

392

Innovation attributes and adoption decisions: perspectives from leaders of a national sample of addiction treatment organizations.  

PubMed

Drawing on diffusion theory to further knowledge about evidence-based practices (EBPs) in the treatment of substance use disorders (SUDs), this study describes the perceived importance of innovation attributes in adoption decisions within a national sample of SUD treatment organizations. Face-to-face interviews were conducted with leaders of 307 organizations. A typology differentiated organizations reporting: (1) adoption of a treatment innovation in the past year ("recent adoption"), (2) plans to adopt an innovation in the upcoming year ("planned adoption"), or (3) no actual or planned adoption ("non-adoption"). About 30.7% of organizations reported recent adoption, 20.5% indicated planned adoption, and 48.8% were non-adopters. Leaders of organizations reporting recent adoption (n=93) or planned adoption (n=62) rated the importance of innovation attributes, including relative advantage, compatibility, complexity, and observability, on these adoption decisions using a Likert scale that ranged from 0 to 5. Innovation attributes most strongly endorsed were consistency with the program's treatment philosophy (mean=4.47, SD=1.03), improvement in the program's reputation with referral sources (mean=4.00, SD=1.33), reputational improvement with clients and their families (mean=3.98, SD=1.31), and reductions in treatment dropout (mean=3.75, SD=1.54). Innovation characteristics reflecting organizational growth and implementation costs were less strongly endorsed. Adopters and planners were generally similar in their importance ratings. There were modest differences in importance ratings when pharmacological innovations were compared to psychosocial interventions. These findings are consistent with diffusion theory and suggest that efforts to link EBPs with client satisfaction and potential reputational benefits may enhance the diffusion of EBPs. Attention to these attributes when developing and evaluating SUD treatment interventions may enhance efforts to increase subsequent adoption. PMID:25218918

Knudsen, Hannah K; Roman, Paul M

2014-08-23

393

Surgical Treatment Guidelines for Digital Deformity Associated with Intrinsic Muscle Spasticity (Intrinsic Plus Foot) in Adults with Cerebral Palsy.  

PubMed

Intrinsic plus foot deformity has primarily been associated with cerebral palsy and involves spastic contracture of the intrinsic musculature with resultant toe deformities. Digital deformity is caused by a dynamic imbalance between the intrinsic muscles in the foot and extrinsic muscles in the lower leg. Spastic contracture of the toes frequently involves curling under of the lesser digits or contracture of the hallux into valgus or plantar flexion deformity. Patients often present with associated pressure ulcers, deformed toenails, shoe or brace fitting challenges, and pain with ambulation or transfers. Four different patterns of intrinsic plus foot deformity have been observed by the authors that likely relate to the different patterns of muscle involvement. Case examples are provided of the 4 patterns of intrinsic plus foot deformity observed, including global intrinsic plus lesser toe deformity, isolated intrinsic plus lesser toe deformity, intrinsic plus hallux valgus deformity, and intrinsic plus hallux flexus deformity. These case examples are presented to demonstrate each type of deformity and our approach for surgical management according to the contracture pattern. The surgical approach has typically involved tenotomy, capsulotomy, or isolated joint fusion. The main goals of surgical treatment are to relieve pain and reduce pressure points through digital realignment in an effort to decrease the risk of pressure sores and allow more effective bracing to ultimately improve the patient's mobility. PMID:25154656

Boffeli, Troy J; Collier, Rachel C

2014-08-21

394

NIH Stem Cell Research Guidelines  

NSDL National Science Digital Library

A hot topic of recent news has been the lifting of the ban, put in place by the NIH in January 1999, on research using human pluripotent stem cells derived from human embryos and fetal tissue. The ban was lifted on August 25, 2000 with the strong endorsement of President Clinton. Now, the National Institutes of Health Guidelines for Research Using Human Pluripotent Stem Cells is available online in HTML format. According to the site, "The NIH received approximately 50,000 comments from members of Congress, patient advocacy groups, scientific societies, religious organizations, and private citizens. This Notice presents the final Guidelines together with NIH's response to the substantive public comments that addressed provisions of the Guidelines." (For more on the NIH guidelines, see the August 25, 2000 Scout Report).

395

Exposure guidelines for magnetic fields  

SciTech Connect

The powerful magnetic fields produced by a controlled fusion experiment at Lawrence Livermore National Laboratory (LLNL) necessitated the development of personnel-exposure guidelines for steady magnetic fields. A literature search and conversations with active researchers showed that it is currently possible to develop preliminary exposure guidelines for steady magnetic fields. An overview of the results of past research into the bioeffects of magnetic fields was compiled, along with a discussion of hazards that may be encountered by people with sickle-cell anemia or medical electronic and prosthetic implants. The LLNL steady magnetic-field exposure guidelines along with a review of developments concerning the safety of time-varying fields were also presented in this compilation. Guidelines developed elsewhere for time varying fields were also given. Further research is needed to develop exposure standards for both steady or time-varying fields.

Miller, G.

1987-12-01

396

Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines.  

PubMed

While lifestyle management is recommended as first-line treatment of polycystic ovary syndrome (PCOS), the optimal dietary composition is unclear. The aim of this study was to compare the effect of different diet compositions on anthropometric, reproductive, metabolic, and psychological outcomes in PCOS. A literature search was conducted (Australasian Medical Index, CINAHL, EMBASE, Medline, PsycInfo, and EBM reviews; most recent search was performed January 19, 2012). Inclusion criteria were women with PCOS not taking anti-obesity medications and all weight-loss or maintenance diets comparing different dietary compositions. Studies were assessed for risk of bias. A total of 4,154 articles were retrieved and six articles from five studies met the a priori selection criteria, with 137 women included. A meta-analysis was not performed due to clinical heterogeneity for factors including participants, dietary intervention composition, duration, and outcomes. There were subtle differences between diets, with greater weight loss for a monounsaturated fat-enriched diet; improved menstrual regularity for a low-glycemic index diet; increased free androgen index for a high-carbohydrate diet; greater reductions in insulin resistance, fibrinogen, total, and high-density lipoprotein cholesterol for a low-carbohydrate or low-glycemic index diet; improved quality of life for a low-glycemic index diet; and improved depression and self-esteem for a high-protein diet. Weight loss improved the presentation of PCOS regardless of dietary composition in the majority of studies. Weight loss should be targeted in all overweight women with PCOS through reducing caloric intake in the setting of adequate nutritional intake and healthy food choices irrespective of diet composition. PMID:23420000

Moran, Lisa J; Ko, Henry; Misso, Marie; Marsh, Kate; Noakes, Manny; Talbot, Mac; Frearson, Meredith; Thondan, Mala; Stepto, Nigel; Teede, Helena J

2013-04-01

397

Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013 III. Treatment and prognosis of autoimmune pancreatitis.  

PubMed

The standard treatment for autoimmune pancreatitis (AIP) is steroid therapy, although some patients improve spontaneously. Indications for steroid therapy in AIP patients are symptoms such as obstructive jaundice, abdominal pain, back pain, and the presence of symptomatic extrapancreatic lesions. Prior to steroid therapy, obstructive jaundice should be managed by biliary drainage, and blood glucose levels should be controlled in patients with diabetes mellitus. The recommended initial oral prednisolone dose for induction of remission is 0.6 mg/kg/day, which is administered for 2-4 weeks. The dose is then tapered by 5 mg every 1-2 weeks, based on changes in clinical manifestations, biochemical blood tests (such as liver enzymes and IgG or IgG4 levels), and repeated imaging findings (US, CT, MRCP, ERCP, etc.). The dose is tapered to a maintenance dose (2.5-5 mg/day) over a period of 2-3 months. Cessation of steroid therapy should be based on the disease activity in each case. Termination of maintenance therapy should be planned within 3 years in cases with radiological and serological improvement. Re-administration or dose-up of steroid is effective for treating AIP relapse. Application of immunomodulatory drugs is considered for AIP patients who prove resistant to steroid therapy. The prognosis of AIP appears to be good over the short-term with steroid therapy. The long-term outcome is less clear, as there are many unknown factors, such as relapse, pancreatic exocrine or endocrine dysfunction, and associated malignancy. PMID:24639058

Kamisawa, Terumi; Okazaki, Kazuichi; Kawa, Shigeyuki; Ito, Tetsuhide; Inui, Kazuo; Irie, Hiroyuki; Nishino, Takayoshi; Notohara, Kenji; Nishimori, Isao; Tanaka, Shigeki; Nishiyama, Toshimasa; Suda, Koichi; Shiratori, Keiko; Tanaka, Masao; Shimosegawa, Tooru

2014-06-01

398

Hip fracture risk in older US adults by treatment eligibility status based on new National Osteoporosis Foundation Guidance  

Technology Transfer Automated Retrieval System (TEKTRAN)

The relationship between treatment eligibility by the new National Osteoporosis Foundation (NOF) FRAX® -based Guide to the Prevention and Treatment of Osteoporosis and the risk of subsequent hip fracture is unknown. The study sample consisted of 3208 men and women ages 65 years and older who were ex...

399

Failure and Delay in Initial Treatment Contact After First Onset of Mental Disorders in the National Comorbidity Survey Replication  

Microsoft Academic Search

Context: An understudied crucial step in the help- seeking process is making prompt initial contact with a treatment provider after first onset of a mental disorder. Objective: To provide data on patterns and predictors of failure and delay in making initial treatment contact after first onset of a mental disorder in the United States from the recently completed National Comorbidity

Philip S. Wang; Patricia Berglund; Mark Olfson; Harold A. Pincus; Kenneth B. Wells; Ronald C. Kessler

2005-01-01

400

United Nations Office on Drugs and Crime International Network of Drug Dependence Treatment and Rehabilitation Resource Centres: Treatnet  

ERIC Educational Resources Information Center

Key to the dissemination of evidence-based addiction treatments is the exchange of experiences and mutual support among treatment practitioners, as well as the availability of accurate addiction training materials and effective trainers. To address the shortage of such resources, the United Nations Office on Drugs and Crime (UNODC) created…

Tomas-Rossello, Juana; Rawson, Richard A.; Zarza, Maria J.; Bellows, Anne; Busse, Anja; Saenz, Elizabeth; Freese, Thomas; Shawkey, Mansour; Carise, Deni; Ali, Robert; Ling, Walter

2010-01-01

401

Tobacco Use Treatment at the U.S. National Cancer Institute’s Designated Cancer Centers  

PubMed Central

Introduction: Tobacco use is a leading cause of cancer, and continued use after cancer diagnosis puts patients at greater risk for adverse health outcomes, including increased risk for cancer recurrence. This study surveyed National Cancer Institute (NCI)–designated Cancer Centers to assess the availability of tobacco use treatment (TUT) services. Methods: Directors and oncology providers of 58 NCI-designated Cancer Centers received invitations to participate in an online survey. The questionnaire asked about attitudes, awareness, policies, and practices related to TUT; barriers to treatment provision; and factors likely to increase services. Results: All 58 Cancer Centers participated. Twelve (20.7%) Centers reported no TUT services for their patients. Of the remainder, 34 (58.6%) reported a TUT program within their Center and 12 (20.7%) reported external TUT services in their health care system or affiliated university. Only 62% of Centers reported routinely providing tobacco education materials to patients, just over half reported effective identification of patient tobacco use, and less than half reported an employee dedicated to providing TUT services or a clear commitment to providing TUT services from Center leadership. The 34 centers with internal TUT programs reported significantly greater services and administration support for TUT Services. Conclusions: These data demonstrate a national need for Cancer Centers to embrace and incorporate recommended standards for TUT. Tying TUT services to NCI recognition and providing stable funding for TUT services in Cancer Centers could lead to better health outcomes, treatment efficacy, and satisfaction for all U.S. Cancer Centers and their patients. PMID:22499079

Ripley-Moffitt, Carol E.; Pathman, Donald E.; Patsakham, Katharine M.

2013-01-01

402

CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core: Canadian guidelines for management and treatment of HIV/hepatitis C coinfection in adults  

PubMed Central

BACKGROUND: Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV, and is responsible for a heavy burden of morbidity and mortality. HIV-HCV management is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug-drug interactions between new HCV direct-acting antiviral therapies and antiretroviral regimens. OBJECTIVE: To develop national standards for the management of HCV-HIV coinfected adults in the Canadian context. METHODS: A panel with specific clinical expertise in HIV-HCV co-infection was convened by The CIHR HIV Trials Network to review current literature, existing guidelines and protocols. Following broad solicitation for input, consensus recommendations were approved by the working group, and were characterized using a Class (benefit verses harm) and Level (strength of certainty) quality-of-evidence scale. RESULTS: All HIV-HCV coinfected individuals should be assessed for HCV therapy. Individuals unable to initiate HCV therapy should initiate antiretroviral therapy to slow liver disease progression. Standard of care for genotype 1 is pegylated interferon and weight-based ribavirin dosing plus an HCV protease inhibitor; traditional dual therapy for 24 weeks (for genotype 2/3 with virological clearance at week 4); or 48 weeks (for genotypes 2–6). Therapy deferral for individuals with mild liver disease may be considered. HIV should not be considered a barrier to liver transplantation in coinfected patients. DISCUSSION: Recommendations may not supersede individual clinical judgement. PMID:24489565

Hull, Mark; Klein, Marina; Shafran, Stephen; Tseng, Alice; Giguère, Pierre; Côté, Pierre; Poliquin, Marc; Cooper, Curtis

2013-01-01