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Sample records for national treatment guidelines

  1. Hypertension in Older Persons: A Systematic Review of National and International Treatment Guidelines.

    PubMed

    Alhawassi, Tariq M; Krass, Ines; Pont, Lisa G

    2015-06-01

    Despite good evidence regarding the benefits of managing hypertension in elderly populations, the extent to which this evidence has been incorporated into national and international clinical hypertension treatment guidelines is unknown. A systematic review was conducted to identify recommendations in current national and international hypertension treatment guidelines with a focus on specific targets and treatment recommendations for older persons with uncomplicated hypertension. Guidelines for the management of hypertension published or updated over a 5-year period (2009-2014) were identified by searching Medline, Google, and Google Scholar. Thirteen guidelines that met the predefined inclusion criteria were included in the review. Among these guidelines was considerable variation regarding who is considered an older person. However, there was general consensus regarding blood pressure targets. While current hypertension guidelines do include recommendations regarding management of uncomplicated hypertension in older populations, the depth and breadth of these recommendations vary considerably between guidelines and may limit the usefulness of such treatment guidelines to clinicians. PMID:25827023

  2. National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis*

    PubMed Central

    Ulrich, U.; Buchweitz, O.; Greb, R.; Keckstein, J.; von Leffern, I.; Oppelt, P.; Renner, S. P.; Sillem, M.; Stummvoll, W.; De Wilde, R.-L.; Schweppe, K.-W.

    2014-01-01

    In this guideline, recommendations and standards for optimum diagnosis and treatment of endometriosis are presented. They are based on the analysis of the available scientific evidence as published in prospective randomized and retrospective studies as well as in systematic reviews. The guideline working group consisted of experts from Austria, Germany, Switzerland, and the Czech Republic. PMID:26157194

  3. Danish national guidelines for treatment of diverticular disease.

    PubMed

    Andersen, Jens Christian; Bundgaard, Lars; Elbrønd, Henrik; Laurberg, Søren; Walker, Line Rosell; Støvring, Jens

    2012-05-01

    In order to elaborate evidence-based, national Danish guidelines for the treatment of diverticular disease the literature was reviewed concerning the epidemiology, staging, diagnosis and treatment of diverticular disease in all its aspects. The presence of colonic diverticula, which is considered to be a mucosal herniation through the intestinal muscle wall, is inversely correlated to the intake of dietary fibre. Other factors in the genesis of diverticular disease may be physical inactivity, obesity, and use of NSAIDs or acetaminophen. Diverticulosis is most common in Western countries with a prevalence of 5% in the population aged 30-39 years and 60% in the part of the population > 80 years. The incidence of hospitalization for acute diverticulitis is 71/100,000 and the incidence of complicated diverticulitis is 3.5-4/100,000. Acute diverticulitis is conveniently divided into uncomplicated and complicated diverticulitis. Complicated diverticulitis is staged by the Hinchey classification 1-4 (1: mesocolic/pericolic abscess, 2: pelvic abscess, 3: purulent peritonitis, 4: faecal peritonitis). Diverticulitis is suspected in case of lower left quadrant abdominal pain and tenderness associated with fever and raised WBC and/or CRP; but the clinical diagnosis is not sufficiently precise. Abdominal CT confirms the diagnosis and enables the classification of the disease according to Hinchey. The distinction between Hinchey 3 and 4 is done by laparoscopy or, when not possible, by laparotomy. Uncomplicated diverticulitis is treated by conservative means. There is no evidence of any beneficial effect of antibiotics in uncomplicated diverticulitis, but antibiotics may be used in selected cases depending on the overall condition of the patients and the severity of the infection. Abscess formation is best treated by US- or CT-guided drainage in combination with antibiotics. When the abscess is < 3 cm in diameter, drainage may be unnecessary, and only antibiotics should be instituted. The surgical treatment of acute perforated diverticulitis has interchanged between resection and non-resection strategies: The three-stage procedure dominating in the beginning of the 20th century was later replaced by the Hartmann procedure or, alternatively, resection of the sigmoid with primary anastomosis. Lately a non-resection strategy consisting of laparoscopy with peritoneal lavage and drainage has been introduced in the treatment of Hinchey stage 3 disease. Evidence so far for the lavage regime is promising, comparing favourably with resection strategies, but lacking in solid proof by randomized, controlled investigations. In recent years, morbidity has declined in complicated diverticulitis due to improved diagnostics and new treatment modalities. Recurrent diverticulitis is relatively rare and furthermore often uncomplicated than previously assumed. Elective surgery in diverticular disease should probably be limited to symptomatic cases not amenable to conservative measures, since prophylactic resection of the sigmoid, evaluated from present evidence, confers unnecessary risks in terms of morbidity and mortality to the individual as well as unnecessary costs to society. Any recommendation for routine resection following multiple cases of diverticulitis should await results of randomized studies. Laparoscopic resection is preferred in case of need for elective surgery. When malignancy is ruled out preoperatively, a sigmoid resection with preservation of the inferior mesenteric artery, oral division of colon in soft compliant tissue and anastomosis to upper rectum is recommended. Fistulae to bladder or vagina, or stenosis of the colon may be dealt with according to symptoms and comorbidity. Resection of the diseased segment of colon is preferred when possible and safe; alternatively, a diverting stoma can be the best solution. PMID:22549495

  4. National Bookmobile Guidelines, 1992.

    ERIC Educational Resources Information Center

    Ohio State Library, Columbus.

    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…

  5. Evaluation of adherence to national treatment guidelines among tuberculosis patients in three provinces of South Africa

    PubMed Central

    Ershova, J V; Podewils, L J; Bronner, L E; Stockwell, H G; Dlamini, S; Mametja, L D

    2016-01-01

    Background Standardised tuberculosis (TB) treatment through directly observed therapy (DOT) is available in South Africa, but the level of adherence to standardised TB treatment and its impact on treatment outcomes is unknown. Objectives To describe adherence to standardised TB treatment and provision of DOT, and analyse its impact on treatment outcome. Methods We utilised data collected for an evaluation of the South African national TB surveillance system. A treatment regimen was considered appropriate if based on national treatment guidelines. Multivariate log-binomial regression was used to evaluate the association between treatment regimens, including DOT provision, and treatment outcome. Results Of 1 339 TB cases in the parent evaluation, 598 (44.7%) were excluded from analysis owing to missing outcome or treatment information. The majority (697, 94.1%) of the remaining 741 patients received an appropriate TB regimen. Almost all patients (717, 96.8%) received DOT, 443 (59.8%) throughout the treatment course and 274 (37.0%) during the intensive (256, 34.6%) or continuation (18, 2.4%) phase. Independent predictors of poor outcome were partial DOT (adjusted risk ratio (aRR) 3.1, 95% confidence interval (CI) 2.2 4.3) and previous treatment default (aRR 2.3, 95% CI 1.1 4.8). Conclusion Patients who received incomplete DOT or had a history of defaulting from TB treatment had an increased risk of poor outcomes. PMID:25212205

  6. Guidelines for National Libraries.

    ERIC Educational Resources Information Center

    Sylvestre, Guy

    This report is designed to provide practical assistance to government officials and librarians responsible for the planning, creation, and development of national library services. Based on a number of authoritative studies and a broad consensus among experts, including directors of national libraries, these guidelines give special attention to…

  7. Guideline 3: Psychosocial Treatment.

    ERIC Educational Resources Information Center

    American Journal on Mental Retardation, 2000

    2000-01-01

    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…

  8. Guideline 3: Psychosocial Treatment.

    ERIC Educational Resources Information Center

    American Journal on Mental Retardation, 2000

    2000-01-01

    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

  9. [National guidelines of diagnosis and treatment of the non-Hodgkin lymphoma].

    PubMed

    Candelaria, Myrna; Cervera-Ceballos, Eduardo; Meneses-García, Abelardo; Avilés-Salas, Alejandro; Lome-Maldonado, Carmen; Zárate-Osorno, Alejandra; Ortiz-Hidalgo, Carlos; Rodríguez-Moguel, Leticia; Quiñónez-Urrego, Enoe Enedina; Ramos-Salazar, Patricia; Romero-Guadarrama, Mónica Belinda; Lara-Torres, César; Ramírez-Aceves, Rocío; López-Navarro, Omar; Rivas-Vera, Silvia; Díaz-Meneses, Iván Eudaldo; Estrada-Lobato, Enrique; Cervera-Ceballos, José; Rojas-Marín, Carlos Enrique; Hernández-Rodriguez, José Mario; Pérez-López, Berenice; Gómez-Almaguer, David; Altamirano-Ley, Javier; Baz, Patricia; Valero-Saldaña, Luis Manuel; Navarrete-Herrera, José René; Torres-Salgado, Francisco Gerardo; Solano-Murillo, Pedro; Nambo-Lucio, María de Jesús; Rivas-Llamas, Ramón; Aquino-Salgado, Jorge Luis; Avila-Arreguín, Elsa Verónica; Cortês-Esteban, Patricia; Chongo-Alfaro, Martha Lilia; Pérez-Ramírez, Oscar de Jesús; Toledano-Cuevas, Diana Vanesa; Lobato-Mendizábal, Eduardo; Martínez-Ramírez, Mario Alberto; Morales-Maravilla, Adrián; Sosa-Camas, Rosa Elena; Agreda-Vásquez, Gladys P; Camacho-Hernández, Alejandro; Aguayo-González, Alvaro; Espinoza-Zamora, José Ramiro; Sánchez-Guerrero, Sergio A; Lozano-Zavaleta, Valentín; Selva-Pallares, Julio Edgar; Hernádez-Rodríguez, Juan Manuel; Cardiel-Silva, Mariela; Castillo-Rivera, Manuel Héctor; Villela, Luis; Loarca-Piña, Luis Martín; Zurita-Martínez, Hugo; Graham-Casassus, Juan; Azaola-Espinosa, Patricio; Silva-López, Salvador; Armenta-San Sebastián, Jorge Antonio; Mijangos-Huesca, Francisco; Pérez-Osorio, Jorge Eduardo; Aldaco-Sarvide, Fernando; Castellanos, Guillermo; Ramírez-Ibarguen, Ana Florencia; Zapata-Canto, Nidia; Labardini-Méndez, Juan Rafael

    2013-06-01

    Non-Hodgkin lymphoma comprises a heterogeneous group of haematological malignancies, classified according to their clinic, anatomic-pathological features and, lately, to their molecular biomarkers. Despite the therapeutic advances, nearly half of the patients will die because of this disease. The new diagnostic tools have been the cornerstone to design recent therapy targets, which must be included in the current treatment guidelines of this sort of neoplasms by means of clinical trials and evidence-based medicine. In the face of poor diagnoses devices in most of the Mexican hospitals, we recommend the present diagnose stratification, and treatment guidelines for non-Hodgkin lymphoma, based on evidence. They include the latest and most innovative therapeutic approaches, as well as specific recommendations for hospitals with limited framework and therapy resources. PMID:24459777

  10. Coordinating locally 'owned' treatment guidelines.

    PubMed

    Collier, J; Picton, C; Littlejohns, P

    1994-01-01

    South West Thames Regional Health Authority established and commissioned a regional guidelines unit to coordinate the introduction of a set of treatment guidelines on the management of common medical emergencies into all the acute intaking National Health Service (NHS) hospitals throughout the region. All hospitals were offered a set of template guidelines to be used at their discretion for producing their own customised equivalent. They were also offered full typing and production facilities, together with printing costs if publication was achieved by a target deadline (1 August 1993). In 11 of the 14 NHS hospitals guidelines were available to hospital staff by the target deadline, and one set was produced for a non-NHS hospital. In two hospitals the target date was not met, and one other declined to take part. As part of the project the unit assessed the extent to which the published guidelines were adapted to meet the requirements of each individual hospital. The template offered guidelines on 34 topic titles. No hospital used all core titles of the original template; titles were omitted or replaced in some, and added in others. Where the original guideline titles were used, there was almost always some customisation--changes in sentence structure, names or contact numbers, alterations in drugs and doses or the addition or omission of entire sections. By using an established resource, sets of customised, locally determined treatment guidelines were introduced with relative ease into most of the acute hospitals in a UK health region. PMID:7884707

  11. National Bookmobile Guidelines, 1988.

    ERIC Educational Resources Information Center

    Ohio State Library, Columbus.

    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…

  12. Are there national strategies, plans and guidelines for the treatment of hepatitis C in people who inject drugs? A survey of 33 European countries

    PubMed Central

    2014-01-01

    Background Hepatitis C virus (HCV) infection represents a major global health problem, which in high-income countries now mostly affects people who inject drugs (PWID). Many studies show that the treatment of HCV infection is as successful among PWID as among other populations and recently PWID have been included in the international guidelines for the treatment of HCV infection. The aim of this survey was to collect data from European countries on the existence of national strategies, action plans and clinical guidelines for HCV treatment in the general population and PWID in particular. Methods Thirty-three European countries were invited to participate. Data on available national strategies, action plans and guidelines for HCV treatment in general population and in PWID specifically were collected prospectively by means of a structured electronic questionnaire and analyzed accordingly. Results All of the 33 invited European countries participated in the survey. Twenty-two responses came from non-governmental organizations, six from public health institutions, four from university institutions and one was an independent consultant. Fourteen (42.4%) of the countries reported having a national strategy and/or national action plan for HCV treatment, from which ten of them also reported having a national strategy and/or national action plan for treatment of HCV infection in PWID. Nearly three-quarters reported having national HCV treatment guidelines. PWID were included in the majority (66.7%) of the guidelines. Fourteen (42.4%) countries reported having separate guidelines for the treatment of HCV infection in PWID. Conclusions Given the high burden of HCV-related morbidity and mortality in PWID in Europe, the management of HCV infection should become a healthcare priority in all European countries, starting with developing or using already-existing national strategies, action plans and guidelines for this population. PMID:25252635

  13. Economic modelling of diagnostic and treatment pathways in National Institute for Health and Care Excellence clinical guidelines: the Modelling Algorithm Pathways in Guidelines (MAPGuide) project.

    PubMed Central

    Lord, J; Willis, S; Eatock, J; Tappenden, P; Trapero-Bertran, M; Miners, A; Crossan, C; Westby, M; Anagnostou, A; Taylor, S; Mavranezouli, I; Wonderling, D; Alderson, P; Ruiz, F

    2013-01-01

    BACKGROUND National Institute for Health and Care Excellence (NICE) clinical guidelines (CGs) make recommendations across large, complex care pathways for broad groups of patients. They rely on cost-effectiveness evidence from the literature and from new analyses for selected high-priority topics. An alternative approach would be to build a model of the full care pathway and to use this as a platform to evaluate the cost-effectiveness of multiple topics across the guideline recommendations. OBJECTIVES In this project we aimed to test the feasibility of building full guideline models for NICE guidelines and to assess if, and how, such models can be used as a basis for cost-effectiveness analysis (CEA). DATA SOURCES A 'best evidence' approach was used to inform the model parameters. Data were drawn from the guideline documentation, advice from clinical experts and rapid literature reviews on selected topics. Where possible we relied on good-quality, recent UK systematic reviews and meta-analyses. REVIEW METHODS Two published NICE guidelines were used as case studies: prostate cancer and atrial fibrillation (AF). Discrete event simulation (DES) was used to model the recommended care pathways and to estimate consequent costs and outcomes. For each guideline, researchers not involved in model development collated a shortlist of topics suggested for updating. The modelling teams then attempted to evaluate options related to these topics. Cost-effectiveness results were compared with opinions about the importance of the topics elicited in a survey of stakeholders. RESULTS The modelling teams developed simulations of the guideline pathways and disease processes. Development took longer and required more analytical time than anticipated. Estimates of cost-effectiveness were produced for six of the nine prostate cancer topics considered, and for five of eight AF topics. The other topics were not evaluated owing to lack of data or time constraints. The modelled results suggested 'economic priorities' for an update that differed from priorities expressed in the stakeholder survey. LIMITATIONS We did not conduct systematic reviews to inform the model parameters, and so the results might not reflect all current evidence. Data limitations and time constraints restricted the number of analyses that we could conduct. We were also unable to obtain feedback from guideline stakeholders about the usefulness of the models within project time scales. CONCLUSIONS Discrete event simulation can be used to model full guideline pathways for CEA, although this requires a substantial investment of clinical and analytic time and expertise. For some topics lack of data may limit the potential for modelling. There are also uncertainties over the accessibility and adaptability of full guideline models. However, full guideline modelling offers the potential to strengthen and extend the analytical basis of NICE's CGs. Further work is needed to extend the analysis of our case study models to estimate population-level budget and health impacts. The practical usefulness of our models to guideline developers and users should also be investigated, as should the feasibility and usefulness of whole guideline modelling alongside development of a new CG. FUNDING This project was funded by the Medical Research Council and the National Institute for Health Research through the Methodology Research Programme [grant number G0901504] and will be published in full in Health Technology Assessment; Vol. 17, No. 58. See the NIHR Journals Library website for further project information. PMID:24325843

  14. Antihypertensive drug prescription patterns, rationality, and adherence to Joint National Committee-7 hypertension treatment guidelines among Indian postmenopausal women

    PubMed Central

    Tandon, Vishal R.; Sharma, Sudhaa; Mahajan, Shagun; Mahajan, Annil; Khajuria, Vijay; Mahajan, Vivek; Prakash, Chander

    2014-01-01

    Aim of Study: The aim of this study is to evaluate antihypertensive drug prescription patterns, rationality and adherence to Joint National Committee (JNC-7) hypertension (HT) treatment recommendations among Indian postmenopausal women (PMW). Materials and Methods: An observational and cross-sectional prospective prescription audit study was carried over a period of 1 year. A total of 500 prescriptions prescribed to PMW for diagnosed HT, were identified for one point analysis. Drug prescription patterns/trends, and their adherence to JNC-7 report as well as rationality using WHO guide to good prescribing was assessed. Results: In the monotherapy, category angiotensin receptor blockers (ARBs) accounted (24.8%), calcium channel blockers (CCBs) (19.4%), angiotensin converting enzyme inhibitors (ACEIs) (11%), beta blockers (BBs) (2.8%), and diuretics (2%) of the total prescription. Individually, amlodipine was maximally prescribed in 16.4%. 31.6% had double combination, whereas 2.2% and 1% had triple and four drug combinations, respectively. About 3.6% of the prescription contained antihypertensive combination along with other class of drug. ARBs + diuretic were observed in 11%, CCBs + BB 10% and ACEI + diuretic in 2.6% of the total prescriptions. Among the combination therapy amlodipine + atenolol (8.4%), telmisartan + hydrochlorothiazide (6%) and losartan + hydrochlorothiazide (4.4%) were maximally prescribed. 84.21% (P < 0.001) of the prescription showed nonadherence as per recommendations for pre-HT. 100% and 43.25% adherence rates were noticed for Stage 1 HT (P < 0.001) and Stage 2 HT (P > 0.05) patients. Conclusion: Antihypertensive prescription trends largely adhere to existing guidelines and are rational except polypharmacy, generic and fixed dose combinations prescribing, were some of the common pharmacologically considered irrationality noticed. PMID:24970986

  15. Guidelines for makeup water treatment

    SciTech Connect

    Cline, D.A. Jr.; Shields, K.J. Associates, Baltimore, MD )

    1990-03-01

    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, instrumentation and control, guideline demonstration and verification, and related subject areas. This guideline reviews available technology for and preferred approaches to production of fossil plant cycle makeup from various raw water supplies. Subject areas covered include makeup water source and source characteristics, unit processes comprising makeup treatment systems, guidelines for process selection, resin and membrane selection guidelines, techniques for monitoring performance and cost effectiveness, and waste disposal considerations. The report also identifies additional research activity needed to advance the state-of-the-art for makeup water treatment, results of a utility industry survey and other related topics. 72 refs., 60 figs., 74 tabs.

  16. Jordan tobacco dependence treatment guidelines: rationale and development.

    PubMed

    Ayub, H; Obeidat, N; Leischow, S; Glynn, T; Hawari, F

    2016-11-01

    Jordan, a high tobacco-burden country, has been working to expand its tobacco dependence treatment services and has completed development of its first customized treatment guidelines. Our paper presents the development process for these guidelines. A group of national and international experts was formed and a national situation analysis for tobacco dependence treatment practices and a detailed review of international evidence were conducted. The guidelines were then drafted and reviewed by national, regional and international experts and were official endorsed by the Jordanian Ministry of Health before being launched. The guidelines comprise concise descriptions and practical supplementary flowcharts covering the major elements of general tobacco dependence treatment. These are the first comprehensive Arabic-language guidelines, including a section focusing on waterpipe use, and we believe they are a reliable and useful resource for neighbouring countries seeking to develop similar guidelines. PMID:26857722

  17. Alternative national guidelines for treating attention and depression problems in children: comparison of treatment approaches and prescribing rates in the United Kingdom and United States.

    PubMed

    Murphy, J Michael; McCarthy, Alyssa E; Baer, Lee; Zima, Bonnie T; Jellinek, Michael S

    2014-01-01

    The use of psychotropic medications for children and adolescents with attention and depression problems continues to generate both attention in the news media and controversy within the field. Given that the United Kingdom has recently issued guidelines for its national health service that differ substantially from those in the United States, the time is ripe to reexamine the evidence. The purpose of this article is to describe the UK's new "stepped care" guidelines for treating attention and depression problems in children and to compare them to the US guidelines issued by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. Our findings are that, despite many similarities, the UK guidelines are generally more conservative in their recommendations for medication use, especially for children experiencing only moderate impairment. Our article also compares prescription and diagnosis rates in the UK and the US, and reports evidence for lower rates of prescribing in the UK, despite some evidence that the rates of problems may not differ substantially. We conclude by noting that the existence of an alternative standard provides validation for clinicians or families who prefer to take a more conservative approach to medication use. The two different approaches to care also provide a valuable opportunity for research to determine whether the approaches result in different treatment outcomes. PMID:24736521

  18. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute–Working Group 1996 guidelines

    PubMed Central

    Hallek, Michael; Cheson, Bruce D.; Catovsky, Daniel; Caligaris-Cappio, Federico; Dighiero, Guillaume; Döhner, Hartmut; Hillmen, Peter; Keating, Michael J.; Montserrat, Emili; Rai, Kanti R.; Kipps, Thomas J.

    2008-01-01

    Standardized criteria for diagnosis and response assessment are needed to interpret and compare clinical trials and for approval of new therapeutic agents by regulatory agencies. Therefore, a National Cancer Institute–sponsored Working Group (NCI-WG) on chronic lymphocytic leukemia (CLL) published guidelines for the design and conduct of clinical trials for patients with CLL in 1988, which were updated in 1996. During the past decade, considerable progress has been achieved in defining new prognostic markers, diagnostic parameters, and treatment options. This prompted the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) to provide updated recommendations for the management of CLL in clinical trials and general practice. PMID:18216293

  19. National Osteoporosis Society vitamin D guideline summary.

    PubMed

    Aspray, Terry J; Bowring, Claire; Fraser, William; Gittoes, Neil; Javaid, M Kassim; Macdonald, Helen; Patel, Sanjeev; Selby, Peter; Tanna, Nuttan; Francis, Roger M

    2014-09-01

    The National Osteoporosis Society (NOS) published its document, Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management, in 2013 as a practical clinical guideline on the management of vitamin D deficiency in adult patients with, or at risk of developing, bone disease. There has been no clear consensus in the UK on vitamin D deficiency its assessment and treatment, and clinical practice is inconsistent. This guideline is aimed at clinicians, including doctors, nurses and dieticians. It recommends the measurement of serum 25 (OH) vitamin D (25OHD) to estimate vitamin D status in the following clinical scenarios: bone diseases that may be improved with vitamin D treatment; bone diseases, prior to specific treatment where correcting vitamin D deficiency is appropriate; musculoskeletal symptoms that could be attributed to vitamin D deficiency. The guideline also states that routine vitamin D testing is unnecessary where vitamin D supplementation with an oral antiresorptive treatment is already planned and sets the following serum 25OHD thresholds: <30 nmol/l is deficient; 30-50 nmol/l may be inadequate in some people; >50 nmol/l is sufficient for almost the whole population. For treatment, oral vitamin D3 is recommended with fixed loading doses of oral vitamin D3 followed by regular maintenance therapy when rapid correction of vitamin D deficiency is required, although loading doses are not necessary where correction of deficiency is less urgent or when co-prescribing with an oral antiresorptive agent. For monitoring, serum calcium (adjusted for albumin) should be checked 1 month after completing a loading regimen, or after starting vitamin D supplementation, in case primary hyperparathyroidism has been unmasked. However, routine monitoring of serum 25OHD is generally unnecessary but may be appropriate in patients with symptomatic vitamin D deficiency or malabsorption and where poor compliance with medication is suspected. The guideline focuses on bone health as, although there are numerous putative effects of vitamin D on immunity modulation, cancer prevention and the risks of cardiovascular disease and multiple sclerosis, there remains considerable debate about the evaluation of extraskeletal factors and optimal vitamin D status in these circumstances. PMID:25074538

  20. Obtaining the new HIV treatment guidelines.

    PubMed

    2001-02-28

    How to order the new HIV/AIDS official adult treatment guidelines by mail if you do not have computer access; how to get your questions about treatments answered at the same office; and other guidelines available including prevention of opportunistic infections, and what to do in case of occupational exposure to HIV. In addition, the official Web site for the guidelines has a marked copy which shows where the current adult guidelines are changed from the previous version. PMID:12765150

  1. Current Controversies With Recent Cholesterol Treatment Guidelines.

    PubMed

    Phillips, Elizabeth; Saseen, Joseph J

    2016-02-01

    Several guidelines and expert recommendations have been published recently regarding the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD) risk. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend a drastic paradigm change in the treatment of cholesterol where treatment, based on level of cardiovascular risk, is based around using a fixed statin intensity therapy. This approach is endorsed by the American Diabetes Association. However, recommendations by the National Lipid Association (NLA) consist of the traditional approach of titrating therapy to achieve patient-specific lipoprotein targets. Despite the differences in overall approaches, the use of statin therapy as the cornerstone of treatment to reduce risk of cardiovascular events in at risk patients is a strong common theme. Clinicians should be aware of these differences, as they represent controversies with the overall treatment of ASCVD risk. Additional controversies related to the treatment of patients with ASCVD risk pertain to the role of nonstatin drugs and approaches to managing side effects. These topics are reviewed within this article and discuss implications for patient care. PMID:26611871

  2. Recent Update to the US Cholesterol Treatment Guidelines: A Comparison With International Guidelines.

    PubMed

    Nayor, Matthew; Vasan, Ramachandran S

    2016-05-01

    The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guideline advocated several changes from the previous Adult Treatment Panel III guidelines. Assuming full implementation, the 2013 ACC/AHA guideline would identify ≈13 million Americans as newly eligible for consideration of statin therapy. Three features of the 2013 ACC/AHA guideline primarily responsible for these differences are the specific risk assessment tool endorsed, the risk threshold considered sufficient to warrant primary prevention statin therapy, and the decision not to include cholesterol treatment targets. There is no consensus among international guidelines on the optimal approach to these 3 components. The 2013 ACC/AHA guideline recommends assessing absolute risk with the Pooled Cohort equations, which were developed to improve on previous risk assessment models by including stroke as an outcome and by broadening racial and geographic diversity. Each of the leading international guidelines recommends a different equation for absolute risk assessment. The 2013 ACC/AHA guideline advises consideration of statin therapy for an estimated 10-year risk of atherosclerotic vascular disease of ≥7.5%, which is lower than the thresholds recommended by other leading international guidelines. Lastly, the 2013 ACC/AHA guideline does not endorse a treat-to-target strategy but instead specifies the appropriate intensity of statin for each risk category. This approach is shared by the National Institute for Health and Care Excellence guidelines but differs from other international guidelines. In this review, we summarize the 2013 ACC/AHA cholesterol guideline recommendations and compare them with recommendations from Adult Treatment Panel III and other leading international guidelines. PMID:27143546

  3. American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

    PubMed

    Kampman, Kyle; Jarvis, Margaret

    2015-01-01

    The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This "Practice Guideline" was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) - a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted. PMID:26406300

  4. Treatment for Panic Disorder: Practical Guidelines.

    ERIC Educational Resources Information Center

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

    2002-01-01

    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)

  5. Updated Heart Failure Treatment Guidelines Issued

    MedlinePlus

    ... nih.gov/medlineplus/news/fullstory_158956.html Updated Heart Failure Treatment Guidelines Issued Two new drugs added to ... drugs to the list of treatment options for heart failure. In people with the condition, the heart can' ...

  6. Shoulder Conditions: Diagnosis and Treatment Guideline.

    PubMed

    Codsi, Michael; Howe, Chris R

    2015-08-01

    The following guideline covers a wide array of shoulder conditions seen in the workers' compensation, as well as the nonworkers' compensation, population. The guideline is intended to help establish work relatedness and aid in making the diagnosis of shoulder injuries and degenerative conditions. It also provides a nonoperative and operative guideline for the treatment of several shoulder conditions, not limited to rotator cuff tears, subacromial impingement syndrome, acromioclavicular arthritis and dislocations, as well as glenohumeral arthritis. PMID:26231960

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

    PubMed

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

    2013-09-01

    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

  8. Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents: Updated Guidelines From the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America

    PubMed Central

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

    2014-01-01

    In May 2013, a revised and updated version of the Centers for Disease Control and Prevention/National Institutes of Health/HIV Medicine Association Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents was released online. These guidelines, since their inception in 1989, have been widely accessed in the United States and abroad. These guidelines have focused on the management of HIV/AIDS-related opportunistic infections that occur in the United States. In other parts of the world, the spectrum of complications may be different and the resources available for diagnosis and management may not be identical to those in the United States. The sections that have been most extensively updated are those on immune reconstitution inflammatory syndrome, tuberculosis, hepatitis B, hepatitis C, human papillomavirus, and immunizations. The guidelines will not be published in hard copy form. This document will be revised as needed throughout each year as new data become available. PMID:24585567

  9. American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use

    PubMed Central

    Kampman, Kyle; Jarvis, Margaret

    2015-01-01

    The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This “Practice Guideline” was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) – a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted. PMID:26406300

  10. Report of the Adult Treatment Panel III: the 2001 National Cholesterol Education Program guidelines on the detection, evaluation and treatment of elevated cholesterol in adults.

    PubMed

    Pasternak, Richard C

    2003-08-01

    The ATP III report represents an important advance from previous ATP reports dating back to the late 1980s. The guidelines are more tightly evidence-based than previous reports, partly because of evolution of the guideline process, requiring clearly delineated links between evidence and recommendations and also because of the robust evidence base published over the last decade. An important change in ATP III is the expansion of the high-risk category to include patients without evident vascular disease, but with a level of risk equivalent to those patients with established CHD. This group termed "coronary heart disease equivalents" now includes patients with diabetes, and those with a 10-year absolute risk of over 20 percent for CHD events. With the ATP III report, the Framingham risk score is formally introduced into the guideline process. The scoring system allows for easy calculation of the absolute risk for an individual of having a "hard" CHD event (myocardial infarction, or CHD death). The report also discusses in detail concepts of lifetime or long-term risk. ATP III has broadened recommendations for lifestyle change termed "therapeutic lifestyle change (TLC)," and eliminated the step 1 and step 2 diet approach. Finally, the report details established approaches to improve adherence and provides patients and clinicians with a set of implementation tools to enhance use of the guidelines and compliance with the guidelines' recommendations. It is hoped that by improved understanding, recognition of a firm evidence base, and education through multiple channels, that adherence with the new ATP III guidelines will improve the care of our population by more effectively targeting lipid factors that lead to the development and progression of atherosclerotic cardiovascular disease. PMID:14621453

  11. [National French guidelines for management of infants with cystic fibrosis].

    PubMed

    Sermet-Gaudelus, I; Couderc, L; Vrielynck, S; Brouard, J; Weiss, L; Wizla, N; Llerena, C; Lebourgeois, M; Bailly, C; Dirou, A; Renouil, M; Dalphin, M-L; Rault, G; Munck, A; Roussey, M

    2014-06-01

    These guidelines aim to standardize the care of infants diagnosed with a typical form of cystic fibrosis (CF) at neonatal screening. They have been implemented by the National Working Group for Neonatal Screening of the French Federation for CF and have been validated using the Delphi methodology by a large group of clinicians involved in the care of CF infants. These guidelines encompass management and organization of care at diagnosis and describe nutritional, digestive, and respiratory monitoring and treatment during the first 2 years of life. PMID:24815598

  12. Sexually transmitted diseases treatment guidelines, 2015.

    PubMed

    Workowski, Kimberly A; Bolan, Gail A

    2015-06-01

    These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs. PMID:26042815

  13. Updated treatment guidelines for gonorrhea infections.

    PubMed

    Fantasia, Heidi Collins

    2013-01-01

    Gonorrhea is the second most common bacterial sexually transmitted infection in the United States. It continues to be a major cause of morbidity for women and has been linked to infertility and pelvic inflammatory disease. In 2012, the Centers for Disease Control and Prevention revised the current treatment guidelines for gonorrhea in response to the rising rates of antibiotic resistance. This column will discuss the new guidelines, including the rationale for the change as well as nursing implications to support timely and effective treatment of gonorrhea. PMID:23773196

  14. UK malaria treatment guidelines 2016.

    PubMed

    Lalloo, David G; Shingadia, Delane; Bell, David J; Beeching, Nicholas J; Whitty, Christopher J M; Chiodini, Peter L

    2016-06-01

    1.Malaria is the tropical disease most commonly imported into the UK, with 1300-1800 cases reported each year, and 2-11 deaths. 2. Approximately three quarters of reported malaria cases in the UK are caused by Plasmodium falciparum, which is capable of invading a high proportion of red blood cells and rapidly leading to severe or life-threatening multi-organ disease. 3. Most non-falciparum malaria cases are caused by Plasmodium vivax; a few cases are caused by the other species of plasmodium: Plasmodium ovale, Plasmodium malariae or Plasmodium knowlesi. 4. Mixed infections with more than one species of parasite can occur; they commonly involve P. falciparum with the attendant risks of severe malaria. 5. There are no typical clinical features of malaria; even fever is not invariably present. Malaria in children (and sometimes in adults) may present with misleading symptoms such as gastrointestinal features, sore throat or lower respiratory complaints. 6. A diagnosis of malaria must always be sought in a feverish or sick child or adult who has visited malaria-endemic areas. Specific country information on malaria can be found at http://travelhealthpro.org.uk/. P. falciparum infection rarely presents more than six months after exposure but presentation of other species can occur more than a year after exposure. 7. Management of malaria depends on awareness of the diagnosis and on performing the correct diagnostic tests: the diagnosis cannot be excluded until more than one blood specimen has been examined. Other travel related infections, especially viral haemorrhagic fevers, should also be considered. 8. The optimum diagnostic procedure is examination of thick and thin blood films by an expert to detect and speciate the malarial parasites. P. falciparum and P. vivax (depending upon the product) malaria can be diagnosed almost as accurately using rapid diagnostic tests (RDTs) which detect plasmodial antigens. RDTs for other Plasmodium species are not as reliable. 9. Most patients treated for P. falciparum malaria should be admitted to hospital for at least 24 h as patients can deteriorate suddenly, especially early in the course of treatment. In specialised units seeing large numbers of patients, outpatient treatment may be considered if specific protocols for patient selection and follow up are in place. 10. Uncomplicated P. falciparum malaria should be treated with an artemisinin combination therapy (Grade 1A). Artemether-lumefantrine (Riamet(®)) is the drug of choice (Grade 2C) and dihydroartemisinin-piperaquine (Eurartesim(®)) is an alternative. Quinine or atovaquone-proguanil (Malarone(®)) can be used if an ACT is not available. Quinine is highly effective but poorly-tolerated in prolonged treatment and should be used in combination with an additional drug, usually oral doxycycline. 11. Severe falciparum malaria, or infections complicated by a relatively high parasite count (more than 2% of red blood cells parasitized) should be treated with intravenous therapy until the patient is well enough to continue with oral treatment. Severe malaria is a rare complication of P. vivax or P. knowlesi infection and also requires parenteral therapy. 12. The treatment of choice for severe or complicated malaria in adults and children is intravenous artesunate (Grade 1A). Intravenous artesunate is unlicensed in the EU but is available in many centres. The alternative is intravenous quinine, which should be started immediately if artesunate is not available (Grade 1A). Patients treated with intravenous quinine require careful monitoring for hypoglycemia. 13. Patients with severe or complicated malaria should be managed in a high-dependency or intensive care environment. They may require haemodynamic support and management of: acute respiratory distress syndrome, disseminated intravascular coagulation, acute kidney injury, seizures, and severe intercurrent infections including Gram-negative bacteraemia/septicaemia. 14. Children with severe malaria should also be treated with empirical broad spectrum antibiotics until bacterial infection can be excluded (Grade 1B). 15. Haemolysis occurs in approximately 10-15% patients following intravenous artesunate treatment. Haemoglobin concentrations should be checked approximately 14 days following treatment in those treated with IV artemisinins (Grade 2C). 16. Falciparum malaria in pregnancy is more likely to be complicated: the placenta contains high levels of parasites, stillbirth or early delivery may occur and diagnosis can be difficult if parasites are concentrated in the placenta and scanty in the blood. 17. Uncomplicated falciparum malaria in the second and third trimester of pregnancy should be treated with artemether-lumefantrine (Grade 2B). Uncomplicated falciparum malaria in the first trimester of pregnancy should usually be treated with quinine and clindamycin but specialist advice should be sought. Severe malaria in any trimester of pregnancy should be treated as for any other patient with artesunate preferred over quinine (Grade 1C). 18. Children with uncomplicated malaria should be treated with an ACT (artemether-lumefantrine or dihydroartemisinin-piperaquine) as first line treatment (Grade 1A). Quinine with doxycycline or clindamycin, or atovaquone-proguanil at appropriate doses for weight can also be used. Doxycycline should not be given to children under 12 years. 19. Either an oral ACT or chloroquine can be used for the treatment of non-falciparum malaria. An oral ACT is preferred for a mixed infection, if there is uncertainty about the infecting species, or for P. vivax infection from areas where chloroquine resistance is common (Grade 1B). 20. Dormant parasites (hypnozoites) persist in the liver after treatment of P. vivax or P. ovale infection: the only currently effective drug for eradication of hypnozoites is primaquine (1A). Primaquine is more effective at preventing relapse if taken at the same time as chloroquine (Grade 1C). 21. Primaquine should be avoided or given with caution under expert supervision in patients with Glucose-6-phosphate dehydrogenase deficiency (G6PD), in whom it may cause severe haemolysis. 22. Primaquine (for eradication of P. vivax or P. ovale hypnozoites) is contraindicated in pregnancy and when breastfeeding (until the G6PD status of child is known); after initial treatment for these infections a pregnant woman should take weekly chloroquine prophylaxis until after delivery or cessation of breastfeeding when hypnozoite eradication can be considered. 23. An acute attack of malaria does not confer protection from future attacks: individuals who have had malaria should take effective anti-mosquito precautions and chemoprophylaxis during future visits to endemic areas. PMID:26880088

  15. Sarcoidosis: recognition and treatment guidelines.

    PubMed

    Kaye, O; Ribbens, C; Kahn, M F; Malaise, M G

    1997-06-01

    Sarcoidosis is a systemic disorder of unknown aetiology characterised by noncaseating granulomas leading principally to bilateral hilar lymphadenopathies, pulmonary infiltration and skin and eye lesions. Sarcoidosis may involve other organs, including peripheral lymph nodes, liver, spleen, nervous and musculoskeletal systems, heart, ear, nose and kidney. Although the clinical involvement of liver and heart is relatively uncommon, hepatic and cardiac granulomas are present at autopsy in about 70 to 80% and 25 to 50%, respectively, of patients with this disease. The diagnosis of sarcoidosis includes compatible clinical and/or radiological presentations and histological evidence of noninfectious and noncaseating epitheloid cell granulomas in the absence of other identifiable agents responsible for such histological lesions. Disease course is variable and usually characterised by frequent remissions, but it may become progressive and chronic in a small percentage of patients. The optimal treatment of sarcoidosis remains poorly defined. In patients with progressive pulmonary dysfunction as well as in those with severe extrapulmonary localisations, systemic corticosteroids usually represent the first approach, limited by long term toxicity and frequent relapses after treatment interruption. In the presence of refractory or corticosteroid-dependent forms of the disease, antimalarial drugs or low dosage methotrexate may be used with prolonged benefit. The indications for immunosuppressive agents such as azathioprine, chlorambucil, cyclophosphamide and cyclosporin are uncommon and limited because of potentially serious adverse effects and lack of information on their long term efficacy. In the case of ocular and limited cutaneous manifestations, local corticosteroid therapy may be useful. PMID:18020492

  16. Standard treatment guidelines in primary healthcare practice.

    PubMed

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

    2014-01-01

    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. PMID:25657957

  17. Standard Treatment Guidelines in Primary Healthcare Practice

    PubMed Central

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

    2014-01-01

    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. PMID:25657957

  18. [Diagnostic guideline and treatment of dementia].

    PubMed

    Olde Rikkert, Marcel G M; van Exel, Eric; Knol, Wilma; Lemstra, A W Evelien; Roks, Gerwin; Verhey, Frans R J

    2015-01-01

    - The Dutch dementia guideline has been extended to include recommendations in the area of psychosocial interventions for patients, caregivers and professionals.- The diagnostic recommendations in the revised directive are based on a stepwise work-up with the aim of establishing the cause of the dementia. This is guided by the recent diagnostic criteria, evidence of the diagnostic value of additional investigations, and the patient's wishes.- Although there have been no major breakthroughs in the treatment of patients with Alzheimer's disease in recent years, the revised guideline also contains important new recommendations in this area. For example, it includes recommendations on administration routes (first-choice use of patches or preparations with slow release of cholinesterase inhibitors), the use of combination therapy (not prescribing memantine in combination with cholinesterase inhibitors) and regular monitoring of the effectiveness of antipsychotics and cholinesterase inhibitors.- The guideline (in Dutch) can be found at www.richtlijnendatabase.nl (search for 'dementie') and will be actively implemented. PMID:25873222

  19. Sexually transmitted diseases treatment guidelines, 2010.

    PubMed

    Workowski, Kimberly A; Berman, Stuart

    2010-12-17

    These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 18-30, 2009. The information in this report updates the 2006 Guidelines for Treatment of Sexually Transmitted Diseases (MMWR 2006;55[No. RR-11]). Included in these updated guidelines is new information regarding 1) the expanded diagnostic evaluation for cervicitis and trichomoniasis; 2) new treatment recommendations for bacterial vaginosis and genital warts; 3) the clinical efficacy of azithromycin for chlamydial infections in pregnancy; 4) the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; 5) lymphogranuloma venereum proctocolitis among men who have sex with men; 6) the criteria for spinal fluid examination to evaluate for neurosyphilis; 7) the emergence of azithromycin-resistant Treponema pallidum; 8) the increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae; 9) the sexual transmission of hepatitis C; 10) diagnostic evaluation after sexual assault; and 11) STD prevention approaches. PMID:21160459

  20. Guidelines for treatment naming in radiation oncology.

    PubMed

    Denton, Travis R; Shields, Lisa B E; Hahl, Michael; Maudlin, Casey; Bassett, Mark; Spalding, Aaron C

    2015-01-01

    Safety concerns may arise from a lack of standardization and ambiguity during the treatment planning and delivery process in radiation therapy. A standardized target and organ-at-risk naming convention in radiation therapy was developed by a task force comprised of several Radiation Oncology Societies. We present a nested-survey approach in a community setting to determine the methodology for radiation oncology departments to standardize their practice. Our Institution's continuous quality improvement (CQI) committee recognized that, due to growth from one to three centers, significant variability existed within plan parameters specific to patients' treatment. A multidiscipline, multiclinical site consortium was established to create a guideline for standard naming. Input was gathered using anonymous, electronic surveys from physicians, physicists, dosimetrists, chief therapists, and nurse managers. Surveys consisted of several primary areas of interest: anatomical sites, course naming, treatment plan naming, and treatment field naming. Additional concepts included capitalization, specification of later-ality, course naming in the event of multiple sites being treated within the same course of treatment, primary versus boost planning, the use of bolus, revisions for plans, image-guidance field naming, forbidden characters, and standard units for commonly used physical quantities in radiation oncology practice. Guidelines for standard treatment naming were developed that could be readily adopted. This multidisciplinary study provides a clear, straightforward, and easily implemented protocol for the radiotherapy treatment process. Standard nomenclature facilitates the safe means of communication between team members in radiation oncology. The guidelines presented in this work serve as a model for radiation oncology clinics to standardize their practices. PMID:27074449

  1. Sexually transmitted diseases treatment guidelines, 2006.

    PubMed

    Workowski, Kimberly A; Berman, Stuart M

    2006-08-01

    These guidelines for the treatment of persons who have sexually transmitted diseases (STDs) were developed by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta, Georgia, during April 19-21, 2005. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2002 (MMWR 2002;51[No. RR-6]). Included in these updated guidelines are an expanded diagnostic evaluation for cervicitis and trichomoniasis; new antimicrobial recommendations for trichomoniasis; additional data on the clinical efficacy of azithromycin for chlamydial infections in pregnancy; discussion of the role of Mycoplasma genitalium and trichomoniasis in urethritis/cervicitis and treatment-related implications; emergence of lymphogranuloma venereum protocolitis among men who have sex with men (MSM); expanded discussion of the criteria for spinal fluid examination to evaluate for neurosyphilis; the emergence of azithromycin- resistant Treponema pallidum; increasing prevalence of quinolone-resistant Neisseria gonorrhoeae in MSM; revised discussion concerning the sexual transmission of hepatitis C; postexposure prophylaxis after sexual assault; and an expanded discussion of STD prevention approaches. PMID:16888612

  2. Double Up on Acne Treatments, New Guidelines Say

    MedlinePlus

    ... medlineplus/news/fullstory_157421.html Double Up on Acne Treatments, New Guidelines Say Skin doctors say combining ... Combining treatments is the best way to combat acne, new guidelines from the American Academy of Dermatology ...

  3. Fertility preservation during cancer treatment: clinical guidelines

    PubMed Central

    Rodriguez-Wallberg, Kenny A; Oktay, Kutluk

    2014-01-01

    The majority of children, adolescents, and young adults diagnosed with cancer today will become long-term survivors. The threat to fertility that cancer treatments pose to young patients cannot be prevented in many cases, and thus research into methods for fertility preservation is developing, aiming at offering cancer patients the ability to have biologically related children in the future. This paper discusses the current status of fertility preservation methods when infertility risks are related to surgical oncologic treatments, radiation therapy, or chemotherapy. Several scientific groups and societies have developed consensus documents and guidelines for fertility preservation. Decisions about fertility and imminent potentially gonadotoxic therapies must be made rapidly. Timely and complete information on the impact of cancer treatment on fertility and fertility preservation options should be presented to all patients when a cancer treatment is planned. PMID:24623991

  4. National and international guidelines for COPD: the need for evidence.

    PubMed

    Pauwels, R A

    2000-02-01

    The introduction of guidelines for the management of asthma has led to standardization of management and better care of patients with the condition. Many national and international respiratory societies have developed guidelines for COPD. The World Health Organization and the National Heart, Lung, and Blood Institute are jointly developing guidelines that will present evidence-based recommendations for the management of COPD. The guidelines will discuss the definition, epidemiology, natural history, risk factors, pathology, and diagnosis of COPD. There will be guidance on the management of chronic disease and acute exacerbations, education, prevention, and socioeconomics. PMID:10673469

  5. Treatment Guidelines for Children and Adolescents with Bipolar Disorder

    ERIC Educational Resources Information Center

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

    2005-01-01

    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

  6. Treatment Guidelines for Children and Adolescents with Bipolar Disorder

    ERIC Educational Resources Information Center

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

    2005-01-01

    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…

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

    PubMed

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

    2009-04-10

    This report updates and combines earlier versions of guidelines for the prevention and treatment of opportunistic infections (OIs) in HIV-infected adults (i.e., persons aged >/=18 years) and adolescents (i.e., persons aged 13--17 years), last published in 2002 and 2004, respectively. It has been prepared by the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by clinicians and other health-care providers, HIV-infected patients, and policy makers in the United States. These guidelines address several OIs that occur in the United States and five OIs that might be acquired during international travel. Topic areas covered for each OI include epidemiology, clinical manifestations, diagnosis, prevention of exposure; prevention of disease by chemoprophylaxis and vaccination; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; discontinuation of secondary prophylaxis after immune reconstitution; and special considerations during pregnancy. These guidelines were developed by a panel of specialists from the United States government and academic institutions. For each OI, a small group of specialists with content-matter expertise reviewed the literature for new information since the guidelines were last published; they then proposed revised recommendations at a meeting held at NIH in June 2007. After these presentations and discussion, the revised guidelines were further reviewed by the co-editors; by the Office of AIDS Research, NIH; by specialists at CDC; and by HIVMA of IDSA before final approval and publication. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of evidence supporting the recommendation, so that readers can ascertain how best to apply the recommendations in their practice environments. Major changes in the guidelines include 1) greater emphasis on the importance of antiretroviral therapy for the prevention and treatment of OIs, especially those OIs for which no specific therapy exists; 2) information regarding the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information regarding the use of interferon-gamma release assays for the diagnosis of latent Mycobacterium tuberculosis (TB) infection; 4) updated information concerning drug interactions that affect the use of rifamycin drugs for prevention and treatment of TB; 5) the addition of a section on hepatitis B virus infection; and 6) the addition of malaria to the list of OIs that might be acquired during international travel. This report includes eleven tables pertinent to the prevention and treatment of OIs, a figure that pertains to the diagnois of tuberculosis, a figure that describes immunization recommendations, and an appendix that summarizes recommendations for prevention of exposure to opportunistic pathogens. PMID:19357635

  8. A review of national guidelines for management of COPD in Europe

    PubMed Central

    Vogelmeier, Claus; Roche, Nicolas; Halpin, David; Cardoso, João; Chuchalin, Alexander G.; Kankaanranta, Hannu; Sandström, Thomas; Śliwiński, Paweł; Zatloukal, Jaromir; Blasi, Francesco

    2016-01-01

    The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them. This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7 years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of patient phenotypes, criteria for the use of inhaled corticosteroids and recommendations for other medications (e.g. theophylline and mucolytics) in addition to bronchodilators. There is generally good agreement on treatment goals, criteria for diagnosis of COPD and use of long-acting bronchodilators as the cornerstone of treatment among guidelines for COPD management in Europe and Russia. However, there are differences in the definitions of patient subgroups and other recommended treatments. PMID:26797035

  9. A review of national guidelines for management of COPD in Europe.

    PubMed

    Miravitlles, Marc; Vogelmeier, Claus; Roche, Nicolas; Halpin, David; Cardoso, Joo; Chuchalin, Alexander G; Kankaanranta, Hannu; Sandstrm, Thomas; ?liwi?ski, Pawe?; Zatloukal, Jaromir; Blasi, Francesco

    2016-02-01

    The quality of care can be improved by the development and implementation of evidence-based treatment guidelines. Different national guidelines for chronic obstructive pulmonary disease (COPD) exist in Europe and relevant differences may exist among them.This was an evaluation of COPD treatment guidelines published in Europe and Russia in the past 7?years. Each guideline was reviewed in detail and information about the most important aspects of patient diagnosis, risk stratification and pharmacotherapy was extracted following a standardised process. Guidelines were available from the Czech Republic, England and Wales, Finland, France, Germany, Italy, Poland, Portugal, Russia, Spain and Sweden. The treatment goals, criteria for COPD diagnosis, consideration of comorbidities in treatment selection and support for use of long-acting bronchodilators, were similar across treatment guidelines. There were differences in measures used for stratification of disease severity, consideration of patient phenotypes, criteria for the use of inhaled corticosteroids and recommendations for other medications (e.g. theophylline and mucolytics) in addition to bronchodilators.There is generally good agreement on treatment goals, criteria for diagnosis of COPD and use of long-acting bronchodilators as the cornerstone of treatment among guidelines for COPD management in Europe and Russia. However, there are differences in the definitions of patient subgroups and other recommended treatments. PMID:26797035

  10. A comparison of guidelines for the treatment of schizophrenia.

    PubMed

    Milner, Karen K; Valenstein, Marcia

    2002-07-01

    Although the clinical and administrative rationales for the use of guidelines in the treatment of schizophrenia are convincing, meaningful implementation has been slow. Guideline characteristics themselves influence whether implementation occurs. The authors examine three widely distributed guidelines and one set of algorithms to compare characteristics that are likely to influence implementation, including their degree of scientific rigor, comprehensiveness, and clinical applicability (ease of use, timeliness, specificity, and ease of operationalizing). The three guidelines are the Expert Consensus Guideline Series' "Treatment of Schizophrenia"; the American Psychiatric Association's "Practice Guideline for the Treatment of Patients With Schizophrenia"; and the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. The algorithms are those of the Texas Medication Algorithm Project (TMAP). The authors outline the strengths of each and suggest how a future guideline might build on these strengths. PMID:12096176

  11. The wound/burn guidelines - 2: Guidelines for the diagnosis and treatment for pressure ulcers.

    PubMed

    Tachibana, Takao; Imafuku, Shinichi; Irisawa, Ryokichi; Ohtsuka, Masaki; Kadono, Takafumi; Fujiwara, Hiroshi; Asano, Yoshihide; Abe, Masatoshi; Ishii, Takayuki; Isei, Taiki; Ito, Takaaki; Inoue, Yuji; Ohtsuka, Mikio; Ogawa, Fumihide; Kodera, Masanari; Kawakami, Tamihiro; Kawaguchi, Masakazu; Kukino, Ryuichi; Kono, Takeshi; Sakai, Keisuke; Takahara, Masakazu; Tanioka, Miki; Nakanishi, Takeshi; Nakamura, Yasuhiro; Hashimoto, Akira; Hasegawa, Minoru; Hayashi, Masahiro; Fujimoto, Manabu; Maekawa, Takeo; Matsuo, Koma; Madokoro, Naoki; Yamasaki, Osamu; Yoshino, Yuichiro; Le Pavoux, Andres; Ihn, Hironobu

    2016-05-01

    The Wound/Burn Guidelines Committee consists of members commissioned by the Board of Directors of the Japanese Dermatological Association (JDA). It held several meetings and evaluations in writing since October 2008, and drafted five guidelines for the diagnosis and treatment including commentaries on wounds in general and the Guidelines for the Diagnosis and Treatment for Pressure Ulcers by taking opinions of the Scientific Committee and Board of Directors of JDA into consideration. PMID:26972598

  12. 76 FR 22342 - National Standard 10 Guidelines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-21

    ..., Attn: Debra Lambert. Mail: Debra Lambert; National Marine Fisheries Service, NOAA; 1315 East-West... Adobe PDF file formats only. FOR FURTHER INFORMATION CONTACT: Debra Lambert, National Marine Fisheries... Standard 10 (NS10) to the MSA (15 U.S.C. 1801 et seq.). National Standard 10 states: ``Conservation...

  13. Using sperm posthumously: national guidelines versus practice.

    PubMed

    Raziel, Arieh; Friedler, Shevach; Strassburger, Deborah; Kaufman, Sarit; Umansky, Ana; Ron-El, Raphael

    2010-08-01

    Under pressure from involved families and time limitations, Israeli judges tend to authorize postmortem sperm retrieval and freezing, even in unmarried men and in contradiction to current, albeit non-legally binding, guidelines of the Attorney General. Postmortem sperm retrieval in our institution (2003 to June 2009) was successful in 17 cases, motile sperm was found in 16/17, and cryopreservation was performed in 15/16: no application for use of any of the postmortem frozen samples has been performed thus far. PMID:19962140

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

    PubMed

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

    2015-02-01

    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

  15. Deriving cleanup guidelines for radionuclides at Brookhaven National Laboratory

    SciTech Connect

    Meinhold, A.F.; Morris, S.C.; Dionne, B.; Moskowitz, P.D.

    1997-01-01

    Past activities at Brookhaven National Laboratory (BNL) resulted in soil and groundwater contamination. As a result, BNL was designated a Superfund site under the Comprehensive Environmental Response Compensation and Liability Act (CERCLA). BNL`s Office of Environmental Restoration (OER) is overseeing environmental restoration activities at the Laboratory. With the exception of radium, there are no regulations or guidelines to establish cleanup guidelines for radionuclides in soils at BNL. BNL must derive radionuclide soil cleanup guidelines for a number of Operable Units (OUs) and Areas of Concern (AOCs). These guidelines are required by DOE under a proposed regulation for radiation protection of public health and the environment as well as to satisfy the requirements of CERCLA. The objective of this report is to propose a standard approach to deriving risk-based cleanup guidelines for radionuclides in soil at BNL. Implementation of the approach is briefly discussed.

  16. Treatment guidelines for Hepatitis C in Spain.

    PubMed

    Crespo-Casal, M

    2015-10-01

    The discovery of new orally administered drugs that can block different targets of the replication cycle of the hepatitis C virus (HCV) with major antiviral activity, has revolutionized treatment of this infection and relegated interferon-based treatments to a secondary position. The start up of the National Strategic Plan for Combating Hepatitis C, which acknowledges the greater efficacy and safety of oral antiviral drugs, as well as the agreements between the pharmaceutical companies and different government bodies has enabled the initial difficulties of access to these medicines due to their high cost to be overcome. In this rapidly changing environment, the availability of a therapeutic guide based on a critical analysis of the available evidence, takes on special relevance and provides a basic support for medical practitioners involved in HCV treatment. However, the speed with which new therapeutic options are included and the limited evidence in some clinical scenarios signifies a challenge for those responsible for scientific societies whose job it is to coordinate the preparation of therapeutic guides and to keep recommendations up to date. In this review we analyze the treatment recommendations for HCV in a consensus document drawn up by the Spanish Association for the Study of Liver Diseases (AEEH), to contrast them with recommendations given by American and European associations that study hepatic diseases. PMID:26191787

  17. UK national guidelines on the management of syphilis 2015.

    PubMed

    Kingston, M; French, P; Higgins, S; McQuillan, O; Sukthankar, A; Stott, C; McBrien, B; Tipple, C; Turner, A; Sullivan, A K; Radcliffe, Keith; Cousins, Darren; FitzGerald, Mark; Fisher, Martin; Grover, Deepa; Higgins, Stephen; Kingston, Margaret; Rayment, Michael; Sullivan, Ann

    2016-05-01

    These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline. PMID:26721608

  18. National Emphysema Treatment Trial

    PubMed Central

    Criner, Gerard J.; Sternberg, Alice L.

    2008-01-01

    The National Emphysema Treatment Trial (NETT) has published many articles reporting the various outcomes of lung volume reduction surgery versus medical treatment for patients with severe emphysema. However, long and complex clinical trials like NETT that involve both medical and surgical issues generate multiple manuscripts over a period of years and report an array of various outcomes. As a result, the essential findings of the trial may appear to be fragmented to the clinician or clinical researcher or be lost among the many medical reports published each year. In this review, we summarize in one publication the major medical and surgical outcomes of NETT. PMID:18453345

  19. A systematic review of treatment guidelines for metastatic colorectal cancer

    PubMed Central

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

    2012-01-01

    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

  20. Human Factors Guidelines for UAS in the National Airspace System

    NASA Technical Reports Server (NTRS)

    Hobbs, Alan; Shively, R. Jay

    2013-01-01

    The ground control stations (GCS) of some UAS have been characterized by less-than-adequate human-system interfaces. In some cases this may reflect a failure to apply an existing regulation or human factors standard. In other cases, the problem may indicate a lack of suitable guidance material. NASA is leading a community effort to develop recommendations for human factors guidelines for GCS to support routine beyond-line-of-sight UAS operations in the national airspace system (NAS). In contrast to regulations, guidelines are not mandatory requirements. However, by encapsulating solutions to identified problems or areas of risk, guidelines can provide assistance to system developers, users and regulatory agencies. To be effective, guidelines must be relevant to a wide range of systems, must not be overly prescriptive, and must not impose premature standardization on evolving technologies. By assuming that a pilot will be responsible for each UAS operating in the NAS, and that the aircraft will be required to operate in a manner comparable to conventionally piloted aircraft, it is possible to identify a generic set of pilot tasks and the information, control and communication requirements needed to support these tasks. Areas where guidelines will be useful can then be identified, utilizing information from simulations, operational experience and the human factors literature. In developing guidelines, we recognize that existing regulatory and guidance material will, at times, provide adequate coverage of an area. In other cases suitable guidelines may be found in existing military or industry human factors standards. In cases where appropriate existing standards cannot be identified, original guidelines will be proposed.

  1. Quality Concerns in Antipsychotic Prescribing for Youth: A Review of Treatment Guidelines

    PubMed Central

    Kealey, Edith; Scholle, Sarah Hudson; Byron, Sepheen C.; Hoagwood, Kimberly; Leckman-Westin, Emily; Kelleher, Kelly; Finnerty, Molly

    2015-01-01

    Background Antipsychotic prescribing for youth has increased rapidly, is linked with serious health concerns, and lacks clear measures of quality for pediatric care. We reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics: 1) use in very young children, 2) multiple concurrent antipsychotics, 3) higher-than-recommended doses, 4) use without a primary indication, 5) access to psychosocial interventions, 6) metabolic screening, and 7) follow-up visits with a prescriber. Methods We searched for clinical practice guidelines meeting the following criteria: developed or endorsed by a national body, published after 2000, and specific treatment recommendations made related to 1 or more of the 7 quality concepts. Sources included electronic databases, the American Academy of Child and Adolescent Psychiatry Web site, and stakeholder and expert advisory committee recommendations. Two raters reviewed the 11 guidelines identified, extracting treatment recommendations, including details that could support measure definitions, and ratings of strength of recommendation and evidence. Results All 7 quality concepts were strongly endorsed by 1 or more guidelines, and 2 or more guidelines assigned their highest strength of recommendation ratings to 6 of the 7 concepts. Two guidelines rated evidence, providing high strength of evidence for 2 quality concepts: psychosocial interventions and metabolic monitoring. Conclusions Guidelines provide support for 7 quality concepts addressing antipsychotic prescribing for youth. However, guideline support is often based on strong clinical consensus rather than a robust evidence base. PMID:25169461

  2. Treatment Guidelines for Substance Use Disorders and Serious Mental Illnesses: Do They Address Co-Occurring Disorders?

    PubMed Central

    Perron, Brian E.; Bunger, Alicia; Bender, Kimberly; Vaughn, Michael G.; Howard, Matthew O.

    2012-01-01

    Practice guidelines are important tools for improving the delivery of evidence-based practices and reducing inappropriate variation in current treatment approaches. This study examined the degree to which guidelines targeted to the treatment of substance use disorders or serious mental illness address treatment of co-occurring disorders. Guidelines archived by the National Guideline Clearinghouse (NGC) were retrieved in December 2007 and content analyzed. Nineteen pertinent guidelines were identified, and 11 included recommendations regarding the assessment and/or treatment of co-occurring disorders. None of the guidelines making recommendations for treatment of co-occurring disorders included outcomes that clearly targeted both substance use and mental health disorders. Limitations and implications of this study are noted. PMID:20441462

  3. Carbamazepine in Bipolar Disorder With Pain: Reviewing Treatment Guidelines

    PubMed Central

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

    2014-01-01

    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. PMID:25667814

  4. 75 FR 13137 - National Institutes of Health Guidelines for Human Stem Cell Research

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-18

    ... Health Guidelines for Human Stem Cell Research'' (Guidelines). Due to a technical problem, comments... . Comments may also be mailed to: NIH Stem Cell Guidelines, MSC 7997, 9000 Rockville Pike, Bethesda, Maryland... HUMAN SERVICES National Institutes of Health National Institutes of Health Guidelines for Human...

  5. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment.

    PubMed

    Fujimoto, Kazuma; Fujishiro, Mitsuhiro; Kato, Mototsugu; Higuchi, Kazuhide; Iwakiri, Ryuichi; Sakamoto, Choitsu; Uchiyama, Shinichiro; Kashiwagi, Atsunori; Ogawa, Hisao; Murakami, Kazunari; Mine, Tetsuya; Yoshino, Junji; Kinoshita, Yoshikazu; Ichinose, Masao; Matsui, Toshiyuki

    2014-01-01

    Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment have been produced by the Japan Gastroenterological Endoscopy Society in collaboration with the Japan Circulation Society, the Japanese Society of Neurology, the Japan Stroke Society, the Japanese Society on Thrombosis and Hemostasis and the Japan Diabetes Society. Previous guidelines from the Japan Gastroenterological Endoscopy Society have focused primarily on prevention of hemorrhage after gastroenterological endoscopy as a result of continuation ofantithrombotic therapy, without considering the associated risk of thrombosis. The new edition of the guidelines includes discussions of gastroenterological hemorrhage associated with continuation of antithrombotic therapy, as well as thromboembolism associated with withdrawal of antithrombotic therapy. PMID:24215155

  6. Investigating the use of NICE guidelines and IAPT services in the treatment of depression

    PubMed Central

    2012-01-01

    Background There is evidence that the National Institute for Health and Clinical Excellence (NICE) guidelines for mental health disorders are used to varying degrees in primary care. A lack of access to cognitive–behavioural therapy (CBT) has been found to be a barrier to their implementation. The Improving Access to Psychological Therapies (IAPT) initiative was created in 2007 to increase the availability of NICE-recommended psychological treatments for depression and anxiety disorders within the National Health Service in England. Aim This study aims to investigate whether general practitioners (GPs) who have access to IAPT services and use NICE guidelines are more likely to use NICE concordant treatments for depression than those who do not. Depression was chosen as it is the most common mental health problem facing primary care physicians. Method Questionnaires were sent to 830 GPs in southeast England and six GPs were interviewed. The response rate to the questionnaires was 27% (n = 222). Results Ninety-five per cent of GPs were aware of the NICE guidelines for depression, and 76% had read them. Concordance with the guidelines was significantly higher when GPs had access to a local IAPT service or had read the NICE guidelines. Conclusions The interviews revealed favourable views to IAPT services when used, although access to treatments was still a common barrier to the implementation of the NICE guidelines for depression. PMID:23997821

  7. Guidelines in the medical treatment of Helicobacter pylori infection.

    PubMed

    Dzieniszewski, J; Jarosz, M

    2006-09-01

    Scientific evidence based on controlled clinical research confirm substantial benefits resulting from the eradication of H. pylori infection in such pathologies of the alimentary tract as: gastric peptic and duodenal ulcer (active or confirmed in the future and ulcer disease complications), MALT (Mucosa Associated Limphoid Tissue) lymphoma, atrophic gastritis, past stomach resection, gastric cancer in the family. The above group of indications is strongly recommended for eradicative treatment. During the last several years there have been many guidelines made by international and national specialist groups. "Test and treat" strategy of undiagnosed dyspepsia treatment is based on possibility to carry out non-invasive tests confirming H. pylori infection. First symptoms of dyspepsia in people over 45 years of age constitute recommendation for endoscopy, as well as symptoms assumed to be "alarming" (loss of weight, anaemia, bloody vomiting, tarry stool, dysphagia) regardless of patient age. An individual approach to eradication is proposed in gastroesophageal reflux disease, and use of non-steroid anti-inflammatory drugs. Antibacterial activity towards H. pylori is shown by many antibiotics (amoxicillin, macrolides, tetracyclines) and some other chemotherapeutic agents (nitroimidazoles) and bismuth. PPIs are recommended, because through increase of pH in stomach they create conditions to act for antibiotics. During the stage of first line triple therapy, it is advised to apply PPI and two antibacterial medicines at the same time (PPI + amoxicillin+metronidazole or clarithromycin). Such therapeutic action ensures achievement of eradication of H. pylori infection in 80-90% of cases. In case of lack of treatment efficiency in the first-line therapy, 7-14 day treatment may be repeated using triple therapies (PPI + 2 antibiotics) substituting the antibiotic with the metronidazole or tetracycline, or quadruple therapies (PPI + bismuth citrate + 2 antibiotics). Side effects during eradicative treatments occur quite rarely (from 15 to 30%). PMID:17033112

  8. [Guidelines for the biological treatment of bipolar depression].

    PubMed

    Samalin, L; Charpeaud, T; Guillaume, S

    2011-12-01

    Numerous guidelines for the treatment of bipolar disorder have been published in the recent years. A review focusing on recent international and French guidelines the last 5 years on the management of bipolar depression was conducted. The comparison of guidelines showed differences in the choice of initial treatment: monotherapy (in first line: quetiapine and lamotrigine) or polypharmacotherapy (in first line: combination olanzapine/fluoxetine). All guidelines recommend in patients with inadequate response a therapeutic strategy in two steps. An initial clinical stage seeking the causes of poor therapeutic response and a second therapeutic stage trying to optimize the current treatment, to change treatment or to consider a co-therapy. In first line, the prophylactic drugs recommended are: lithium, valproate, quetiapine; olanzapine, risperidone (and long-acting formulation) and aripiprazole mainly for the prevention of manic episodes; lamotrigine limited to prevention of depressive episodes. The duration of treatment before patient reassessment and that of maintenance therapy are not consensual. The development of second-generation antipsychotics in bipolar depression is an interesting development for our therapeutic armamentarium and has been incorporated in recent guidelines. PMID:22212879

  9. Supportive Care Treatment Guidelines: Value, Limitations, and Opportunities

    PubMed Central

    Peterson, Douglas E.; Bensadoun, Rene-Jean; Lalla, Rajesh V.; McGuire, Deborah B.

    2013-01-01

    Evidence-based guidelines in clinical oncology practice are now prominent, with emphasis on clinical, health outcome and economic perspectives. Given the complexity of cancer management, a multidisciplinary approach is essential. Evidence-based guidelines to address supportive cancer care have merged expert opinion, systematic evaluation of clinical and research data, and meta-analyses of clinical trials. Production of supportive care guidelines by the interdisciplinary team is dependent on sufficient high-quality research studies. Once published, it is essential they be customized at institutional and national levels. Implementation in clinical practice is perhaps the greatest challenge. Optimal management occurs through integration of country-specific issues, including care access, healthcare resources, information technology, and national coordination of healthcare practices. The purpose of this article is to: (1) provide an overview of interdisciplinary cancer management using evidence-based guidelines; (2) delineate the theory and practice of guideline dissemination, utilization and outcome assessment; and (3) recommend future research strategies to maximize guidelines use in clinical practice. PMID:21600365

  10. A review of recently published radiotherapy treatment guidelines for bone metastases: Contrasts or convergence?

    PubMed Central

    Lutz, Stephen; Chow, Edward

    2012-01-01

    Bone metastases are a common manifestation of malignancy, and external beam radiotherapy (EBRT) effectively and safely palliates the pain caused by this clinical circumstance. The myriad of EBRT dosing schemes and complexities involved with coordinating radiotherapy with other interventions necessitated the need for bone metastases treatment guidelines. Here we compare and contrast the bone metastases radiotherapy treatment guidelines recently published by the American Society for Radiation Oncology (ASTRO) and the American College of Radiology (ACR). These evaluations acknowledge current controversies in treatment approaches, they evaluate the nuances of ASTRO and ACR task force decision-making regarding standard approaches to care, and they project the upcoming research results that may clarify approaches to palliative radiotherapy for bone metastases. The results of these two dedicated radiotherapy guidelines are compared to the brief mentions of radiotherapy for bone metastases in the National Comprehensive Cancer Network (NCCN) guidelines. Finally, the paper describes how treatment guidelines may influence patterns of care and reimbursement by their use as quality measures by groups such as the National Quality Forum (NQF). PMID:26909250

  11. Guidelines for treatment of liver cancer.

    PubMed

    Livraghi, T

    2001-06-01

    In the treatment of hepatocellular carcinoma, the range of indications for percutaneous ablation techniques is becoming wider than surgery and intra-arterial therapies. Indeed, whereas for some years only patients with up to three small lesions were treated, with the introduction of the single-session technique under general anesthesia, even patients with more advanced disease are now being treated. Although it is understood that partial resection assures the highest local control, the survival rates after surgery are roughly comparable with percutaneous ethanol injection (PEI). The explanation is due to a balance among advantages and disadvantages of the two therapies. PEI survival curves are better than curves of resected patients who present adverse prognostic factors, and this means that surgery needs a better selection of the patients. Indications for both therapies are reported. Single-session radiofrequency (RF) ablation seems to offer better results in terms of local control and safety than transarterial chemoembolisation (TACE) in multifocal tumours. An open question remains the choice between PEI and other new ablation procedures. In our department, we use RF, PEI and segmental TACE, according to the features of the disease. In the treatment of colorectal liver metastases, the initial survival curves of thermal ablation techniques are promising. However, they are size and site dependent, so partial resection remains the gold standard. An interesting indication seems to be the treatment of breast liver metastases in selected patients. PMID:11369528

  12. Receipt of Guideline-Concordant Treatment in Elderly Prostate Cancer Patients

    SciTech Connect

    Chen, Ronald C.; Carpenter, William R.; Hendrix, Laura H.; Bainbridge, John; Wang, Andrew Z.; Nielsen, Matthew E.; and others

    2014-02-01

    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.

  13. Using a national guideline to prevent and manage pressure ulcers.

    PubMed

    Neilson, Julie; Avital, Liz; Willock, Jane; Broad, Nigel

    2014-05-01

    Developing pressure ulcers is a painful and distressing event for patients, and one that can be prevented. The National Institute for Health and Care Excellence pressure ulcer guideline has recently been updated to cover the prevention and management of this condition. This article focuses on the recommendations that are relevant to nurses, covering areas such as risk assessment, skin assessment, repositioning, pressure-redistributing devices, dressings, patient and carer information, and training and education. It also identifies what senior nurses and nurse managers must do to ensure their staff can prevent and manage pressure ulcers effectively. PMID:24779761

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

    PubMed Central

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

    2015-01-01

    Background Low adherence to Global initiative for chronic Obstructive Lung Disease (GOLD) guideline recommendations has been reported worldwide. There has been no study on the adherence to GOLD guidelines for COPD treatment in Turkey. Objectives To investigate the rates of adherence to GOLD 2010 guidelines for COPD treatment among pulmonologists. Design A multi-center, cross-sectional, observational study was carried out in eleven pulmonary outpatient clinics across Turkey. Adherence to GOLD was evaluated through hospital records. Demographic and clinical data were recorded. Results Study included 719 patients (mean age: 62.9±9.7 years; males 85.4%) of whom 16 was classified as GOLD Stage I, 238 as II, 346 as III, and 119 as IV, and only 59.5% received appropriate treatment. Rates of guideline adherence varied across GOLD stages (I, 6.3%; II, 14.7%; III, 84.4%; and IV, 84%). Causes of inappropriate therapies were overtreatment (Stage I, 100% and Stage II, 91.1%), undertreatment (Stage III, 3.3% and Stage IV, 10.9%) and lack of treatment (Stage II, 3.8%; Stage III, 2.3%; and Stage IV, 5.9%). The most preferred regimen (43.4%) was long-acting β2-agonist-inhaled corticosteroid-long-acting muscarinic antagonist. Overall, 614 patients (89%) received treatment containing inhaled corticosteroid. Conclusion Pulmonologists in Turkey have low rates of adherence to GOLD guidelines in COPD treatment. Inappropriateness of therapies was due to overtreatment in early stages and excessive use of inhaled corticosteroid (ICS) in all disease stages. PMID:26715844

  15. Treatment guidelines for HIV-associated wasting.

    PubMed

    Nemechek, P M; Polsky, B; Gottlieb, M S

    2000-04-01

    Patients with acquired immunodeficiency syndrome (AIDS) often suffer from weight loss manifested by a loss of body cell mass (BCM). The causes of human immunodeficiency virus (HIV)-associated wasting may include anorexia, malabsorption, and a variety of altered metabolic states. Malabsorption and diarrhea may result from gastrointestinal tract opportunistic infections or from direct effects of HIV on the gastrointestinal tract. Infection with HIV may produce metabolic derangements that alter nutrient utilization, resulting in loss of BCM. Nutritional assessment of the patient with AIDS should include an evaluation of BCM and physical and psychosocial functioning. Antiretroviral therapy and eradication of opportunistic infections do not always reverse wasting. Treatment should include nutritional counseling. Total parenteral nutrition is sometimes of benefit, particularly in patients with damaged gastrointestinal tracts. Dronabinol and megestrol acetate may promote weight gain; however, dronabinol may have adverse effects, and most of the gain with megestrol acetate is in fat rather than BCM. If gonadal dysfunction is present, testosterone replacement therapy should be included in the treatment plan. Some studies suggest that oral anabolic steroids may improve muscle strength and body composition. In randomized, placebo-controlled trials, mammalian-derived human growth hormone (rhGH[m]) has produced sustained weight and BCM gains in AIDS patients. If a patient continues to lose BCM after the above factors have been addressed and corrected, a 12-week course of rhGH[m] is indicated. Halting the progression of HIV-associated wasting may improve survival, enhance physical and social functioning, and enrich quality of life. PMID:10761494

  16. Guidelines to Career Development for Wastewater Treatment Plant Personnel.

    ERIC Educational Resources Information Center

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

    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…

  17. National Synchrotron Light Source guidelines for the conduct of operations

    SciTech Connect

    Buckley, M.

    1998-01-01

    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.

  18. Community adherence to schizophrenia treatment and safety monitoring guidelines.

    PubMed

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

    2014-01-01

    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

  19. [Antihyperglycemic treatment guidelines for diabetes mellitus type 2].

    PubMed

    Clodi, Martin; Abrahamian, Heidemarie; Drexel, Heinz; Fasching, Peter; Föger, Bernhard; Francesconi, Claudia; Hoppichler, Friedrich; Kaser, Susanne; Kautzky-Willer, Alexandra; Lechleitner, Monika; Ludvik, Bernhard; Prager, Rudolf; Fröhlich-Reiterer, Elke; Roden, Michael; Säly, Christoph; Schernthaner, Guntram; Sourij, Harald; Toplak, Hermann; Wascher, Thomas C; Weitgasser, Raimund

    2016-04-01

    Hyperglycemia significantly contributes to micro- and macrovascular complications in patients with diabetes mellitus. While lifestyle interventions remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. The definition of individual targets regarding optimal therapeutic efficacy and safety is of great importance. In this guideline we present the most current evidence-based best clinical practice data for healthcare professionals. PMID:27052250

  20. [Psychiatric emergencies: guidelines for the treatment of agitation].

    PubMed

    Majorana, M; Todini, L; Luciani, A; Orso, L

    2012-07-01

    Psychomotor agitation represents a common phenomenon in emergency psychiatry settings. The awareness of its clinical manifestations and the early management can permit the control over a potentially dangerous behavior that could otherwise convert itself into a violent one. Health professionals should be able to adopt de-escalation strategies, structured to achieve the stabilization of patients' aggressiveness and motor agitation. When abnormal behaviors persist clinicians should be competent in the adoption of the most adequate psychopharmacological treatment for patient de-escalation. In this work we analyze psychomotor agitation treatment guide-lines. PMID:23007828

  1. Clinical recommendations in current practice guidelines for diagnosis and treatment of ADHD in adults.

    PubMed

    Gibbins, Christopher; Weiss, Margaret

    2007-10-01

    Attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder in which approximately two thirds of patients experience impairment in adulthood. Although some adults with ADHD were diagnosed as children, many are first diagnosed as adults. This poses particular challenges given the limited familiarity with ADHD of many adult mental health services. As a result, several organizations, including the Canadian ADHD Resource Alliance, the American Academy of Child and Adolescent Psychiatry, the National Institutes of Health, and the British Association for Psychopharmacology, have developed practice guidelines for the assessment and treatment of adults with ADHD. This article reviews those guidelines in order to examine current best practices in adult ADHD. There is considerable agreement among these guidelines, which should be a critical part of moving from emerging knowledge to patient care, although both empirical evaluation and ongoing updates as new knowledge emerges will be important for their future development. PMID:17915083

  2. EMT-Paramedic and EMT-Intermediate Continuing Education. National Guidelines.

    ERIC Educational Resources Information Center

    Brown, William E., Jr.; Dotterer, Robert W.; Gainor, Dia; Judd, Richard L.; Larmon, Baxter; Lewis, Kathryn M.; Margolis, Gregg S.; Mercer, Steve; Mistovich, Joseph J.; Newell, Lawrence D.; Politis, Jonathan F.; Stoy, Walt A.; Stupar, James A.; Walz, Bruce J.; Wagoner, Robert

    This document, which replaces the 1985 national guidelines for emergency medical technician (EMT) continuing education (CE), presents guidelines for designing, implementing, and evaluating CE for EMTs. The introduction explains the process used to develop the revised guidelines. Section 1 discusses the following competency assurance principles…

  3. 2014 UK national guideline for the management of anogenital herpes.

    PubMed

    Patel, Raj; Green, John; Clarke, Emily; Seneviratne, Kanchana; Abbt, Naomi; Evans, Ceri; Bickford, Jane; Nicholson, Marian; O'Farrell, Nigel; Barton, Simon; FitzGerald, Mark; Foley, Elizabeth

    2015-10-01

    These guidelines concern the management of anogenital herpes simplex virus infections in adults and give advice on diagnosis, management, and counselling of patients. This guideline replaces the 2007 BASHH herpes guidelines and includes new sections on herpes proctitis, key points to cover with patients regarding transmission and removal of advice on the management of HSV in pregnancy which now has a separate joint BASHH/RCOG guideline. PMID:25861804

  4. [Guideline-oriented treatment of alcohol-related disorders].

    PubMed

    Mann, K; Hoch, E; Batra, A; Bonnet, U; Günthner, A; Reymann, G; Soyka, M; Wodarz, N; Schäfer, M

    2016-01-01

    Alcohol use disorders (e.g. abuse and dependence) account for a plethora of consequences for affected individuals and for a substantial proportion of the overall burden of disease for the community. To date, existing treatment options are either poorly known by doctors or they are not fully applied and only approximately 15 % of potential patients are treated with a mean latent period of 10 years between early symptoms and the first intervention. So-called S3 treatment guidelines were recently developed to close this gap. Representatives of more than 50 learned societies, families and patients were involved. A systematic literature search from 2005 to 2012 was performed and more than 120 recommendations were made. Financing came exclusively from those societies and the academic and treatment institutes involved.This article summarizes the recommendations pertinent for psychiatrists and include early detection and intervention, acute withdrawal and long-term psychotherapy and pharmacotherapy. Classical and new treatment goals are discussed. If the new guidelines were properly applied an increase in patients receiving treatment to 30-40 % could be expected, which would improve the quality of lives of affected persons and their families and in Germany would save several thousand lives per year. PMID:26670021

  5. Evidence-based guideline update: Treatment of essential tremor

    PubMed Central

    Zesiewicz, T.A.; Elble, R.J.; Louis, E.D.; Gronseth, G.S.; Ondo, W.G.; Dewey, R.B.; Okun, M.S.; Sullivan, K.L.; Weiner, W.J.

    2011-01-01

    Background: This evidence-based guideline is an update of the 2005 American Academy of Neurology practice parameter on the treatment of essential tremor (ET). Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 2004 and April 2010. Results and Recommendations: Conclusions and recommendations for the use of propranolol, primidone (Level A, established as effective); alprazolam, atenolol, gabapentin (monotherapy), sotalol, topiramate (Level B, probably effective); nadolol, nimodipine, clonazepam, botulinum toxin A, deep brain stimulation, thalamotomy (Level C, possibly effective); and gamma knife thalamotomy (Level U, insufficient evidence) are unchanged from the previous guideline. Changes to conclusions and recommendations from the previous guideline include the following: 1) levetiracetam and 3,4-diaminopyridine probably do not reduce limb tremor in ET and should not be considered (Level B); 2) flunarizine possibly has no effect in treating limb tremor in ET and may not be considered (Level C); and 3) there is insufficient evidence to support or refute the use of pregabalin, zonisamide, or clozapine as treatment for ET (Level U). PMID:22013182

  6. 2014 Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guideline for the Management of Hepatocellular Carcinoma

    PubMed Central

    2015-01-01

    The guideline for the management of hepatocellular carcinoma (HCC) was first developed in 2003 and revised in 2009 by the Korean Liver Cancer Study Group and the National Cancer Center, Korea. Since then, many studies on HCC have been carried out in Korea and other countries. In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies. Accordingly, the new guideline presented herein was developed on the basis of recent evidence and expert opinions. The primary targets of this guideline are patients with suspicious or newly diagnosed HCC. This guideline provides recommendations for the initial treatment of patients with newly diagnosed HCC. PMID:25995680

  7. 78 FR 28865 - Request for Comment on the Federal Guidelines for Opioid Treatment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-16

    ..., (``Final Rule'' 66 FR 4075-4102, January 17, 2001) include standards for opioid treatment. OTPs are... Federal Guidelines for Opioid Treatment AGENCY: Substance Abuse and Mental Health Services Administration... draft of the Federal Guidelines for Opioid Treatment. These guidelines elaborate upon the Federal...

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

    PubMed

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

    2014-06-01

    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

  9. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Acute and continuation treatment of major depressive disorder.

    PubMed

    Bauer, Michael; Whybrow, Peter C; Angst, Jules; Versiani, Marcio; Möller, Hans-Jürgen

    2002-01-01

    These practice guidelines for the biological treatment of unipolar depressive disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal for developing these guidelines was to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to 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 seeing and treating patients with these conditions. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for depressive disorders, as well as from meta-analyses and 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 four levels of evidence (A-D). This first part of the guidelines covers disease definition, classification, epidemiology and course of unipolar depressive disorders, as well as the management of the acute and continuation-phase treatment. These guidelines are primarily concerned with the biological treatment (including antidepressants, other psychopharmacological and hormonal medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of young adults and also, albeit to a lesser extent, children, adolescents and older adults. PMID:12479086

  10. Practical guidelines for the treatment of inflammatory bowel disease

    PubMed Central

    Kuhbacher, T; Flsch, UR

    2007-01-01

    In recent years, great progress has been made regarding the treatment of inflammatory bowel disease (IBD), particularly in the field of biological therapies. Nevertheless, the ultimate treatment is not in sight. With the development of new medication, it has become clear that we need a new understanding of IBD. Therapy needs to fit the different subtypes of IBD; e.g. mild disease in comparison to severe chronic active disease or Crohn's disease with or without fistulation or stenosis. The following article gives a practical overview of actual treatments for IBD. The intention of this article is not to provide a complete review of all new scientific developments, but to give a practical guideline for therapy of IBD. PMID:17451192

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

    PubMed Central

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

    2009-01-01

    Objective To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. Design A cross-sectional telephone survey. Setting All municipal health centres in Finland. Subjects Health centres where both the head physician and the senior nursing officer responded. Main outcome measures Agreement in views of the senior executives on the adoption of clinical practices as recommended in the Hypertension 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

  12. Child Physical and Sexual Abuse: Guidelines for Treatment. Final Report.

    ERIC Educational Resources Information Center

    Saunders, B. E.; Berliner, L.; Hanson, R. F.

    Helping child abuse victims receive the mental health treatment they need is an important component of victim advocacy with children, and benefits both the children and the criminal justice system. As part of this work, the National Crime Victims Research and Treatment Center at the Medical University of South Carolina and the Center for Sexual

  13. The German guidelines for the treatment of anxiety disorders.

    PubMed

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

    2015-08-01

    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

  14. Assessment of the quality and content of national and international guidelines on hypertensive disorders of pregnancy using the AGREE II instrument

    PubMed Central

    Bazzano, Alessandra N; Madison, Anita; Barton, Andrew; Gillispie, Veronica; Bazzano, Lydia A L

    2016-01-01

    Objectives High-quality evidence-based clinical practice guidelines can guide diagnosis and treatment to optimise outcomes. The purpose of this study was to evaluate the quality and content of national and international guidelines on hypertensive disorders of pregnancy. Data Sources: The MEDLINE database, the National Guideline Clearinghouse and several international databases were searched for appropriate guidelines from the past 10 years. Study Appraisal and Synthesis Methods: Six guidelines met inclusion and exclusion criteria and were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Results A total of 695 records were identified and screened by two authors. Disorder definitions, classifications, preventive measures and treatment recommendations were evaluated and compared among guidelines. AGREE II results varied widely across domains and categories. Only two guidelines received consistently high ratings across domains and few demonstrated a high level of methodological rigour. Recommendations regarding classification and treatment were similar across guidelines, while assessment of preventive measures varied widely. Conclusions Clinical practice guidelines for hypertensive disorders of pregnancy vary significantly in quality and with respect to assessment of preventive measures. PMID:26781503

  15. Commentary on the 2014 BP guidelines from the panel appointed to the Eighth Joint National Committee (JNC 8).

    PubMed

    Reisin, Efrain; Harris, Raymond C; Rahman, Mahboob

    2014-11-01

    The recently published article "2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8)" (James et al., JAMA 311: 507-520, 2014) has generated considerable controversy. In this commentary, we evaluate the document and compare the recommendations contained within it with those of the JNC 7 and other national and international guidelines. The evidence quality rating approach followed by the article "2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8)" (James et al., JAMA 311: 507-520, 2014) disqualified nearly 98% of previous studies from review; as a result, some of the key recommendations were on the basis of expert opinion alone. We are especially concerned that the recommendation to raise the systolic/diastolic BP levels at which treatment is initiated to ≥150/≥90 mmHg in adults≥60 years old may affect cardiovascular and renal health in these patients. Additionally, we recommend that hypertension guidelines should be updated every 3-4 years with a fresh approach to the definition of target BP levels, the use of modern technology in the diagnosis of hypertension, and the treatment of hypertension in special populations not addressed in earlier guidelines. PMID:25114277

  16. Antiviral Treatment Guidelines for Middle East Respiratory Syndrome.

    PubMed

    Chong, Yong Pil; Song, Joon Young; Seo, Yu Bin; Choi, Jae-Phil; Shin, Hyoung-Shik

    2015-09-01

    Middle East respiratory syndrome (MERS) is an acute infectious disease of the respiratory system caused by the new betacoronavirus (MERS coronavirus, MERS-CoV), which shows high mortality rates. The typical symptoms of MERS are fever, cough, and shortness of breath, and it is often accompanied by pneumonia. The MERS-CoV was introduced to Republic of Korea in May 2015 by a patient returning from Saudi Arabia. The disease spread mostly through hospital infections, and by the time the epidemic ended in August, the total number of confirmed diagnoses was 186, among which 36 patients died. Reflecting the latest evidence for antiviral drugs in the treatment of MERS-CoV infection and the experiences of treating MERS patients in Republic of Korea, these guidelines focus on antiviral drugs to achieve effective treatment of MERS-CoV infections. PMID:26483999

  17. Antiviral Treatment Guidelines for Middle East Respiratory Syndrome

    PubMed Central

    Chong, Yong Pil; Song, Joon Young; Seo, Yu Bin; Choi, Jae-Phil

    2015-01-01

    Middle East respiratory syndrome (MERS) is an acute infectious disease of the respiratory system caused by the new betacoronavirus (MERS coronavirus, MERS-CoV), which shows high mortality rates. The typical symptoms of MERS are fever, cough, and shortness of breath, and it is often accompanied by pneumonia. The MERS-CoV was introduced to Republic of Korea in May 2015 by a patient returning from Saudi Arabia. The disease spread mostly through hospital infections, and by the time the epidemic ended in August, the total number of confirmed diagnoses was 186, among which 36 patients died. Reflecting the latest evidence for antiviral drugs in the treatment of MERS-CoV infection and the experiences of treating MERS patients in Republic of Korea, these guidelines focus on antiviral drugs to achieve effective treatment of MERS-CoV infections. PMID:26483999

  18. Dietary treatments for epilepsy: management guidelines for the general practitioner.

    PubMed

    Lee, Paul R; Kossoff, Eric H

    2011-06-01

    As ketogenic diets become more frequently used as a standard treatment for epilepsy in children and adults, hospital and community neurologists, pediatricians, intensivists, general practitioners, and house officers will readily encounter patients who are receiving these dietary treatments. A growing body of evidence demonstrates that dietary therapies for epilepsy (classic ketogenic diet, medium-chain triglyceride diet, modified Atkins diet, and low-glycemic-index treatment) are highly effective, with approximately 30-60% of children overall having at least a 50% reduction in seizures after 6 months of treatment. However, as would be true of any other medical anticonvulsant therapy, these treatments have known side effects and complications requiring recognition and timely action. In addition, the ketogenic diet is a significant intervention requiring rigorous daily adherence; not every family is willing or able to make the necessary commitment to this therapy. We provide herein a survey of the most common situations faced in both the inpatient and outpatient settings, including a discussion of triage and management based on our center's experience as well as the recent 2009 International Consensus Guideline. PMID:21514240

  19. China national lung cancer screening guideline with low-dose computed tomography (2015 version)

    PubMed Central

    Zhou, Qing-hua; Fan, Ya-guang; Bu, Hong; Wang, Ying; Wu, Ning; Huang, Yun-chao; Wang, Guiqi; Wang, Xin-yun; Qiao, You-lin

    2015-01-01

    Background Lung cancer is the leading cause of cancer-related death in China. Results from a randomized controlled trial using annual low-dose computed tomography (LDCT) in specific high-risk groups demonstrated a 20% reduction in lung cancer mortality. Methods A China national lung cancer screening guideline was developed by lung cancer early detection and treatment expert group appointed by the National Health and Family Planning Commission, based on results of the National Lung Screening Trial, systematic review of evidence related to LDCT screening, and protocol of lung cancer screening program conducted in rural China. Results Annual lung cancer screening with LDCT is recommended for high risk individuals aged 50–74 years who have at least a 20 pack-year smoking history and who currently smoke or have quit within the past five years. Individualized decision making should be conducted before LDCT screening. LDCT screening also represents an opportunity to educate patients as to the health risks of smoking; thus, education should be integrated into the screening process in order to assist smoking cessation. Conclusions A lung cancer screening guideline is provided for the high-risk population in China. PMID:26557925

  20. A Canadian evidence-based guideline for the first-line treatment of follicular lymphoma: joint consensus of the Lymphoma Canada Scientific Advisory Board.

    PubMed

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

    2015-02-01

    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

  1. German ambulatory care physicians' perspectives on clinical guidelines – a national survey

    PubMed Central

    Butzlaff, Martin; Kempkens, Daniela; Schnee, Melanie; Dieterle, Wilfried E; Böcken, Jan; Rieger, Monika A

    2006-01-01

    Background There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM) The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. Methods Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables. Results Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p < 0.01; mean GrP 2.55, SP 2.80, p < 0.05). 33.1% of the participants demonstrated a strong rejection to the application of guidelines in patient care. Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care. Conclusion Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs. PMID:16857051

  2. Clinical Guidelines for the Antimicrobial Treatment of Bone and Joint Infections in Korea

    PubMed Central

    2014-01-01

    There are many various diseases in the bone and joint infections, and we tried to make antimicrobial treatment guidelines for common infectious diseases based on available data for microbiology and clinical trials. This guidelines focused on the treatment of osteomyelitis and septic arthritis, which can be experienced by physicians at diverse clinical settings. This guidelines is not applicable to diabetic foot infections, postoperative infections or post-traumatic infections which need special considerations. The guidelines for those conditions will be separately developed later. Surgical treatment of bone and joint infections, pediatric bone and joint infection, tuberculous bone and joint infection, and prophylactic antibiotic use were not included in this guideline. PMID:25024877

  3. New AHA and ACC guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk.

    PubMed

    Klose, Gerald; Beil, Frank Ulrich; Dieplinger, Hans; von Eckardstein, Arnold; Fger, Bernhard; Gouni-Berthold, Ioanna; Heigl, Franz; Koenig, Wolfgang; Kostner, Gert M; Landmesser, Ulf; Laufs, Ulrich; Leistikow, Frank; Mrz, Winfried; Noll, Georg; Parhofer, Klaus G; Paulweber, Bernhard; Riesen, Walter F; Schaefer, Jrgen R; Steinhagen-Thiessen, Elisabeth; Steinmetz, Armin; Toplak, Hermann; Wanner, Christoph; Windler, Eberhard

    2014-03-01

    After the publication of the new guidelines of the European Society of Cardiology and the European Atherosclerosis Society for the prevention and treatment of dyslipidemias (Eur Heart J 32:1769-1818, 2011; Eur Heart J 33:1635-1701, 2012), a group of authors has recently published on behalf of the American Heart Association and the American College of Cardiology guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk (Circulation 2013). These new guidelines are supposed to replace the until now widely accepted, at least in the USA, recommendations of the National Cholesterol Education Program Adult Treatment Panel III from the years 2002 (Circulation 106:3143-3421, 2002) and 2004 (Circulation 110:227-39, 2004). Furthermore, they claim to be based mainly on hard evidence derived from the interpretation of results of prospective randomized controlled trials. This Joint Position Statement of the Society for the Prevention of Cardiovascular Diseases e.V. (D.A.CH), the Austrian Atherosclerosis Society and the Working Group on Lipids and Atherosclerosis (AGLA) of the Swiss Society of Cardiology concludes that the use of individualized prevention strategies based on specific indications and LDL cholesterol target concentrations, a strategy whose worth has been widely proven and accepted for more than a decade in Europe, should not be given up. PMID:24615676

  4. Chronic hepatitis B therapy: available drugs and treatment guidelines.

    PubMed

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

    2015-06-01

    There are currently several drugs approved for the treatment of chronic hepatitis B including recombinant interferons, such as interferon-α 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

  5. National Health Guidelines in I.R of Iran, an Innovative Approach for Developing Countries

    PubMed Central

    Esmaeil Akbari, Mohammad; Mohammadi, Gohar; Vosoogh-Moghaddam, Abbas; Rabanikhah, Fahimeh; Javadi, Hamideh; Rostami-Gooran, Narges; Safaei, Asal; Akbari, Atieh

    2015-01-01

    Background Guidelines have produced and used in complex environment of health care system with its ethical, economical, legal and other aspects; that should be taken into account in any country. Modifying the format and content of guidelines might facilitate their usage and lead to improved quality of care and cost containment. We have produced this tool for explained above purpose. Methods A coordinating national team has settled at the office of minster of health and medical education, supported by a guideline review committee. An innovative and appropriate approach for adapting national health guidelines has consisted of eight steps, have defined For preparing the draft of each guideline a technical team which, including main author, her/his co-workers have nominated. The authors of each topic have systematically searched databases of the proposed Twenty-two International Sites, and then have selected at least five sources of them that were more relevant. The final recommendations have proposed by agreement of technical team and Guideline Review Committee. Results In less than 5 months, more than 500 authors in whole country have selected to prepare guidelines and, approximately 150 guidelines have provided in three volumes of the published and distributed book. Each guideline had a national ID number, constant forever; all topics should be reviewed every 3-5 years. Conclusion National health guideline(s) would be essential means for policy making in health system and increased the cost containment and quality of care. Ministry of Health and Medical Education should provide and distribute the guidelines based on its accountability to legal responsibility. PMID:25960845

  6. [Clinical practice guidelines for assessment and treatment of transsexualism. SEEN Identity and Sexual Differentiation Group (GIDSEEN)].

    PubMed

    Moreno-Pérez, Oscar; Esteva De Antonio, Isabel

    2012-01-01

    Transsexual patients can only be diagnosed and treated at functional gender identity Units with provision of high quality care, development of clinical practice guidelines, and interdisciplinary working groups. The therapeutic process has three mainstays: initial psychological diagnostic evaluation and psychotherapy, endocrinological evaluation and hormone therapy, and sex reassignment surgery. Cross-sex hormone therapy is essential for the anatomical and psychological transition process in duly selected patients. Hormones help optimize real-life sex identity, improve quality of life, and limit psychiatric co-morbidities often associated to lack of treatment. Development of this clinical practice guideline addresses the need for implementing a coordinated action protocol for comprehensive health care for transgender people in the National Health System. PMID:22542505

  7. Clinical practice guideline on diagnosis and treatment of hyponatraemia.

    PubMed

    Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J; Hoorn, Ewout; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; Van Biesen, Wim; Nagler, Evi

    2014-03-01

    Hyponatraemia, defined as a serum sodium concentration <135 mmol/L, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. Hyponatraemia is present in 15-20% of emergency admissions to hospital and occurs in up to 20% of critically ill patients. Symptomatology may vary from subtle to severe or even life threatening. Despite this, the management of patients remains problematic. Against this background, the European Society of Intensive Care Medicine, the European Society of Endocrinology and the European Renal Association-European Dialysis and Transplant Association, represented by European Renal Best Practice have developed a Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. PMID:24562549

  8. Surgical treatment of melanoma in pregnancy: a practical guideline.

    PubMed

    Crisan, Diana; Treiber, Nicolai; Kull, Thomas; Widschwendter, Peter; Adolph, Oliver; Schneider, Lars Alexander

    2016-06-01

    A tumor primarily requiring surgical treatment, newly diagnosed or preexisting melanoma during pregnancy is a clinical rarity. In such cases, the surgeon faces the challenge of having to decide on the appropriate therapeutic course of action. Based on our clinical experience and a review of the literature, we herein provide a guideline on how to practically deal with this rare clinical conundrum. In our experience, pregnant melanoma patients require thorough counseling with respect to their therapeutic options. They naturally tend to put their unborn child first, and are hesitant to consent to necessary surgery despite a potentially life-threatening diagnosis. It is therefore crucial to clearly inform these patients that - based on existing medical experience - pregnancy by itself is no reason to hold off on any type of necessary melanoma surgery. However, various parameters such as preoperative imaging procedures, positioning on the operating table, monitoring, anesthesia, and perioperative medication require certain adjustments in order to comply with this special situation. PMID:27240064

  9. Guideline for diagnosis and treatment of subacromial pain syndrome

    PubMed Central

    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

    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

  10. 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

    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

    2009-09-01

    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 preventing and treating OIs, especially those OIs for which no specific therapy exists; 2) information about the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information about managing antiretroviral therapy in children with OIs, including potential drug--drug interactions; 4) new guidance on diagnosing of HIV infection and presumptively excluding HIV infection in infants that affect the need for initiation of prophylaxis to prevent Pneumocystis jirovecii pneumonia (PCP) in neonates; 5) updated immunization recommendations for HIV-exposed and HIV-infected children, including hepatitis A, human papillomavirus, meningococcal, and rotavirus vaccines; 6) addition of sections on aspergillosis; bartonella; human herpes virus-6, -7, and -8; malaria; and progressive multifocal leukodystrophy (PML); and 7) new recommendations on discontinuation of OI prophylaxis after immune reconstitution in children. The report includes six tables pertinent to preventing and treating OIs in children and two figures describing immunization recommendations for children aged 0--6 years and 7--18 years. Because treatment of OIs is an evolving science, and availability of new agents or clinical data on existing agents might change therapeutic options and preferences, these recommendations will be periodically updated and will be available at http://AIDSInfo.nih.gov. PMID:19730409

  11. 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

    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

    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 preventing and treating OIs, especially those OIs for which no specific therapy exists; 2) information about the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information about managing antiretroviral therapy in children with OIs, including potential drug--drug interactions; 4) new guidance on diagnosing of HIV infection and presumptively excluding HIV infection in infants that affect the need for initiation of prophylaxis to prevent Pneumocystis jirovecii pneumonia (PCP) in neonates; 5) updated immunization recommendations for HIV-exposed and HIV-infected children, including hepatitis A, human papillomavirus, meningococcal, and rotavirus vaccines; 6) addition of sections on aspergillosis; bartonella; human herpes virus-6, −7, and −8; malaria; and progressive multifocal leukodystrophy (PML); and 7) new recommendations on discontinuation of OI prophylaxis after immune reconstitution in children. The report includes six tables pertinent to preventing and treating OIs in children and two figures describing immunization recommendations for children aged 0--6 years and 7--18 years. Because treatment of OIs is an evolving science, and availability of new agents or clinical data on existing agents might change therapeutic options and preferences, these recommendations will be periodically updated and will be available at http://AIDSInfo.nih.gov. PMID:19730409

  12. Evaluation and Treatment of Hypertriglyceridemia: An Endocrine Society Clinical Practice Guideline

    PubMed Central

    Berglund, Lars; Brunzell, John D.; Goldberg, Anne C.; Goldberg, Ira J.; Sacks, Frank; Murad, Mohammad Hassan; Stalenhoef, Anton F. H.

    2012-01-01

    Objective: The aim was to develop clinical practice guidelines on hypertriglyceridemia. Participants: The Task Force included a chair selected by The Endocrine Society Clinical Guidelines Subcommittee (CGS), five additional experts in the field, and a methodologist. The authors received no corporate funding or remuneration. Consensus Process: Consensus was guided by systematic reviews of evidence, e-mail discussion, conference calls, and one in-person meeting. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage, the Task Force incorporated changes in response to written comments. Conclusions: The Task Force recommends that the diagnosis of hypertriglyceridemia be based on fasting levels, that mild and moderate hypertriglyceridemia (triglycerides of 150–999 mg/dl) be diagnosed to aid in the evaluation of cardiovascular risk, and that severe and very severe hypertriglyceridemia (triglycerides of > 1000 mg/dl) be considered a risk for pancreatitis. The Task Force also recommends that patients with hypertriglyceridemia be evaluated for secondary causes of hyperlipidemia and that subjects with primary hypertriglyceridemia be evaluated for family history of dyslipidemia and cardiovascular disease. The Task Force recommends that the treatment goal in patients with moderate hypertriglyceridemia be a non-high-density lipoprotein cholesterol level in agreement with National Cholesterol Education Program Adult Treatment Panel guidelines. The initial treatment should be lifestyle therapy; a combination of diet modification and drug therapy may also be considered. In patients with severe or very severe hypertriglyceridemia, a fibrate should be used as a first-line agent. PMID:22962670

  13. 76 FR 30308 - National Standard 10 Guidelines; Public Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-25

    ... human life at sea.'' NMFS published final guidelines for NS10 in 1998 (63 FR 24212; May 1, 1998). NMFS... (76 FR 22342). More background on this action is contained in the ANPR published on April 21, 2011 (76 FR 22342) and is not repeated here. Special Accommodations The public meetings listed in this...

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

    PubMed Central

    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

    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 events associated with a treatment modality, but not a known or observable risk factor, there was evidence to recommend heightened vigilance when a relevant treatment is planned or administered. For adverse events associated with a treatment modality and predicted by an observable risk factor, there was evidence to recommend absolute contraindications, and requirements for treatment modality modification or caution to minimize harm and maximize benefit. For managing the theoretic risk of dissection, there was evidence to recommend a systematic risk-management approach. For managing the theoretic risk of stroke, there was support to recommend minimal rotation in administering any modality of upper-cervical spine treatment, and to recommend caution in treating a patient with hyperhomocysteinemia, although the evidence was especially ambiguous in both of these areas. Research recommendations addressed the poor caliber of many of the studies; the GDC concluded that the scientific base for chiropractic cervical treatment of neck pain was not of sufficient quality or scope to “cover” current chiropractic practice comprehensively, although this should not suggest other disciplines are more evidence-based. VALIDATION This guideline was authored by the 10 members of the GDC (Elizabeth Anderson-Peacock, Jean-Sébastien Blouin, Roland Bryans, Normand Danis, Andrea Furlan, Henri Marcoux, Brock Potter, Rick Ruegg, Janice Gross Stein, Eleanor White) based on the work of 3 literature search teams and an evidence extraction team, and in light of feedback from a commentator (Donald R Murphy), a 5-person review panel (Robert R Burton, Andrea Furlan, Richard Roy, Steven Silk, Roy Till), a 6-person Task Force (Grayden Bridge, H James Duncan, Wanda Lee MacPhee, Bruce Squires, Greg Stewart, Dean Wright), and 2 national profession-wide critiques of complete drafts. Two professional editors with extensive guidelines experience were contracted (Thor Eglington, Bruce P Squires). Key contributors to the guideline included individuals with specialties or expert knowledge in chiropractic, medicine, research processes, literature analysis processes, clinical practice guideline processes, protective association affairs, regulatory affairs, and the public interest. This guideline has been formally peer reviewed. PMID:17549134

  15. [Guidelines for the diagnosis and treatment of hereditary angioedema].

    PubMed

    Marković, Asja Stipić; Rozmanić, Vojko; Anić, Branimir; Aberle, Neda; Racić, Goran; Novak, Srdan; Sunara, Davor; Grdinić, Boris; Karadza-Lapić, Ljerka; Radas, Melanija Razov; Karanović, Boris; Kvenić, Barbara

    2014-01-01

    Hereditary angioedema (HAE) is a rare but potentially fatal genetic disorder with nonpitting, nonerythematous, and not pruritic swelling which can affect the hands, feet, face, genitals and visceral mucosa. The type, frequency, and severity of the attacks vary between patients, and over the lifetime of an individual patient. Efforts in Croatian counties have identified approximately 100 patients (but there must be more undiagnosed patients). The first global guideline for the management of HAE was developed by the World Allergy Organization HAE International Alliance and published in 2012. Based on that document the Working group of Croatian experts was assigned to propose guideline for HAE management in Croatia. HAE is is most often related to decreased or dysfunctional C1 inh with autoactivation of C1 and bradykinin accumulation leading to localized dilatation and increased permeability of blood vessels resulting in tissue swelling. A diagnosis of HAE can be confirmed by measuring complement and C1 inh quantitative and functional levels.Three HAE types could be differentiated: HAE type 1 (C1 inh level is low), HAE type 2 (C1 inh level is normal but dysfunctional), and HAE type 3 (normal level and function of C1 inh). All patients suspected to have HAE-1/2 should be assessed for blood levels of C4, C1 inh protein, and C1 inh function. All attacks that result in debilitation/dysfunction and/or involve the face, the neck, or the abdomen should be considered for on-demand treatment. It is recommended that attacks are treated as early as possible. HAE attacks are treated with C1 inh, ecallantide, or icatibant.If these drugs are not available, attacks should be treated with solvent detergent-treated plasma (SDP). If SDP is not available, then attacks should be treated with frozen plasma.Intubation or tracheotomy should be considered early in progressive upper airway edema. Patients with attacks could receive adjuvant therapy when indicated (pain management, intravenous fluids). All patients should have on-demand treatment for two attacks and carry their on-demand treatment at all times. The administration of short-term prophylaxis should be considered before surgeries (dental/intraoral surgery, where endotracheal intubation is required), where upper airway or pharynx is manipulated, and before bronchoscopy or endoscopy. Long-term prophylaxis should be considered in all severely symptomatic HAE-1/2 patients. C1 inh concentrate or androgens can be used. Screening children for HAE-1/2 should be deferred until the age of 12 months, and all offspring of an affected parent should be tested. PMID:25154179

  16. Clinical practice guideline on diagnosis and treatment of hyponatraemia.

    PubMed

    Spasovski, Goce; Vanholder, Raymond; Allolio, Bruno; Annane, Djillali; Ball, Steve; Bichet, Daniel; Decaux, Guy; Fenske, Wiebke; Hoorn, Ewout J; Ichai, Carole; Joannidis, Michael; Soupart, Alain; Zietse, Robert; Haller, Maria; van der Veer, Sabine; Van Biesen, Wim; Nagler, Evi

    2014-04-01

    Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice. PMID:24569496

  17. Korean Medication Algorithm for Depressive Disorder: Comparisons with Other Treatment Guidelines

    PubMed Central

    Wang, Hee Ryung; Park, Young-Min; Lee, Hwang Bin; Song, Hoo Rim; Jeong, Jong-Hyun; Seo, Jeong Seok; Lim, Eun-Sung; Hong, Jeong-Wan; Kim, Won; Jon, Duk-In; Hong, Jin-Pyo; Woo, Young Sup; Min, Kyung Joon

    2014-01-01

    We aimed to compare the recommendations of the Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012) with other recently published treatment guidelines for depressive disorder. We reviewed a total of five recently published global treatment guidelines and compared each treatment recommendation of the KMAP-DD 2012 with those in other guidelines. For initial treatment recommendations, there were no significant major differences across guidelines. However, in the case of nonresponse or incomplete response to initial treatment, the second recommended treatment step varied across guidelines. For maintenance therapy, medication dose and duration differed among treatment guidelines. Further, there were several discrepancies in the recommendations for each subtype of depressive disorder across guidelines. For treatment in special populations, there were no significant differences in overall recommendations. This comparison identifies that, by and large, the treatment recommendations of the KMAP-DD 2012 are similar to those of other treatment guidelines and reflect current changes in prescription pattern for depression based on accumulated research data. Further studies will be needed to address several issues identified in our review. PMID:24605117

  18. [Concept and Overview of JSMO Guidelines for the Treatment of Bone Metastasis].

    PubMed

    Shibata, Hiroyuki

    2015-11-01

    Many diagnostic and treatment modalities for bone metastasis are available. They include biomarker examination, imaging techniques, surgery, radiation therapy, chemotherapy, palliation, and rehabilitation, among others. Diagnosis of the disease and administration of these treatments require caregivers and other medical personnel including medical oncologists for primary tumors, radiologists, pathologists, orthopedists, radiotherapists, palliative care doctors, rehabilitation doctors, dentists, nurses, pharmacists, physical therapists, psychologists, and medical social workers. In multidisciplinary teamwork, knowledge of the potency of each intervention performed for the patients is important to improve treatment outcomes. Therefore, guidelines can contribute to better understanding and collaboration of one intervention with another. Guidelines should be based on medical evidences obtained from clinical studies that yield highly reliable results. Evidences for the treatment of bone metastasis are still lacking. Especially, the evidences for multi-modal treatment are rarely of described. In 2015, the Japanese Society for Medical Oncology released guidelines for the diagnosis and treatment of bone metastases. These guidelines aim to improve clinical procedures and treatment outcomes. In these guidelines, we described the current measures applicable for the treatment and care of patients with bone metastasis, the cost of which is covered by Japanese medical insurance. During the development of these guidelines, we recognized unsolved clinical questions in some parts of this field. Although the development of these guidelines is just a step toward improvement of treatment outcomes in patients with bone metastases, we hope that these guidelines are beneficial for such patients. PMID:26602391

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

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

    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.

  20. The Framingham study and treatment guidelines for stroke prevention.

    PubMed

    Grossi, Enzo

    2008-06-01

    In recent years, institutional bodies and scientific societies of principal Western countries have produced several guidelines dealing with risk assessment, primary prevention, and treatment of acute stroke. From a prospective, community-based, observational cohort of patients from the Framingham Heart Study, an absolute estimate of risk for stroke alone or stroke or death was determined based on several risk factors, including advanced age, female sex, increased systolic blood pressure, prior stroke or transient ischemic attack, and diabetes mellitus. This algorithm considers many variables and expresses their results as the percentage of risk of developing a fatal or nonfatal stroke in the following 5 years. The author has identified three major pitfalls of this algorithm, which are related to the limitation of the classic statistical approach in handling this kind of nonlinear and complex information: 1) the very large confidence interval of individual risk assessment, 2) the inability to capture the process dynamics, and 3) the inability to capture the disease complexity. The artificial intelligence armamentarium may provide an advantage in the attempt to overcome these limitations. The theoretic background and some application examples related to artificial neural networks (ANNs) and fuzzy logic are reviewed and discussed. Newer approaches linked to artificial intelligence, such as fuzzy logic and ANNs, seem better at addressing the challenge of the increasing complexity of the predisposing factors linked to cerebrovascular events and at predicting future events in an individual patient. PMID:18582409

  1. [Guidelines for treatment of pneumonia in intensive care units].

    PubMed

    Emmi, V

    2005-01-01

    Patients affected by pneumonia can be admitted in Intensive Care Units (ICUs) independently by the setting where the infection has been acquired (community, hospital, long-term care facilities); even more frequently pneumonia can develop in patients already hospitalized in ICU especially in those requiring mechanical ventilation for different reasons. Within the severe community acquired pneumonia requiring admission in ICU, the most frequently responsible micro-organisms are mainly represented by Streptococcus pneumoniae, but also by Legionella and Haemophilus. Pseudomonas aeruginona, anyway, cannot be excluded. The most recent Canadian and American guidelines for treatment of the above mentioned infections suggest the use of a combination therapy with beta-lactams (ceftriaxone, cefotaxime, ampicillin/sulbactam, piperacillin/tazobactam) and a new generation macrolide or respiratory fluoroquinolone. In case of allergy to beta-lactams, the association fluoroquinolone-clindamycin should be preferred. Whenever a Pseudomonas etiology is suspected because of the presence of risk factors such as COPD, cystic fibrosis, bronchiectasis, previous and/or frequent therapies with antibiotics and/or steroids, the same guidelines suggest the use of an anti-pseudomonas beta-lactam (such as piperacillin/tazobactam, carbapenems, cefepime) associated with an anti-pseudomonas fluoroquinolone (high doses ciprofloxacin). An anti-pseudomonas beta-lactam plus an aminoglycoside or aminoglicosyde plus fluoroquinolone can be an alternative. Early onset Hospital Acquired Pneumonia (HAP) and early onset Ventilator Associated Pneumonia (VAP) in patients without risk factors for multi-resistant etiological agents are generally sustained by S. pneumoniae, H. influenzae, methicillin-susceptible Staphylocccus aureus e Gram negative enteric rods. These infections can be treated with one of the following antibiotics: ceftriaxone or fluoroquinolones (moxifloxacin or ciprofloxacin or levofloxacin) or ampicillin/sulbactam or ertapenem. Late onset VAP and HAP in patients with risk factors for multi-resistant, by contrast, should be treated with a combination therapy: in case of defined or suspected P. aeruginosa, Klebsiella pneumoniae (ESbL+), Acinetobacter sp etiology, it is required the use of an anti-pseudomonas cephalosporin or an anti-pseudomonas carbapenem or b-lactam + beta-lactamase inhibitor associated with an anti-pseudomonas fluoroquinolone or an aminoglicoside. The possible presence of MRSA or Legionella pneumophila suggests the use of anti-Gram positive antibiotics such as glycopeptides or linezolid. These quidelines confirm the role of ciprofloxacin combined with beta-lactams whenever P. aeruginosa, Klebsiella pneumoniae (ESbL+), Acinetobacter sp. etiology is suspected. PMID:16801748

  2. Korean Medication Algorithm for Bipolar Disorder 2014: comparisons with other treatment guidelines

    PubMed Central

    Jeong, Jong-Hyun; Lee, Jeong Goo; Kim, Moon-Doo; Sohn, Inki; Shim, Se-Hoon; Wang, Hee Ryung; Woo, Young Sup; Jon, Duk-In; Seo, Jeong Seok; Shin, Young-Chul; Min, Kyung Joon; Yoon, Bo-Hyun; Bahk, Won-Myong

    2015-01-01

    Our goal was to compare the recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2014 (KMAP-BP 2014) with other recently published guidelines for the treatment of bipolar disorder. We reviewed a total of four recently published global treatment guidelines and compared each treatment recommendation of the KMAP-BP 2014 with those in other guidelines. For the initial treatment of mania, there were no significant differences across treatment guidelines. All recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or the combination of an MS with an AAP as a first-line treatment strategy for mania. However, the KMAP-BP 2014 did not prefer monotherapy with MS or AAP for dysphoric/psychotic mania. Aripiprazole, olanzapine, quetiapine, and risperidone were the first-line AAPs in nearly all of the phases of bipolar disorder across the guidelines. Most guidelines advocated newer AAPs as first-line treatment options in all phases, and lamotrigine in depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. As research evidence accumulated over time, recommendations of newer AAPs – such as asenapine, paliperidone, lurasidone, and long-acting injectable risperidone – became prominent. This comparison identifies that the treatment recommendations of the KMAP-BP 2014 are similar to those of other treatment guidelines and reflect current changes in prescription patterns for bipolar disorder based on accumulated research data. Further studies are needed to address several issues identified in our review. PMID:26170669

  3. Korean Medication Algorithm for Bipolar Disorder 2014: comparisons with other treatment guidelines.

    PubMed

    Jeong, Jong-Hyun; Lee, Jeong Goo; Kim, Moon-Doo; Sohn, Inki; Shim, Se-Hoon; Wang, Hee Ryung; Woo, Young Sup; Jon, Duk-In; Seo, Jeong Seok; Shin, Young-Chul; Min, Kyung Joon; Yoon, Bo-Hyun; Bahk, Won-Myong

    2015-01-01

    Our goal was to compare the recommendations of the Korean Medication Algorithm Project for Bipolar Disorder 2014 (KMAP-BP 2014) with other recently published guidelines for the treatment of bipolar disorder. We reviewed a total of four recently published global treatment guidelines and compared each treatment recommendation of the KMAP-BP 2014 with those in other guidelines. For the initial treatment of mania, there were no significant differences across treatment guidelines. All recommended mood stabilizer (MS) or atypical antipsychotic (AAP) monotherapy or the combination of an MS with an AAP as a first-line treatment strategy for mania. However, the KMAP-BP 2014 did not prefer monotherapy with MS or AAP for dysphoric/psychotic mania. Aripiprazole, olanzapine, quetiapine, and risperidone were the first-line AAPs in nearly all of the phases of bipolar disorder across the guidelines. Most guidelines advocated newer AAPs as first-line treatment options in all phases, and lamotrigine in depressive and maintenance phases. Lithium and valproic acid were commonly used as MSs in all phases of bipolar disorder. As research evidence accumulated over time, recommendations of newer AAPs - such as asenapine, paliperidone, lurasidone, and long-acting injectable risperidone - became prominent. This comparison identifies that the treatment recommendations of the KMAP-BP 2014 are similar to those of other treatment guidelines and reflect current changes in prescription patterns for bipolar disorder based on accumulated research data. Further studies are needed to address several issues identified in our review. PMID:26170669

  4. Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment

    PubMed Central

    Kim, Jung Eun; Kim, Hyun Jeong; Lew, Bark-Lynn; Lee, Kyung Ho; Hong, Seung Phil; Jang, Yong Hyun; Park, Kui Young; Seo, Seong Jun; Bae, Jung Min; Choi, Eung Ho; Suhr, Ki Beom; Lee, Seung Chul; Ko, Hyun Chang; Park, Young Lip; Son, Sang Wook; Seo, Young Jun; Lee, Yang Won; Cho, Sang Hyun; Park, Chun Wook

    2015-01-01

    Background Since the treatment guidelines for atopic dermatitis (AD) were issued by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been further advances in the systemic treatment of AD. Objective We aimed to establish updated evidence- and experience-based systemic treatment guidelines for Korean AD. Methods We compiled a database of references from relevant systematic reviews and guidelines regarding the systemic management of AD, including antihistamines, antimicrobials, systemic immunomodulators, allergen-specific immunotherapy, phototherapy, adjunctive treatment, and complementary and alternative medicines. Evidence for each statement was graded and classified based on the strength of the recommendation. Thirty-nine council members of KADA participated in the three rounds of votes and expert consensus recommendations were established. Results The use of antihistamines is recommended to relieve pruritus and to prevent exacerbation due to scratching in AD patients. Infection should be controlled as needed and long-term medication should be avoided. For moderate to severe AD patients, concomitant active treatments with systemic immunomodulators are indicated. Cyclosporine is the first choice among systemic immunomodulators and others should be considered as second-line alternatives. Allergen-specific immunotherapy could be effective in AD patients with aeroallergen hypersensitivity. Phototherapy can be useful for moderate to severe AD patients and narrow-band ultraviolet B is the most effective option. Complementary and alternative medicines cannot be recommended for treating AD. Conclusion We expect these recommendations to be a reference guide for physicians and AD patients in choosing the appropriate treatment to improve quality of life and decrease unnecessary social medical costs. PMID:26512172

  5. Guidelines for diagnosis and treatment of 21-hydroxylase deficiency (2014 revision)

    PubMed Central

    Ishii, Tomohiro; Anzo, Makoto; Adachi, Masanori; Onigata, Kazumichi; Kusuda, Satoshi; Nagasaki, Keisuke; Harada, Shohei; Horikawa, Reiko; Minagawa, Masanori; Minamitani, Kanshi; Mizuno, Haruo; Yamakami, Yuji; Fukushi, Masaru; Tajima, Toshihiro

    2015-01-01

    Purpose of developing the guidelines: The first guidelines for diagnosis and treatment of 21-hydroxylase deficiency (21-OHD) were published as a diagnostic handbook in Japan in 1989, with a focus on patients with severe disease. The “Guidelines for Treatment of Congenital Adrenal Hyperplasia (21-Hydroxylase Deficiency) Found in Neonatal Mass Screening (1999 revision)” published in 1999 were revised to include 21-OHD patients with very mild or no clinical symptoms. Accumulation of cases and experience has subsequently improved diagnosis and treatment of the disease. Based on these findings, the Mass Screening Committee of the Japanese Society for Pediatric Endocrinology further revised the guidelines for diagnosis and treatment. Target disease/conditions: 21-hydroxylase deficiency. Users of the guidelines: Physician specialists in pediatric endocrinology, pediatric specialists, referring pediatric practitioners, general physicians; and patients. PMID:26594092

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

    SciTech Connect

    Kamboj, S., Dr.; Yu, C ., Dr.

    2011-08-12

    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.

  7. The 2015 Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections in HIV-Infected Koreans: Guidelines for Opportunistic Infections

    PubMed Central

    2016-01-01

    The Committee for Clinical Guidelines for the Treatment and Prevention of Opportunistic Infections of the Korean Society for AIDS was founded in 2011. The first edition of the Korean guidelines was published in 2012. The guideline recommendations contain important information for physicians working with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in the clinical field. It has become necessary to revise the guidelines due to new data in this field. These guidelines aim to provide up-to-date, comprehensive information regarding the treatment and prevention of opportunistic infections in HIV-infected Koreans. These guidelines deal with several common opportunistic infections, including pneumocystis pneumonia, tuberculosis, cryptococcal meningitis, etc. A brief summary of the revised guidelines is provided below. Recommendations are rated using the same system used in the previous guidelines. PMID:27104018

  8. A critical review of recent clinical practice guidelines on the diagnosis and treatment of non-neurogenic male lower urinary tract symptoms

    PubMed Central

    Chua, Michael Erlano; Mendoza, Jonathan; See, Manuel; Esmena, Ednalyn; Aguila, Dean; Silangcruz, Jan Michael; Reyes, Buenaventura Jose; Luna, Saturnino; Morales, Marcelino

    2015-01-01

    Introduction: We provide an overview of the quality of recent clinical clinical practice guidelines (CPGs) for non-neurogenic male lower urinary tract symptoms (LUTS) and summarize the recommendations for their diagnosis, assessment, and treatment. Methods: We systematically searched recent (2008–2013) CPGs for non-neurogenic male LUTS. Eligible CPGs were assessed and appraised using Appraisal of Guidelines, Research and Evaluation II (AGREE II) tool by a CPG-appraisal group. The appraisal scores for each guideline were summarized according to each domain and in total. A recommendation summary was made across the guidelines for diagnostics, conservative management, medical, minimally invasive therapy, and surgical management. Results: A total of 8 guidelines were considered. According to AGREE II appraisal of guidelines, the National Institute for Health and Clinical Excellence (NICE), American Urological Association (AUA) and European Association of Urology (EAU) consistently scored high on the guideline domains assessed. Recommendations on diagnostics, conservative management, medical, and surgical management were consistent among the top 3 guidelines. However, we noted a discrepancy in recommending minimally invasive therapy as an alternative management of moderate to severe or bothersome non-neurogenic male LUTS secondary to benign prostatic enlargement (BPE); the NICE guideline, in particular, does not recommend using minimally invasive therapy. Conclusion: The quality of recent CPGs on non-neurogenic male LUTS was appraised and summarized. The guidelines from NICE, AUA and EAU were considered highly compliant to the AGREE II proposition for guideline formation and development. PMID:26279717

  9. National Prehospital Evidence-Based Guidelines Strategy: A Summary for EMS Stakeholders.

    PubMed

    Martin-Gill, Christian; Gaither, Joshua B; Bigham, Blair L; Myers, J Brent; Kupas, Douglas F; Spaite, Daniel W

    2016-01-01

    Multiple national organizations have recommended and supported a national investment to increase the scientific evidence available to guide patient care delivered by Emergency Medical Services (EMS) and incorporate that evidence directly into EMS systems. Ongoing efforts seek to develop, implement, and evaluate prehospital evidence-based guidelines (EBGs) using the National Model Process created by a multidisciplinary panel of experts convened by the Federal Interagency Committee on EMS (FICEMS) and the National EMS Advisory Council (NEMSAC). Yet, these and other EBG efforts have occurred in relative isolation, with limited direct collaboration between national projects, and have experienced challenges in implementation of individual guidelines. There is a need to develop sustainable relationships among stakeholders that facilitate a common vision that facilitates EBG efforts. Herein, we summarize a National Strategy on EBGs developed by the National Association of EMS Physicians (NAEMSP) with involvement of 57 stakeholder organizations, and with the financial support of the National Highway Traffic Safety Administration (NHTSA) and the EMS for Children program. The Strategy proposes seven action items that support collaborative efforts in advancing prehospital EBGs. The first proposed action is creation of a Prehospital Guidelines Consortium (PGC) representing national medical and EMS organizations that have an interest in prehospital EBGs and their benefits to patient outcomes. Other action items include promoting research that supports creation and evaluates the impact of EBGs, promoting the development of new EBGs through improved stakeholder collaboration, and improving education on evidence-based medicine for all prehospital providers. The Strategy intends to facilitate implementation of EBGs by improving guideline dissemination and incorporation into protocols, and seeks to establish standardized evaluation methods for prehospital EBGs. Finally, the Strategy proposes that key stakeholder organizations financially support the Prehospital Guidelines Consortium as a means of implementing the Strategy, while together promoting additional funding for continued EBG efforts. PMID:26808116

  10. Analysis Treatment Guideline versus Clinical Practice Protocol in Patients Hospitalized due to Heart Failure

    PubMed Central

    Corrêa, Alessandra da Graça; Makdisse, Marcia; Katz, Marcelo; Santana, Thamires Campos; Yokota, Paula Kiyomi Onaga; Galvão, Tatiana de Fatima Gonçalves; Bacal, Fernando

    2016-01-01

    Background Despite the availability of guidelines for treatment of heart failure (HF), only a few studies have assessed how hospitals adhere to the recommended therapies. Objectives Compare the rates of adherence to the prescription of angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers (ACEI/ARB) at hospital discharge, which is considered a quality indicator by the Joint Commission International, and to the prescription of beta-blockers at hospital discharge, which is recommended by national and international guidelines, in a hospital with a case management program to supervise the implementation of a clinical practice protocol (HCP) and another hospital that follows treatment guidelines (HCG). Methods Prospective observational study that evaluated patients consecutively admitted to both hospitals due to decompensated HF between August 1st, 2006, and December 31st, 2008. We used as comparing parameters the prescription rates of beta-blockers and ACEI/ARB at hospital discharge and in-hospital mortality. Results We analyzed 1,052 patients (30% female, mean age 70.6 ± 14.1 years), 381 (36%) of whom were seen at HCG and 781 (64%) at HCP. The prescription rates of beta-blockers at discharge at HCG and HCP were both 69% (p = 0.458), whereas those of ACEI/ARB were 83% and 86%, respectively (p = 0.162). In-hospital mortality rates were 16.5% at HCP and 27.8% at HCG (p < 0.001). Conclusion There was no difference in prescription rates of beta-blocker and ACEI/ARB at hospital discharge between the institutions, but HCP had lower in-hospital mortality. This difference in mortality may be attributed to different clinical characteristics of the patients in both hospitals. PMID:26815461

  11. From Physical Activity Guidelines to a National Activity Plan

    ERIC Educational Resources Information Center

    Bornstein, Daniel B.; Pate, Russell R.

    2014-01-01

    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

  12. From Physical Activity Guidelines to a National Activity Plan

    ERIC Educational Resources Information Center

    Bornstein, Daniel B.; Pate, Russell R.

    2014-01-01

    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…

  13. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update.

    PubMed

    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

    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

  14. 76 FR 35959 - Capital Adequacy Guidelines; Small Bank Holding Company Policy Statement: Treatment of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-21

    ... CFR Part 225 Capital Adequacy Guidelines; Small Bank Holding Company Policy Statement: Treatment of... Director, Capital and Regulatory Policy, or Brendan G. Burke, (202) Senior Supervisory Financial Analyst... the debt-to-equity standard under the Policy Statement. Capital Guidelines Under the Troubled...

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

    SciTech Connect

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

    1994-11-01

    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.

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

    ERIC Educational Resources Information Center

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

    2004-01-01

    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…

  17. [On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Medical treatment for osteoporosis].

    PubMed

    Yamauchi, Mika; Sugimoto, Toshitsugu

    2015-09-01

    The main revisions to the item of medical treatment in the 2015 edition of the Guidelines for Prevention and Treatment of Osteoporosis are the additions of the drugs such as ibandronate, teriparatide acetate (once-weekly preparation), and denosumab, which were approved after the release of the 2011 edition, and of information on new dosage forms for existing drugs. Furthermore, the heading "Evaluation and Recommendations" for each drug was changed to "Evaluation of Efficacy" . The choice of drug is determined based on evidence for the effectiveness of each drug and in accordance with the age, fracture risk, and pathophysiology of each patient. As for the selection and combined use of the various drugs, accumulation of evidence is anticipated, but sequential therapy using antiresorptive agents following treatment with teriparatide preparations is recommended. PMID:26320527

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

    ERIC Educational Resources Information Center

    Xiaobing, Sun

    2012-01-01

    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…

  19. Examining the Alignment of Chinese National Physics Curriculum Guidelines and 12th-Grade Exit Examinations: A Case Study

    ERIC Educational Resources Information Center

    Liang, Ling L.; Yuan, Haiquan

    2008-01-01

    This study reports findings from an analysis of the 2002 Chinese National Physics Curriculum Guidelines and the alignment between the curriculum guidelines and two most recent provincial-level 12th-grade exit examinations in China. Both curriculum guidelines and test content were represented using two-dimensional matrices (i.e., topic by level of…

  20. Guidelines for the treatment of acidaemia with THAM.

    PubMed

    Nahas, G G; Sutin, K M; Fermon, C; Streat, S; Wiklund, L; Wahlander, S; Yellin, P; Brasch, H; Kanchuger, M; Capan, L; Manne, J; Helwig, H; Gaab, M; Pfenninger, E; Wetterberg, T; Holmdahl, M; Turndorf, H

    1998-02-01

    THAM (trometamol; tris-hydroxymethyl aminomethane) is a biologically inert amino alcohol of low toxicity, which buffers carbon dioxide and acids in vitro and in vivo. At 37 degrees C, the pK (the pH at which the weak conjugate acid or base in the solution is 50% ionised) of THAM is 7.8, making it a more effective buffer than bicarbonate in the physiological range of blood pH. THAM is a proton acceptor with a stoichiometric equivalence of titrating 1 proton per molecule. In vivo, THAM supplements the buffering capacity of the blood bicarbonate system, accepting a proton, generating bicarbonate and decreasing the partial pressure of carbon dioxide in arterial blood (paCO2). It rapidly distributes through the extracellular space and slowly penetrates the intracellular space, except for erythrocytes and hepatocytes, and it is excreted by the kidney in its protonated form at a rate that slightly exceeds creatinine clearance. Unlike bicarbonate, which requires an open system for carbon dioxide elimination in order to exert its buffering effect, THAM is effective in a closed or semiclosed system, and maintains its buffering power in the presence of hypothermia. THAM rapidly restores pH and acid-base regulation in acidaemia caused by carbon dioxide retention or metabolic acid accumulation, which have the potential to impair organ function. Tissue irritation and venous thrombosis at the site of administration occurs with THAM base (pH 10.4) administered through a peripheral or umbilical vein: THAM acetate 0.3 mol/L (pH 8.6) is well tolerated, does not cause tissue or venous irritation and is the only formulation available in the US. In large doses, THAM may induce respiratory depression and hypoglycaemia, which will require ventilatory assistance and glucose administration. The initial loading dose of THAM acetate 0.3 mol/L in the treatment of acidaemia may be estimated as follows: THAM (ml of 0.3 mol/L solution) = lean body-weight (kg) x base deficit (mmol/L). The maximum daily dose is 15 mmol/kg for an adult (3.5L of a 0.3 mol/L solution in a 70kg patient). When disturbances result in severe hypercapnic or metabolic acidaemia, which overwhelms the capacity of normal pH homeostatic mechanisms (pH < or = 7.20), the use of THAM within a 'therapeutic window' is an effective therapy. It may restore the pH of the internal milieu, thus permitting the homeostatic mechanisms of acid-base regulation to assume their normal function. In the treatment of respiratory failure, THAM has been used in conjunction with hypothermia and controlled hypercapnia. Other indications are diabetic or renal acidosis, salicylate or barbiturate intoxication, and increased intracranial pressure associated with cerebral trauma. THAM is also used in cardioplegic solutions, during liver transplantation and for chemolysis of renal calculi. THAM administration must follow established guidelines, along with concurrent monitoring of acid-base status (blood gas analysis), ventilation, and plasma electrolytes and glucose. PMID:9506241

  1. Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea

    PubMed Central

    Park, Seon-Cheol; Oh, Hong Seok; Oh, Dong-Hoon; Jung, Seung Ah; Na, Kyoung-Sae; Lee, Hwa-Young; Kang, Ree-Hun; Choi, Yun-Kyeung; Lee, Min-Soo

    2014-01-01

    Although pharmacological treatment constitutes the main therapeutic approach for depression, non-pharmacological treatments (self-care or psychotherapeutic approach) are usually regarded as more essential therapeutic approaches in clinical practice. However, there have been few clinical practice guidelines concerning self-care or psychotherapy in the management of depression. This study introduces the 'Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea.' For the first time, a guideline was developed for non-pharmacological treatments for Korean adults with mild-to-moderate depression. The guideline development process consisted of establishing several key questions related to non-pharmacologic treatments of depression, searching the literature for studies which answer these questions, assessing the evidence level of each selected study, drawing up draft recommendation, and peer review. The Scottish Intercollegiate Guidelines Network grading system was used to evaluate the quality of evidence. As a result of this process, the guideline recommends exercise therapy, bibliotherapy, cognitive behavior therapy, short-term psychodynamic supportive psychotherapy, and interpersonal psychotherapy as the non-pharmacological treatments for adult patients with mild-to-moderate depression in Korea. Hence, it is necessary to develop specific methodologies for several non-pharmacological treatment for Korean adults with depression. PMID:24431900

  2. Evidence-based, non-pharmacological treatment guideline for depression in Korea.

    PubMed

    Park, Seon-Cheol; Oh, Hong Seok; Oh, Dong-Hoon; Jung, Seung Ah; Na, Kyoung-Sae; Lee, Hwa-Young; Kang, Ree-Hun; Choi, Yun-Kyeung; Lee, Min-Soo; Park, Yong Chon

    2014-01-01

    Although pharmacological treatment constitutes the main therapeutic approach for depression, non-pharmacological treatments (self-care or psychotherapeutic approach) are usually regarded as more essential therapeutic approaches in clinical practice. However, there have been few clinical practice guidelines concerning self-care or psychotherapy in the management of depression. This study introduces the 'Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea.' For the first time, a guideline was developed for non-pharmacological treatments for Korean adults with mild-to-moderate depression. The guideline development process consisted of establishing several key questions related to non-pharmacologic treatments of depression, searching the literature for studies which answer these questions, assessing the evidence level of each selected study, drawing up draft recommendation, and peer review. The Scottish Intercollegiate Guidelines Network grading system was used to evaluate the quality of evidence. As a result of this process, the guideline recommends exercise therapy, bibliotherapy, cognitive behavior therapy, short-term psychodynamic supportive psychotherapy, and interpersonal psychotherapy as the non-pharmacological treatments for adult patients with mild-to-moderate depression in Korea. Hence, it is necessary to develop specific methodologies for several non-pharmacological treatment for Korean adults with depression. PMID:24431900

  3. Impact of current treatment guidelines on minority patients with HIV infection.

    PubMed

    Stone, Valerie; Virgil, Luther A

    2004-10-01

    Guidelines regarding treatment of HIV/AIDS are frequently updated in response to the growing complexity of antiretroviral medicine and the volume of data emerging from clinical research. Since april 1998, the Department of Health and Human Services has issued 11 updates of its Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. These guidelines impact physician practice in the treatment of HIV-infected patients of multiple races and ethnicities, though their benefit in improving outcomes in minority patient populations is not fully understood. PMID:15497216

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

    ERIC Educational Resources Information Center

    Holthe, Asle; Larsen, Torill; Samdal, Oddrun

    2011-01-01

    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…

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

    ERIC Educational Resources Information Center

    Holthe, Asle; Larsen, Torill; Samdal, Oddrun

    2011-01-01

    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

  6. How Public Health Nurses Identify and Intervene in Child Maltreatment Based on the National Clinical Guideline

    PubMed Central

    Eija, Paavilainen; Mika, Helminen; Aune, Flinck; Leila, Lehtomäki

    2014-01-01

    Objectives. To describe how Finnish public health nurses identify and intervene in child maltreatment and how they implement the National Clinical Guideline in their work. Design and Sample. Cross-sectional survey of 367 public health nurses in Finland. Measures. A web-based questionnaire developed based on the content areas of the guideline: identifying, intervening, and implementing. Results. The respondents reported they identify child maltreatment moderately (mean 3.38), intervene in it better (4.15), and implement the guideline moderately (3.43, scale between 1 and 6). Those with experience of working with maltreated children reported they identify them better (P < 0.001), intervene better (P < 0.001), and implement the guideline better (P < 0.001) than those with no experience. This difference was also found for those who were aware of the guideline, had read it, and participated in training on child maltreatment, as compared to those who were not aware of the guideline, had not read it, or had not participated in such training. Conclusions. The public health nurses worked quite well with children who had experienced maltreatment and families. However, the results point out several developmental targets for increasing training on child maltreatment, for devising recommendations for child maltreatment, and for applying these recommendations systematically in practice. PMID:25505986

  7. [NONALCOHOLIC FATTY LIVER DISEASE: DIAGNOSTIC, SYMPTOMS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

    PubMed

    Lazebnik, L B; Radchenko, V G; Golovanova, E V; Zvenigorodskaya, L A; Konev, Yu V; Seliverstov, P V; Sitkin, S I; Tkachenko, E I; Aylamazayn, E K; Vlasov, N N; Kornienko, E A; Novikova, V P; Horoshinina, L P; Zhestkova, N V; Oreshko, L S; Dudanova, O P; Dobrica, V P; Turyeva, L V; Tirikova, O V; Kozlova, N M; Eliseev, S M; Gumerov, R R; Vencak, E V

    2015-01-01

    According to the World Health Organization, it is recorded steady growth of the number of chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), in recent years. As an independent nosological entity, NAFLD is one of the risk factors for cardiovascular diseases, associated with abdominal-visceral obesity, peripheral insulin resistance (IR), and is regarded as the hepatic component of Metabolic syndrome (MS). Nowadays there are no generally accepted national standards for diagnosis and treatment of NAFLD for physicians, gen- eral practitioners, gastroenterologists in Russia. This was the essential reason in their development. The main reason of The guidelines development is the absence of generally accepted national standards for diagnosis and treatment of NAFLD for physicians, general practitioners, gastroenterologists in Russia. These guidelines are based on the global and local data of treatment experience of NAFLD, recently published in reviews, analytical studies in the literature. Guidelines are intended for physicians, general practitioners, gastroenterologists and contain the description of the preferred approaches to the provision of diagnostic, curative and preventive care of patients NAFLD. The quality of recommendations was grading according to the GRADE approach. PMID:26817127

  8. Balancing on the edge: implications of a UK national audit of the use of BSR-BHPR guidelines for the diagnosis and management of polymyalgia rheumatica

    PubMed Central

    Das, Parthajit; Samanta, Ash; Dasgupta, Bhaskar

    2015-01-01

    Introduction The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR-BHPR) guidelines for management of polymyalgia rheumatica (PMR) were published in 2010, aiming to provide guidance for diagnosis, management and disease monitoring. A national study was conducted across multiple rheumatology units throughout the UK in order to study the level of adoption of guidelines in clinical practice. Methods This study was a retrospective analysis of patient records with a diagnosis of PMR from multiple centres across the UK. The primary objective was to explore the national compliance of PMR management according to BSR guidelines. Results We included 81 responses across 10 rheumatology units in the UK. The guideline core inclusion criteria were followed in more than 90% in making the diagnosis of PMR, but limited concordance was observed with respect to excluding PMR-mimics, the initial recommended glucocorticoid dosage (74%), steroid taper (41%), treatment of relapse (76%), bone protection (84%) and patient follow-up (43%). Conclusions We observed a wide variation in clinical practice and limited adherence to BSR-BHPR guidelines in the UK. This study highlights the need for robust multilayered and multifaceted implementation strategies involving the providers and the consumers for apposite dissemination of guideline-based practice and consistency of care. We believe that the findings of this study have significant relevance for formulation and dissemination of PMR guidelines in the future. PMID:26509072

  9. Langerhans Cell Histiocytosis (LCH): Guidelines for Diagnosis, Clinical Work-Up, and Treatment for Patients Till the Age of 18 Years

    PubMed Central

    Haupt, Riccardo; Minkov, Milen; Astigarraga, Itziar; Schäfer, Eva; Nanduri, Vasanta; Jubran, Rima; Egeler, R Maarten; Janka, Gritta; Micic, Dragan; Rodriguez-Galindo, Carlos; Van Gool, Stefaan; Visser, Johannes; Weitzman, Sheila; Donadieu, Jean

    2013-01-01

    These guidelines for the management of patients up to 18 years with Langerhans cell histiocytosis (LCH) have been set up by a group of experts involved in the Euro Histio Net project who participated in national or international studies and in peer reviewed publications. Existing guidelines were reviewed and changed where new evidence was available in the literature up to 2012. Data and publications have been ranked according to evidence based medicine and when there was a lack of published data, consensus between experts was sought. Guidelines for diagnosis, initial clinical work-up, and treatment and long-term follow-up of LCH patients are presented. PMID:23109216

  10. [Polish guidelines for the prevention and treatment of venous thromboembolism: 2009 update].

    PubMed

    Zawilska, Krystyna; Jaeschke, Roman; Tomkowski, Witold; Mayzner-Zawadzka, Ewa; Nizankowski, Rafał; Olejek, Anita; Pasierski, Tomasz; Torbicki, Adam; Undas, Anetta; Jawień, Arkadiusz; Gajewski, Piotr; Sznajd, Jan; Brozek, Jan

    2009-01-01

    The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia. We systematically identified all current clinical practice guidelines concerning the prevention and/or treatment of venous thromboembolism and assessed their methodological quality using the AGREE instrument. We chose to update existing Polish guidelines by adapting the most recent high quality guidelines that we identified to Polish cultural and organizational setting rather than develop all recommendations de novo. We based our recommendations primarily on the 8th edition of the American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines on Antithrombotic and Thrombolytic Therapy and on the European Society of Cardiology (ESC) Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. To make recommendations regarding specific management issues that had not been addressed in ACCP guidelines, or whenever panel members felt they needed additional information to reach the decision we also consulted guidelines developed by other professional societies and organizations as well as additional sources of evidence. For each recommendation we explicitly assessed its relevance and applicability in the context of health care system in Poland. We adapted recommendations when necessary, explicitly stating the rationale for modification and judgements about the values and preferences we assumed. We developed original recommendations on the use of new oral anticoagulants that have recently become available, following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. PMID:19841614

  11. Provider Adherence to National Guidelines for Managing Hypertension in African Americans

    PubMed Central

    Sessoms, Jeanette; Reid, Kathryn; Williams, Ishan; Hinton, Ivora

    2015-01-01

    Purpose. To evaluate provider adherence to national guidelines for the treatment of hypertension in African Americans. Design. A descriptive, preexperimental, quantitative method. Methods. Electronic medical records were reviewed and data were obtained from 62 charts. Clinical data collected included blood pressure readings, medications prescribed, laboratory studies, lifestyle modification, referral to hypertension specialist, and follow-up care. Findings. Overall provider adherence was 75%. Weight loss, sodium restriction, and physical activity recommendations were documented on 82.3% of patients. DASH diet and alcohol consumption were documented in 6.5% of participants. Follow-up was documented in 96.6% of the patients with controlled blood pressure and 9.1% in patients with uncontrolled blood pressure. Adherence in prescribing ACEIs in patients with a comorbidity of DM was documented in 70% of participants. Microalbumin levels were ordered in 15.2% of participants. Laboratory adherence prior to prescribing medications was documented in 0% of the patients and biannual routine labs were documented in 65% of participants. Conclusion. Provider adherence overall was moderate. Despite moderate provider adherence, BP outcomes and provider adherence were not related. Contributing factors that may explain this lack of correlation include patient barriers such as nonadherence to medication and lifestyle modification recommendations and lack of adequate follow-up. Further research is warranted. PMID:26550489

  12. National Institutes of Health: Mixed waste minimization and treatment

    SciTech Connect

    1995-08-01

    The Appalachian States Low-Level Radioactive Waste Commission requested the US Department of Energy`s National Low-Level Waste Management Program (NLLWMP) to assist the biomedical community in becoming more knowledgeable about its mixed waste streams, to help minimize the mixed waste stream generated by the biomedical community, and to identify applicable treatment technologies for these mixed waste streams. As the first step in the waste minimization process, liquid low-level radioactive mixed waste (LLMW) streams generated at the National Institutes of Health (NIH) were characterized and combined into similar process categories. This report identifies possible waste minimization and treatment approaches for the LLMW generated by the biomedical community identified in DOE/LLW-208. In development of the report, on site meetings were conducted with NIH personnel responsible for generating each category of waste identified as lacking disposal options. Based on the meetings and general waste minimization guidelines, potential waste minimization options were identified.

  13. Guidelines for diagnosis, prevention and treatment of hand eczema--short version.

    PubMed

    Diepgen, Thomas L; Andersen, Klaus E; Chosidow, Oliver; Coenraads, Peter Jan; Elsner, Peter; English, John; Fartasch, Manigé; Gimenez-Arnau, Ana; Nixon, Rosemary; Sasseville, Denis; Agner, Tove

    2015-01-01

    The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in "head-to-head" RCTs are needed. The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany). No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest. PMID:25640512

  14. Treatment of steroid-resistant nephrotic syndrome in children: new guidelines from KDIGO.

    PubMed

    Lombel, Rebecca M; Hodson, Elisabeth M; Gipson, Debbie S

    2013-03-01

    Kidney Disease: Improving Global Outcomes (KDIGO) recently published the clinical practice guideline on glomerulonephritis (GN) to assist the practitioner caring for patients with GN. Chapter 4 of the guideline focuses on managing children aged 1-18 years with steroid-resistant nephrotic syndrome (SRNS), defined by an inability to achieve complete remission with corticosteroid therapy. Guideline development followed a thorough evidence review, and management recommendations and suggestions were based on the best available evidence. Limitations of the evidence, including the paucity of large-scale randomized controlled trials, are discussed. This article provides both the guideline recommendations and a brief review of relevant treatment trials related to each recommendation. This précis serves as a summary of the complete guidelines recently published. PMID:23052648

  15. [A decade of National Curriculum Guidelines for Graduation in Nursing: advances and challenges].

    PubMed

    Fernandes, Josicelia Dumêt; Rebouças, Lyra Calhau

    2013-09-01

    The Curriculum Guidelines of the Undergraduate Nursing are references to the strengthening of the changes in training of professionals critics and committed to health. Seeking to identify these changes, this study aimed to analyze the progress and challenges of a decade of these Guidelines. This is a documentary research, in which it was analyzed the Law of Guidelines and Bases of National Education, the CNE / CES Resolution n º 03/2001, and the Brazilian intellectual production on the theme in the decade of 2001 to 2011. This production was sought in scientific journals, through the data bases BDENF, SciELO and LILACS. The analysis was anchored on the methodological framework of the dialectic which provided the study of the subject in its dynamism, contradictions and all of its inclusion in public policy. The results showed improvements in the strengthening of change in nursing education, in line with the policies of education and health. PMID:24092316

  16. NICE to HELP: operationalizing National Institute for Health and Clinical Excellence guidelines to improve clinical practice.

    PubMed

    Yue, Jirong; Tabloski, Patricia; Dowal, Sarah L; Puelle, Margaret R; Nandan, Rakesh; Inouye, Sharon K

    2014-04-01

    The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom developed guidelines for the diagnosis, prevention, and management of delirium in July 2010 that included 10 recommendations for delirium prevention. The Hospital Elder Life Program (HELP) is a targeted multicomponent strategy that has proven effective and cost-effective at preventing functional and cognitive decline in hospitalized older persons. HELP provided much of the basis for seven of the NICE recommendations. Given interest by new HELP sites to meet NICE guidelines, three new protocols addressing hypoxia, infection, and pain that were not previously included in the HELP program were developed. In addition, the NICE dehydration guideline included constipation, which was not specifically addressed in the HELP protocols. This project describes the systematic development of three new protocols (hypoxia, infection, pain) and the expansion of an existing HELP protocol (constipation and dehydration) to achieve alignment between the HELP protocols and NICE guidelines. Following the Institute of Medicine recommendations for developing trustworthy guidelines, an interdisciplinary group of experts conducted a systematic review of current literature, rated the quality of the evidence, developed intervention protocols based on the highest-quality evidence, and submitted the protocols first to internal review and then to external review by an interdisciplinary panel of experts. The protocols were revised based on the review process and incorporated into the HELP materials. Inclusion of these protocols enhances the scope of the HELP program and allows fulfillment of NICE guideline recommendations for delirium prevention. The rigorous process applied may provide a useful example for updating existing guidelines or protocols that may be applicable to a broad range of clinical applications. PMID:24697606

  17. Guideline Conformity Treatment in Young Women with Early-Onset Breast Cancer in Germany

    PubMed Central

    Pursche, Telja; Hedderich, Marianne; Heinrichs, Alessa; Baumann, Kristin; Banz-Jansen, Constanze; Rody, Achim; Waldmann, Annika; Fischer, Dorothea

    2014-01-01

    Summary Background The purpose of the study was to characterize the treatment of young mothers with breast cancer in Germany and to investigate whether it followed applicable guidelines. Method Retrospective data obtained between 2002 and 2011 for 1,053 mothers with children of < 12 years of age with adjuvantly treated loco-regional primary breast cancer were analyzed. Collected data included sociodemographic data, TNM stage, biology of tumor and therapies. Actually received therapies were compared to those suggested in guideline treatment plans. Results The mean age of the patients was 39 years. 97% of the women with node positivity received an axillary dissection. Overall, 90% of the patients received chemotherapy with a guideline adherence range of 87–99% depending on clinical parameters. For radiation therapy, guideline adherence was high (range 82–100%). 95% of the patients with a hormone receptor-positive tumor received endocrine therapy; in 94%, tamoxifen therapy was performed in compliance with guidelines, whereas gonadotropin-releasing hormone (GnRH) agonist therapy complied with the guidelines in 52% of the cases. Conclusion Guideline adherence in young mothers with breast cancer in Germany was high (with the exception of GnRH therapy), as comorbidity or the ambiguity of the therapeutic success does not need to be considered as much in this young, otherwise usually healthy, cohort compared to an age-heterogeneous group. PMID:25759616

  18. Wilderness Medical Society practice guidelines for the prevention and treatment of acute altitude illness: 2014 update.

    PubMed

    Luks, Andrew M; McIntosh, Scott E; Grissom, Colin K; Auerbach, Paul S; Rodway, George W; Schoene, Robert B; Zafren, Ken; Hackett, Peter H

    2014-12-01

    To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for prevention and treatment of acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. These guidelines present the main prophylactic and therapeutic modalities for each disorder and provide recommendations about their role in disease management. Recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens according to criteria put forth by the American College of Chest Physicians. The guidelines also provide suggested approaches to prevention and management of each disorder that incorporate these recommendations. This is an updated version of the original WMS Consensus Guidelines for the Prevention and Treatment of Acute Altitude Illness published in Wilderness & Environmental Medicine 2010;21(2):146-155. PMID:25498261

  19. 2015 UK national guideline for the management of infection with Chlamydia trachomatis.

    PubMed

    Nwokolo, Nneka C; Dragovic, Bojana; Patel, Sheel; Tong, Cy William; Barker, Gary; Radcliffe, Keith

    2016-03-01

    This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of Chlamydia trachomatis genital infection. It covers the management of the initial presentation, as well the prevention of transmission and future infection. The guideline is aimed at individuals aged 16 years and older presenting to healthcare professionals working in departments offering Level 3 care in sexually transmitted infections management within the UK. However, the principles of the recommendations should be adopted across all levels, using local care pathways where appropriate. PMID:26538553

  20. Mass casualty triage: an evaluation of the science and refinement of a national guideline.

    PubMed

    Lerner, E Brooke; Cone, David C; Weinstein, Eric S; Schwartz, Richard B; Coule, Phillip L; Cronin, Michael; Wedmore, Ian S; Bulger, Eileen M; Mulligan, Deborah Ann; Swienton, Raymond E; Sasser, Scott M; Shah, Umair A; Weireter, Leonard J; Sanddal, Teri L; Lairet, Julio; Markenson, David; Romig, Lou; Lord, Gregg; Salomone, Jeffrey; O'Connor, Robert; Hunt, Richard C

    2011-06-01

    Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed. PMID:21685309

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

    PubMed Central

    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

    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

  2. An evidence-based approach to the development of national dietary guidelines.

    PubMed

    Cooper, Marcia Janet; Zlotkin, Stanley Howard

    2003-12-01

    It has become apparent that confusing and conflicted nutritional advice from the media in combination with a quick reversal of policymakers' national nutrition recommendations have the potential to lead to public disbelief and cynicism for both the process and the conclusions. Consequently, poor design of policy can lead to ineffective communications with health professionals and the public. The ultimate result is that the public will ignore the recommendations with potentially adverse outcomes. Formal evidence-based clinical practice guidelines are being used regularly in the medical community. The methodology used to develop these guidelines includes a systematic review of the literature, filtering the literature for relevant articles, assessing the scientific quality of the available evidence, and rating the strength or weakness of the final recommendation. This article suggests that national dietary guidelines may be improved if they are based on a more formal evidence-based approach. Current research that is being conducted to test components of a generic, standardized methodology for developing evidence-based population targeted dietary guidelines is described. PMID:14666497

  3. Obesity Before, During, and After Pregnancy: A Review and Comparison of Five National Guidelines.

    PubMed

    Kominiarek, Michelle A; Chauhan, Suneet P

    2016-04-01

    Objective This study aims to compare how national guidelines approach the management of obesity in reproductive age women. Study Design We conducted a search for national guidelines in the English language on the topic of obesity surrounding the time of a pregnancy. We identified six primary source documents and several secondary source documents from five countries. Each document was then reviewed to identify: (1) statements acknowledging increased health risks related to obesity and reproductive outcomes, (2) recommendations for the management of obesity before, during, or after pregnancy. Results All guidelines cited an increased risk for miscarriage, birth defects, gestational diabetes, hypertension, fetal growth abnormalities, cesarean sections, difficulty with anesthesia, postpartum hemorrhage, and obesity in offspring. Counseling on the risks of obesity and weight loss before pregnancy were universal recommendations. There were substantial differences in the recommendations pertaining to gestational weight gain goals, nutrient and vitamin supplements, screening for gestational diabetes, and thromboprophylaxis among the guidelines. Conclusion Stronger evidence from randomized trials is needed to devise consistent recommendations for obese reproductive age women. This research may also assist clinicians in overcoming one of the many obstacles they encounter when providing care to obese women. PMID:26588260

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

    ERIC Educational Resources Information Center

    World Health Organization, Geneva (Switzerland).

    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

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

    ERIC Educational Resources Information Center

    World Health Organization, Geneva (Switzerland).

    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…

  6. Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment

    ERIC Educational Resources Information Center

    Choate, Laura H.; Gintner, Gary G.

    2011-01-01

    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

  7. Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment

    ERIC Educational Resources Information Center

    Choate, Laura H.; Gintner, Gary G.

    2011-01-01

    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…

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

    PubMed

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

    2014-01-01

    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

  9. Seom guidelines for the treatment of gastric cancer 2015.

    PubMed

    Martin-Richard, M; Custodio, A; García-Girón, C; Grávalos, C; Gomez, C; Jimenez-Fonseca, P; Manzano, J L; Pericay, C; Rivera, F; Carrato, A

    2015-12-01

    Gastric cancer is the fourth cause of death by cancer in Spain and a significant medical problem. Molecular biology results evidence that gastroesophageal junction tumors and gastric cancer should be considered as two independent entities with a different prognosis and treatment approach. Endoscopic resection in very early tumors is feasible. Neoadjuvant and adjuvant therapy in locally advanced resectable tumor increase overall survival and should be considered standard treatments. In stage IV tumors, platinum-fluoropyrimidine-based schedule, with trastuzumab in HER2-overexpressed tumors, is the first-line treatment. Different therapies in second line have demonstrated in randomized studies their clear benefit in survival improvement. PMID:26691658

  10. Executive Summary: Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children: Recommendations From the National Institutes of Health, the Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics.

    PubMed

    Siberry, George K; Abzug, Mark J; Nachman, Sharon

    2013-12-01

    The Guidelines for the Prevention and Treatment of Opportunistic Infections (OIs) in HIV-Exposed and HIV-Infected Children in the United States were developed by a panel of specialists in pediatric HIV infection and infectious diseases from the U.S. government and academic institutions, intended for use by clinicians and health care workers providing medical care for HIV-exposed and HIV-infected children in the United States. For each OI, pediatric specialists with subject matter expertise reviewed the literature for new information since the last guidelines were published (2009) and then proposed revised recommendations that were reviewed and approved by the full Panel and endorsing governmental agencies and professional organizations. This executive summary highlights the most important, rated recommendations for each OI from the full Guidelines document. PMID:26619492

  11. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    SciTech Connect

    Baldini, Elizabeth H.; Wang, Dian; Haas, Rick L.M.; Catton, Charles N.; Indelicato, Daniel J.; Kirsch, David G.; Roberge, David; Salerno, Kilian; Deville, Curtiland; Guadagnolo, B. Ashleigh; O'Sullivan, Brian; Petersen, Ivy A.; Le Pechoux, Cecile; Abrams, Ross A.; DeLaney, Thomas F.

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy and toxicity.

  12. Brazilian guidelines for the diagnosis and treatment of hereditary angioedema

    PubMed Central

    Giavina-Bianchi, Pedro; França, Alfeu T.; Grumach, Anete S.; Motta, Abílio A.; Fernandes, Fátima R.; Campos, Regis A.; Valle, Solange O.; Rosário, Nelson A.; Solé, Dirceu

    2011-01-01

    Hereditary angioedema is an autosomal dominant disease characterized by edema attacks with multiple organ involvement. It is caused by a quantitative or functional deficiency of the C1 inhibitor, which is a member of the serine protease inhibitor family. Hereditary angioedema is unknown to many health professionals and is therefore an underdiagnosed disease. The causes of death from hereditary angioedema include laryngeal edema with asphyxia. The estimated mortality rate in patients in whom the disease goes undetected and who are therefore incorrectly treated is 25-40%. In addition to edema of the glottis, hereditary angioedema often results in edema of the gastrointestinal tract, which can be incapacitating. Patients with hereditary angioedema may undergo unnecessary surgical interventions because the digestive tract can be the primary or only organ system involved, thus mimicking acute surgical abdomen. It is estimated that patients with hereditary angioedema experience some degree of disability 20-100 days per year. The Experts in Clinical Immunology and Allergy of the “Associação Brasileira de Alergia e Imunopatologia - ASBAI” developed these guidelines for the diagnosis, therapy, and management of hereditary angioedema. PMID:22179171

  13. Commentary: Treatment Guidelines for Child and Adolescent Bipolar Disorder

    ERIC Educational Resources Information Center

    McClellan, Jon

    2005-01-01

    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

  14. Commentary: Treatment Guidelines for Child and Adolescent Bipolar Disorder

    ERIC Educational Resources Information Center

    McClellan, Jon

    2005-01-01

    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…

  15. The Appleton Consensus: suggested international guidelines for decisions to forego medical treatment.

    PubMed Central

    Stanley, J M

    1989-01-01

    Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forego Medical Treatment. The guidelines deal with four specific decision-making circumstances: 1. Five guidelines were created for decisions involving competent patients or patients who have executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom 'no substituted judgement' can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities, given the reality of scarce health resources (1). The term 'physician' is used in the American sense, synonymous with 'medical practitioner'. PMID:2677379

  16. Effectiveness of clinical guidelines for the presumptive treatment of streptococcal pharyngitis in Egyptian children.

    PubMed

    Steinhoff, M C; Abd el Khalek, M K; Khallaf, N; Hamza, H S; el Ayadi, A; Orabi, A; Fouad, H; Kamel, M

    1997-09-27

    In developing country settings without access to bacterial culture and rapid diagnostic tests, the prevention of acute rheumatic fever depends on clinicians' presumptive treatment of streptococcal pharyngitis. This study evaluated the effectiveness of World Health Organization (WHO) acute respiratory infection guidelines in a large pediatric clinic (Abu Reesh Children's Hospital) in Cairo, Egypt. 451 children 2-13 years of age with sore throat and pharyngeal erythema were enrolled, 107 (24%) of whom had group A beta-hemolytic streptococci on throat culture. Purulent exudate, present in 99 (22%) of these children, was 31% sensitive and 81% specific for a positive culture. The WHO guidelines, which recommend treatment for pharyngeal exudate plus enlarged and tender cervical node, were 12% sensitive and 94% specific. Based on these guidelines, 13 of 107 children with a positive throat culture would correctly receive antibiotics and 323 of 344 with a negative culture would not receive antibiotics. A modified guideline in which exudate or large cervical nodes would indicate antibiotic treatment would be 84% sensitive and 40% specific. With this modification, 90 of 107 children with a positive throat culture would correctly receive antibiotics and 138 out of 344 with a negative culture would not receive treatment. However, additional prospective studies from other regions of Egypt are necessary before modified guidelines are implemented. PMID:9314870

  17. [Guidelines of treatment for bleeding peptic ulcer disease].

    PubMed

    Chung, Il Kwun; Lee, Dong Ho; Kim, Heung Up; Sung, In Kyung; Kim, Jin-Ho

    2009-11-01

    Peptic ulcer (PU) bleeding is the main cause of non-variceal gastrointestinal bleeding. Negative outcomes include re-bleeding and death, and many of the deaths are associated with decompensation of coexisting medical conditions precipitated by acute bleeding event. Accurate analysis of risk for clinical features can help physician to decide treatment modality. Endoscopy can detect bleeding stigmata and perform therapeutic hemostasis. Proton pump inhibitor (PPI) compared with placebo or H2RA reduces mortality following PU bleeding among patients with high-risk endoscopic findings, and reduces re-bleeding rates and surgical intervention. PPI treatment initiated prior to endoscopy in upper gastrointestinal (UGI) bleeding significantly reduces the proportion of patients with stigmata of recent hemorrhage (SRH) at index endoscopy but does not reduce mortality, re-bleeding or the need for surgery. The strategy of giving oral PPI before and after endoscopy, with endoscopic hemostasis for those with major SRH, is likely to be the most cost-effective. The treatment of H. pylori infection was found to be more effective than anti-secretory therapy in preventing recurrent bleeding from PU. H. pylori eradication alone and eradication followed by misoprostol (with switch to PPI, if misoprostol is not tolerated) are the two most cost-effective strategies to prevent ulcer bleeding among H. pylori-infected NSAID users, although the data cannot exclude PPIs also being cost-effective treatment. This review focuses specifically on the current treatment of patients with acute bleeding from a peptic ulcer. PMID:19934611

  18. Treatment of steroid-sensitive nephrotic syndrome: new guidelines from KDIGO.

    PubMed

    Lombel, Rebecca M; Gipson, Debbie S; Hodson, Elisabeth M

    2013-03-01

    The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on glomerulonephritis (GN) is intended to assist the practitioner caring for patients with GN. Two chapters of this guideline focus specifically on nephrotic syndrome in children. Guideline development followed a thorough evidence review, and management recommendations and suggestions were based on the best available evidence. Critical appraisal of the quality of evidence and strength of recommendations followed the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach. Chapters 3 and 4 of the guideline focus on the management of nephrotic syndrome in children aged 1-18 years. Guideline recommendations for children who have steroid-sensitive nephrotic syndrome (SNSS), defined by their response to corticosteroid therapy with complete remission, are addressed here. Recommendations for those with steroid-resistant nephrotic syndrome (SRNS) (i.e., do not achieve complete remission) are discussed in the companion article. Limitations of the evidence, including the paucity of large-scale randomized controlled trials, are discussed. This article provides a short description of the KDIGO process, the guideline recommendations for treatment of SSNS in children and a brief review of relevant treatment trials related to each recommendation. PMID:23052651

  19. Outsourcing water treatment chemicals and equipment -- guidelines for success

    SciTech Connect

    Loretitsch, G.A.; Puckorius, P.R.; Maxwell, R.

    1998-12-31

    Outsourcing of water treatment chemicals, services and related equipment is a technique and process available to end users. Outsourcing enables the use of capital for plant equipment expansion and/or modernization of salable products -- not towards utilities. Outsourcing also enables reduced costs of water treatment chemicals and reduced plant labor for applying controlling and evaluating these chemicals. Today, the water business resembles a sort of market bazaar teeming with all variety of players -- equipment makers, specialty chemical producers, analytical monitoring firms, engineers and consultants, service providers, and system integrators. The industry is made up of a vast range of companies whose only real similarity in many cases is the ultimate goal of providing clean water to their varied markets. In recent years. the overall water treatment marketplace has grown dramatically and was recently estimated at $300 billion worldwide in all categories of water and wastewater treatment companies. One study has estimated that the international market could grow to more than $500 billion within just the next four years. Other reports are somewhat less sanguine and predict slightly smaller market sizes. However, no matter how one analyzes the field. one thing has become clear to all observers - the overall water services industry is a growing business whose true economic significance is gaining wider appreciation. Water markets are often broadly broken down into two key segments: (1) Industrial and process water and wastewater treatment; and (2) municipal potable water delivery and sewage treatment. In a simplistic sense, water markets can be divided into the following categories: (1) Heavy industrial process and high-purity water; (2) Light commercial and industrial water; and (3) Commercial and residential drinking water (point of use and water dispensers).

  20. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update.

    PubMed

    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

    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

  1. Physician Peer Assessments for Compliance with Methadone Maintenance Treatment Guidelines

    ERIC Educational Resources Information Center

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

    2007-01-01

    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

  2. Physician Peer Assessments for Compliance with Methadone Maintenance Treatment Guidelines

    ERIC Educational Resources Information Center

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

    2007-01-01

    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…

  3. The European Society of Human Reproduction and Embryology guideline for the diagnosis and treatment of endometriosis: an electronic guideline implementability appraisal

    PubMed Central

    2011-01-01

    Background Clinical guidelines are intended to improve healthcare. However, even if guidelines are excellent, their implementation is not assured. In subfertility care, the European Society of Human Reproduction and Embryology (ESHRE) guidelines have been inventoried, and their methodological quality has been assessed. To improve the impact of the ESHRE guidelines and to improve European subfertility care, it is important to optimise the implementability of guidelines. We therefore investigated the implementation barriers of the ESHRE guideline with the best methodological quality and evaluated the used instrument for usability and feasibility. Methods We reviewed the ESHRE guideline for the diagnosis and treatment of endometriosis to assess its implementability. We used an electronic version of the guideline implementability appraisal (eGLIA) instrument. This eGLIA tool consists of 31 questions grouped into 10 dimensions. Seven items address the guideline as a whole, and 24 items assess the individual recommendations in the guideline. The eGLIA instrument identifies factors that influence the implementability of the guideline recommendations. These factors can be divided into facilitators that promote implementation and barriers that oppose implementation. A panel of 10 experts from three European countries appraised all 36 recommendations of the guideline. They discussed discrepancies in a teleconference and completed a questionnaire to evaluate the ease of use and overall utility of the eGLIA instrument. Results Two of the 36 guideline recommendations were straightforward to implement. Five recommendations were considered simply statements because they contained no actions. The remaining 29 recommendations were implementable with some adjustments. We found facilitators of the guideline implementability in the quality of decidability, presentation and formatting, apparent validity, and novelty or innovation of the recommendations. Vaguely defined actions, lack of facilities, immeasurable outcomes, and inflexibility within the recommendations formed barriers to implementation. The eGLIA instrument was generally useful and easy to use. However, assessment with the eGLIA instrument is very time-consuming. Conclusions The ESHRE guideline for the diagnosis and treatment of endometriosis could be improved to facilitate its implementation in daily practice. The eGLIA instrument is a helpful tool for identifying obstacles to implementation of a guideline. However, we recommend a concise version of this instrument. PMID:21247418

  4. CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS.

    PubMed

    De Jongh, Ad; Resick, Patricia A; Zoellner, Lori A; van Minnen, Agnes; Lee, Christopher W; Monson, Candice M; Foa, Edna B; Wheeler, Kathleen; Broeke, Erik Ten; Feeny, Norah; Rauch, Sheila A M; Chard, Kathleen M; Mueser, Kim T; Sloan, Denise M; van der Gaag, Mark; Rothbaum, Barbara Olasov; Neuner, Frank; de Roos, Carlijn; Hehenkamp, Lieve M J; Rosner, Rita; Bicanic, Iva A E

    2016-05-01

    According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase-based approach is needed. As reviewed in this paper, the research supporting the need for phase-based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase-based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front-line trauma-focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma-focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence-based treatments from which they might profit. PMID:26840244

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

    ERIC Educational Resources Information Center

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

    2003-01-01

    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…

  6. Financial Policies for Education in the "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)"

    ERIC Educational Resources Information Center

    Liansheng, Yuan

    2012-01-01

    The "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)" (hereafter abbreviated as the "Guideline"), formulated by the Chinese Communist Party Central Committee and the State Council, posits the basic completion of the modernization of China's education and other development targets by 2020. As measures to…

  7. [Guidelines for the diagnosis, treatment and management of mastocytosis].

    PubMed

    De la Hoz, B; González de Olano, D; Alvarez, I; Sánchez, L; Núñez, R; Sánchez, I; Escribano, L

    2008-01-01

    Mastocytosis consists of a group of disorders characterized by a pathologicincrease in mast cells in tissues including skin, bone marrow, liver, spleen, andlymph nodes. Mastocytosis is a rare disease and general practitioners have limited exposure to its clinical manifestations, diagnosis, classification, and management. Moreover a complete and clear review in this field is not easy founded. Diagnosis of mastocytosis is suspected on clinical grounds and is established by histopathologic examination of involved tissues such as skin and bone marrow. The most common clinical sign of mastocytosis is the presence of typical skin lesions of urticaria pigmentosa. Most patients experience symptoms related to mast cell mediator release, and prevention of the effects of these mediators on tissues constitutes the major therapeutic goal in the management of mastocytosis. Despite recent advances in knowledge about the pathophysiology, diagnosis, and classification of mastocytosis, a curative treatment for mastocytosis does not now exist; furthermore mastocytosis is a chronic diseases with different severity grades but in all of them with an important negative impact on quality of live of patients. Management of patients within all categories of mastocytosis includes: 1. A careful counselling of patients (parents in paediatric cases) and care providers. 2. Avoidance of factors triggering acute mediator release. 3. Treatment of acute mast cell mediator release. 4. Treatment of chronic mast cell mediator release, and if indicated. 5. An attempt to treat organ infiltration by mast cells. The goal of this review is to provide a practical guide focus on diagnostic criteria for the different treatment options currently available and their management. PMID:18496577

  8. Diagnosis and treatment of acromegaly and its complications: consensus guidelines.

    PubMed

    Bonadonna, S; Doga, M; Gola, M; Mazziotti, G; Giustina, A

    2005-01-01

    In February 1999, May 2000 and April 2002, three workshops were held in Cortina, Montecarlo and Versailles, respectively, to develop a consensus defining the diagnosis and treatment of acromegaly and its complications. The workshops were sponsored by the Pituitary Society and European Neuroendocrine Association. Invited international participants included endocrinologists, neurosurgeons and radiotherapists skilled in the management of acromegaly. This review paper summarizes the main points of the three consensus statements published following these three workshops. PMID:16625844

  9. [Technical guidelines for the prevention and treatment of chikungunya fever].

    PubMed

    Barrera-Cruz, Antonio; Díaz-Ramos, Rita Delia; Viniegra-Osorio, Arturo; Grajales-Muñiz, Concepción; Dávila-Torres, Javier

    2015-01-01

    Chikungunya fever is an emerging disease caused by an alphavirus belonging to the Togaviridae family, transmitted by the bite of Aedes genus species: Aedesaegypti and Aedesalbopictus. In 2013, PAHO/WHO received confirmation of the first cases of indigenous transmission of chikungunya in the Americas. This disease may be acute, subacute and chronic, affecting all age groups. Following an incubation period from three to seven days, the patient usually begins with a high fever (greater than 39 °C), arthralgia, back pain, headache, nausea, vomiting, arthritis, rash, and conjunctivitis (acute phase: 3-10 days). Most patients recover fully, but in some cases, joint involvement may persist chronically and cause discapacity and affect life quality. Serious complications are rare, however, attention must be focused on vulnerable populations (the elderly, children and pregnant women). So far, there is no specific antiviral treatment or effective vaccine, so it is giving priority symptomatic and supportive treatment for the acute phase and make an early diagnosis of atypical and severe forms, and to implement effective prevention and control measures. Given the eco-epidemiological conditions and distribution of vectors in the region of the Americas, the spread of the virus to other countries is likely, so that health professionals should be aware of and identify risk factors and major clinical manifestations, allow timely prevention and safe and effective treatment of this disease. PMID:25680650

  10. SEOM guidelines for the treatment of malignant pleural mesothelioma.

    PubMed

    Lianes, Pilar; Remon, Jordi; Bover, Isabel; Isla, Dolores

    2011-08-01

    Mesothelioma is a rare malignant tumour. Asbestos is the principal aetiological agent of malignant pleural mesothelioma (MPM) (?80% of cases). The incidence of MPM is still increasing and will peak within the next 10 years. There are three main histological types of MPM: epithelial (?60%), sarcomatous and mixed. There is no standard approach for patients with MPM. Surgery (radical extra-pleural pneumonectomy or pleurectomy/decortication) may be part of the initial treatment for carefully selected patients, generally combined with neoadjuvant or adjuvant chemotherapy and/or adjuvant radiotherapy, and should only be performed by experienced thoracic surgeons as part of a multidisciplinary team. Radiotherapy could be used as prophylaxis to reduce the incidence of recurrence at sites of diagnoses or therapeutic instrument insertion, in a multimodal treatment to improve locoregional control and to palliate symptoms. Based on the better compliance of neoadjuvant chemotherapy, lower rate of surgical morbidity and the possibility to select the optimal patients to be submitted to surgery, a neoadjuvant strategy is a better option than adjuvant chemotherapy, although there is no standard optimal sequence and types of treatment for multimodal therapy. In patients with no resectable disease, chemotherapy is the best option with platinum and pemetrexed or raltitrexed. At this time there is no widely approved salvage therapy. PMID:21821492

  11. British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012.

    PubMed

    Williams, Ian; Churchill, Duncan; Anderson, Jane; Boffito, Marta; Bower, Mark; Cairns, Gus; Cwynarski, Kate; Edwards, Simon; Fidler, Sarah; Fisher, Martin; Freedman, Andrew; Geretti, Anna Maria; Gilleece, Yvonne; Horne, Rob; Johnson, Margaret; Khoo, Saye; Leen, Clifford; Marshall, Neal; Nelson, Mark; Orkin, Chloe; Paton, Nicholas; Phillips, Andrew; Post, Frank; Pozniak, Anton; Sabin, Caroline; Trevelion, Roy; Ustianowski, Andrew; Walsh, John; Waters, Laura; Wilkins, Edmund; Winston, Alan; Youle, Mike

    2012-09-01

    The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection with antiretroviral therapy (ART). The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii)support of patients on treatment; (iii) management of patients experiencing virological failure; and (iv) recommendations in specific patient populations where other factors need to be taken into consideration. The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection and at community advocates responsible for promoting the best interests and care of HIV-positive adults. They should be read in conjunction with other published BHIVA guidelines. PMID:22830364

  12. Clinical practice guideline for the diagnosis and treatment of hypophysitis.

    PubMed

    Català Bauset, Miguel; Gilsanz Peral, Alberto; Girbés Borràs, Juan; Zugasti Murillo, Ana; Moreno Esteban, Basilio; Halperin Rabinovich, Irene; Obiols Alfonso, Gabriel; Picó Alfonso, Antonio; Del Pozo Picó, Carlos; Soto Moreno, Alfonso; Torres Vela, Elena; Tortosa Henzi, Frederic; Lucas Morante, Tomás; Páramo Fernández, Concha; Varela da Ousa, César; Villabona Artero, Carles

    2008-01-01

    Hypophysitis are a group of inflammatory lesions affecting the pituitary gland and pituitary stalk. These lesions should be included in the differential diagnosis of sellar masses. There are three types of primary hypophysitis: lymphocytic, granulomatous and xanthomatous. Lymphocytic hypophysitis is the most frequent form of chronic pituitary inflammation and is believed to have an autoimmune origin. This form characteristically affects women during the peripartum, with diverse types of pituitary deficiency, especially ACTH deficiency, and frequently there are other associated autoimmune processes. Lymphocytic hypophysitis can affect the anterior pituitary only, the infundibular stalk and posterior lobe of the pituitary (infundibuloneurohypophysitis), or the entire pituitary (panhypophysitis). Clinically, lymphocytic hypophysitis can manifest with compression symptoms, hypopituitarism, diabetes insipidus or hyperprolactinemia. The imaging technique of choice is magnetic resonance imaging, which helps to characterize the sellar lesion. Treatment includes replacement of the functional pituitary deficiency and the use of corticosteroids, generally at high doses. Surgical treatment is reserved for patients unresponsive to conservative therapy. Granulomatous hypophysitis can be of known etiology, whether infectious (currently highly infrequent) or non-infectious (ruptured Rathke's cyst, etc.). Granulomatous hypophysitis of unknown etiology is manifested by the presence of idiopathic granulomas. Xanthomatous hypophysitis is characterized by a histiocytic infiltrate with cystic characteristics on imaging. Secondary hypophysitis is due to pituitary inflammation caused by surrounding lesions or can form part of systemic diseases. PMID:22967850

  13. Low Concordance With Guidelines for Treatment of Acute Cystitis in Primary Care

    PubMed Central

    Grigoryan, Larissa; Zoorob, Roger; Wang, Haijun; Trautner, Barbara W.

    2015-01-01

    Background. The updated 2010 Infectious Diseases Society of America guidelines recommended 3 first-line therapies for uncomplicated cystitis: nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), and fosfomycin, while fluoroquinolones (FQs) remained as second-line agents. We assessed guideline concordance for antibiotic choice and treatment duration after introduction of the updated guidelines and studied patient characteristics associated with prescribing of specific antibiotics and with treatment duration. Methods. We used the Epic Clarity database (electronic medical record system) to identify all female patients aged ≥18 years with uncomplicated cystitis in 2 private family medicine clinics in the period of 2011–2014. For each eligible visit, we extracted type of antibiotic prescribed, duration of treatment, and patient and visit characteristics. Results. We included 1546 visits. Fluoroquinolones were the most common antibiotic class prescribed (51.6%), followed by nitrofurantoin (33.5%), TMP-SMX (12.0%), and other antibiotics (3.2%). A significant trend occurred toward increasing TMP-SMX and toward decreasing nitrofurantoin use. The duration of most prescriptions for TMP-SMX, nitrofurantoin, and FQs was longer than guidelines recommendations (longer durations were prescribed for these agents in 82%, 73%, and 71% of the prescriptions, respectively). No patient or visit characteristic was associated with use of specific antibiotics. Older age and presence of diabetes were independently associated with longer treatment duration. Conclusions. We found low concordance with the updated guidelines for both the choice of drug and duration of therapy for uncomplicated cystitis in primary care. Identifying barriers to guideline adherence and designing interventions to decrease overuse of FQs may help preserve the antimicrobial efficacy of these important antimicrobials. PMID:26753168

  14. Low Concordance With Guidelines for Treatment of Acute Cystitis in Primary Care.

    PubMed

    Grigoryan, Larissa; Zoorob, Roger; Wang, Haijun; Trautner, Barbara W

    2015-12-01

    Background.  The updated 2010 Infectious Diseases Society of America guidelines recommended 3 first-line therapies for uncomplicated cystitis: nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), and fosfomycin, while fluoroquinolones (FQs) remained as second-line agents. We assessed guideline concordance for antibiotic choice and treatment duration after introduction of the updated guidelines and studied patient characteristics associated with prescribing of specific antibiotics and with treatment duration. Methods.  We used the Epic Clarity database (electronic medical record system) to identify all female patients aged ≥18 years with uncomplicated cystitis in 2 private family medicine clinics in the period of 2011-2014. For each eligible visit, we extracted type of antibiotic prescribed, duration of treatment, and patient and visit characteristics. Results.  We included 1546 visits. Fluoroquinolones were the most common antibiotic class prescribed (51.6%), followed by nitrofurantoin (33.5%), TMP-SMX (12.0%), and other antibiotics (3.2%). A significant trend occurred toward increasing TMP-SMX and toward decreasing nitrofurantoin use. The duration of most prescriptions for TMP-SMX, nitrofurantoin, and FQs was longer than guidelines recommendations (longer durations were prescribed for these agents in 82%, 73%, and 71% of the prescriptions, respectively). No patient or visit characteristic was associated with use of specific antibiotics. Older age and presence of diabetes were independently associated with longer treatment duration. Conclusions.  We found low concordance with the updated guidelines for both the choice of drug and duration of therapy for uncomplicated cystitis in primary care. Identifying barriers to guideline adherence and designing interventions to decrease overuse of FQs may help preserve the antimicrobial efficacy of these important antimicrobials. PMID:26753168

  15. A Dutch guideline for the treatment of scoliosis in neuromuscular disorders

    PubMed Central

    Mullender, MG; Blom, NA; De Kleuver, M; Fock, JM; Hitters, WMGC; Horemans, AMC; Kalkman, CJ; Pruijs, JEH; Timmer, RR; Titarsolej, PJ; Van Haasteren, NC; Jager, MJ Van Tol-de; Van Vught, AJ; Van Royen, BJ

    2008-01-01

    Background Children with neuromuscular disorders with a progressive muscle weakness such as Duchenne Muscular Dystrophy and Spinal Muscular Atrophy frequently develop a progressive scoliosis. A severe scoliosis compromises respiratory function and makes sitting more difficult. Spinal surgery is considered the primary treatment option for correcting severe scoliosis in neuromuscular disorders. Surgery in this population requires a multidisciplinary approach, careful planning, dedicated surgical procedures, and specialized after care. Methods The guideline is based on scientific evidence and expert opinions. A multidisciplinary working group representing experts from all relevant specialties performed the research. A literature search was conducted to collect scientific evidence in answer to specific questions posed by the working group. Literature was classified according to the level of evidence. Results For most aspects of the treatment scientific evidence is scarce and only low level cohort studies were found. Nevertheless, a high degree of consensus was reached about the management of patients with scoliosis in neuromuscular disorders. This was translated into a set of recommendations, which are now officially accepted as a general guideline in the Netherlands. Conclusion In order to optimize the treatment for scoliosis in neuromuscular disorders a Dutch guideline has been composed. This evidence-based, multidisciplinary guideline addresses conservative treatment, the preoperative, perioperative, and postoperative care of scoliosis in neuromuscular disorders. PMID:18822133

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

    PubMed

    Persson, M; Bohlin, J; Eklund, P

    2000-03-01

    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

  17. [Clinical practice guideline. Diagnosis and treatment of postmenopausal and perinemopausia].

    PubMed

    Alvarado-García, Alberto; Hernández-Quijano, Tomás; Hernández-Valencia, Marcelino; Negrín-Pérez, Miriam Concepción; Ríos-Castillo, Brendha; Valencia-Pérez, Gregorio Urbano; Vital-Reyes, Víctor Saúl; Basavilvazo-Rodríguez, María Antonia; Torres-Arreola, Laura Pilar; Ortiz-Luna, Guillermo Federico; Sánchez-Aguirre, Fernando; Montaño-Uscanga, Armando

    2015-01-01

    Post-menopause is the period of life where a deep decline occurs in circulating estrogen levels, inducing the appearance of psycho and somatic symptoms. The classification to understand the chronology of reproductive aging in women (known as STRAW) determines the clinical and endocrine changes contemplating menstrual cycles, symptoms, measurements of FSH, LH, inhibin B, anti-Mullerian hormone , and follicular account. The diagnosis of menopause is established by the absence of menstruation for 12 months or more. The most frequent clinical manifestations of the climacteric syndrome transition to menopause are menstrual disorders, vasomotor symptoms (flushes and/or sweats) and genitourinary manifestations. The assessment of women in the peri- or postmenopause aims to develop: cervicovaginal cytology , lipid profile , serum glucose, basal Mammography at least a year before, pelvic ultrasound, urinalysis, serum TSH, Densitometry in patients older than 60 years if there is no recourse can be applied and FRAX. Drug therapy for the treatment of disorders of the transition to menopause or menopause is divided into: hormone therapy (HT) based estrogens and progestin hormone not being the most recommended the serotonin reuptake inhibitors and norepinephrine, clonidine, gabapentin or veralipride. PMID:25760751

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

    SciTech Connect

    Rand, T.; Uberoi, R.; Cil, B.; Munneke, G.; Tsetis, D.

    2013-02-15

    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.

  19. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines

    PubMed Central

    Dumbreck, Siobhan; Flynn, Angela; Nairn, Moray; Wilson, Martin; Treweek, Shaun; Mercer, Stewart W; Alderson, Phil; Thompson, Alex; Payne, Katherine

    2015-01-01

    Objective To identify the number of drug-disease and drug-drug interactions for exemplar index conditions within National Institute of Health and Care Excellence (NICE) clinical guidelines. Design Systematic identification, quantification, and classification of potentially serious drug-disease and drug-drug interactions for drugs recommended by NICE clinical guidelines for type 2 diabetes, heart failure, and depression in relation to 11 other common conditions and drugs recommended by NICE guidelines for those conditions. Setting NICE clinical guidelines for type 2 diabetes, heart failure, and depression Main outcome measures Potentially serious drug-disease and drug-drug interactions. Results Following recommendations for prescription in 12 national clinical guidelines would result in several potentially serious drug interactions. There were 32 potentially serious drug-disease interactions between drugs recommended in the guideline for type 2 diabetes and the 11 other conditions compared with six for drugs recommended in the guideline for depression and 10 for drugs recommended in the guideline for heart failure. Of these drug-disease interactions, 27 (84%) in the type 2 diabetes guideline and all of those in the two other guidelines were between the recommended drug and chronic kidney disease. More potentially serious drug-drug interactions were identified between drugs recommended by guidelines for each of the three index conditions and drugs recommended by the guidelines for the 11 other conditions: 133 drug-drug interactions for drugs recommended in the type 2 diabetes guideline, 89 for depression, and 111 for heart failure. Few of these drug-disease or drug-drug interactions were highlighted in the guidelines for the three index conditions. Conclusions Drug-disease interactions were relatively uncommon with the exception of interactions when a patient also has chronic kidney disease. Guideline developers could consider a more systematic approach regarding the potential for drug-disease interactions, based on epidemiological knowledge of the comorbidities of people with the disease the guideline is focused on, and should particularly consider whether chronic kidney disease is common in the target population. In contrast, potentially serious drug-drug interactions between recommended drugs for different conditions were common. The extensive number of potentially serious interactions requires innovative interactive approaches to the production and dissemination of guidelines to allow clinicians and patients with multimorbidity to make informed decisions about drug selection. PMID:25762567

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

    PubMed Central

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

    2009-01-01

    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

  1. Pharmacotherapy for acute mania and disconcordance with treatment guidelines: bipolar mania pathway survey (BIPAS) in mainland China

    PubMed Central

    2014-01-01

    Background With the recent attention to evidence-based medicine in psychiatry, a number of treatment guidelines for bipolar disorders have been published. This survey investigated prescribing patterns and predictors for guideline disconcordance in the acute treatment of a manic and mixed episode across mainland China. Methods The pharmacological treatments of 2828 patients with a recent hypomanic/manic episode or mixed state 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. Results The most common pattern of pharmacological treatments for an acute manic or mixed episode was a mood stabilizer plus an atypical antipsychotic (n?=?1345, 47.6%), and the rate of guideline-disconcordant treatments was 11.1%. The patients who were treated in general hospitals were more likely to receive guideline-disconcordant treatments than those who were treated in psychiatric hospitals, with an OR of 1.84 (95% CI 1.44-2.36). Similarly, the patients with a mixed episode at study entry were more likely to receive guideline-disconcordant treatments than those with a manic episode, with an OR of 1.69 (95% CI 1.22-2.35). In contrast, the patients with a longer duration of disease (>5years) were less likely to receive guideline-disconcordant treatments than those with a short duration, with an OR of 0.47 (95% CI 0.36-0.60). Conclusions In mainland China, the disconcordance with treatment guidelines for a most recent acute manic or mixed episode was modest under naturalistic conditions. The higher risk for disconcordance in general hospitals than in psychiatric hospitals suggests that special education based on treatment guidelines to practitioners in general hospitals is necessary in order to reduce the risk for disconcordant treatments. PMID:24903426

  2. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Lung Cancer Screening.

    PubMed

    Wood, Douglas E

    2015-05-01

    The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 25 of the world's leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. The intent of the NCCN Guidelines is to assist in the decision-making process of individuals involved in cancer care-including physicians, nurses, pharmacists, payers, patients, and their families-with the ultimate goal of advancing patient care in the fight against cancer. PMID:25901562

  3. Summary of proposed approach for deriving cleanup guidelines for radionuclides in soil at Brookhaven National Laboratory

    SciTech Connect

    Meinhold, A.F.; Morris, S.C.; Dionne, B.; Moskowitz, P.D.

    1996-11-01

    Past activities at Brookhaven National Laboratory (BNL) resulted in soil and groundwater contamination. As a result, BNL was designated a Superfund site under the Comprehensive Environmental Response Compensation and Liability Act (CERCLA). BNL`s Office of Environmental Restoration (OER) is overseeing environmental restoration activities at the Laboratory, carried out under an Interagency Agreement (IAG) with the United States Department of Energy (DOE), the United States Environmental Protection Agency (EPA) and the New York State Department of Environmental Conservation (NYSDEC). The objective of this paper is to propose a standard approach to deriving risk-based cleanup guidelines for radionuclides in soil at BNL.

  4. Clinical Practice Guideline for Accurate Diagnosis and Effective Treatment of Gastrointestinal Stromal Tumor in Korea

    PubMed Central

    Kim, Kyoung-Mee; Sohn, Taesung; Choi, Dongil; Kang, Hye Jin; Ryu, Min-Hee; Kim, Woo Ho; Yang, Han-Kwang

    2010-01-01

    Despite the rarity in incidence and prevalence, gastrointestinal stromal tumor (GIST) has emerged as a distinct pathogenetic entity. And the clinical management of GIST has been evolving very rapidly due to the recent recognition of its oncogenic signal transduction pathway and the introduction of new molecular-targeted therapy. Successful management of GIST requires a multidisciplinary approach firmly based on accurate histopathologic diagnosis. However, there was no standardized guideline for the management of Korean GIST patients. In 2007, the Korean GIST study group (KGSG) published the first guideline for optimal diagnosis and treatment of GIST in Korea. As the second version of the guideline, we herein have updated recent clinical recommendations and reflected changes in diagnosis, surgical and medical treatments for more optimal clinical practice for GIST in Korea. We hope the guideline can be of help in enhancing the quality of diagnosis by members of the Korean associate of physicians involving in GIST patients's care and subsequently in achieving optimal efficacy of treatment. PMID:21060741

  5. 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

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note... conditions must be given medically indicated treatment, defined in terms of action to respond to the...

  6. 45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note... conditions must be given medically indicated treatment, defined in terms of action to respond to the...

  7. 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

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note... conditions must be given medically indicated treatment, defined in terms of action to respond to the...

  8. Indoor Noise and High Sound LEVELS—A Transcription of the Swedish National Board of Health and Welfare's Guidelines

    NASA Astrophysics Data System (ADS)

    Pettersson, B.

    1997-08-01

    The National Board of Health and Welfare is together with the National Board of Environment responsible for health protection in Sweden on a national level and issues, recommendations or guidelines for environmental factors. The Board of Health and Welfare is responsible for the indoor environment and the Board of Environment is responsible for the outdoor environment. Board guidelines for noise cover indoor noise from different activities in society, except transportation noise. The guidelines for indoor levels are 35-45 dB expressed asLAFmaxfor intermittent noise and 30 dBA expressed asLAqfro continuous noise. Low frequency noise is assessed in one third octave bands with specific dB equivalent pressure levels for each band. The guidelines are intended to be used in situations where the noises come from neighbours, elevators, restaurants and other buildings.

  9. Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment

    PubMed Central

    Kim, Jung Eun; Kim, Hyun Jeong; Lew, Bark-Lynn; Lee, Kyung Ho; Hong, Seung Phil; Jang, Yong Hyun; Park, Kui Young; Seo, Seong Jun; Bae, Jung Min; Choi, Eung Ho; Suhr, Ki Beom; Lee, Seung Chul; Ko, Hyun Chang; Park, Young Lip; Son, Sang Wook; Seo, Young Jun; Lee, Yang Won; Cho, Sang Hyun; Park, Chun Wook

    2015-01-01

    Background Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management. Objective We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD. Methods We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations. Results Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD. Conclusion This report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented. PMID:26512171

  10. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma.

    PubMed

    Weller, Michael; van den Bent, Martin; Hopkins, Kirsten; Tonn, Jörg C; Stupp, Roger; Falini, Andrea; Cohen-Jonathan-Moyal, Elizabeth; Frappaz, Didier; Henriksson, Roger; Balana, Carmen; Chinot, Olivier; Ram, Zvi; Reifenberger, Guido; Soffietti, Riccardo; Wick, Wolfgang

    2014-08-01

    This guideline provides recommendations for diagnostic and therapeutic procedures for patients with malignant gliomas. We differentiate evidence-based standards from reasonable options or non-evidence-based measures that should no longer be considered. The recommendations herein should provide a framework and assurance for the choice of diagnostic procedures and therapeutic measures and aim to reduce complications from unnecessary treatment and cost. The guideline contributes to a critical appreciation of concurrent drugs with a focus on the controlled use of anticonvulsants and steroids. It should serve as a guideline for all professionals involved in the diagnostics and care of glioma patients and also as a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in Europe. Implementation of the recommendations summarised here will need interdisciplinary structures of care for patients with brain tumours and structured processes of diagnostic and therapeutic procedures. PMID:25079102

  11. Cycle chemistry guidelines for fossil plants: All-volatile treatment. Final report

    SciTech Connect

    Dooley, R.B.; Aschoff, A.F.; Pocock, F.J.

    1996-04-01

    The Interim Consensus Guidelines (ICG) for Fossil Plant Cycle Chemistry were introduced in 1986 to provide the guidance needed to better control cycle corrosion and deposition. The ICG were considered interim; they would be reviewed over the next several years in the light of subsequent research and operating experience in implementing these Guidelines, and then revised as necessary. The guidelines provide a set of target values and action levels for the critical sample points throughout the water and steam cycle for drum and once-through units, covering a pressure range of 600--3,600 psi. In specific, the guidelines--which are applicable to baseload, startup, cycling, and peaking operation--discuss corrective actions to be taken when the guideline limits are exceeded as well as sampling, instrumentation, and monitoring issues. Moreover, for the first time, the guidelines address conversion of a drum boiler to AVT as well as procedures for reacting to contaminant ingress. The major philosophy changes from the ICG involve relaxing the feedwater oxygen limits for all-ferrous feedwater systems, indicating that at least one ppb of oxygen should be present at the economizer inlet and that perhaps an oxygen scavenger is not required. For units with mixed metallurgy feedwater systems, the optimum treatment involves maintaining a reducing environment with an oxygen scavenger. Wherever possible, the guidelines have been organized in tabular and graphical form to facilitate use and present information logically and clearly. Sample points, monitoring parameters, target values, and action levels have been summarized on the familiar single generic-cycle diagrams used in the ICG; these may be modified, as appropriate, and permanently displayed at key locations in each plant.

  12. Treatment and prevention of Mycobacterium ulcerans infection (Buruli ulcer) in Australia: guideline update.

    PubMed

    O'Brien, Daniel P; Jenkin, Grant; Buntine, John; Steffen, Christina M; McDonald, Anthony; Horne, Simon; Friedman, N Deborah; Athan, Eugene; Hughes, Andrew; Callan, Peter P; Johnson, Paul D R

    2014-03-17

    Guidelines reflecting contemporary clinical practice in the management of Buruli ulcer (Mycobacterium ulcerans infection) in Australia were published in 2007. • Management has continued to evolve, as new evidence has become available from randomised trials, case series and increasing clinical experience with oral antibiotic therapy. • Therefore, guidelines on the diagnosis, treatment and prevention of Buruli ulcer in Australia have been updated. They include guidance on the new role of antibiotics as first-line therapy; the shortened duration of antibiotic treatment and the use of all-oral antibiotic regimens; the continued importance, timing and role of surgery; the recognition and management of paradoxical reactions during antibiotic treatment; and updates on the prevention of disease. PMID:24641151

  13. Economic analysis of effluent limitation guidelines and standards for the centralized waste treatment industry

    SciTech Connect

    Wheeler, W.

    1998-12-01

    This report estimates the economic and financial effects and the benefits of compliance with the proposed effluent limitations guidelines and standards for the Centralized Waste Treatment (CWT) industry. The Environmental Protection Agency (EPA) has measured these impacts in terms of changes in the profitability of waste treatment operations at CWT facilities, changes in market prices to CWT services, and changes in the quantities of waste management at CWT facilities in six geographic regions. EPA has also examined the impacts on companies owning CWT facilities (including impacts on small entities), on communities in which CWT facilities are located, and on environmental justice. EPA examined the benefits to society of the CWT effluent limitations guidelines and standards by examining cancer and non-cancer health effects of the regulation, recreational benefits, and cost savings to publicly owned treatment works (POTWs) to which indirect-discharging CWT facilities send their wastewater.

  14. Saudi guidelines on the diagnosis and treatment of pulmonary hypertension: 2014 updates

    PubMed Central

    Idrees, Majdy M.; Saleemi, Sarfraz; Azem, M Ali; Aldammas, Saleh; Alhazmi, Manal; Khan, Javid; Gari, Abdulgafour; Aldabbagh, Maha; Sakkijha, Husam; Aldalaan, Abdulla; Alnajashi, Khalid; Alhabeeb, Waleed; Nizami, Imran; Kouatli, Amjad; Chehab, May; Tamimi, Omar; Banjar, Hanaa; Kashour, Tarek; Lopes, Antonio; Minai, Omar; Hassoun, Paul; Pasha, Qadar; Mayer, Eckhard; Butrous, Ghazwan; Bhagavathula, Sastry; Ghio, Stefano; Swiston, John; Boueiz, Adel; Tonelli, Adriano; Levy, Robert D.

    2014-01-01

    The Saudi Association for Pulmonary Hypertension (previously called Saudi Advisory Group for Pulmonary Hypertension) has published the first Saudi Guidelines on Diagnosis and Treatment of Pulmonary Arterial Hypertension back in 2008.[1] That guideline was very detailed and extensive and reviewed most aspects of pulmonary hypertension (PH). One of the disadvantages of such detailed guidelines is the difficulty that some of the readers who just want to get a quick guidance or looking for a specific piece of information might face. All efforts were made to develop this guideline in an easy-to-read form, making it very handy and helpful to clinicians dealing with PH patients to select the best management strategies for the typical patient suffering from a specific condition. This Guideline was designed to provide recommendations for problems frequently encountered by practicing clinicians involved in management of PH. This publication targets mainly adult and pediatric PH-treating physicians, but can also be used by other physicians interested in PH. PMID:25076987

  15. Treatment of Community-Acquired Pneumonia in Adults: Analysis of the National Dispensing Database.

    PubMed

    Matuz, Maria; Bognar, Julia; Hajdu, Edit; Doro, Peter; Bor, Andrea; Viola, Reka; Soos, Gyongyver; Benko, Ria

    2015-11-01

    Crude national ambulatory antibiotic dispensing data (2007-2011) of adult patients (aged between 20 and below 65 years) with CAP were obtained and expressed as DDD per 1000 inhabitants and per day (DID). European quality indicators of antibiotic prescribing were calculated and adherence rate to the national CAP guideline was assessed. Antibiotic use for CAP in adults ranged between 0.27 and 0.30 DID in various years. The most frequently used antibacterials were levofloxacin, co-amoxiclav and clarithromycin. Antibiotic use in CAP was compliant with the European recommendations in 6.4% in 2007, which decreased to 4.9% by 2011, in contrast to the optimal compliant range of 80-100%. The consumption of fluoroquinolones mounted up to ~40% in both genders, which exceeded the recommended range (0-5%) substantially. National guideline also favoured the use of macrolides in the empiric therapy of CAP in otherwise healthy adults; hence, guideline-concordant antibiotic use ranged between 24.0-32.3%. Agents that were contra-indicated in the empiric therapy of CAP were also used in 6.5-9.0% in various years. These data reflect some worrisome figures and trends in the outpatient antibiotic treatment of adults with CAP. Clarified and updated national guidelines focusing on outpatients and incentives/regulations to increase guideline concordance are warranted. PMID:26046802

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

    PubMed

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

    2013-01-01

    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

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

    PubMed Central

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

    2013-01-01

    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

  18. Failure to follow evidence-based best practice guidelines in the treatment of severe acute pancreatitis

    PubMed Central

    Vlada, Adrian C; Schmit, Bradley; Perry, Andrew; Trevino, Jose G; Behrns, Kevin E; Hughes, Steven J

    2013-01-01

    Objectives Evidence-based guidelines for the treatment of severe acute pancreatitis have been established. This study was conducted to investigate the hypothesis that deviation from guidelines occurs frequently. Methods With institutional review board approval, the outside medical records of patients with severe pancreatitis who were transferred to the study institution during the period from July 2005 to May 2012 were reviewed. Severe pancreatitis was defined using the Atlanta Classification criteria. Records were reviewed with respect to published guidelines defining the appropriate use of imaging, antibiotics and nutritional support. Results A total of 538 patients with acute pancreatitis were identified. Of 67 patients with severe acute pancreatitis, 44 (66%) were male. The mean age of the patients was 55 years. Forty-five of 61 (74%) patients for whom relevant data were available were imaged upon admission, but only 15 (31%) patients were imaged appropriately by computerized tomography with i.v. contrast to assess the presence of necrosis or other complications. In patients for whom relevant data were available, prophylactic antibiotics were initiated in the absence of culture data or a specific infectious target in 26 (53%) patients. Total parenteral nutrition (TPN) was administered to 38 (60%) of 63 patients for whom relevant data were available; only 10 (17%) patients received enteric feeding. No nutritional support was provided to 15 (23%) patients. Conclusions Adherence to best practice guidelines in the treatment of severe pancreatitis is poor. The consistent application of current knowledge might improve outcomes in these patients. PMID:24028271

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

    PubMed Central

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

    2014-01-01

    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

  20. SEOM clinical guidelines for diagnosis and treatment of metastatic colorectal cancer 2015.

    PubMed

    Aranda, E; Aparicio, J; Alonso, V; Garcia-Albeniz, X; Garcia-Alfonso, P; Salazar, R; Valladares, M; Vera, R; Vieitez, J M; Garcia-Carbonero, R

    2015-12-01

    Colorectal cancer (CRC) is the second leading cause of cancer dead in Spain. About half the patients will eventually develop distant metastases. However, as treatment options are expanding, prognosis has steadily improved over the last decades. Management of advanced CRC should be discussed within an experienced multidisciplinary team to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures when indicated. Disease site and extent, resectability, tumor biology and gene mutations, clinical presentation, patient preferences, and comorbidities are key factors to design a customized treatment plan. The aim of these guidelines is to provide synthetic recommendations for managing advanced CRC patients. PMID:26669312

  1. Comparison of Adherence to Guideline-Based Cholesterol Treatment Goals in Men Versus Women.

    PubMed

    Schoen, Martin W; Tabak, Rachel G; Salas, Joanne; Scherrer, Jeffrey F; Buckhold, Fred R

    2016-01-01

    Studies show women do not receive aggressive cardiovascular interventions and may not be given guideline-based treatment to reduce cardiac events. We describe cholesterol treatment in an academic practice of family and internal medicine physicians to understand factors associated with achievement of guideline-based treatment goals in women compared with men. Primary care patients aged 40 to 75 years were included if they were prescribed a statin, had a Framingham risk score of ≥ 10%, had diabetes, or had atherosclerotic cardiovascular disease. Patients were classified into Adult Treatment Panel III categories and assessed to whether they were in compliance with Adult Treatment Panel III guidelines. Odds ratios of goal adherence between women and men were calculated, and a multivariate model for goal achievement was created. In 2,747 patients, women were less likely to achieve cholesterol goals (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.70 to 0.95) despite having more prescriptions for statins (48% vs 39%, p <0.001). More women than men failed to reach low-density lipoprotein goals because they were not prescribed a statin (OR 0.69; 95% CI 0.56 to 0.85) and women on high-intensity statins were less likely than men to achieve goals (OR 0.51; 95% CI 0.27 to 0.96). In all patients, diabetes was associated with nonattainment of cholesterol goals, but in high-risk women, the presence of diabetes improved goal achievement. In conclusion, women achieved guideline-based cholesterol recommendations at a lower rate than men, even when individual goals are considered. PMID:26589821

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed Central

    Balmaceda, Casilda M

    2014-01-01

    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

  4. Noninvasive Diagnosis of Hepatocellular Carcinoma: Elaboration on Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guidelines Compared with Other Guidelines and Remaining Issues

    PubMed Central

    Yoon, Jeong Hee; Park, Joong-Won

    2016-01-01

    Hepatocellular carcinoma (HCC) can be diagnosed based on characteristic findings of arterial-phase enhancement and portal/delayed "washout" in cirrhotic patients. Several countries and major academic societies have proposed varying specific diagnostic criteria for HCC, largely reflecting the variable HCC prevalence in different regions and ethnic groups, as well as different practice patterns. In 2014, a new version of Korean practice guidelines for management of HCC was released by the Korean Liver Cancer Study Group (KLCSG) and the National Cancer Center (NCC). According to the KLCSG-NCC Korea practice guidelines, if the typical hallmark of HCC (i.e., hypervascularity in the arterial phase with washout in the portal or 3 min-delayed phases) is identified in a nodule ≥ 1 cm in diameter on either dynamic CT, dynamic MRI, or MRI using hepatocyte-specific contrast agent in high-risk groups, a diagnosis of HCC is established. In addition, the KLCSG-NCC Korea practice guidelines provide criteria to diagnose HCC for subcentimeter hepatic nodules according to imaging findings and tumor marker, which has not been addressed in other guidelines such as Association for the Study of Liver Diseases and European Association for the Study of the Liver. In this review, we briefly review the new HCC diagnostic criteria endorsed by the 2014 KLCSG-NCC Korea practice guidelines, in comparison with other recent guidelines; we furthermore address several remaining issues in noninvasive diagnosis of HCC, including prerequisite of sonographic demonstration of nodules, discrepancy between transitional phase and delayed phase, and implementation of ancillary features for HCC diagnosis. PMID:26798212

  5. [S2e guideline of the German urologists : Conservative and pharmacologic treatment of benign prostatic hyperplasia].

    PubMed

    Höfner, K; Bach, T; Berges, R; Dreikorn, K; Gratzke, C; Madersbacher, S; Michel, M-S; Muschter, R; Oelke, M; Reich, O; Tschuschke, C; Bschleipfer, T

    2016-02-01

    This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail. PMID:26518303

  6. Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines.

    PubMed

    Binda, G A; Cuomo, R; Laghi, A; Nascimbeni, R; Serventi, A; Bellini, D; Gervaz, P; Annibale, B

    2015-10-01

    The mission of the Italian Society of Colorectal Surgery (SICCR) is to optimize patient care. Providing evidence-based practice guidelines is therefore of key importance. About the present report it concernes the SICCR practice guidelines for the diagnosis and treatment of diverticular disease of the colon. The guidelines are not intended to define the sole standard of care but to provide evidence-based recommendations regarding the available therapeutic options. PMID:26377584

  7. Implementing tobacco use treatment guidelines in public health dental clinics in New York City.

    PubMed

    Shelley, Donna; Anno, Jaime; Tseng, Tuo-Yen; Calip, Greg; Wedeles, John; Lloyd, Madeleine; Wolff, Mark S

    2011-04-01

    In this study we evaluated the effect of a multicomponent intervention to implement the Public Health Service (PHS) guideline Treating Tobacco Use and Dependence in six randomly selected dental clinics in New York University's College of Dentistry. The main outcome measure-provider adherence to tobacco use treatment guidelines-was assessed by auditing a random selection of patient charts pre (698) and post (641) intervention. The intervention components included a chart reminder and referral system, free nicotine replacement therapy (NRT), and provider training and feedback. The results showed that rates of screening for tobacco use did not change between pre and post test chart audits. However, providers were significantly more likely to offer advice (28.4 percent pre, 49 percent post), assess readiness to quit (17.8 percent pre, 29.9 percent post), and offer assistance (6.5 percent pre and 15.6 percent post) in the post test period. Increases in NRT distribution were associated with booster training sessions but declined in the time periods between those trainings. Research is needed to further define sustainable strategies for implementing tobacco use treatment in dental clinics. The results of this study suggest the feasibility and effectiveness of using a tailored multicomponent approach to implement tobacco use treatment guidelines in dental clinics. PMID:21460273

  8. Evidence-based review of diabetic macular edema management: Consensus statement on Indian treatment guidelines

    PubMed Central

    Das, Taraprasad; Aurora, Ajay; Chhablani, Jay; Giridhar, Anantharaman; Kumar, Atul; Raman, Rajiv; Nagpal, Manish; Narayanan, Raja; Natarajan, Sundaram; Ramasamay, Kim; Tyagi, Mudit; Verma, Lalit

    2016-01-01

    The purpose of the study was to review the current evidence and design a diabetic macular edema (DME) management guideline specific for India. The published DME guidelines from different organizations and publications were weighed against the practice trends in India. This included the recently approved drugs. DME management consisted of control of diabetes and other associated systemic conditions, such as hypertension and hyperlipidemia, and specific therapy to reduce macular edema. Quantification of macular edema is precisely made with the optical coherence tomography and treatment options include retinal laser, intravitreal anti-vascular endothelial growth factors (VEGF), and implantable dexamethasone. Specific use of these modalities depends on the presenting vision and extent of macular involvement. Invariable eyes with center-involving macular edema benefit from intravitreal anti-VEGF or dexamethasone implant therapy, and eyes with macular edema not involving the macula center benefit from retinal laser. The results are illustrated with adequate case studies and frequently asked questions. This guideline prepared on the current published evidence is meant as a guideline for the treating physicians. PMID:26953019

  9. Treatment of overlapping asthma-chronic obstructive pulmonary disease: Can guidelines contribute in an evidence-free zone?

    PubMed

    Reddel, Helen K

    2015-09-01

    In their most typical forms, asthma and chronic obstructive pulmonary disease (COPD) are clearly distinguishable, but many patients with chronic airflow limitation demonstrate features of both conditions and have worse health outcomes than those with either disease alone. This has been called the asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS), but as yet, it lacks a precise definition. However, given the different pathways by which a patient can come to demonstrate features of both asthma and COPD, ACOS is not thought to represent a single disease but to include several heterogeneous phenotypes with different underlying mechanisms. These issues have important implications for guidelines because some existing treatment recommendations for asthma and COPD are in conflict, and patients with both asthma and COPD have specifically been excluded from major pharmacologic trials. As a result, there is little evidence at present to support specific treatment recommendations for ACOS on the basis of efficacy or effectiveness, yet these patients continue to present for diagnosis and management, mainly in primary care. This article highlights the need for clinical guidance about ACOS, summarizes recommendations about its diagnosis and treatment from a sample of national asthma and COPD guidelines, and proposes a way forward, as suggested in a collaborative Global Initiative for Asthma/Global Initiative for Chronic Obstructive Lung Disease report, to provide health professionals with interim recommendations about syndromic recognition and initial treatment based on both potential effectiveness and potential risk. Additional research in broad populations is urgently needed to develop a precise definition for ACOS, characterize its phenotypes, and identify opportunities for targeted treatment. PMID:26343938

  10. Systemic treatment approaches in her2-negative advanced breast cancerguidance on the guidelines

    PubMed Central

    Joy, A.A.; Ghosh, M.; Fernandes, R.; Clemons, M.J.

    2015-01-01

    Despite advancements in the treatment of early-stage breast cancer, many patients still develop disease recurrence; others present with de novo metastatic disease. For most patients with advanced breast cancer, the primary treatment intent is noncurativethat is, palliativein nature. The goals of treatment should therefore focus on maximizing symptom control and extending survival. Treatments should be evaluated on an individualized basis in terms of evidence, but also with full respect for the wishes of the patient in terms of acceptable toxicity. Given the availability of extensive reviews on the roles of endocrine therapy and her2 (human epidermal growth factor receptor 2)targeted therapies for advanced disease, we focus here mainly on treatment guidelines for the non-endocrine management of her2-negative advanced breast cancer in a Canadian health care context. PMID:25848337

  11. Physicians Lack of Adherence to National Heart, Lung, and Blood Institute Guidelines for Pediatric Lipid Screening

    PubMed Central

    Valle, Christopher W.; Binns, Helen J.; Quadri-Sheriff, Maheen; Benuck, Irwin; Patel, Angira

    2015-01-01

    Objectives To determine adherence to the 2011 National Heart, Lung, and Blood Institute lipid screening guidelines and identify patient factors promoting screening. Methods Records of children who received well-child care at age 11 years and turned 12 in 2013 were reviewed. Subjects were stratified by guideline-defined dyslipidemia risk based on documented medical or family history risk factors. We defined adherence as the order of a lipid profile when age 11 years or completed lipid screening at 9 to 10 years. Results Of 298 subjects, 42% were assigned to the dyslipidemia high-risk subgroup. Records of 27.2% demonstrated adherence. Fifty-six percent of high-risk subjects versus 6% of their non-high-risk counterparts received lipid screening by age 12 (P < .001). Among screened subjects, history of obesity and parental history of dyslipidemia were significantly associated with lipid testing. Conclusions Lipid screening rates were low. Strategies to increase lipid screening in the primary care setting are needed. PMID:25813383

  12. A national pilot to implement pressure ulcer guidelines: results of the baseline audit.

    PubMed

    Stephens, Fiona; Bick, Debra

    2002-12-01

    The Royal College of Nursing (RCN) national pilot audit project aims to facilitate the dissemination and implementation of the RCN clinical guideline on pressure ulcer risk assessment and prevention using an evidence-based, tailored strategy. Recent government White Papers reinforced the move towards evidence-based healthcare that includes performance measures, clinical effectiveness and ongoing professional development. Structured dissemination and implementation of the RCN guideline can aid this process by improving patient care, as well as in a culture where more patients are seeking recompense for "poor" care assist in reducing litigation and complaints. This article focuses on the findings of the baseline audit. Providing a summary of the project to date, looking at site recruitment, the provisional results and recommendations of the baseline audit and local initiatives for supporting the ongoing implementation and the implementation resources developed to assist the sites in the process. The project is due for completion at the end of 2002 following which the final results will be published. PMID:12514499

  13. Knowledge and Adherence to the National Guidelines for Malaria Case Management in Pregnancy among Healthcare Providers and Drug Outlet Dispensers in Rural, Western Kenya

    PubMed Central

    Riley, Christina; Dellicour, Stephanie; Ouma, Peter; Kioko, Urbanus; ter Kuile, Feiko O.; Omar, Ahmeddin; Kariuki, Simon; Buff, Ann M.; Desai, Meghna; Gutman, Julie

    2016-01-01

    Background Although prompt, effective treatment is a cornerstone of malaria control, information on provider adherence to malaria in pregnancy (MIP) treatment guidelines is limited. Incorrect or sub-optimal treatment can adversely affect the mother and fetus. This study assessed provider knowledge of and adherence to national case management guidelines for uncomplicated MIP. Methods We conducted a cross-sectional study from September to November 2013, in 51 health facilities (HF) and a randomly-selected sample of 39 drug outlets (DO) in the KEMRI/CDC Health and Demographic Surveillance System area in western Kenya. Provider knowledge of national treatment guidelines was assessed with standardized questionnaires. Correct practice required adequate diagnosis, pregnancy assessment, and treatment with correct drug and dosage. In HF, we conducted exit interviews in all women of childbearing age assessed for fever. In DO, simulated clients posing as first trimester pregnant women or as relatives of third trimester pregnant women collected standardized information. Results Correct MIP case management knowledge and practice were observed in 45% and 31% of HF and 0% and 3% of DO encounters, respectively. The correct drug and dosage for pregnancy trimester was prescribed in 62% of HF and 42% of DO encounters; correct prescription occurred less often in first than in second/ third trimesters (HF: 24% vs. 65%, p<0.01; DO: 0% vs. 40%, p<0.01). Sulfadoxine-pyrimethamine, which is not recommended for malaria treatment, was prescribed in 3% of HF and 18% of DO encounters. Exposure to artemether-lumefantrine in first trimester, which is contraindicated, occurred in 29% and 49% of HF and DO encounters, respectively. Conclusion This study highlights knowledge inadequacies and incorrect prescribing practices in the treatment of MIP. Particularly concerning is the prescription of contraindicated medications in the first trimester. These issues should be addressed through comprehensive trainings and increased supportive supervision. Additional innovative means to improve care should be explored. PMID:26789638

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

    PubMed Central

    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

    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 1.181.97), with a depressive episode (OR?=?1.67, 95% CI 1.272.19) and an older age at first onset (OR?=?1.62, 95% CI 1.152.28) 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 0.240.77), 0.52 (95CI% 0.360.75), 0.48 (95% CI 0.360.65), and 0.50 (95% CI 0.380.64), 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

  15. European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults.

    PubMed

    Bollerslev, Jens; Rejnmark, Lars; Marcocci, Claudio; Shoback, Dolores M; Sitges-Serra, Antonio; van Biesen, Wim; Dekkers, Olaf M

    2015-08-01

    Hypoparathyroidism (HypoPT) is a rare (orphan) endocrine disease with low calcium and inappropriately low (insufficient) circulating parathyroid hormone levels, most often in adults secondary to thyroid surgery. Standard treatment is activated vitamin D analogues and calcium supplementation and not replacement of the lacking hormone, as in other hormonal deficiency states. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of chronic HypoPT in adults who do not have end-stage renal disease. We intend to draft a practical guideline, focusing on operationalized recommendations deemed to be useful in the daily management of patients. This guideline was developed and solely sponsored by The European Society of Endocrinology, supported by CBO (Dutch Institute for Health Care Improvement) and based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles as a methodological base. The clinical question on which the systematic literature search was based and for which available evidence was synthesized was: what is the best treatment for adult patients with chronic HypoPT? This systematic search found 1100 articles, which was reduced to 312 based on title and abstract. The working group assessed these for eligibility in more detail, and 32 full-text articles were assessed. For the final recommendations, other literature was also taken into account. Little evidence is available on how best to treat HypoPT. Data on quality of life and the risk of complications have just started to emerge, and clinical trials on how to optimize therapy are essentially non-existent. Most studies are of limited sample size, hampering firm conclusions. No studies are available relating target calcium levels with clinically relevant endpoints. Hence it is not possible to formulate recommendations based on strict evidence. This guideline is therefore mainly based on how patients are managed in clinical practice, as reported in small case series and based on the experiences of the authors. PMID:26160136

  16. Biochemotherapy for the treatment of metastatic malignant melanoma: a clinical practice guideline

    PubMed Central

    Verma, S.; Petrella, T.; Hamm, C.; Bak, K.; Charette, M.

    2008-01-01

    Questions What is the role of biochemotherapy in the treatment of metastatic malignant melanoma? What are the adverse effects and effects on quality of life of biochemotherapy as a treatment option? For the purposes of this report, “biochemotherapy” is defined as a therapeutic regimen that includes, at a minimum, chemotherapy (either single-agent or combination) and interleukin-2. Perspectives Although early detection, appropriate surgery, and in some cases adjuvant therapy have improved outcomes, at least one third of patients with early-stage melanoma will develop metastases. Recently, in an effort to potentially maximize outcomes, the combination of chemotherapy and immunotherapy (biochemotherapy) was evaluated. The level of interest that this approach has generated, particularly with regard to the apparently high response rates seen in this otherwise devastating illness, was sufficient to merit closer examination by the Melanoma Disease Site Group (dsg) of Cancer Care Ontario’s Program in Evidence-based Care (pebc). Outcomes Outcomes of interest include response rate, diseasefree survival, overall survival, quality of life, and incidence of grades 3 and 4 toxicities. Methodology Evidence was selected and reviewed by three members of the pebc’s Melanoma dsg and by two methodologists. The present practice guideline report was reviewed and approved by the Melanoma dsg, which comprises medical and radiation oncologists, surgeons, and dermatologists. External review by Ontario practitioners was obtained through a mailed survey, the results of which were incorporated into the practice guideline. Final approval of the original guideline report was obtained from the pebc’s Report Approval Panel. Results Clinical recommendations were drafted based on the evidence identified through a systematic review. The practice guideline report with draft recommendations was mailed to Ontario practitioners for external review and to the Report Approval Panel. Feedback from both groups was incorporated into this report to create the final practice guideline. Practice Guideline The recommendations that follow apply to adult patients with metastatic malignant melanoma. Because of the inconsistent results of the available studies with regard to benefit (response, time to progression, and survival) and consistently high toxicity rates, biochemotherapy is not recommended for the treatment of metastatic melanoma. PMID:18454183

  17. A review of the guidelines for the evaluation and treatment of congenital syphilis.

    PubMed

    Kwak, Jieun; Lamprecht, Catherine

    2015-05-01

    Congenital syphilis (CS) is a disease that continues to persist in the United States despite its preventable nature. Mother-to-child transmission of CS can be avoided with appropriate maternal diagnosis and treatment during the pregnancy. Diagnosing CS and determining the therapeutic course can be challenging. This review covers the recent guidelines for the diagnosis and treatment of CS and the various factors that affect management decisions. These factors include the mother's antenatal management, the infant's clinical presentation and results, laboratory and serologic testing, and more. PMID:25996197

  18. 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

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note.... The discussion that follows is organized under headings that generally correspond to the...

  19. 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

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note.... The discussion that follows is organized under headings that generally correspond to the...

  20. The 2015 Clinical Guidelines for the Diagnosis and Treatment of HIV/AIDS in HIV-Infected Koreans

    PubMed Central

    2015-01-01

    The Committee for Clinical Guidelines for the Diagnosis and Treatment of HIV/AIDS of the Korean Society for AIDS was founded in 2010. The first edition of the Korean guidelines was published in 2011, and revised in 2013. The recommendations in the guideline contain important information for physicians working with HIV/AIDS in the clinical field. However, due to the rapid discovery of new data in the field of HIV and the evolution of the clinical environment in Korea, it has become necessary to revise the guideline again. This guideline aims to provide up-to-date comprehensive information regarding the diagnosis and management of HIV/AIDS in Korea. This guideline deals with issues regarding the initial assessment of newly diagnosed patients, timing of antiretroviral treatment (ART) initiation, preferred ART regimens in treatment-naïve as well as treatment-experienced patients and special populations such as HBV/HCV co-infected patients, or pregnant women. A brief summary of the revised guidelines and key changes to the original version of the guidelines are summarized below. PMID:26483998

  1. Follow up of women with borderline cervical smears as defined by national guidelines.

    PubMed Central

    Heatley, M K

    1999-01-01

    AIM: To determine the proportion of women with abnormalities in cervical smears corresponding to borderline nuclear change, as defined by national guidelines, which return to normal or persist as cytological or histological abnormalities. METHODS: 313 women with borderline nuclear change diagnosed by a single pathologist using the national criteria were followed up for up to two years. RESULTS: On initial follow up, 45% of women had a negative smear or biopsy, 46.5% had a low grade cytological or histological abnormality, and 8.5% had a high grade abnormality. Of 81 patients in whom a second follow up smear or biopsy was available, 47% had no detectable abnormality, 38.5% had low grade lesion, and 14.5% had a high grade lesion. In total, 32 patients (10.2%) had a high grade lesion (defined as moderate or severe dyskaryosis on smear or CINII or CINIII on biopsy) on at least one follow up sample. CONCLUSIONS: The results support the use of the national criteria defining borderline nuclear change in identifying women at increased risk of developing a high grade cervical intraepithelial neoplasia, as identified histologically or cytologically, and highlight the importance of follow up in these patients. PMID:10674043

  2. Guidelines for treatment and prevention of venous thromboembolism among patients with cancer

    PubMed Central

    Kuderer, Nicole M.; Lyman, Gary H.

    2014-01-01

    The association between cancer and thrombosis has been recognized for more than 150 years. Not only are patients with cancer at a substantially increased risk of developing venous thromboembolism (VTE), the link between several coagulation factors and tumor growth, invasion, and the development of metastases has been established. Reported rates of VTE in patients with cancer have increased in recent years likely reflecting, in part, improved diagnosis with sophisticated imaging techniques as well as the impact of more aggressive cancer diagnosis, staging, and treatment. Various therapeutic interventions, such as surgery, chemotherapy, hormonal therapy, targeted therapeutic strategies as well as the frequent use of indwelling catheters and other invasive procedures also place cancer patients at increased risk of VTE. The increasing risk of VTE, the multitude of risk factors, and the greater risk of VTE recurrence and death among patients with cancer represent considerable challenges in modern clinical oncology. The American Society of Clinical Oncology (ASCO) originally developed guidelines for VTE in patients with cancer in 2007. ASCO recently updated clinical practice guidelines on the treatment and prevention of VTE in patients with cancer following an extensive systematic review of the literature. Revised 2013 guidelines have now been presented and will be discussed in this review. Although several new studies were identified and considered, many important questions remain regarding the relationship between thrombosis and cancer and the optimal care of patients at risk for VTE. PMID:24862132

  3. National clinical guidelines for the extraction of first permanent molars in children.

    PubMed

    Cobourne, M T; Williams, A; Harrison, M

    2014-12-01

    This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the extraction of first permanent molars in children. The first permanent molar is susceptible to chronological enamel defects, molar-incisor hypomineralisation and caries, which may necessitate enforced extraction in the developing dentition. In the right circumstances, the extraction of these teeth can be followed by successful eruption of the second permanent molar and ultimately, third molar eruption to complete the molar dentition. For this reason, elective extraction of first permanent molars with a questionable long-term prognosis should be considered when planning enforced extractions. However, a number of factors can influence the decision-making process, including the necessity for a general anaesthetic to allow extraction, potential cooperation with restorative or orthodontic treatment and likely future preventative practice within the family. Moreover, the presence of any underlying malocclusion also needs to be evaluated within the context of extraction planning. The current available evidence has been evaluated and awarded a grade based upon those recommended by the Scottish Intercollegiate Guidelines Network. PMID:25476643

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

    SciTech Connect

    Punglia, Rinaa S. Hughes, Melissa E.; Edge, Stephen B.; Theriault, Richard L.; Bookman, Michael A.; Wilson, John L.; Ottesen, Rebecca A.; Niland, Joyce C.; Weeks, Jane C.

    2008-12-01

    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.

  5. Controversy and progress for treatment of acute cholangitis after Tokyo Guidelines (TG13).

    PubMed

    Sun, Zhipeng; Zhu, Yubing; Zhu, Bin; Xu, Guangzhong; Zhang, Nengwei

    2016-01-01

    Tokyo Guideline 2013 (TG13) is an international guideline for the diagnosis, classification and treatment of acute cholangitis. Progress and controversy for the two years after TG13 was summarized. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are both effective imaging tests for common bile duct (CBD) stones. More factors e.g. obesity may be involved in severity assessment. Initiation of broad-spectrum antibiotics addressing the typical Gram-negative enteric bacteria spectrum and early biliary drainage are the mainstay therapeutic options. Early laparoscopic exploration is also an option for stone-related nonsevere acute cholangitis besides endoscopic retrograde cholangial or percutaneous transhepatic cholangial drainage. Surgical biliary drainage should be avoided in severe cholangitis. PMID:26961212

  6. An introduction to the Endocrine Society Clinical Practice Guideline on treatment of symptoms of the menopause.

    PubMed

    Stuenkel, Cynthia A; Santen, Richard J

    2016-03-01

    Treatment of symptoms of menopause remains a challenge for many health care practitioners. In an effort to facilitate this process, the Endocrine Society convened an international Task Force of menopause experts to review the relevant clinical evidence and formulate practical recommendations for relieving the most common menopausal symptoms. The result is a comprehensive evidence-based guideline, which emphasizes an individualized approach to alleviate bothersome vasomotor symptoms and those related to postmenopausal changes of the vagina and urinary tract. Therapies including estrogen, either alone or in combination with progestogen or bazedoxifene, tibolone, antidepressants, gabapentin, as well as complementary approaches are discussed. In this commentary, the chairs of the Task Force highlight the organization and content of the guideline and the processes involved in its development. PMID:26936942

  7. S2k guideline on diagnosis and treatment of atopic dermatitis--short version.

    PubMed

    Werfel, Thomas; Heratizadeh, Annice; Aberer, Werner; Ahrens, Frank; Augustin, Matthias; Biedermann, Tilo; Diepgen, Thomas; Fölster-Holst, Regina; Gieler, Uwe; Kahle, Julia; Kapp, Alexander; Nast, Alexander; Nemat, Katja; Ott, Hagen; Przybilla, Bernhard; Roecken, Martin; Schlaeger, Martin; Schmid-Grendelmeier, Peter; Schmitt, Jochen; Schwennesen, Thomas; Staab, Doris; Worm, Margitta

    2016-01-01

    Atopic dermatitis (AD) represents a pruritic, non-contagious, chronic or chronically relapsing, inflammatory skin disease. The course of the disease may be complicated by bacterial or viral superinfections. The first manifestation of the disease and further flare-ups are due to genetic predisposition and also to a variety of further trigger factors. The therapy regimen should be adapted to disease symptoms that are actually present and consider individual features of the disease as reported by the patients or their parents. This short version of the German guideline on AD provides an overview of evidence-based diagnostic and treatment options. All recommendations made here are the result of a consensus of the scientific medical societies, working groups and support groups based on scientific data published to date. Abstracts and details of the studies cited are provided in the long version of this guideline (see: www.awmf.org). PMID:26713654

  8. Brazilian guidelines for diagnosis, treatment and follow-up of primary cutaneous melanoma - Part II*

    PubMed Central

    Castro, Luiz Guilherme Martins; Bakos, Renato Marchiori; Duprat Neto, João Pedreira; Bittencourt, Flávia Vasques; Giacomo, Thais Helena Bello Di; Serpa, Sérgio Schrader; Messina, Maria Cristina de Lorenzo; Loureiro, Walter Refkalefsky; Macarenco, Ricardo Silvestre e Silva; Stolf, Hamilton Ometto; Gontijo, Gabriel

    2016-01-01

    The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed? PMID:26982779

  9. Brazilian guidelines for diagnosis, treatment and follow-up of primary cutaneous melanoma - Part II.

    PubMed

    Castro, Luiz Guilherme Martins; Bakos, Renato Marchiori; Duprat Neto, João Pedreira; Bittencourt, Flávia Vasques; Giacomo, Thais Helena Bello Di; Serpa, Sérgio Schrader; Messina, Maria Cristina de Lorenzo; Loureiro, Walter Refkalefsky; Macarenco, Ricardo Silvestre E Silva; Stolf, Hamilton Ometto; Gontijo, Gabriel

    2016-02-01

    The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed? PMID:26982779

  10. International Guidelines for the Management and Treatment of Morquio A Syndrome

    PubMed Central

    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

    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

  11. Japanese epidemiological survey with consensus statement on Japanese guidelines for treatment of iron overload in bone marrow failure syndromes

    PubMed Central

    Suzuki, Takahiro; Tomonaga, Masao; Miyazaki, Yasushi; Nakao, Shinji; Ohyashiki, Kazuma; Matsumura, Itaru; Kohgo, Yutaka; Niitsu, Yoshiro; Kojima, Seiji

    2008-01-01

    Many patients with bone marrow failure syndromes need frequent transfusions of red blood cells, and most of them eventually suffer from organ dysfunction induced by excessively accumulated iron. The only way to treat transfusion-induced iron overload is iron chelating therapy. However, most patients have not been treated effectively because daily/continuous administration of deferoxamine is difficult for outpatients. Recently, a novel oral iron chelator, deferasirox, has been developed, and introduction of the drug may help many patients benefit from iron chelation therapy. In this review, we will discuss the current status of iron overload in transfusion-dependent patients, and the development of Japanese guidelines for the treatment of iron overload in Japan, which were established by the National Research Group on Idiopathic Bone Marrow Failure Syndromes in Japan. PMID:18581199

  12. Use of medicines and adherence to standard treatment guidelines in rural community health centers, Timor-Leste.

    PubMed

    Higuchi, Michiyo; Okumura, Junko; Aoyama, Atsuko; Suryawati, Sri; Porter, John

    2015-03-01

    The use of medicines and nurses'/midwives' adherence to standard treatment guidelines (STGs) were examined in Timor-Leste during the early stage of the nation's new health system development. A cross-sectional study was conducted as the quantitative element of mixed methods research. Retrospective samples from patient registration books and prospective observations were obtained in 20 randomly selected rural community health centers. The medicines use indicators, in particular the level of injection use, in Timor-Leste did not suggest overprescription. Prescribers with clinical nurse training prescribed significantly fewer antibiotics than those without such training (P < .01). The adjusted odds ratio of prescribing adherence for clinical nurse training, after accounting for confounders and prescriber clustering, was 6.6 (P < .01). STGs for nonphysician health professionals at the primary health care level have potential value in basic health care delivery, including appropriate use of medicines, in resource-limited communities when strategically developed and introduced. PMID:22548774

  13. Addressing malnutrition in young children in South Africa. Setting the national context for paediatric food-based dietary guidelines.

    PubMed

    Bourne, Lesley T; Hendricks, Michael K; Marais, Debbie; Eley, Brian

    2007-10-01

    Despite various national nutrition and primary healthcare programmes being initiated in South Africa over the last decade, child health has deteriorated. This is seen by the rise in infant and child mortality rates, the high prevalence of preventable childhood diseases, e.g. diarrhoea and lower respiratory tract infections, and the coexistence of under-nutrition along with HIV/AIDS. Poor dietary intake, food insecurity and poor quality of basic services prevail within this precarious causal web. The national Integrated Nutrition Programme is a comprehensive nutrition strategy that focuses on children below 6 years old, at-risk pregnant and lactating women, and those affected by communicable and non-communicable diseases. Focus areas relevant to pre-school children include disease-specific nutrition treatment, support and counselling; growth monitoring and promotion (GMP); micronutrient malnutrition control; breastfeeding promotion, protection and support; contributions to household food security; nutrition interventions among HIV-infected children; and nutrition promotion, education and advocacy. Progress towards this includes the Baby-Friendly Hospital Initiative; mandatory fortification of maize meal and wheat flour with multiple micronutrients; vitamin A supplementation coverage and mandatory iodization of salt by legislation; the provision of free road-to-health charts for GMP; and the National School Nutrition Programme. Since 2003, the basis of the nutrition education strategy has been the locally developed food-based dietary guidelines (FBDGs), directed at adults and school-going children. This review sketches the backdrop to and motivation for the introduction of specifically targeted paediatric FBDGs, for mothers and caregivers of children from birth to age 7 years, as a national initiative. PMID:17824851

  14. 2015 UK National Guideline on the management of non-gonococcal urethritis.

    PubMed

    Horner, P; Blee, K; O'Mahony, C; Muir, P; Evans, C; Radcliffe, K

    2016-02-01

    We present the updated British Association for Sexual Health and HIV guideline for the management of non-gonococcal urethritis in men. This document includes a review of the current literature on its aetiology, diagnosis and management. In particular it highlights the emerging evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium and that neither azithromycin 1 g nor doxycycline 100 mg twice daily for seven days achieves a cure rate of >90% for this micro-organism. Evidence-based diagnostic and management strategies for men presenting with symptoms suggestive of urethritis, those confirmed to have non-gonococcal urethritis and those with persistent symptoms following first-line treatment are detailed. PMID:26002319

  15. [Comparison of treatment principles of elderly hypertensive patients with different cardiovascular risks based on Hungarian and international guidelines (2001-2015)].

    PubMed

    Bödör, Anikó; Kiss, István

    2016-02-14

    The aim of this review is to present recommendations of the currently valid Hungarian practice guidelines regarding antihypertensive therapy of the elderly and very elderly with different cardiovascular risk profiles, compare and contrast these with international guidelines, describe changes brought about by the past 15 years, and review the evidence behind. Hypertension treatment guidelines and relevant statements of the Hungarian and European Societies of Hypertension, of the Joint National Committee and American Heart Association were processed. The use of age-independent treatment threshold, goal blood pressure values, and the tendency towards more intensive control in co-morbidities conferring high cardiovascular risk were overcome by the upsurge of new evidence and the re-evaluation of previous clinical trial data. These lead to the introduction of age-specific and generally less stringent blood pressure targets in all regions compared. However, the guidelines currently in force still differ in terms of the attainable values in concomitant diabetes, chronic kidney disease or albuminuria, use of beta-blockers and the definition of elderly. Nevertheless, there is unanimous agreement that benefit from lowering of blood pressure under systolic 140 mmHg is not supported by evidence and further investigation is warranted to determine optimal treatment targets in the elderly, in the aged over 80 and specific elderly risk groups. PMID:26853726

  16. Managing Conflicts of Interest in the UK National Institute for Health and Care Excellence (NICE) Clinical Guidelines Programme: Qualitative Study

    PubMed Central

    Graham, Tanya; Alderson, Phil; Stokes, Tim

    2015-01-01

    Background There is international concern that conflicts of interest (COI) may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs) are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence). Methods Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE’s guideline development centres and 6 chairs of guideline development groups (GDGs). We conducted a thematic analysis. Results Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take “on trust” the information they receive, certain types of COI (non-financial) are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills. Conclusions We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice. PMID:25811754

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

    PubMed Central

    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

    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

  18. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia.

    PubMed

    Zafren, Ken; Giesbrecht, Gordon G; Danzl, Daniel F; Brugger, Hermann; Sagalyn, Emily B; Walpoth, Beat; Weiss, Eric A; Auerbach, Paul S; McIntosh, Scott E; Némethy, Mária; McDevitt, Marion; Dow, Jennifer; Schoene, Robert B; Rodway, George W; Hackett, Peter H; Bennett, Brad L; Grissom, Colin K

    2014-12-01

    To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. PMID:25443771

  19. Evidence-based pharmacologic treatment for people with severe mental illness: a focus on guidelines and algorithms.

    PubMed

    Mellman, T A; Miller, A L; Weissman, E M; Crismon, M L; Essock, S M; Marder, S R

    2001-05-01

    Medication treatment of severe mental illness has been advanced and complicated by the introduction of numerous therapeutic agents. Practice guidelines based on research evidence have been developed to help clinicians make complex decisions. Studies of usual care suggest an important potential role for guidelines in improving the quality of medication treatment for people with severe mental illness. The authors review current evidence-based guidelines for medication treatment of persons with severe mental illness. Four categories of guidelines are described: recommendations, comprehensive treatment options, medication algorithms, and expert consensus. The authors note that more research is needed on optimal next-step strategies and the treatment of patients with comorbidity and other complicating problems. They discuss barriers to the implementation of guidelines, and they observe that the potential of guidelines and algorithms to promote evidence-based medication treatment for persons with severe mental illness depends on refinement of tools, progress in research, and cooperation of physicians, nonphysician clinicians, administrators, and consumers and family members. PMID:11331795

  20. [Gender dysphoria in children and adolescents - treatment guidelines and follow-up study].

    PubMed

    Meyenburg, Bernd; Kröger, Anne; Neugebauer, Rebecca

    2015-01-01

    Treatment guidelines for transidentity in children and adolescents are presently under discussion. We present an overview of the various treatment modalities. Further, follow-up data on children and adolescents referred for gender-identity problems are presented. Of the 84 patients seen for the first time more than 3 years before follow-up, 37 mailed in the completed questionnaires. In addition, 33 patients agreed to answer some short follow-up questions. We assessed steps of treatment, gender role, psychopathology, and psychotherapy. We compared differences in psychopathology in patients with vs. without gender role change and in patients with intense vs. less intense psychotherapy. A total of 22 patients had completely changed gender role, and some had started hormonal treatment und sex reassignment surgery. Most patients were satisfied with the treatment results. All patients showed less psychopathology on follow-up, independent of role change or intensity of psychotherapy. In general, the patients reported little psychopathology. Our follow-up results support the present treatment approach. In patients with little psychopathology, low-frequency supportive treatment appears sufficient to obtain safe judgement on hormonal of surgical treatment. PMID:25536896

  1. Methods underpinning national clinical guidelines for hypertension: describing the evidence shortfall

    PubMed Central

    Campbell, Fiona; Dickinson, Heather O; Cook, Julia VF; Beyer, Fiona R; Eccles, Martin; Mason, James M

    2006-01-01

    Background To be useful, clinical practice guidelines need to be evidence based; otherwise they will not achieve the validity, reliability and credibility required for implementation. Methods This paper compares the methods used in gathering, analysing and linking of evidence to guideline recommendations in ten current hypertension guidelines. Results It found several guidelines had failed to implement methods of searching for the relevant literature, critical analysis and linking to recommendations that minimise the risk of bias in the interpretation of research evidence. The more rigorous guidelines showed discrepancies in recommendations and grading that reflected different approaches to the use of evidence in guideline development. Conclusion Clinical practice guidelines as a methodology are clearly still an evolving health care technology. PMID:16597334

  2. ESCMID guideline for the diagnosis and treatment of biofilm infections 2014.

    PubMed

    Høiby, N; Bjarnsholt, T; Moser, C; Bassi, G L; Coenye, T; Donelli, G; Hall-Stoodley, L; Holá, V; Imbert, C; Kirketerp-Møller, K; Lebeaux, D; Oliver, A; Ullmann, A J; Williams, C

    2015-05-01

    Biofilms cause chronic infections in tissues or by developing on the surfaces of medical devices. Biofilm infections persist despite both antibiotic therapy and the innate and adaptive defence mechanisms of the patient. Biofilm infections are characterized by persisting and progressive pathology due primarily to the inflammatory response surrounding the biofilm. For this reason, many biofilm infections may be difficult to diagnose and treat efficiently. It is the purpose of the guideline to bring the current knowledge of biofilm diagnosis and therapy to the attention of clinical microbiologists and infectious disease specialists. Selected hallmark biofilm infections in tissues (e.g. cystic fibrosis with chronic lung infection, patients with chronic wound infections) or associated with devices (e.g. orthopaedic alloplastic devices, endotracheal tubes, intravenous catheters, indwelling urinary catheters, tissue fillers) are the main focus of the guideline, but experience gained from the biofilm infections included in the guideline may inspire similar work in other biofilm infections. The clinical and laboratory parameters for diagnosing biofilm infections are outlined based on the patient's history, signs and symptoms, microscopic findings, culture-based or culture-independent diagnostic techniques and specific immune responses to identify microorganisms known to cause biofilm infections. First, recommendations are given for the collection of appropriate clinical samples, for reliable methods to specifically detect biofilms, for the evaluation of antibody responses to biofilms, for antibiotic susceptibility testing and for improvement of laboratory reports of biofilm findings in the clinical microbiology laboratory. Second, recommendations are given for the prevention and treatment of biofilm infections and for monitoring treatment effectiveness. Finally, suggestions for future research are given to improve diagnosis and treatment of biofilm infections. PMID:25596784

  3. Clinical Guidelines for the Diagnosis and Treatment of Cushing's Disease in Korea

    PubMed Central

    Hur, Kyu Yeon; Kim, Jung Hee; Kim, Byung Joon; Kim, Min-Seon; Lee, Eun Jig

    2015-01-01

    Cushing's disease (CD) is a rare disorder characterized by the overproduction of adrenocorticotropic hormone due to a pituitary adenoma that ultimately stimulates excessive cortisol secretion from the adrenal glands. Prior to the detection of pituitary adenomas, various clinical signs of CD such as central obesity, moon face, hirsutism, and facial plethora are usually already present. Uncontrolled hypercortisolism is associated with metabolic, cardiovascular, and psychological disorders that result in increased mortality. Hence, the early detection and treatment of CD are not only important but mandatory. Because its clinical manifestations vary from patient to patient and are common in other obesity-related conditions, the precise diagnosis of CD can be problematic. Thus, the present set of guidelines was compiled by Korean experts in this field to assist clinicians with the screening, diagnoses, and treatment of patients with CD using currently available tests and treatment modalities. PMID:25827452

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

    PubMed Central

    2013-01-01

    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

  5. Guideline for diagnosis and treatment of Waldenström's macroglobulinaemia.

    PubMed

    Vos, J M I; Minnema, M C; Wijermans, P W; Croockewit, S; Chamuleau, M E D; Pals, S T; Klein, S K; Delforge, M; van Imhoff, G W; Kersten, M J

    2013-03-01

    On behalf of the lymphoma and multiple myeloma working parties of the Dutch/Belgian Haemato-Oncology Foundation for Adults in The Netherlands (HOVON), we present a guideline for diagnosis and management of Waldenström's macroglobulinemia (WM). Considering the indolent behaviour and heterogeneous clinical presentation of WM, it is crucial to determine the right indications for treatment, as well as to individualise therapeutic options. There are significant differences from the approach to multiple myeloma or the treatment of other indolent non-Hodkgin lymphomas, and these results cannot always be extrapolated. There is a lack of large clinical trials due to the low incidence of WM. Based on the available data, we provide a practical diagnostic classification, as well as recommendations for first-line therapy and options for treating relapsed disease. Some typical clinical features of WM, such as autoimmune phenomena and 'IgM flare' after rituximab treatment, are highlighted. A more elaborate version of this guideline was published in the 'Nederlands Tijdschrift voor Hematologie' (Dutch Journal for Hematology) September 2012. PMID:23462052

  6. Guidelines for the Topical Treatment of Psoriasis Vulgaris in the Levant and Iraq Area.

    PubMed

    Abbas, Ossama; Ammoury, Alfred; Abbadi, Mohammad; Malek, Medhat Abdel; Akkash, Laith; Al-Chakharah, Kamal; Al-Hamdi, Khalil; Al-Qarqaz, Firas; Al-Soudani, Abduljabbar; Al-Soudani, Nameer; Dandashle, Anwar; El-Sayed, Fouad; Ghafir, Yasser; Gargour, Nazek; Kabalan, Said; Kibbi, Abdul-Ghani; Oumeish, Isam; Tannous, Zeina; Tomb, Roland

    2015-01-01

    Psoriasis vulgaris is a common chronic, inflammatory, multisystem disorder that affects approximately 1.5% to 3.4% of the population in the Middle East. The disease has an impact on the quality of life in a significant number of affected patients. The majority of patients (approximately 70%) have mild to moderate psoriasis that is manageable with topical agents, which generally show a high efficacy to safety ratio. Topical agents can be used alone when treating patients with limited disease or may be used as adjunctive therapy for patients with more extensive psoriasis undergoing systemic treatment. Treatment should also be customized to meet individual patients' needs. To optimize the topical treatment of psoriasis in the Levant and Iraq area, dermatology experts from Iraq, Jordan, Lebanon, Palestine, and Syria met and initiated a project to develop guidelines and recommendations for the topical management of psoriasis. The guidelines are based on literature evidence and experts' opinions. We present recommendations for the use of topical corticosteroids, vitamin D analogues, calcineurin inhibitors, tazarotene, salicylic acid, anthralin, and coal tar, as well as combination therapy, based on their efficacy and safety profiles. PMID:26861521

  7. [S2e guideline of the German urologists : Instrumental treatment of benign prostatic hyperplasia].

    PubMed

    Bschleipfer, T; Bach, T; Berges, R; Dreikorn, K; Gratzke, C; Madersbacher, S; Michel, M-S; Muschter, R; Oelke, M; Reich, O; Tschuschke, C; Höfner, K

    2016-02-01

    This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail. PMID:26518304

  8. Chronic pain in patients with substance abuse disorder: general guidelines and an approach to treatment.

    PubMed

    Mitchell, Adam M; Dewey, Charlene M

    2008-04-01

    Treating pain may be difficult in patients with a coexisting substance abuse disorder. Opioids can be used successfully to control pain in such a patient population, but the physician must have a general understanding of addictive behavior and early signs of abuse. The challenge is not in treating pain, but identifying true pain from drug-seeking behaviors. Furthermore, several myths of opioid usage, such as iatrogenic addiction and risk of disciplinary action, may be unfounded. General guidelines and open communication between patient and physician may aid in controlling pain. With better understanding and a systematic treatment approach, patients with substance abuse disorders can receive adequate symptomatic pain relief. PMID:18467812

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

    SciTech Connect

    Kelekis, Alexis D. Filippiadis, Dimitris K.; Martin, Jean-Baptiste; Brountzos, Elias

    2010-10-15

    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.

  10. Wilderness Medical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update.

    PubMed

    Zafren, Ken; Giesbrecht, Gordon G; Danzl, Daniel F; Brugger, Hermann; Sagalyn, Emily B; Walpoth, Beat; Weiss, Eric A; Auerbach, Paul S; McIntosh, Scott E; Némethy, Mária; McDevitt, Marion; Dow, Jennifer; Schoene, Robert B; Rodway, George W; Hackett, Peter H; Bennett, Brad L; Grissom, Colin K

    2014-12-01

    To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445. PMID:25498264

  11. Treatment and follow-up strategies in desmoid tumours: a practice guideline

    PubMed Central

    Ghert, M.; Yao, X.; Corbett, T.; Gupta, A.A.; Kandel, R.A.; Verma, S.; Werier, J.

    2014-01-01

    Objectives We set out to determine the optimal treatment options—surgery, radiation therapy (rt), systemic therapy, or any combinations thereof—for patients with desmoid tumours once the decision to undergo active treatment has been made (that is, monitoring and observation have been determined to be inadequate).provide clinical-expert consensus opinions on follow-up strategies in patients with desmoid tumours after primary interventional management. Methods This guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care and the Sarcoma Disease Site Group. The medline, embase, and Cochrane Library databases, main guideline Web sites, and abstracts of relevant annual meetings (1990 to September 2012) were searched. Internal and external reviews were conducted, with final approval by the Program in Evidence-Based Care and the Sarcoma Disease Site Group. Recommendations Treatments Surgery with or without rt can be a reasonable treatment option for patients with desmoid tumours whose surgical morbidity is deemed to be low. The decision about whether rt should be offered in conjunction with surgery should be made by clinicians and patients after weighing the potential benefit of improved local control against the potential harms and toxicity associated with rt. Depending on individual patient preferences, systemic therapy alone or rt alone might also be reasonable treatment options, regardless of whether the desmoid umours are deemed to be resectable. Follow-Up Strategies Undergo evaluation for rehabilitation (occupational therapy or physical therapy, or both). Continue with rehabilitation until maximal function is achieved. Undergo history and physical examinations with appropriate imaging every 3–6 months for 2–3 years, and then annually. PMID:25089635

  12. The National Emphysema Treatment Trial (NETT)

    PubMed Central

    Cordova, Francis; Sternberg, Alice L.; Martinez, Fernando J.

    2011-01-01

    Substantial information regarding the role of lung volume reduction surgery (LVRS) in severe emphysema emanates from the National Emphysema Treatment Trial (NETT). The NETT was not a crossover trial and therefore was able to examine the effects of optimal medical management and LVRS on short- and long-term survival, as well as lung function, exercise performance, and quality of life. The NETT generated multiple insights into the preoperative, perioperative, and postoperative management of patients undergoing thoracotomy; described pain control techniques that were safe and effective; and emphasized the need to address nonpulmonary issues to optimize surgical outcomes. After the NETT, newer investigation has focused on bronchoscopic endobronchial interventions and other techniques less invasive than LVRS to achieve lung reduction. In this review, we summarize what we currently know about the role of LVRS in the treatment of severe emphysema as a result of insights gained from the NETT and provide a brief review of the newer techniques of lung volume reduction. PMID:21719757

  13. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA).

    PubMed

    Warren, J W; Abrutyn, E; Hebel, J R; Johnson, J R; Schaeffer, A J; Stamm, W E

    1999-10-01

    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 does not contain recommendations for asymptomatic bacteriuria, complicated UTIs, Foley catheter-associated infections, UTIs in men or children, or prostatitis. The targeted providers are internists and family practitioners. The targeted groups are immunocompetent women. Criteria are specified for determining whether the inpatient or outpatient setting is appropriate for treatment. Differences from other guidelines written on this topic include use of laboratory criteria for diagnosis and approach to antimicrobial therapy. Panel members represented experts in adult infectious diseases and urology. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendation and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council, the sponsor and supporter of the guideline. The American Urologic Association and the European Society of Clinical Microbiology and Infectious Diseases have endorsed it. An executive summary and tables highlight the major recommendations. Performance measures are described to aid in monitoring compliance with the guideline. The guideline will be listed on the IDSA home page at http://www.idsociety.org It will be evaluated for updating in 2 years. PMID:10589881

  14. International guidelines for the treatment of community-acquired pneumonia in adults: the role of macrolides.

    PubMed

    File, Thomas M; Tan, James S

    2003-01-01

    The significance of community-acquired pneumonia (CAP) has led to the publication of guidelines from numerous international organisations. Because the macrolide class of antimicrobials is active against most of the key pathogens associated with CAP, agents from this class are commonly included in recommendations from these guidelines. However, there are differences among the various guidelines concerning the positioning of the macrolides for empirical therapy. An important factor concerning the use of macrolides for CAP is the emergence of resistance of Streptococcus pneumoniae over the past decade. The rate of S. pneumoniae resistance to macrolides ranges from 4 to 70% of strains in worldwide surveillance studies. The most common mechanisms of resistance include methylation of a ribosomal target encoded by the erm gene and efflux of the macrolides by a cell membrane protein transporter, encoded by the mef gene. S. pneumoniae strains with the mef gene are resistant at a lower level (with minimum inhibitory concentration [MIC] values generally 1-16 microg/ml) than erm resistant strains; and it is possible that such strains may be inhibited if sufficiently high levels of macrolide can be obtained at the infected site. Currently mef-associated resistance predominates in North America, whereas erm predominates in Europe. Until recently, reports of failure of treatment of CAP with macrolides has been rare, particularly for patients with low-risk for drug-resistant strains. However, since 2000, several patients treated with an oral macrolide who have subsequently required admission to the hospital for macrolide-resistant S. pneumoniae (MRSP) bacteraemia have been reported in the literature. Major issues, which are fundamental to the use of the macrolides as recommended in the various guidelines, include the importance of providing therapy for 'atypical' pathogens and the clinical significance of MRSP. Presently, the macrolides are more prominently recommended in the North American guidelines than in other parts of the world. The difference in the emphasis placed on the importance of the atypical pathogens as well as the expression of MRSP in North America compared with Europe partly explains this variance. PMID:12515565

  15. Guidelines on the treatment of chronic coinfection by Trypanosoma cruzi and HIV outside endemic areas.

    PubMed

    Pérez-Molina, José A; Rodríguez-Guardado, Azucena; Soriano, Antonio; Pinazo, María-Jesús; Carrilero, Bartolomé; García-Rodríguez, Magdalena; Salas, Joaquín; Torrús, Diego; Soler-Ferrer, Cristina; Puente, Sabino; Haro-González, Juan Luís; Martín-Rabadán, Pablo; Gascon, Joaquim

    2011-01-01

    As a result of population migration, Chagas disease is no longer limited to the North and South American continents. In HIV-infected patients, chronic infection by Trypanosoma cruzi behaves as an opportunistic infection in severely immunosuppressed patients and is responsible for high morbidity and mortality. Unlike other opportunistic infections, information on the natural history, diagnosis, treatment, and prevention of Chagas disease is scarce. Spain has the highest number of cases of Chagas disease outside the North and South American continents, and coinfection with HIV is increasingly prevalent. In this article, the Spanish Society for Tropical Medicine and International Health (Sociedad Española de Medicina Tropical y Salud Internacional) reviews the current situation of coinfection with HIV and T. cruzi infection and provides guidelines on the diagnosis, treatment, and prevention in areas where Chagas disease is not endemic. It also identifies areas of uncertainty where additional research is necessary. PMID:22189148

  16. European guidelines for the diagnosis and treatment of pelvic girdle pain

    PubMed Central

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

    2008-01-01

    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

  17. National Trends of Antiparkinsonism Treatment in Taiwan: 2004–2011

    PubMed Central

    Liu, Weng-Ming; Wu, Ruey-Meei; Chang, Chia-Hsuin; Lin, Jou-Wei; Liu, Ying-Chun; Lin, Chin-Hsien

    2016-01-01

    Background. Several guidelines for Parkinson's disease (PD) management were recently updated. We examined temporal trends for antiparkinsonism drugs in Taiwan. Methods. Antiparkinsonism prescriptions, including levodopa, ergot/nonergot dopamine agonists (DAs), amantadine, selegiline, entacapone, and anticholinergics, were identified in the Taiwan National Health Insurance Database from 2004 to 2011. Time trend analyses were estimated assuming Poisson distribution. Results. A total of 19,302 PD patients in 2004 and 41,606 PD patients in 2011 were analyzed. Antiparkinsonism prescriptions increased significantly from 187,137 in 2004 to 414,587 in 2011. Levodopa monotherapy or combination therapy was the mainstay. Levodopa monotherapy comprised 37.4% of prescriptions in 2004 and 44.2% in 2011, with an annual increase rate of 18.14%. There was a substantially increasing trend of DA prescriptions, which were higher in younger-aged patients (<60 years) than in older-aged group (p = 0.0006). Among combination therapy, DA combined with levodopa or other antiparkinsonism medications became the main combinations for younger-aged patients after 2009. After 2005, the proportion of ergot DA usage markedly decreased and PD patients using nonergot DA increased. Conclusions. Levodopa was the major treatment from 2004 to 2011. There was a steeply increased trend of DA use, especially in younger-aged patients. Nonergot agents comprised the major DA group after 2005. PMID:26989558

  18. Recommendations for using TNFα antagonists and French Clinical Practice Guidelines endorsed by the French National Authority for Health.

    PubMed

    Goëb, Vincent; Ardizzone, Marc; Arnaud, Laurent; Avouac, Jérôme; Baillet, Athan; Belot, Alexandre; Bouvard, Béatrice; Coquerelle, Pascal; Dadoun, Sabrina; Diguet, Alain; Launay, David; Lebouc, Danielle; Loulergue, Pierre; Mahy, Sophie; Mestat, Pascal; Mouterde, Gaël; Terrier, Benjamin; Varoquier, Coralie; Verdet, Mathieu; Puéchal, Xavier; Sibilia, Jean

    2013-12-01

    The use of TNFα antagonists must follow specific guidelines to ensure optimal effectiveness and safety. The French Society for Rheumatology (SFR) and Task Force on Inflammatory Joint Diseases (CRI), in partnership with several French learned societies, asked the French National Authority for Health (HAS) to develop and endorse good practice guidelines for the prescription and monitoring of TNFα antagonist therapy by physicians belonging to various specialties. These guidelines were developed, then, validated by two multidisciplinary panels of experts based on an exhaustive review of the recent literature and in compliance with the methodological rules set forth by the HAS. They pertain to the initial prescription of TNFα antagonists and to a variety of clinical situations that can arise during the follow-up of patients receiving TNFα antagonists (infections, malignancies, pregnancy, vaccination, paradoxical adverse events, surgery, use in older patients, and vasculitides). PMID:24176736

  19. 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

    PubMed Central

    2012-01-01

    Background The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS). Methods All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. Results The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. Conclusion These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence. PMID:22264320

  20. Selection of odour removal technologies in wastewater treatment plants: a guideline based on Life Cycle Assessment.

    PubMed

    Alfonsín, Carolina; Lebrero, Raquel; Estrada, José M; Muñoz, Raúl; Kraakman, N J R Bart; Feijoo, Gumersindo; Moreira, M Teresa

    2015-02-01

    This paper aims at analysing the environmental benefits and impacts associated with the treatment of malodorous emissions from wastewater treatment plants (WWTPs). The life cycle assessment (LCA) methodology was applied to two biological treatments, namely biofilter (BF) and biotrickling filter (BTF), two physical/chemical alternatives, namely activated carbon tower (AC) and chemical scrubber (CS), and a hybrid combination of BTF + AC. The assessment provided consistent guidelines for technology selection, not only based on removal efficiencies, but also on the environmental impact associated with the treatment of emissions. The results showed that biological alternatives entailed the lowest impacts. On the contrary, the use of chemicals led to the highest impacts for CS. Energy use was the main contributor to the impact related to BF and BTF, whereas the production of glass fibre used as infrastructure material played an important role in BTF impact. Production of NaClO entailed the highest burdens among the chemicals used in CS, representing ∼ 90% of the impact associated to chemicals. The frequent replacement of packing material in AC was responsible for the highest environmental impacts, granular activated carbon (GAC) production and its final disposal representing more than 50% of the impact in most categories. Finally, the assessment of BTF + AC showed that the hybrid technology is less recommendable than BF and BTF, but friendlier to the environment than physical/chemical treatments. PMID:25463573

  1. UK National Clinical Guidelines in Paediatric Dentistry: diagnosis, prevention and management of dental erosion.

    PubMed

    O'Sullivan, E; Milosevic, A

    2008-11-01

    This revised Clinical Guideline in Paediatric Dentistry replaces the previously published ninth guideline (Shaw L, O'Sullivan E. Int J Paediatr Dent 2000; 10: 356-365). The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated widely for consultation to all UK consultants in paediatric dentistry, council members of the British Society of Paediatric Dentistry (BSPD), and to people of related specialities recognized to have expertise in the subject. The final version of this guideline is produced from a combination of this input and thorough review of the published literature. In the case of the present guideline, an internationally recognized expert in the field was invited to be a co-author (AM). The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. Further details regarding the process of paediatric dentistry guideline production in the UK is described in the Int J Paediatr Dent 1997; 7: 267-268. PMID:18808545

  2. American National Standard Acoustical Performance Criteria, Design Requirements, and Guidelines for Schools.

    ERIC Educational Resources Information Center

    Acoustical Society of America, Melville, New York.

    This standards publication provides acoustical performance criteria, design requirements, and design guidelines for new school classrooms and other learning spaces. The standards may be applied when practicable to the major renovation of existing classrooms. These criteria, requirements, and guidelines are keyed to the acoustical qualities needed…

  3. [On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Osteoporosis associated with sex hormone depletion treatment].

    PubMed

    Takahashi, Shunji

    2015-09-01

    Breast cancer and prostate cancer are sex hormone-dependent cancers and suppression of estrogen or androgen function is the standard therapy for those cancers. One of its important adverse effects is bone loss or osteoporosis. Recent evidences are : 1) Endocrine therapy for breast cancer or prostate cancer is associated with significant bone loss. 2) Treatment with aromatase inhibitors (AI) for breast cancer is associated with significant increase of pathologic fractures. Androgen depletion treatment (ADT) for prostate cancer is also probably associated with increased risk of fracture. 3) Bisphosphonates and denosumab treatment increases bone mineral density of patients treated with endocrine therapy for breast cancer. Bisphosphonates, denosumab and SERMs (raloxifene and toremifene) increase bone mineral density of patients treated with ADT for prostate cancer. 4) Bisphosphonates and denosumab decrease fracture risk of AI-treated breast cancer patients. Toremifene and denosumab decrease fracture risk of ADT-treated prostate cancer patients. PMID:26320536

  4. Guidelines for Management of Hyperlipidemia: Implications for Treatment of Patients with Stroke Secondary to Atherosclerotic Disease.

    PubMed

    Dandapat, Sudeepta; Robinson, Jennifer G

    2016-03-01

    After careful review of randomized cardiovascular outcomes trial data, the 2013 ACC/AHA cholesterol guideline focused on using the appropriate intensity of statin therapy to reduce atherosclerotic cardiovascular disease (ASCVD) risk and moved away from recommending specific low-density lipoprotein cholesterol (LDL-C) treatment targets. In patients who have had a stroke or other clinical ASCVD event, a high-intensity statin should be initiated up to age 75years unless there are safety concerns, including a history of hemorrhagic stroke. A moderate-intensity statin is recommended if there are safety concerns or age is greater than 75years. Atorvastatin 40-80mg and rosuvastatin 20-40mg are considered high-intensity statins. These new guidelines avoid unnecessary usage of non-statins to achieve specific LDL-C values, thus avoiding potential adverse effects or use of an inadequate statin intensity in patients who are "at goal." When non-statins are considered for additional LDL-C lowering, ezetimibe is the only non-statin clearly shown to further reduce ASCVD risk when added to background statin therapy. PMID:26838351

  5. Report of the Japan Atherosclerosis Society (JAS) Guideline for Diagnosis and Treatment of Hyperlipidemia in Japanese adults.

    PubMed

    Hata, Yoshiya; Mabuchi, Hiroshi; Saito, Yasushi; Itakura, Hiroshige; Egusa, Genshi; Ito, Hideki; Teramoto, Tamio; Tsushima, Motoo; Tada, Norio; Oikawa, Shinichi; Yamada, Nobuhiro; Yamashita, Shizuya; Sakuma, Nagahiko; Sasaki, Jun

    2002-01-01

    This paper described the Guideline for Diagnosis and Management of Hyperlipidemias for Prevention of Atherosclerosis proposed by The Japan Atherosclerosis Society (JAS) Guideline Investigating Committee (1,995-2,000) under the auspices of the JAS Board of Directors. 1) The guideline defines the diagnostic criteria for serum total cholesterol (Table 1), LDL-cholesterol (Table 1), triglycerides (Table 4) and HDL-cholesterol (Table 7). It also indicates the desirable range (Table 1), the initiation levels of management (Table 2) and the target levels of treatment (Table 2) for total and LDL-cholesterol. 2) Though both total and LDL-cholesterol are shown as atherogenic parameter in the guideline, the use of LDL-cholesterol, rather than total cholesterol, is encouraged in daily medical practice and lipid-related studies, because LDL-cholesterol is more closely related to atherosclerosis. 3) Elevated triglycerides and low HDL-cholesterol are included in the risk factors, since no sufficient data have been accumulated to formulate the guideline for these two lipid disorders. 4) Emphasis is laid on evaluation of risk factors of each subject before starting any kind of treatment (Table 2). 5) This guideline is applied solely for adults (age 20-64). Lipid abnormalities in children or the youth under age 19, and the elderly with an age over 65 have to be evaluated by their own standard. 6) This part of the guideline gives only the diagnostic aspects of hyperlipidemias. The part of management and treatment will follow in the second section of the guideline that will be published in future. PMID:12238634

  6. [Evaluating the total incapacity to work: implementing French National Authority for Health guidelines in clinical practice].

    PubMed

    Chariot, Patrick; Bécache, Nathalie; François-Purssell, Irène; Dantchev, Nicolas; Delpla, Pierre-André; Fournier, Lionel; Proust, Bernard

    2013-10-01

    Total incapacity to work (TIW) is a legal concept that allows magistrates to assess the severity of violence against persons. The TIW is the duration of the victims' inability to fulfil their usual activities and is determined by physicians. Professional guidelines from the French National Authority for Health indicate that TIW applies both to physical and psychological problems. The law of 9 July 2010 makes explicit reference to TIW in cases of psychological violence and intimate partner harassment. Prosecutors base criminal penalties on the duration of TIW in cases of assault and battery. Whatever the physician, they should describe the mental state of the victim and identify the signs that may indicate the mental impact of reported assaults. Identifying combinations of symptoms can be useful in deciding whether the duration of TIW should be increased because of the psychic state. In case of stalking, assessment of TIW can allow prosecutors to link the reported facts to a criminal offence. In complex situations, the physician may be unable to assess a duration of TIW and can suggest expert assessment. In all cases, the duration of TIW needs to be based on functional criteria. The extent of harm to the life of relationships results from suffered violence, from the victim's reaction, and from the perception of their family and friends. In this area, we suggest to limit the first assessment of TIW to a few days and to reassess it later, according to real information reported by the victims, to careful observation of their behaviour, and to results of a questioning that should be as little suggestive as possible. At either end of the age scale and in case of preexisting functional impairment, assessment of TIW should take into account the actual and global capacity of the person before the assault. PMID:23659917

  7. NICE v. SIGN on psychosis and schizophrenia: same roots, similar guidelines, different interpretations.

    PubMed

    Kendall, Tim; Whittington, Craig J; Kuipers, Elizabeth; Johnson, Sonia; Birchwood, Max J; Marshall, Max; Morrison, Anthony P

    2016-04-01

    A recent editorial claimed that the 2014 National Institute for Health and Care Excellence (NICE) guideline on psychosis and schizophrenia, unlike its equivalent 2013 Scottish Intercollegiate Guidelines Network (SIGN) guideline, is biased towards psychosocial treatments and against drug treatments. In this paper we underline that the NICE and SIGN guidelines recommend similar interventions, but that the NICE guideline has more rigorous methodology. Our analysis suggests that the authors of the editorial appear to have succumbed to bias themselves. PMID:27036696

  8. The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR).

    PubMed

    Segre, D; Pozzo, M; Perinotti, R; Roche, B

    2015-10-01

    The Italian Society of Colorectal Surgery (SICCR.) has prepared clinical practice guidelines to help its members to optimize the treatment of pilonidal disease, a very common condition, especially among young people, and therefore of great importance on a socioeconomic level. The SICCR committee of experts on pilonidal disease analyzed the international literature and evaluated current evidence. Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection: reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence. Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention. On the whole, no clear benefit is demonstrated for one technique over the other. PMID:26377583

  9. Guideline for the Diagnosis and Treatment of Recurrent Aphthous Stomatitis for Dental Practitioners

    PubMed Central

    Tarakji, Bassel; Gazal, Giath; Al-Maweri, Sadeq Ali; Azzeghaiby, Saleh Nasser; Alaizari, Nader

    2015-01-01

    Recurrent aphthous stomatitis (RAS) is a well-known oral disease with unclear etiopathogenesis for which symptomatic therapy is only available. This kind of study aimed to highlight the main points that the general practitioners should be taken in their consideration. We have collected our data from PubMed line from 1972 to 2011. Our criteria included the papers that refer to the general predisposing factors, and the general treatment of RAS. Some papers which indicated to the specific details related to RAS that needed a consultant or specialist in Oral Medicine have not included. There is no clear guideline of the etiology, diagnosis, and management of RAS; therefore, the majority of the general practitioners refer most of the cases to appropriate specialist. PMID:26028911

  10. Traumatic globe dislocation into the paranasal sinuses: Literature review and treatment guidelines.

    PubMed

    Amaral, Marcio Bruno Figueiredo; Nery, André Cardoso

    2016-05-01

    Traumatic globe dislocation into the paranasal sinuses is rare. Only 24 cases have been reported in the English-language literature indexed in PUBMED. This form of injury frequently occurs as a result of high-energy blunt trauma mainly associated to traffic accidents. Traumatic globe dislocation into the paranasal sinuses can be explained by the mechanism of blowout fracture when strong blunt trauma forces are applied to the globe fracturing the thin orbital walls and displacing the eyeball. Medical and surgical management of severe globe displacement is still controversial. However, the majority of researchers agreed that the globe should be replaced into the orbital cavity as soon as possible. The present study aims to describe a case of traumatic globe dislocation into the maxillary sinus suggesting treatment guidelines based on English-language literature from 1971 to 2015. PMID:26948171

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

    PubMed

    Eggebrecht, H

    2014-12-01

    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

  12. Neuroimaging in aphasia treatment research: Consensus and practical guidelines for data analysis

    PubMed Central

    Meinzer, Marcus; Beeson, Pélagie M.; Cappa, Stefano; Crinion, Jenny; Kiran, Swathi; Saur, Dorothee; Parrish, Todd; Crosson, Bruce; Thompson, Cynthia K.

    2012-01-01

    Functional magnetic resonance imaging is the most widely used imaging technique to study treatment-induced recovery in post-stroke aphasia. The longitudinal design of such studies adds to the challenges researchers face when studying patient populations with brain damage in cross-sectional settings. The present review focuses on issues specifically relevant to neuroimaging data analysis in aphasia treatment research identified in discussions among international researchers at the Neuroimaging in Aphasia Treatment Research Workshop held at Northwestern University (Evanston, Illinois, USA). In particular, we aim to provide the reader with a critical review of unique problems related to the pre-processing, statistical modeling and interpretation of such data sets. Despite the fact that data analysis procedures critically depend on specific design features of a given study, we aim to discuss and communicate a basic set of practical guidelines that should be applicable to a wide range of studies and useful as a reference for researchers pursuing this line of research. PMID:22387474

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

    PubMed Central

    Prandoni, Paolo

    2008-01-01

    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

  14. The feasibility of meeting the WHO guidelines for sodium and potassium: a cross-national comparison study

    PubMed Central

    Drewnowski, Adam; Maillot, Matthieu; Mendoza, Alfonso; Monsivais, Pablo

    2015-01-01

    Objective To determine joint compliance with the WHO sodium–potassium goals in four different countries, using data from nationally representative dietary surveys. Setting Compared to national and international recommendations and guidelines, the world's population consumes too much sodium and inadequate amounts of potassium. The WHO recommends consuming less than 2000 mg sodium (86 mmol) and at least 3510 mg potassium (90 mmol) per person per day. Participants Dietary surveillance data were obtained from the National Health and Nutrition Examination Survey (NHANES 2007–2010) for the USA; the Encuesta Nacional de Salud y Nutrición 2012 for Mexico; the Individual and National Study on Food Consumption (INCA2) for France; and the National Diet and Nutrition Survey (NDNS) for the UK. Primary outcome measures We estimated the proportion of adults meeting the joint WHO sodium–potassium goals in the USA, the UK, France and Mexico. Results The upper bounds of joint compliance with the WHO sodium–potassium goals were estimated at 0.3% in the USA, 0.15% in Mexico, 0.5% in France and 0.1% in the UK. Conclusions Given prevailing food consumption patterns and the current food supply, implementing WHO guidelines will be an enormous challenge for global public health. PMID:25795689

  15. Clinical guidelines.

    PubMed

    Uppal, Elaine

    2016-01-01

    This article is part of the Advancing practice series which is aimed at exploring practice issues in more depth, considering topics that are frequently encountered and facilitating the development of new insights. Elaine Uppal focuses on the importance of all midwives developing guideline writing skills to ensure that local, national and international midwifery/maternity guidelines are up to date, relevant and reflect midwifery knowledge alongside 'gold' standard evidence. The article aims to consider the development, use and critical appraisal of clinical guidelines. It will define and explain guidelines; discuss their development and dissemination; and consider issues relating to their use in practice. Techniques to critique and develop guidelines using the AGREE tool will be outlined in the form of practice challenges to be undertaken by the individual or in a group. PMID:26975126

  16. [Normative definition of staff requirement for a guideline-adherent inpatient qualified detoxification treatment in alcohol dependence].

    PubMed

    Kiefer, F; Koopmann, A; Godemann, F; Wolff, J; Batra, A; Mann, K

    2016-03-01

    The central element of the "qualified withdrawal treatment" of alcohol dependence is - in addition to physical withdrawal treatment - psychotherapy. The treatment of the underlying addictive disorder that is displayed by intoxication, harmful behaviour and withdrawal symptoms is only possible with a combination of somatic and psychotherapeutic treatment elements. The successfully established multimodal therapy of the "qualified alcohol withdrawal treatment", postulated in the current S3-Treatment Guidelines, requires a multi-disciplinary treatment team with psychotherapeutic competence. The aim of the present work is to calculate the normative staff requirement of a guideline-based 21-day qualified withdrawal treatment and to compare the result with the staffing regulations of the German Institute for Hospital Reimbursement. The present data support the hypothesis that even in the case of a hundred per cent implementation of these data, adequate therapy of alcohol-related disorders, according to the guidelines, is not feasible. This has to be considered when further developing the finance compensation system based on the described superseded elements of the German Institute for Hospital Reimbursement. PMID:26842899

  17. 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

    Kai, Jiang

    2012-01-01

    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…

  18. The Institutional Design for Continuing Education in the "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)"

    ERIC Educational Resources Information Center

    Mingming, Ji

    2012-01-01

    The cause of continuing education has gained significant strides in China after the advent of Reform and Opening Up, but it is still the weakest link in the current system of education. The "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)" (hereafter abbreviated as the "Guideline") has established the special…

  19. 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

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

    2015-02-01

    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

  20. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism

    PubMed Central

    Biondi, Bernadette; Bartalena, Luigi; Cooper, David S.; Hegedüs, Laszlo; Laurberg, Peter; Kahaly, George J.

    2015-01-01

    Endogenous subclinical hyperthyroidism (SHyper) is caused by Graves' disease, autonomously functioning thyroid nodules and multinodular goitre. Its diagnosis is based on a persistently subnormal serum thyroid-stimulating hormone (TSH) level with free thyroid hormone levels within their respective reference intervals. In 2014 the European Thyroid Association Executive Committee, given the controversies regarding the treatment of Endo SHyper, formed a task force to develop clinical practice guidelines based on the principles of evidence-based medicine. The task force recognized that recent meta-analyses, including those based on large prospective cohort studies, indicate that SHyper is associated with increased risk of coronary heart disease mortality, incident atrial fibrillation, heart failure, fractures and excess mortality in patients with serum TSH levels <0.1 mIU/l (grade 2 SHyper). Therefore, despite the absence of randomized prospective trials, there is evidence that treatment is indicated in patients older than 65 years with grade 2 SHyper to potentially avoid these serious cardiovascular events, fractures and the risk of progression to overt hyperthyroidism. Treatment could be considered in patients older than 65 years with TSH levels 0.1-0.39 mIU/l (grade 1 SHyper) because of their increased risk of atrial fibrillation, and might also be reasonable in younger (<65 years) symptomatic patients with grade 2 SHyper because of the risk of progression, especially in the presence of symptoms and/or underlying risk factors or co-morbidity. Finally, the task force concluded that there are no data to support treating SHyper in younger asymptomatic patients with grade 1 SHyper. These patients should be followed without treatment due to the low risk of progression to overt hyperthyroidism and the weaker evidence for adverse health outcomes. PMID:26558232

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

    PubMed

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

    2014-06-01

    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

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

    PubMed

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

    2014-10-01

    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

  3. Analysis of recurrence patterns in acral versus nonacral melanoma: should histologic subtype influence treatment guidelines?

    PubMed

    Gumaste, Priyanka V; Fleming, Nathaniel H; Silva, Ines; Shapiro, Richard L; Berman, Russell S; Zhong, Judy; Osman, Iman; Stein, Jennifer A

    2014-12-01

    Current surgical treatment of primary melanoma is uniform for all histosubtypes, although certain types of melanoma, such as acral lentiginous melanoma (ALM), have a worse prognosis. No study has explored the effectiveness of standard melanoma treatment guidelines for managing ALM compared with nonacral melanoma (NAM). Study subjects were identified from a prospectively enrolled database of patients with primary melanoma at New York University. Patients with ALM were matched to those with NAM (1:3) by gender and melanoma stage, including substage (ALM, 61; NAM, 183). All patients received standard-of-care treatment. Recurrence and survival outcomes in both cohorts were compared. ALM histologic subtype was an independent negative predictor of recurrence-free survival (hazard ratio [HR], 2.24; P=.001) and melanoma-specific survival (HR, 2.58; P=.001) compared with NAM. Recurrence was significantly more common in patients with ALM than in those with NAM (49% vs 30%; P=.007). For tumors less than 2 mm in thickness, a significantly higher recurrence rate was seen with ALM versus NAM (P=.048). No significant difference was seen in recurrence for tumors greater than 2 mm (P=.12). Notably, the rate of locoregional recurrence was nearly double for ALM compared with NAM (P=.001). The data presented herein reveal a high rate of locoregional failure in ALM compared with NAM when controlling for AJCC stage. These results raise the question of whether ALM may require more aggressive surgical treatment than nonacral cutaneous melanomas of equal thickness, particularly in tumors less than 2 mm thick. Larger multicenter trials are necessary for further conclusions. PMID:25505211

  4. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism.

    PubMed

    Biondi, Bernadette; Bartalena, Luigi; Cooper, David S; Hegedüs, Laszlo; Laurberg, Peter; Kahaly, George J

    2015-09-01

    Endogenous subclinical hyperthyroidism (SHyper) is caused by Graves' disease, autonomously functioning thyroid nodules and multinodular goitre. Its diagnosis is based on a persistently subnormal serum thyroid-stimulating hormone (TSH) level with free thyroid hormone levels within their respective reference intervals. In 2014 the European Thyroid Association Executive Committee, given the controversies regarding the treatment of Endo SHyper, formed a task force to develop clinical practice guidelines based on the principles of evidence-based medicine. The task force recognized that recent meta-analyses, including those based on large prospective cohort studies, indicate that SHyper is associated with increased risk of coronary heart disease mortality, incident atrial fibrillation, heart failure, fractures and excess mortality in patients with serum TSH levels <0.1 mIU/l (grade 2 SHyper). Therefore, despite the absence of randomized prospective trials, there is evidence that treatment is indicated in patients older than 65 years with grade 2 SHyper to potentially avoid these serious cardiovascular events, fractures and the risk of progression to overt hyperthyroidism. Treatment could be considered in patients older than 65 years with TSH levels 0.1-0.39 mIU/l (grade 1 SHyper) because of their increased risk of atrial fibrillation, and might also be reasonable in younger (<65 years) symptomatic patients with grade 2 SHyper because of the risk of progression, especially in the presence of symptoms and/or underlying risk factors or co-morbidity. Finally, the task force concluded that there are no data to support treating SHyper in younger asymptomatic patients with grade 1 SHyper. These patients should be followed without treatment due to the low risk of progression to overt hyperthyroidism and the weaker evidence for adverse health outcomes. PMID:26558232

  5. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE)

    PubMed Central

    Althof, Stanley E; McMahon, Chris G; Waldinger, Marcel D; Serefoglu, Ege Can; Shindel, Alan W; Adaikan, P Ganesan; Becher, Edgardo; Dean, John; Giuliano, Francois; Hellstrom, Wayne JG; Giraldi, Annamaria; Glina, Sidney; Incrocci, Luca; Jannini, Emmanuele; McCabe, Marita; Parish, Sharon; Rowland, David; Segraves, R Taylor; Sharlip, Ira; Torres, Luiz Otavio

    2014-01-01

    Introduction In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. Aim The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method A comprehensive literature review was performed. Results This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60–90. PMID:25356302

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

    PubMed Central

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

    2012-01-01

    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

  7. Non-compliance on the part of the professional community with a national guideline: an argumentative policy analysis.

    PubMed

    Moret-Hartman, Margriet; Knoester, Pieter D; Hekster, Yechiel A; van der Wilt, Gert Jan

    2006-10-01

    In 1997, the National Health Insurance Board of the Netherlands (CVZ) introduced a guideline for the use of a new anti-epileptic drug, Lamotrigine. The goal was to limit the use of this relatively expensive drug to patients with difficult-to-treat epilepsy. A survey had shown that only a minority of neurologists were familiar with the guideline, and even fewer applied it in practice. In the present study, interviews were held with stakeholders to obtain a better understanding of why this policy measure failed. The results indicate that the problem definitions of policy maker and practicing neurologists differed widely, and that the policy measure was conflicting with certain professional beliefs. In such cases, the theory of argumentative policy predicts that policy is unlikely to succeed, unless policy makers take actions to ensure a greater congruence in interpretative frames between them and their target population. PMID:16387386

  8. National Institute for Health and Clinical Excellence guidelines on preoperative tests: the use of routine preoperative tests for elective surgery.

    PubMed

    Reynolds, T M

    2006-01-01

    Clinical Guideline CG3 from the National Institute for Health and Clinical Excellence (NICE) makes recommendations on appropriate clinical practice in preoperative testing for elective surgery. Unfortunately, there is minimal evidence on which the guidelines could be based and therefore they were constructed on the basis of professional opinion. This resulted in the construction of a decision matrix of Byzantine complexity built on foundations of sand: surgical risk is estimated using an unvalidated ad hoc risk estimation method; anaesthetic risk is estimated using the American Society of Anesthesiologists (ASA) risk method that has been demonstrated to be incapable of generating consistent risk assessments. The resultant matrix may be suitable for use as a template for future research, but is extremely complex and inadequately rigorous for routine use. PMID:16390604

  9. Management of hyperphosphataemia in chronic kidney disease: summary of National Institute for Health and Clinical Excellence (NICE) guideline.

    PubMed

    Dasgupta, Indranil; Shroff, Rukshana; Bennett-Jones, David; McVeigh, Gary

    2013-01-01

    Bone disease and ectopic calcification are the two main consequences of hyperphosphataemia of chronic kidney disease (CKD). Observational studies have demonstrated that hyperphosphataemia in CKD is associated with increased mortality. Furthermore, the use of phosphate binders in dialysis patients is associated with significantly lower mortality. The UK Renal Registry data show significant underachievement of phosphate targets in dialysis patients. It is believed to be due to wide variation in how management interventions are used. The National Institute for Health and Clinical Excellence (NICE) has developed a guideline on the management of hyperphosphataemia in CKD. This is based on the evidence currently available using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This review outlines the recommendations including research recommendations and discusses methodology, rationale and challenges faced in developing this guideline and the health economic model used to assess the cost-effectiveness of different phosphate binders. PMID:24022619

  10. A comparison of HAS & NICE guidelines for the economic evaluation of health technologies in the context of their respective national health care systems and cultural environments

    PubMed Central

    Massetti, Marc; Aballéa, Samuel; Videau, Yann; Rémuzat, Cécile; Roïz, Julie; Toumi, Mondher

    2015-01-01

    Background Health technology assessment (HTA) has been reinforced in France, notably with the introduction of economic evaluation in the pricing process for the most innovative and expensive treatments. Similarly to the National Institute for Clinical Excellence (NICE) in England, the National Authority for Health (HAS), which is responsible for economic evaluation of new health technologies in France, has published recommendations on the methods of economic evaluation. Since economic assessment represents a major element of HTA in England, exploring the differences between these methodological guidelines might help to comprehend both the shape and the role economic assessment is intended to have in the French health care system. Methods Methodological guidelines for economic evaluation in France and England have been compared topic-by-topic in order to bring out key differences in the recommended methods for economic evaluation. Results The analysis of both guidelines has revealed multiple similarities between France and England, although a number of differences were also noted regarding the elected methodology of analysis, the comparison of studies’ outcomes with cost-effectiveness thresholds, the study population to consider, the quality of life valuation methods, the perspective on costs, the types of resources considered and their valuation, the discount rates to apply in order to reflect the present value of interventions, etc. To account for these differences, modifications will be required in order to adapt economic models from one country to the other. Conclusions Changes in HTA assessment methods occur in response to different challenges determined by the different philosophical and cultural considerations surrounding health and welfare as well as the political considerations regarding the role of public policies and the importance of their evaluation. PMID:27123190

  11. Evidence-based guideline summary: Diagnosis and treatment of limb-girdle and distal dystrophies

    PubMed Central

    Narayanaswami, Pushpa; Weiss, Michael; Selcen, Duygu; David, William; Raynor, Elizabeth; Carter, Gregory; Wicklund, Matthew; Barohn, Richard J.; Ensrud, Erik; Griggs, Robert C.; Gronseth, Gary; Amato, Anthony A.

    2014-01-01

    Objective: To review the current evidence and make practice recommendations regarding the diagnosis and treatment of limb-girdle muscular dystrophies (LGMDs). Methods: Systematic review and practice recommendation development using the American Academy of Neurology guideline development process. Results: Most LGMDs are rare, with estimated prevalences ranging from 0.07 per 100,000 to 0.43 per 100,000. The frequency of some muscular dystrophies varies based on the ethnic background of the population studied. Some LGMD subtypes have distinguishing features, including pattern of muscle involvement, cardiac abnormalities, extramuscular involvement, and muscle biopsy findings. The few published therapeutic trials were not designed to establish clinical efficacy of any treatment. Principal recommendations: For patients with suspected muscular dystrophy, clinicians should use a clinical approach to guide genetic diagnosis based on clinical phenotype, inheritance pattern, and associated manifestations (Level B). Clinicians should refer newly diagnosed patients with an LGMD subtype and high risk of cardiac complications for cardiology evaluation even if they are asymptomatic from a cardiac standpoint (Level B). In patients with LGMD with a known high risk of respiratory failure, clinicians should obtain periodic pulmonary function testing (Level B). Clinicians should refer patients with muscular dystrophy to a clinic that has access to multiple specialties designed specifically to care for patients with neuromuscular disorders (Level B). Clinicians should not offer patients with LGMD gene therapy, myoblast transplantation, neutralizing antibody to myostatin, or growth hormone outside of a research study designed to determine efficacy and safety of the treatment (Level R). Detailed results and recommendations are available on the Neurology® Web site at Neurology.org. PMID:25313375

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

    ERIC Educational Resources Information Center

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

    2011-01-01

    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

  13. 75 FR 32191 - National Health and Nutrition Examination Survey (NHANES) DNA Samples: Guidelines for Proposals...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-07

    ..., 2006 [71 FR 22248]. Category (A): Studies involving the typing of the complete set of NHANES DNA... published see: (Friday, January 13, 2006 [71 FR 22248]). NHANES 1999-2002 and 2007-2008 DNA Samples The... Survey (NHANES) DNA Samples: Guidelines for Proposals To Use Samples and Cost Schedule AGENCY:...

  14. Toward a national plan for the accelerated commercialization of solar energy: guidelines for regional planning

    SciTech Connect

    Miller, G.; Bennington, G.; Bohannon, M.; Gerstein, R.; Kannan, N.; Page, A.; Rebibo, K.; Shulman, M.; Swepak, P.; Taul, J.

    1980-01-01

    This document provides data and guidelines for the development of regional programs for the accelerated commercialization of solar energy. It estimates the solar potential for individual regions based on the solar resources, competing costs of energy, and specific regional characteristics. It also points out the primary decision makers, technology distributors, and potential barriers that should be addressed by a commercialization program.

  15. 77 FR 26238 - Fisheries of the United States; National Standard 1 Guidelines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-03

    ... NS1 are codified in 50 CFR 600.310. NMFS revised the NS1 Guidelines on January 16, 2009 (74 FR 3178... discarded. In the final rule response to comment number 35 (74 FR 3718; January 16, 2009), NMFS stated that... multiple considerations in mixed-stock fisheries may be warranted. 5. Scientific uncertainty and...

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

    ERIC Educational Resources Information Center

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

    2011-01-01

    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…

  17. The National Treatment Improvement Evaluation Study: Retention Analysis.

    ERIC Educational Resources Information Center

    Orwin, Rob; Williams, Valerie

    This study focuses on programmatic factors that predict retention for individuals in drug and alcohol treatment programs through secondary analysis of data from the National Treatment Improvement Evaluation Study (NTIES). It addresses the relationships between completion rates, lengths of stay, and treatment modality. It examines the effect of…

  18. Italian guidelines for management and treatment of hyperbilirubinaemia of newborn infants ≥ 35 weeks’ gestational age

    PubMed Central

    2014-01-01

    Hyperbilirubinaemia is one of the most frequent problems in otherwise healthy newborn infants. Early discharge of the healthy newborn infants, particularly those in whom breastfeeding is not fully established, may be associated with delayed diagnosis of significant hyperbilirubinaemia that has the potential for causing severe neurological impairments. We present the shared Italian guidelines for management and treatment of jaundice established by the Task Force on hyperbilirubinaemia of the Italian Society of Neonatology. The overall aim of the present guidelines is to provide an useful tool for neonatologists and family paediatricians for managing hyperbilirubinaemia. PMID:24485088

  19. Pattern of pharmacotherapy by episode types for patients with bipolar disorders and its concordance with treatment guidelines.

    PubMed

    Baek, Ji Hyun; Ha, Kyooseob; Yatham, Lakshimi N; Chang, Jae Seung; Ha, Tae Hyon; Jeon, Hong Jin; Hong, Kyung Sue; Chang, Sung Man; Ahn, Yong Min; Cho, Hyun Sang; Moon, Eunsoo; Cha, Boseok; Choi, Jung Eun; Joo, Yeon Ho; Joo, Eun Jeong; Lee, Se Young; Park, Yunseong

    2014-10-01

    This study aimed to investigate the overall prescription pattern for patients with bipolar disorders in Korea and its relevance to the practice guidelines. Prescription records from all patients with bipolar I and II disorders who have been admitted or who started the outpatient treatment during the year of 2009 in 10 academic setting hospitals were reviewed. A total of 1447 patients with bipolar I and II disorders were included in this study. Longitudinal prescription patterns of inpatients and outpatients were analyzed by episode types and compared with the clinical practice guideline algorithms. In all phases, polypharmacy was chosen as an initial treatment strategy (>80%). The combination of mood stabilizer and atypical antipsychotics was the most favored. Antipsychotics were prescribed in more than 80% of subjects across all phases. The rate of antidepressant use ranged from 15% to 40%, and it was more frequently used in acute treatment and bipolar II subjects. The concordance rate of prescriptions for manic inpatients to the guidelines was higher and relatively more consistent (43.8%-48.7%) compared with that for depressive inpatients (18.6%-46.9%). Polypharmacy was the most common reason for nonconcordance. In Korean psychiatric academic setting, polypharmacy and atypical antipsychotics were prominently favored in the treatment of bipolar disorder, even with the lack of evidence of its superiority. More evidence is needed to establish suitable treatment strategies. In particular, the treatment strategy for acute bipolar depression awaits more consensuses. PMID:25006813

  20. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescent sexual offenders with paraphilic disorders

    PubMed Central

    Thibaut, Florence; Bradford, John M. W.; Briken, Peer; De La Barra, Flora; Häßler, Frank; Cosyns, Paul

    2016-01-01

    Abstract The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment of adolescents with paraphilic disorders who are also sexual offenders or at-risk of sexual offending. Psychotherapeutic and psychosocial treatments were also reviewed. Adolescents with paraphilic disorders specifically present a different therapeutic challenge as compared to adults. In part, the challenge relates to adolescents being in various stages of puberty and development, which may limit the use of certain pharmacological agents due to their potential side effects. In addition, most of the published treatment programmes have used cognitive behavioural interventions, family therapies and psychoeducational interventions. Psychological treatment is predicated in adolescents on the notion that sexually deviant behaviour can be controlled by the offender, and that more adaptive behaviours can be learned. The main purposes of these guidelines are to improve the quality of care and to aid physicians in their clinical decisions. These guidelines brought together different expert views and involved an extensive literature research. Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for efficacy, safety, tolerability and feasibility. An algorithm is proposed for the treatment of paraphilic disorders in adolescent sexual offenders or those who are at risk. PMID:26595752

  1. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescent sexual offenders with paraphilic disorders.

    PubMed

    Thibaut, Florence; Bradford, John M W; Briken, Peer; De La Barra, Flora; Häßler, Frank; Cosyns, Paul

    2016-01-01

    The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment of adolescents with paraphilic disorders who are also sexual offenders or at-risk of sexual offending. Psychotherapeutic and psychosocial treatments were also reviewed. Adolescents with paraphilic disorders specifically present a different therapeutic challenge as compared to adults. In part, the challenge relates to adolescents being in various stages of puberty and development, which may limit the use of certain pharmacological agents due to their potential side effects. In addition, most of the published treatment programmes have used cognitive behavioural interventions, family therapies and psychoeducational interventions. Psychological treatment is predicated in adolescents on the notion that sexually deviant behaviour can be controlled by the offender, and that more adaptive behaviours can be learned. The main purposes of these guidelines are to improve the quality of care and to aid physicians in their clinical decisions. These guidelines brought together different expert views and involved an extensive literature research. Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for efficacy, safety, tolerability and feasibility. An algorithm is proposed for the treatment of paraphilic disorders in adolescent sexual offenders or those who are at risk. PMID:26595752

  2. Treatment of Infantile Spasms: Report of the Interdisciplinary Guideline Committee Coordinated by the German-Speaking Society for Neuropediatrics.

    PubMed

    Tibussek, Daniel; Klepper, Jörg; Korinthenberg, Rudolf; Kurlemann, Gerhard; Rating, Dietz; Wohlrab, Gabriele; Wolff, Markus; Schmitt, Bernhard

    2016-06-01

    Objectives This report aims to define treatment goals, to summarize the evidence level (EL) of different treatment options for infantile spasms (IS), both in terms of efficacy and adverse effect, and to give recommendations for the management of IS. Methods The Cochrane and Medline (1966-July 2014) databases were searched. Literature known to the guideline working group and identified through citations was also considered. The results of previously published guidelines were taken into account in our analysis. Rating the level of evidence followed the Scottish Intercollegiate Guidelines Network. Recommendations If IS are suspected, electroencephalogram (EEG) should be performed within a few days and, if confirmed, treatment should be initiated immediately. Response to first-line treatments should be evaluated clinically and electroencephalographically after 14 days.Adrenocorticotropic hormone, corticosteroids, and vigabatrin are the first-line drugs for the treatment of IS. In children with tuberous sclerosis complex, vigabatrin is the treatment of first choice. Ketogenic diet, sulthiame, topiramate, valproate, zonisamide, and benzodiazepines can be used when first-line drugs have proved ineffective. Children refractory to drug therapy should be evaluated for epilepsy surgery, especially if focal brain lesions are present.Regular follow-up controls, including EEG (preferably sleep EEG) and standardized developmental assessment are recommended. PMID:26910805

  3. Lack of adherence to hypertension treatment guidelines among GPs in southern Sweden-A case report-based survey

    PubMed Central

    2012-01-01

    Background General practitioners (GPs) often fail to correctly adhere to guidelines for the treatment of hypertension. The reasons for this are unclear, but could be related to lack of knowledge in assessing individual patients' cardiovascular disease risk. Our aim was to investigate how GPs in southern Sweden adhere to clinical guidelines for the treatment of hypertension when major cardiovascular risk factors are taken into consideration. Method A questionnaire with five genuine cases of hypertension with different cardiovascular risk profiles was sent to a random sample of GPs in southern Sweden (n = 109) in order to investigate the attitude towards blood pressure (BP) treatment when major cardiovascular risk factors were present. Results In general, GPs who responded tended to focus on the absolute target BP rather than assessing the entire cardiovascular risk factor profile. Thus, cases with the highest risk of cardiovascular disease were not treated accordingly. However, there was also a tendency to overtreat the lowest risk individuals. Furthermore, the BP levels for initiating pharmacological treatment varied widely (systolic BP 140-210 mmHg). ACE inhibitors (70%) were the most common first choice of pharmacological treatment. Conclusion In this study, GPs in Southern Sweden were suggesting, for different cases, either under- or overtreatment in relation to current guidelines for treatment of hypertension. On reason may be that they failed to correctly assess individual cardiovascular risk factor profiles. PMID:22536853

  4. Nurses’ compliance with prevention of mother-to-child transmission national guidelines in selected sites in Kinshasa, Democratic Republic of Congo

    PubMed Central

    Brysiewicz, Petra

    2015-01-01

    Background The Democratic Republic of Congo (DRC) implemented a prevention of mother-to-child transmission (PMTCT) of HIV infection programme in maternal, newborn and child health (MNCH) services in 2001 with nurses as key personnel. To date there is no information in the DRC and specifically in Kinshasa with respect to compliance with PMTCT national guidelines. Aim The study aimed at describing nurses’ compliance with the PMTCT national guidelines in selected PMTCT sites of Kinshasa. Methods A descriptive cross-sectional study was conducted in Kinshasa with 76 nurses in 18 selected PMTCT sites. The nurses’ compliance with PMTCT national guidelines was assessed using a healthcare provider self-reporting questionnaire developed by the researchers. Results The study showed that the mean score of nurses’ compliance with PMTCT national guidelines was 74% (95% CI: 69% – 78%) which progressively decreased and was significantly different across different MNCH services (p = 0.025). With respect to categories of PMTCT recommendations, nurses were compliant with those related to education in labour and delivery, and antenatal services. Sociodemographic characteristics such as training, length of service and category of nurses did not influence nurses’ compliance score. Conclusion These findings showed that nurses were noncompliant with PMTCT national guidelines, with the score level being 80% or more in the three MNCH services/units. Improvement of nurses’ ‘compliance with the PMTCT national guidelines requires effective monitoring of full integration of PMTCT as routine activities in MNCH care. PMID:26842503

  5. Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure - A national survey of the cardiologists in Pakistan

    PubMed Central

    2011-01-01

    Background The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines. Methods A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File 1). Respondents' management choices were compared with those of an expert panel based on the guidelines for three fictitious patient cases. Cardiologists were also asked about major barriers to adherence to guidelines. Results A total of 372 cardiologists were approached; 305 consented to participate (overall response rate, 82.0%). The survey showed a very high awareness of CHF guidelines; 97.4% aware of any guideline. About 13.8% considered ESC guidelines as relevant or very relevant for guiding treatment decisions while 92.8% chose AHA guidelines in relevance. 87.2% of respondents perceived that they adhered to the HF guidelines. For the patient cases, the proportions of respondents who made recommendations that completely matched those of the guidelines were 7% (Scenario 1), 0% (Scenario 2) and 20% (Scenario 3). Respondents considered patient compliance (59%) and cost/health economics (50%) as major barriers to guideline implementation. Conclusion We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan. PMID:22093082

  6. Practice Guideline for the Surveillance of Patients After Curative Treatment of Colon and Rectal Cancer.

    PubMed

    Steele, Scott R; Chang, George J; Hendren, Samantha; Weiser, Marty; Irani, Jennifer; Buie, W Donald; Rafferty, Janice F

    2015-08-01

    Current evidence suggests improved rates of curative secondary treatment following identification of recurrence among patients who participate in a surveillance program after initial curative resection of colon or rectal cancer. The newer data show that surveillance CEA, chest and liver imaging,and colonoscopy can also improve survival through early diagnosis of recurrence; thus, these modalities are now included in the current guideline. Although the optimum strategy of surveillance for office visits, CEA, chest and liver imaging, and colonoscopy is not yet defined, routine surveillance does improve the detection of recurrence that can be resected with curative intent. Recommended surveillance schedules are shown in Table 4. However, the factors to be considered when recommending surveillance include underlying risk for recurrence, patient comorbidity, and the ability to tolerate major surgery to resect recurrent disease or palliative chemotherapy, performance status, physiologic age, preference, and compliance. The success of surveillance for early detection of curable recurrence will depend on patient and provider involvement to adhere to the surveillance schedule and avoid unnecessary examination. It should be noted that, after curative resection of colorectal cancer, patients are still at risk for other common malignancies(lung, breast, cervix, prostate) for which standard screening recommendations should be observed and measures to maintain general health (risk reduction for cardiovascular disease, eg, cessation of smoking, control of blood pressure and diabetes mellitus, balanced diet, regular exercise and sleep, and flu vaccines) should be recommended. PMID:26163950

  7. Cardiovascular and Interventional Radiological Society of Europe Guidelines on Endovascular Treatment in Aortoiliac Arterial Disease

    SciTech Connect

    Rossi, Michele; Iezzi, Roberto

    2013-11-06

    PurposeThese guidelines are intended for use in assessing the standard for technical success and safety in aorto-iliac percutaneous endovascular interventions.MethodsAny recommendation contained in the text comes from the highest level and extension of literature review available to date.ResultsThe success of endovascular procedures is strictly related to an accurate planning based mainly on CT- or MR-angiography. TASC II A through C lesions have an endovascular-first option Pre-procedure ASA antiplatelet therapy is advisable in all cases. The application of stents improves the immediate hemodynamic and most likely long-term clinical results. Cumulative mean complication rate is 7.51 % according to the most relevant literature. Most of the complications can be managed by means of percutaneous techniques.ConclusionThe design and quality of devices, as well as the easy and accuracy of performing these procedures, have improved over the last decades, leading to the preferential treatment of aorto-iliac steno-obstructive disease via endovascular means, often as first-line therapy, with high technical success rate and low morbidity. This is mirrored by the decreasing number of patients undergoing surgical grafts over the last years with patency, limb salvage, and survival rates equivalent to open reconstruction.

  8. Guideline for the diagnosis and treatment of scabies in Japan (second edition).

    PubMed

    Ishii, Norihisa

    2008-06-01

    The guideline has been prepared by the Japanese Dermatological Association to ensure proper diagnosis and treatment of scabies, as oral therapy became available on August 2006 under health insurance and its clinical use was expected to increase. For making a proper diagnosis, the following three points should be taken into consideration: (i) clinical symptoms; (ii) detection of the mite (Sarcoptes scabiei); and (iii) epidemiological symptoms. The diagnosis is confirmed if the mites or eggs are identified by microscopy or dermoscopy and so forth. Topical sulfur preparations, with only limited usefulness, are the only available topical drugs approved by health insurance coverage for treating scabies. Currently, crotamiton, benzyl benzoate and gamma-benzene hexachloride are also used clinically. It is important to apply these to the whole-body, including hands, fingers and genitals. The dose for ivermectin is a single administration p.o. of approximately 200 microg/kg bodyweight with water before a meal. Administration of a second dose is considered, if new specific lesions develop or the mites are detected. For treating crusted scabies, concomitant administration of oral ivermectin and the topical preparation is necessary. Some safe and useful topical drug preparations are needed to be approved by health insurance. PMID:18578720

  9. Impact of Preexisting Mental Illnesses on Receipt of Guideline-Consistent Breast Cancer Treatment and Health Care Utilization.

    PubMed

    Mahabaleshwarkar, Rohan; Khanna, Rahul; Banahan, Benjamin; West-Strum, Donna; Yang, Yi; Hallam, Jeffrey S

    2015-12-01

    This study determined the impact of preexisting mental illnesses on guideline-consistent breast cancer treatment and breast cancer-related health care utilization. This was a retrospective, longitudinal, cohort study conducted using data from the 2006-2008 Medicaid Analytic Extract files. The target population for the study consisted of female Medicaid enrollees who were aged 18-64 years and were newly diagnosed with breast cancer in 2007. Guideline-consistent breast cancer treatment was defined according to established guidelines. Breast cancer-related health care use was reported in the form of inpatient, outpatient, and emergency room visits. Statistical analyses consisted of multivariable hierarchical regression models. A total of 2142 newly diagnosed cases of breast cancer were identified. Approximately 38% of these had a preexisting mental illness. Individuals with any preexisting mental illness were less likely to receive guideline-consistent breast cancer treatment compared to those without any preexisting mental illness (adjusted odds ratio: 0.793, 95% confidence interval [CI]: 0.646-0.973). A negative association was observed between preexisting mental illness and breast cancer-related outpatient (adjusted incident rate ratio (AIRR): 0.917, 95% CI: 0.892-0.942) and emergency room utilization (AIRR: 0.842, 95% CI: 0.709-0.999). The association between preexisting mental illnesses and breast cancer-related inpatient utilization was statistically insignificant (AIRR: 0.993, 95% CI: 0.851-1.159). The findings of this study indicate that breast cancer patients with preexisting mental illnesses experience disparities in terms of receipt of guideline-consistent breast cancer treatment and health care utilization. The results of this study highlight the need for more focused care for patients with preexisting mental illness. PMID:26106925

  10. Translating national childhood immunization guidelines to a computer-based reminder recall system within an immunization registry.

    PubMed Central

    Wang, D.; Jenders, R. A.; Dasgupta, B.

    1999-01-01

    To translate national childhood immunization guidelines to a computer-based reminder recall system, hierarchical system architecture design and combined approach of tabular and procedural knowledge representation are taken. Nested branches with hierarchical combinations of single antecedent variables are used to avoid logical incompleteness, redundancy and inconsistency. Mapping to the local electronic medical vocabulary is implemented to facilitate the integration with the local information system architecture. 26 second-level modules with 195 original branches and 121 final branches after pruning are encoded. 99.67% of the reminders are confirmed to be correct by SQL query. PMID:10566510

  11. Clinical practice guidelines for the care and treatment of breast cancer: 13. Sentinel lymph node biopsy

    PubMed Central

    Cantin, Jacques; Scarth, Hugh; Levine, Mark; Hugi, Maria

    2001-01-01

    Objective To provide information and recommendations to women with breast cancer and their physicians regarding what is now known about sentinel lymph node (SLN) biopsy. Options Axillary dissection; SLN biopsy followed by backup axillary dissection; SLN biopsy. Outcomes Accurate determination of cancer stage, resulting in better-informed therapeutic decisions. Evidence Systematic review of English-language literature published from January 1991 to December 2000 retrieved primarily from MEDLINE and CANCERLIT. Recommendations · Axillary dissection is the standard of care for the surgical staging of operable breast cancer. · If a patient requests or is offered SLN biopsy, the benefits and risks as well as what is and is not known about the procedure should be outlined. · Patients should be informed of the number of SLN biopsies performed by the surgeon and the surgeon's success rate with the procedure, as determined by the identification of the SLN and the false-negative rate (the presence of tumour cells in the axillary nodes when the SLN biopsy result is negative). · Before surgeons replace axillary dissection by SLN biopsy as the staging procedure at their institution, they should (a) familiarize themselves with the literature on the topic and the techniques needed to perform the procedure, (b) follow a defined protocol for all 3 aspects of the procedure (nuclear medicine, surgery, pathology) and (c) perform backup axillary dissection until an acceptable success rate (as determined by the identification of the SLN and the false-negative rate) is achieved. · A surgeon who performs breast cancer surgery infrequently should not perform SLN biopsy. · A positive SLN biopsy result or failure to identify an SLN should prompt full axillary dissection. · SLN biopsy is contraindicated in women who have clinically palpable nodes, locally advanced breast cancer, multifocal tumours, previous breast surgery or previous irradiation of the breast. · Staining of tissue sections with hematoxylin and eosin, and not immunohistochemical analysis for cytokeratin, should determine adjuvant therapy. · Participation in randomized clinical trials is encouraged. [A patient version of these guidelines appears in Appendix 1.] Validation Internal validation within the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer; no external validation. Sponsor The steering committee was convened by Health Canada. Completion date Apr. 9, 2001. PMID:11501455

  12. [S1 guideline on the "diagnosis and treatment of snoring in adults"].

    PubMed

    Stuck, B A; Abrams, J; de la Chaux, R; Dreher, A; Heiser, C; Hohenhorst, W; Kühnel, T; Maurer, J T; Pirsig, W; Steffen, A; Verse, T

    2010-03-01

    Due to the frequency of this phenomenon and the often considerable distress caused to the affected person, competent advice, diagnosis and treatment of snoring in adults is of particular importance. The aim of this guideline is to promote high-quality medical care for patients affected by this problem. According to the three-level concept of the AWMF, it corresponds to an S1 guideline. Prior to any therapeutic intervention, relevant sleep medical history, clinical examination, as well as a mandatory objective diagnostic measure are performed. Snoring is only treated if the patient asks for it. In general, invasive methods should be viewed critically and the patient should be advised correspondingly. In the case of surgical therapy, minimally invasive techniques are preferred. Reducing body weight (in the case of overweight snorers), abstinence from alcohol, nicotine and sleep medication, as well as maintaining a healthy sleep-wake cycle can be recommended from a sleep-medicine perspective, although convincing clinical studies are not yet available. Since evidence for the effectiveness of muscle stimulation or various methods for toning and training of the muscles of the floor of mouth is not available, these methods are not recommended. Snoring can be successfully treated with the use of an intraoral device; however, careful patient selection is important. Avoiding a supine position during sleep can be helpful in some cases. Only limited data is available on the success rates of the surgical approaches and long term data is often lacking, and not all techniques have been sufficiently evaluated from a scientific point of view. Nasal surgery is only indicated if the patient suffers from nasal obstruction. Extensive data supports the effectiveness of laser-assisted resection of excessive soft palate tissue (laser-assisted uvuloplasty, LAUP). In principle, however, such resections can be performed using other techniques. Placebo-controlled studies were able to prove the effectiveness of radiofrequency surgery of the soft palate. A reduction in snoring could also be achieved in many cases by means of soft palate implants with minimal post-operative morbidity. The indication for tonsillectomy and uvulopalatopharyngoplasty should be made cautiously due to the comparatively high morbidity associated with these procedures. PMID:20204310

  13. Evidence-based guideline for neuropathic pain interventional treatments: Spinal cord stimulation, intravenous infusions, epidural injections and nerve blocks

    PubMed Central

    Mailis, Angela; Taenzer, Paul

    2012-01-01

    BACKGROUND: The Special Interest Group of the Canadian Pain Society has produced consensus-based guidelines for the pharmacological management of neuropathic pain. The society aimed to generate an additional guideline for other forms of neuropathic pain treatments. OBJECTIVE: To develop evidence-based recommendations for neuropathic pain interventional treatments. METHODS: A task force was created and engaged the Institute of Health Economics in Edmonton, Alberta, to survey the literature pertaining to multiple treatments. Sufficient literature existed on four interventions only: spinal cord stimulation; epidural injections; intravenous infusions; and nerve blocks. A comprehensive search was conducted for systematic reviews, randomized controlled trials and evidence-based clinical practice guidelines; a critical review was generated on each topic. A modified United States Preventive Services Task Force tool was used for quality rating and grading of recommendations. RESULTS: Investigators reviewed four studies of spinal cord stimulation, 19 studies of intravenous infusions, 14 studies of epidural injections and 16 studies of nerve blocks that met the inclusion criteria. The task force chairs rated the quality of evidence and graded the recommendations. Feedback was solicited from the members of the task force. CONCLUSION: There is sufficient evidence to support recommendations for some of these interventions for selected neuropathic pain conditions. This evidence is, at best, moderate and is often limited or conflicting. Pain practitioners are encouraged to explore evidence-based treatment options before considering unproven treatments. Full disclosure of risks and benefits of the available options is necessary for shared decision making and informed consent. PMID:22606679

  14. [Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association].

    PubMed

    Birkner, B

    2000-09-01

    The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. Evidence-based clinical guidelines can serve as references for the development of standards in quality measurement. Only little data exists on the implementation strategy of guidelines and evaluation, respectively. A pilot quality management system in consistence with ISO 9001 criteria was developed for ambulatory, gastroenterological services. National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well. PMID:11084717

  15. Total, Free, and Added Sugar Consumption and Adherence to Guidelines: The Dutch National Food Consumption Survey 2007–2010

    PubMed Central

    Sluik, Diewertje; van Lee, Linde; Engelen, Anouk I.; Feskens, Edith J. M.

    2016-01-01

    A high sugar intake is a subject of scientific debate due to the suggested health implications and recent free sugar recommendations by the WHO. The objective was to complete a food composition table for added and free sugars, to estimate the intake of total sugars, free sugars, and added sugars, adherence to sugar guidelines and overall diet quality in Dutch children and adults. In all, 3817 men and women (7–69 years) from the Dutch National Food Consumption Survey 2007–2010 were studied. Added and free sugar content of products was assigned by food composition tables and using labelling and product information. Diet was assessed with two 24-h recalls. Diet quality was studied in adults with the Dutch Healthy Diet-index. Total sugar intake was 22% Total Energy (%TE), free sugars intake 14 %TE, and added sugar intake 12 %TE. Sugar consumption was higher in children than adults. Main food sources of sugars were sweets and candy, non-alcoholic beverages, dairy, and cake and cookies. Prevalence free sugar intake <10 %TE was 5% in boys and girls (7–18 years), 29% in women, and 33% in men. Overall diet quality was similar comparing adults adherent and non-adherent to the sugar guidelines, although adherent adults had a higher intake of dietary fiber and vegetables. Adherence to the WHO free sugar guidelines of <5 %TE and <10 %TE was generally low in the Netherlands, particularly in children. Adherence to the added and free sugar guidelines was not strongly associated with higher diet quality in adults. PMID:26828518

  16. Total, Free, and Added Sugar Consumption and Adherence to Guidelines: The Dutch National Food Consumption Survey 2007-2010.

    PubMed

    Sluik, Diewertje; van Lee, Linde; Engelen, Anouk I; Feskens, Edith J M

    2016-01-01

    A high sugar intake is a subject of scientific debate due to the suggested health implications and recent free sugar recommendations by the WHO. The objective was to complete a food composition table for added and free sugars, to estimate the intake of total sugars, free sugars, and added sugars, adherence to sugar guidelines and overall diet quality in Dutch children and adults. In all, 3817 men and women (7-69 years) from the Dutch National Food Consumption Survey 2007-2010 were studied. Added and free sugar content of products was assigned by food composition tables and using labelling and product information. Diet was assessed with two 24-h recalls. Diet quality was studied in adults with the Dutch Healthy Diet-index. Total sugar intake was 22% Total Energy (%TE), free sugars intake 14 %TE, and added sugar intake 12 %TE. Sugar consumption was higher in children than adults. Main food sources of sugars were sweets and candy, non-alcoholic beverages, dairy, and cake and cookies. Prevalence free sugar intake <10 %TE was 5% in boys and girls (7-18 years), 29% in women, and 33% in men. Overall diet quality was similar comparing adults adherent and non-adherent to the sugar guidelines, although adherent adults had a higher intake of dietary fiber and vegetables. Adherence to the WHO free sugar guidelines of <5 %TE and <10 %TE was generally low in the Netherlands, particularly in children. Adherence to the added and free sugar guidelines was not strongly associated with higher diet quality in adults. PMID:26828518

  17. Technology for Water Treatment (National Water Management)

    NASA Technical Reports Server (NTRS)

    1992-01-01

    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.

  18. Pharmacotherapy for bipolar disorder and concordance with treatment guidelines: survey of a general population sample referred to a tertiary care service

    PubMed Central

    2013-01-01

    Background Many new approaches have been adopted for the treatment of bipolar disorder (BD) in the past few years, which strived to produce more positive outcomes. To enhance the quality of care, several guideline recommendations have been developed. For study purposes, we monitored the prescription of psychotropic drugs administered to bipolar patients who had been referred to tertiary care services, and assessed the degree to which treatment met specific guidelines. Methods Between December 2006 and February 2009, we assessed 113 individuals suffering from BD who had been referred to the Royal Ottawa Mental Health Centre (ROMHC) Mood Disorders Program by physicians within the community, mostly general practitioners. The Structured Clinical Interview for DSM-IV-TR was used to assess diagnosis. The prescribed treatment was compared with specific Canadian guidelines (CANMAT, 2009). Univariate analyses and logistic regression were used to assess the contribution of demographic and clinical factors for concordance of treatment with guidelines. Results Thirty-two subjects had BD type I (BD-I), and 81 subjects had BD type II (BD-II). All subjects with BD-I, and 90% of the BD-II group were given at least one psychotropic treatment. Lithium was more often prescribed for subjects with BD-I (62%) than those with BD-II (19%). Antidepressants were the most frequently prescribed class of psychotropics. Sixty-eight percent of subjects received treatment concordant with guidelines by medication and dose. The presence of a current hypomanic episode was independently associated with poorer concordance to guidelines. In more than half the cases, the inappropriate use of antidepressants was at the origin of the non concordance of treatment with respect to guidelines. Absence of psychotropic treatment in bipolar II patients and inadequate dosage of mood stabilizers were the two other main causes of non concordance with guidelines. Conclusions The factors related to treatment not concordant with guidelines should be further explored to determine appropriate strategies in implementing the use of guidelines in clinical practice. PMID:23941445

  19. Physicians’ Human Papillomavirus Vaccine Recommendations in the Context of Permissive Guidelines for Male Patients: A National Study

    PubMed Central

    Malo, Teri L.; Giuliano, Anna R.; Kahn, Jessica A.; Zimet, Gregory D.; Lee, Ji-Hyun; Zhao, Xiuhua; Vadaparampil, Susan T.

    2014-01-01

    Background Little is known about physicians’ human papillomavirus (HPV) vaccine recommendations for males while the Advisory Committee on Immunization Practices’ (ACIP) permissive guidelines for male vaccination were in effect. The purpose of this study was to examine and explore factors associated with U.S. physicians’ HPV vaccine recommendations to early (ages 11–12), middle (13–17), and late adolescent/young adult (18–26) males. Methods Nationally representative samples of family physicians and pediatricians were selected in 2011 (n=1,219). Physicians reported the frequency with which they recommended HPV vaccine to male patients (“always” [>75% of the time] vs. other) for each age group. Statistically significant predictors of vaccine recommendation were identified using multivariable logistic regression. Results The prevalence of physicians reporting they “always” recommended HPV vaccination for males was 10.8% for ages 11–12, 12.9% for ages 13–17, and 13.2% for ages 18–26. Pediatrician specialty and self-reported early adoption of new vaccines were significantly associated with recommendation for all patient age groups. Additionally, physician race and patient payment method were associated with physician recommendations to patients ages 11–12, and patient race was associated with recommendations to ages 13–17 and 18–26. Conclusions Less than 15% of physicians surveyed reported “always” recommending HPV vaccine to male patients following national guidelines for permissive vaccination. Vaccine financing may have affected physicians’ vaccine recommendations. Impact If these recommendation practices continue following the ACIP’s routine recommendation for males in October 2011, then interventions designed to increase recommendations should target family physicians and possibly utilize early adopters to encourage support of HPV vaccination guidelines. PMID:25028456

  20. Development of the interdisciplinary evidence-based s3 guideline for the diagnosis and treatment of prostate cancer: methodological challenges and solutions.

    PubMed

    Röllig, Christoph; Nothacker, Monika; Wöckel, Achim; Weinbrenner, Susanne; Wirth, Manfred; Kopp, Ina; Ollenschläger, Günter; Weissbach, Lothar

    2010-01-01

    Evidence-based guidelines are important sources of knowledge in everyday clinical practice. In 2005, the German Society for Urology decided to develop a highquality evidence-based guideline for the early detection, diagnosis and treatment of the different clinical manifestations of prostate cancer. The guideline project started in 2005 and involved 75 experts from 10 different medical societies or medical organizations including a patient organization. The guideline was issued in September 2009 and consists of 8 chapters, 170 recommendations, and 42 statements. Due to the broad spectrum of clinical questions covered by the guideline and the high number of participating organizations and authors, the organizers faced several methodological and organizational challenges. This article describes the methods used in the development of the guideline and highlights critical points and challenges in the development process. Strategies to overcome these problems are suggested which might be beneficial in the development of new evidence-based guidelines in the future. PMID:20631488

  1. A comparison of primary care information content in UpToDate and the National Guideline Clearinghouse*

    PubMed Central

    Fenton, Susan H.; Badgett, Robert G.

    2007-01-01

    Objectives: The study sought to determine if two major resources for primary care questions have significant differences in information content and whether the number of documents found differs by disease category, patient age, or patient gender. Methods: Seven hundred fifty-two questions were randomly selected from the Clinical Questions Collection of the National Library of Medicine. UpToDate and the National Guidelines Clearinghouse (NGC) were searched utilizing keywords from the questions. The number of documents retrieved for each question in the resources was recorded. Chi-squared analysis was used to compare differences in retrieval between the resources. Logistic regression was used to evaluate the effect of patient age, patient gender, or disease category on the ability to find content. Results: UpToDate returned 1 or more documents for 580 questions, while NGC returned at least 1 document for 493 questions (77.1% versus 65.5% of question sampled, P = 0.001). In combination, the 2 resources returned content for 91% of searches (n = 685). NGC retrieved a mean of 16.3 documents per question versus 8.7 documents from UpToDate. Disease category was the only variable having a significant impact on the presence of online resource content. Conclusions: UpToDate had greater breadth of content than NGC, while neither resource provided complete coverage. Current practice guidelines, as reflected by those in the NGC, addressed at most two-thirds of the selected clinical questions. PMID:17641755

  2. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

    PubMed Central

    Ramar, Kannan; Dort, Leslie C.; Katz, Sheri G.; Lettieri, Christopher J.; Harrod, Christopher G.; Thomas, Sherene M.; Chervin, Ronald D.

    2015-01-01

    Introduction: Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. Methods: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations. Recommendations: We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) We suggest that qualified dentists provide oversight— rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE) We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits— as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE) Conclusions: The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations. Citation: Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 2015;11(7):773–827. PMID:26094920

  3. What's new in the 2009 US guidelines for prevention and treatment of opportunistic infections among adults and adolescents with HIV?

    PubMed

    Brooks, John T; Kaplan, Jonathan E; Masur, Henry

    2009-01-01

    Despite dramatic declines in the incidence of opportunistic infections (OIs) in the United States, they remain an important cause of morbidity and mortality for HIV-infected persons. Previously separate guidelines on the prevention of OIs and on the treatment of OIs have been combined recently into an updated single document; the present article reviews salient changes to and new information contained in this guidance. Chapters on hepatitis B virus infection and tuberculosis have been expanded substantially, and each chapter now includes information on immune reconstitution inflammatory syndrome. In addition, there is detailed discussion on the role of antiretroviral therapy in OI prevention and issues concerning the initiation of antiretroviral therapy during treatment of an acute OI. In the future, these guidelines will likely be maintained as an internet-based document to facilitate wider dissemination and more rapid updates. PMID:19675369

  4. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society

    PubMed Central

    Shinnar, Shlomo; Gloss, David; Alldredge, Brian; Arya, Ravindra; Bainbridge, Jacquelyn; Bare, Mary; Bleck, Thomas; Dodson, W. Edwin; Garrity, Lisa; Jagoda, Andy; Lowenstein, Daniel; Pellock, John; Riviello, James; Sloan, Edward; Treiman, David M.

    2016-01-01

    CONTEXT: The optimal pharmacologic treatment for early convulsive status epilepticus is unclear. OBJECTIVE: To analyze efficacy, tolerability and safety data for anticonvulsant treatment of children and adults with convulsive status epilepticus and use this analysis to develop an evidence-based treatment algorithm. DATA SOURCES: Structured literature review using MEDLINE, Embase, Current Contents, and Cochrane library supplemented with article reference lists. STUDY SELECTION: Randomized controlled trials of anticonvulsant treatment for seizures lasting longer than 5 minutes. DATA EXTRACTION: Individual studies were rated using predefined criteria and these results were used to form recommendations, conclusions, and an evidence-based treatment algorithm. RESULTS: A total of 38 randomized controlled trials were identified, rated and contributed to the assessment. Only four trials were considered to have class I evidence of efficacy. Two studies were rated as class II and the remaining 32 were judged to have class III evidence. In adults with convulsive status epilepticus, intramuscular midazolam, intravenous lorazepam, intravenous diazepam and intravenous phenobarbital are established as efficacious as initial therapy (Level A). Intramuscular midazolam has superior effectiveness compared to intravenous lorazepam in adults with convulsive status epilepticus without established intravenous access (Level A). In children, intravenous lorazepam and intravenous diazepam are established as efficacious at stopping seizures lasting at least 5 minutes (Level A) while rectal diazepam, intramuscular midazolam, intranasal midazolam, and buccal midazolam are probably effective (Level B). No significant difference in effectiveness has been demonstrated between intravenous lorazepam and intravenous diazepam in adults or children with convulsive status epilepticus (Level A). Respiratory and cardiac symptoms are the most commonly encountered treatment-emergent adverse events associated with intravenous anticonvulsant drug administration in adults with convulsive status epilepticus (Level A). The rate of respiratory depression in patients with convulsive status epilepticus treated with benzodiazepines is lower than in patients with convulsive status epilepticus treated with placebo indicating that respiratory problems are an important consequence of untreated convulsive status epilepticus (Level A). When both are available, fosphenytoin is preferred over phenytoin based on tolerability but phenytoin is an acceptable alternative (Level A). In adults, compared to the first therapy, the second therapy is less effective while the third therapy is substantially less effective (Level A). In children, the second therapy appears less effective and there are no data about third therapy efficacy (Level C). The evidence was synthesized into a treatment algorithm. CONCLUSIONS: Despite the paucity of well-designed randomized controlled trials, practical conclusions and an integrated treatment algorithm for the treatment of convulsive status epilepticus across the age spectrum (infants through adults) can be constructed. Multicenter, multinational efforts are needed to design, conduct and analyze additional randomized controlled trials that can answer the many outstanding clinically relevant questions identified in this guideline. PMID:26900382

  5. Do exergames allow children to achieve physical activity intensity commensurate with national guidelines?

    PubMed Central

    PERRON, RACHEL M.; GRAHAM, COURTNEY A.; FELDMAN, JAMIE R.; MOFFETT, REBECCA A.; HALL, ERIC E.

    2011-01-01

    The purpose of this study was to determine if two popular exergames, Wii Fit™ and EA Sports Active™, both games for the Nintendo Wii™ console, help children achieve intensity consistent with recommended physical activity guidelines. Thirty children (19 males and 11 females, Mean age = 9.4 ± 1.8 years) participated in this study by playing each game during one research session. During the session participants wore a heart rate monitor and accelerometer to measure exercise intensity. Perceived exertion (RPE) was measured with the children’s run/walk OMNI scale. All three measures of exercise intensity (heart rate, accelerometer counts, and RPE) found that the EA Sports Active™ game session elicited higher exercise intensity. However, heart rate data found both games to achieve moderate intensity (65–68% age-predicted HRmax). When using heart rate as an indicator of exercise intensity it appears that both exergames were of sufficient intensity to achieve physical activity guidelines. Future studies should continue to investigate the utility of exergaming in helping children to become more physically active.

  6. National Priority Setting of Clinical Practice Guidelines Development for Chronic Disease Management

    PubMed Central

    2015-01-01

    By November 2013, a total of 125 clinical practice guidelines (CPGs) have been developed in Korea. However, despite the high burden of diseases and the clinical importance of CPGs, most chronic diseases do not have available CPGs. Merely 83 CPGs are related to chronic diseases, and only 40 guidelines had been developed in the last 5 yr. Considering the rate of the production of new evidence in medicine and the worsening burden from chronic diseases, the need for developing CPGs for more chronic diseases is becoming increasingly pressing. Since 2011, the Korean Academy of Medical Sciences and the Korea Centers for Disease Control and Prevention have been jointly developing CPGs for chronic diseases. However, priorities have to be set and resources need to be allocated within the constraint of a limited funding. This study identifies the chronic diseases that should be prioritized for the development of CPGs in Korea. Through an objective assessment by using the analytic hierarchy process and a subjective assessment with a survey of expert opinion, high priorities were placed on ischemic heart disease, cerebrovascular diseases, Alzheimer's disease and other dementias, osteoarthritis, neck pain, chronic kidney disease, and cirrhosis of the liver. PMID:26713047

  7. Exercise prescription in the treatment of type 2 diabetes mellitus : current practices, existing guidelines and future directions.

    PubMed

    O'Hagan, Ciara; De Vito, Giuseppe; Boreham, Colin A G

    2013-01-01

    Exercise is an effective treatment for type 2 diabetes mellitus, resulting in stabilization of plasma glucose in the acute phase and improvements in body composition, insulin resistance and glycosylated haemoglobin with chronic exercise training. However, the most appropriate exercise prescription for type 2 diabetes has not yet been established, resulting from insufficient evidence to determine the optimum type, intensity, duration or frequency of exercise training. Furthermore, patient engagement in exercise is suboptimal. There are many likely reasons for low engagement in exercise; one possible contributory factor may be a tendency for expert bodies to prioritize the roles of diet and medication over exercise in their treatment guidelines. Published treatment guidelines vary in their approach to exercise training, but most agencies suggest that people with type 2 diabetes engage in 150min of moderate to vigorous aerobic exercise per week. This prescription is similar to the established guidelines for cardiovascular health in the general population. Future possibilities in this area include investigation of the physiological effects and practical benefits of exercise training of different intensities in type 2 diabetes, and the use of individualized prescription to maximize the health benefits of training. PMID:23315755

  8. Organizational interventions to encourage guideline implementation.

    PubMed

    Curry, S J

    2000-08-01

    Evidence-based guidelines hold considerable promise for continued improvement of health-care delivery. However, the availability of clinical practice guidelines does not automatically lead to changes in practice patterns. Using a "push-pull-capacity" model, this article describes strategies to improve guideline implementation for three types of organizations: national organizations, insurer and health-care organizations, and health-care purchasers. Push strategies focus on the guideline development process and include rigorous review and meta-analysis of peer-reviewed research, and use of multidisciplinary expert teams, subjecting guidelines to peer review and comment and using measurable clinical outcomes to define guidelines. PULL: strategies focus on creating a demand for guideline implementation and include professional organization endorsement, quality measures based on guideline-related outcomes, and guideline-based performance objectives in purchaser contracts and physician compensation agreements. Capacity strategies focus on systems that facilitate guideline implementation. Example strategies are providing benefit coverage and reimbursement for guideline-based treatment protocols, and implementing clinical information systems for population-based tracking, outcomes monitoring, and benchmarking feedback. PMID:10939998

  9. A methodological critique of the National Institute of Aging and Alzheimer's Association Guidelines for Alzheimer's disease, dementia, and mild cognitive impairments.

    PubMed

    Garrett, Mario D; Valle, Ramón

    2016-03-01

    In 2011, the U.S. National Institute on Aging published guidelines for clinical diagnostics for Alzheimer's disease dementia. These guidelines define a continuum with three stages-an early, pre-clinical stage with no symptoms, followed by mild cognitive impairment, and a final stage of Alzheimer's disease dementia. This methodological critique examines the validity of this continuum. No studies exist showing the progression of these biomarkers to Alzheimer's disease. There is also a lack of empirical evidence showing how biomarkers determine mild cognitive impairment, which has multiple etiologies. The guidelines fail to explain anomalies where there are biomarkers but no expression of Alzheimer's disease. PMID:24662500

  10. Guidelines of care for the management of psoriasis and psoriatic arthritis Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies

    SciTech Connect

    Menter, A.; Korman, N.J.; Elmets, C.A.; Feldman, S.R.; Gelfand, J.M.; Gordon, K.B.; Gottlieb, A.; Koo, J.Y.M.; Lebwohl, M.; Lim, H.W.; Van Voorhees, A.S.; Beutner, K.R.; Bhushan, R.

    2009-04-15

    Psoriasis is a common, chronic, inflammatory, multi-system disease with predominantly skin and joint manifestations affecting approximately 2% of the Population. In this third of 6 sections of the guidelines of care for psoriasis, we discuss the use of topical medications for the treatment of psoriasis. The majority of patients with psoriasis have limited disease (<5% body surface area involvement) and can be treated with topical agents, which generally provide a high efficacy-to-safety ratio. Topical agents may also be used adjunctively for patients with more extensive psoriasis undergoing therapy with either ultraviolet light, systemic or biologic medications. However, the use of topical agents as monotherapy in the setting of extensive disease or in the setting of limited, but recalcitrant, disease is not routinely recommended. Treatment should be tailored to meet individual patients' needs. We will discuss the efficacy and safety of as well as offer recommendations for the use of topical corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, emollients, salicylic acid, anthralin, coal tar, as well as combination therapy.

  11. Adherence patterns to National Comprehensive Cancer Network (NCCN) guidelines for referral to cancer genetic professionals

    PubMed Central

    Febbraro, Terri; Robison, Katina; Wilbur, Jennifer Scalia; Laprise, Jessica; Bregar, Amy; Lopes, Vrishali; Legare, Robert; Stuckey, Ashley

    2016-01-01

    Objective Genetic predisposition is responsible for 5–10% of breast cancer, 10% of ovarian cancer and 2–5% of uterine cancer. The study objective was to compare genetic counseling and testing referral rates among women with breast cancer that met NCCN referral guidelines to the referral rates among women with gynecologic cancers and determine predictors of referral. Methods Utilizing an institutional tumor registry database, patients from an academic women's oncology program were identified who met a subset of NCCN guidelines for genetic referral between 2004 and 2010. Patients diagnosed with ovarian cancer, breast cancer ≤50 years of age, or uterine cancer <50 years of age were included. A retrospective electronic chart review was conducted to evaluate for a genetic referral and uptake of genetic testing. Results 820 women were included (216 uterine, 314 breast, and 290 ovarian cancer). The overall genetic referral rate was 21.7%. 34% of eligible breast cancer patients were referred compared to 13.4% of uterine cancer and 14.5% ofovarian cancer patients (p < 0.0001). Younger age, breast cancer diagnosis, family history and earlier stage were all significant referral predictors. The odds of being referred increased with the number of affected family members. 70.8% of referred patients, consulted with genetics. Among those who consulted with genetics, 95.2% underwent testing. Conclusions Although increasing, genetic counseling remains underutilized across cancer diagnosis. Women with breast cancer are more likely to be referred than women with gynecologic cancers. Younger age, earlier stage and positive family history appear to be predictive of referral for genetic evaluation. PMID:25933682

  12. Factors prompting PSA-testing of asymptomatic men in a country with no guidelines: a national survey of general practitioners

    PubMed Central

    Drummond, Frances J; Carsin, Anne-Elie; Sharp, Linda; Comber, Harry

    2009-01-01

    Background Increased use of prostate specific antigen (PSA) has been associated with increased prostate cancer incidence. Ireland is estimated to have one of the highest prostate cancer incidences in Europe and has no national guidelines for prostate cancer screening. GPs have a pivotal role in influencing PSA testing, therefore, our aim was to describe GP testing practices and to identify factors influencing these. Methods A postal survey, including questions on clinical practice and experience, knowledge and demographics was distributed to all GPs (n = 3,683). The main outcomes were (i) PSA testing asymptomatic men and (ii) "inappropriate" PSA testing, defined as testing asymptomatic men aged < 50 or > 75 years. Factors associated with these outcomes were identified using logistic regression. Results 1,625 GPs responded (response rate corrected for eligibility = 53%). Most respondents (79%) would PSA test asymptomatic men. Of these, 34% and 51% would test asymptomatic men < 50 and > 75 years, respectively. In multivariate analyses, GPs were more likely to test asymptomatic men if they were ≥ 50 years, in practice ≥ 10 years, female or less knowledgeable about PSA efficacy. Male GPs who would have a PSA test themselves were > 8-times more likely to PSA test asymptomatic men than GPs who would not have a test. GPs who had an asymptomatic patient diagnosed with prostate cancer following PSA testing, were > 3-times more likely to test asymptomatic men. Practice-related factors positively associated with testing included: running 'well man' clinics, performing occupational health checks and performing other tests routinely with PSA. Factors positively associated with 'inappropriate' testing included; being male and willing to have a PSA test, having worked/trained in the UK and supporting annual PSA testing. 91% of respondents supported the development of national PSA testing guidelines. Conclusion Our findings suggest that widespread PSA testing of asymptomatic men in primary care is primarily due to a combination of clinical experience, poor knowledge and the support of doctors for PSA testing, as evidenced by the willingness of male doctors to have a PSA test. There is an urgent need for education and support for GPs concerning prostate cancer screening, starting with the implementation of national guidelines. PMID:19138385

  13. Understanding barriers to implementing the Norwegian national guidelines for healthy school meals: a case study involving three secondary schools.

    PubMed

    Holthe, Asle; Larsen, Torill; Samdal, Oddrun

    2011-07-01

    The main goal of the present study was to investigate the barriers to implementing the Norwegian national guidelines for healthy school meals as perceived by principals, project leaders, teachers and students. This study employed a multiple-case design using an explorative approach. Data were collected at three secondary schools in Norway participating in the intervention project Physical activity and healthy school meals. Individual interviews were conducted with school principals and project leaders, and focus group interviews were conducted separately with teachers and students. Four categories of barriers were identified: (1) lack of adaptation of the guidelines to the target group; (2) lack of resources and funding; (3) conflicting values and goals; and (4) access to unhealthy food outside school. The research identified differences in perceived barriers between the staff responsible for implementation and the students as the target group of the measures. All staff groups perceived barriers relating to both resources, and conflicting values and goals. The teachers were more concerned about issues of relevance for adaptation to the target groups than were the principals and project leaders. The students were concerned mostly with issues directly affecting their experience with items offered in the canteen. PMID:21689274

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

    PubMed Central

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

    2012-01-01

    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

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

    PubMed

    Korbel, Krzysztof; Kozinoga, Mateusz; Stoliński, Łukasz; Kotwicki, Tomasz

    2014-01-01

    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

  16. The Treatment of Sex Roles. Guidelines for the Development of Elementary and Secondary Instructional Materials.

    ERIC Educational Resources Information Center

    Holt, Rinehart & Winston, New York, NY.

    Arranged in three sections, this pamphlet outlines publishers' guidelines for developing nonsexist instructional materials for elementary and secondary school use. Section 1 details the following strategies for expanding and balancing the role models of both sexes in instructional literature: illustrations reflecting a variety of dress and…

  17. A Model Policy Statement and Guidelines for Implementation: Equal Treatment of Students.

    ERIC Educational Resources Information Center

    Education Commission of the States, Denver, CO.

    This booklet offers a model policy statement that schools shall provide equal educational opportunities to all students regardless of sex. It includes stipulations and guidelines to achieve equal access in all areas of education. The following areas are considered: (1) Course offerings: every course shall be open to all students and schools should…

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

    ERIC Educational Resources Information Center

    Slenker, Suzanne E.; And Others

    1985-01-01

    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)

  19. The 2013 ACC/AHA Cholesterol Treatment Guidelines: Applicability to Patients with Diabetes.

    PubMed

    Ziaeian, Boback; Dinkler, John; Guo, Yuanlin; Watson, Karol

    2016-02-01

    Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide and the management of blood cholesterol is a cornerstone of medical therapy for the primary and secondary prevention of cardiovascular disease. Patients with diabetes represent an important high-risk group in whom clinicians should advocate the use of statins and lifestyle modification for the reduction of ASCVD. The recent 2013 ACC/AHA guidelines on managing blood cholesterol provide an important framework for the effective implementation of this important risk reduction strategy. The guidelines identify four groups of individuals who have been shown to benefit from statin therapy and update the dosing and monitoring recommendations based on evidence from published, large-scale randomized controlled trials (RCTs) with clinical hard endpoints. Primary care physicians and specialists play key roles in identifying populations at elevated ASCVD risk and providing effective care for patients, especially those with diabetes. This article will summarize the 2013 ACC/AHA guidelines on managing blood cholesterol and provide a practical management overview in order to facilitate implementation of these guidelines for patients with diabetes. PMID:26803649

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

    ERIC Educational Resources Information Center

    Barker, Lauren N.; Ziino, Carlo

    2010-01-01

    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)…

  1. Management of Transient Loss of Consciousness: National Institute for Health and Clinical Excellence Guideline

    MedlinePlus

    ... see the episode. Heart problems, neurologic problems, and psychological problems can be the cause. However, persons with TLoC often undergo unnecessary tests, receive incorrect diagnoses, and may get unnecessary treatments. ...

  2. Postbrushing and fine-needle aspiration biopsy follow-up and treatment options for patients with pancreatobiliary lesions: the Papanicolaou Society of Cytopathology guidelines.

    PubMed

    Kurtycz, Daniel; Tabatabai, Z Laura; Michaels, Claire; Young, Nancy; Schmidt, C Max; Farrell, James; Gopal, Deepak; Simeone, Diane; Merchant, Nipun B; Field, Andrew; Pitman, Martha Bishop

    2014-04-01

    The papanicolaou society of cytopathology (PSC) has developed a set of guidelines for pancreatobiliary cytology including indications for endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) biopsy, techniques of EUS-FNA, terminology and nomenclature for pancreatobiliary cytology, ancillary testing, and postprocedure management. All documents are based on the expertise of the authors, a review of the literature, discussions of the draft document at several national and international meetings over an 18 month period and synthesis of online comments of the draft document on the PSC web site [www.papsociety.org]. This document selectively presents the results of these discussions and focuses on the follow-up and treatment options for patients after procedures performed for obtaining cytology samples for the evaluation of biliary strictures and solid and cystic masses in the pancreas. These recommendations follow the six-tiered terminology and nomenclature scheme proposed by Committee III. PMID:24639399

  3. Patient Outcomes According to Adherence to Treatment Guidelines for Rhythm Control of Atrial Fibrillation

    PubMed Central

    Qin, Dingxin; Leef, George; Alam, Mian Bilal; Rattan, Rohit; Munir, Mohamad Bilal; Patel, Divyang; Khattak, Furqan; Vaghasia, Nishit; Adelstein, Evan; Jain, Sandeep K.; Saba, Samir

    2015-01-01

    Background Although guidelines for antiarrhythmic drug therapy in atrial fibrillation (AF) were published in 2006, it remains uncertain whether adherence to these guidelines affects patient outcomes. Methods and Results We retrospectively evaluated the records of 5976 consecutive AF patients who were prescribed at least 1 antiarrhythmic drug between 2006 and 2013. Patients with 1 or more prescribed antiarrhythmic drugs that did not comply with guideline recommendations comprised the non–guideline‐directed group (=2920); the remainder constituted the guideline‐directed group (=3056). Time to events was assessed using the survival analysis method and adjusted for covariates using Cox regression. Rates of adherence to the guidelines increased significantly with a higher degree of prescriber specialization in arrhythmias (49%, 55%, and 60% for primary care physicians, general cardiologists, and cardiac electrophysiologists, respectively, P=0.001) for the first prescribed antiarrhythmic drug. Compared to the non–guideline‐directed group, the guideline‐directed group had higher rates of heart failure, but lower baseline CHADS2‐VASc scores (P<0.001) and lower rates of coronary artery disease, valvular disease, hypertension, hyperlipidemia, pulmonary disease, and renal insufficiency (P<0.05 for all). During 45±26 months follow‐up, the guideline‐directed group had a lower risk of AF recurrence (hazard ratio=0.86, 95% CI=0.80 to 0.93), fewer hospital admissions for AF (hazard ratio=0.87, 95% CI=0.79 to 0.97), and fewer procedures for recurrent AF, including electrical cardioversion, pacemaker implantation, and atrioventricular nodal ablation (P<0.01 for all). The mortality and stroke risks were similar between the groups. Conclusions Adherence to published guidelines in the antiarrhythmic management of AF is associated with improved patient outcomes. PMID:25845930

  4. A National Survey of Independent Living Donor Advocates: The Need for Practice Guidelines

    PubMed Central

    Steel, Jennifer; Dunlavy, Andrea; Friday, Maranda; Kingsley, Kendal; Brower, Deborah; Unruh, Mark; Tan, Henkie; Shapiro, Ron; Peltz, Mel; Hardoby, Melissa; McCloskey, Christina; Sturdevant, Mark; Humar, Abhi

    2012-01-01

    In 2000, representatives of the transplant community convened for a meeting on living donation in an effort to provide recommendations to promote the welfare of living donors. One key recommendation included in the consensus statement was that all transplant centers which have performed living donor surgeries have an Independent Living Donor Advocate (ILDA) “whose only focus is on the best interest of the donor.” The aims of this study were to begin to understand the sociodemographic characteristics, selection and training, and clinical practices of ILDAs. All U.S. transplant centers performing living donor surgeries were contacted to identify the ILDA at their center. One hundred and twenty ILDAs (60%) completed an anonymous survey. Results indicated considerable variability with regard to the sociodemographic characteristics of ILDAs, how the ILDA was selected and trained, and the ILDAs’ clinical practices, particularly ethical challenges encountered by ILDAs. The variability observed may result in differential selection of donors and could have a potential negative impact the lives of both donors and transplant candidates. The variability in the background, training, and practice of ILDAs suggests the need for strategies, such as practice guidelines, to standardize the interaction between ILDAs and living donors. PMID:22548793

  5. Research and Educational Leadership: Navigating the New National Research Council Guidelines

    ERIC Educational Resources Information Center

    English, Fenwick W., Ed.; Furman, Gail C., Ed.

    2006-01-01

    "Research and Educational Leadership" is the first book to directly address the implications of the National Research Council's (NRC's) "Scientific Research in Education" (2002) in the fields of educational leadership and school administration. This text points out the strengths and weaknesses of the NRC's recommendations and specifically…

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

    PubMed Central

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

    2014-01-01

    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

  7. [Summary of the practice guideline for the diagnosis and treatment of ADHD in adolescents and adults with addictions].

    PubMed

    Matthys, Frieda; Joostens, Peter; van den Brink, Wim; Sabbe, Bernard

    2013-01-01

    Various guidelines are available for the diagnosis and treatment of ADHD in adults, but not for patients with ADHD and a comorbid substance use disorder (SUD). In 2010, the Addiction Medicine Working Party, a division of the VAD (Verenigingvoor Alcohol- en andere Drugproblemen/Association for Alcohol and other Drug Problems) developed a practice guideline on how, when and by whom ADHD can be diagnosed in patients with an addiction, and how these patients should be treated. Given the high prevalence of ADHD in treatment-seeking SUD patients and the availability of valid screening instruments, all SUD patients should be screened for ADHD as soon as their drug use has stabilized. Acquiring information from external sources as well as clinical observation and questionnaires are important tools for the establishment of the diagnosis of ADHD. Integrated treatment primarily includes psycho-education, coaching and cognitive behavioural therapy in addition to pharmacotherapy. Evidence-based treatments for addiction may also be effective in patients with concomitant ADHD, provided the methods are adapted to the limitations that are associated with this condition. PMID:23759179

  8. Colon Cancer Staging in Vulnerable Older Adults: Adherence to National Guidelines and Impact on Survival

    PubMed Central

    Leal, TB; Holden, T; Cavalcante, L; Allen, GO; Schumacher, JR; Smith, MA; Weiss, JM; Neuman, HB; LoConte, NK

    2015-01-01

    Background There is concern that elders are not adequately evaluated prior to colon cancer surgery. We sought to determine adherence with ACOVE-3 (Assessing Care of Vulnerable Elders) quality indicators for pre-operative staging prior to colectomy for colon cancer utilizing the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database (1992–2005). Methods We determined the proportion of patients aged 75 and older who had preoperative staging prior to colectomy for colon adenocarcinoma. Preoperative staging was defined as abdominopelvic computed tomography or magnetic resonance imaging scan (SCAN) and colonoscopy or flexible sigmoidoscopy (SCOPE). Multivariate logistic regression identified predictors of adherence. Odds ratios were adjusted for comorbidity, socioeconomic status, and disease severity. The association of adherence to ACOVE-3 and survival was quantified. Results Of the 37,862 patients, the majority were 75–84 years, 28% of the patients were ≥85 years. Regarding preoperative staging in the 6-month interval prior to surgical resection, 8% had neither SCAN nor SCOPE, 6% had only SCAN, 43% had only SCOPE, and 43% had both SCAN and SCOPE. Compared to patients who were not staged, those evaluated with either SCOPE alone or SCAN plus SCOPE had lower odds of 3-year mortality. Patients who were staged with SCAN alone had an increased odds of death compared to those who had neither SCAN or SCOPE. Conclusions These data demonstrate that the majority of vulnerable elders with colon cancer did not receive appropriate preoperative staging prior to resection. The findings also confirm that adherence to ACOVE-3 guidelines is associated with improved long-term survival. PMID:25914900

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

    SciTech Connect

    Kielusiak, C.

    1993-02-01

    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.

  10. National General Aviation Design Competition Guidelines 1999-2000 Academic Year

    NASA Technical Reports Server (NTRS)

    1999-01-01

    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.

  11. 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

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

    2012-01-01

    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 5α-reductase inhibitor plus α 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

  12. 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. ...

  13. Problem Gambling Treatment within the British National Health Service

    ERIC Educational Resources Information Center

    Rigbye, Jane; Griffiths, Mark D.

    2011-01-01

    According to the latest British Gambling Prevalence Survey, there are approximately 300,000 adult problem gamblers in Great Britain. In January 2007, the "British Medical Association" published a report recommending that those experiencing gambling problems should receive treatment via the National Health Service (NHS). This study examines the…

  14. 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

    Menda Behrens, Eduardo

    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…

  15. Connecting Marketing and Implementation Research and Library Program Development: A Case Study of the Implementation of [U.S.] National Guidelines and Standards.

    ERIC Educational Resources Information Center

    Haycock, Ken; Cavill, Pat

    This case study examined: (1) what market research is required for planning for the implementation of "Information Power: Building Partnerships for Learning," the 1998 national guidelines for effective school library media programs; (2) what issues need to be addressed and what target audiences are required to effect change, as well as how these

  16. Sharing Collegiate Resources: The New Challenge: Guidelines to Facilitate Interinstitutional Resource Sharing Based on a National Invitational Conference at Wingspread (Racine, Wisconsin, March 23-25, 1981).

    ERIC Educational Resources Information Center

    Konkel, Richard H.; Patterson, Lewis D.

    Guidelines that are designed to facilitate interinstitutional resource sharing are presented for trustees, legislators, business and lay leaders and educators based on a 1981 national conference. Attention is directed to the range of potential benefits of resource sharing, the structures and processes for achieving resource sharing, and the action

  17. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pregnancy in pulmonary hypertension

    PubMed Central

    Khan, Javed; Idrees, Majdy M.

    2014-01-01

    Pregnancy in pulmonary hypertension (PH) is known to be associated with high morbidity and mortality. The physiological changes occur during normal pregnancy, such as increase blood volume and cardiac output (CO) may be detrimental in PH patients. Several practice guidelines advise against pregnancy and even recommend termination of pregnancy. Occasionally PH may be diagnosed for the first time during pregnancy, as stress of pregnancy can unmask previously undiagnosed PH in an asymptomatic individual. This narrative review provides a detailed discussion about the physiologic parameters associated in pregnancy and their negative effect on the right ventricle. It also gives practical evidence-based recommendations about different management issues in PH pregnant patients. PMID:25076988

  18. Guidelines for submitting data to the National Space Science Data Center

    NASA Technical Reports Server (NTRS)

    1984-01-01

    The mission of the National Space Science Data Center (NSSDC) is to disseminate space science data for further analysis beyond that provided by the principal investigators (PIs) or team leaders (TLs) and their coworkers. Consequently, the NSSDC is responsible for the acquisition, organization, storage, retrieval, announcement, and distribution of scientific data obtained mainly from satellites and spacecraft. Any scientist may acquired data from the NSSDC and use them in further studies, either alone or in conjunction with data from ground-based or spacecraft experiments. With the responsibility for archiving data is the concomitant responsibility for distributing the documentation necessary to make those data usable. Since the group most knowledgeable about a particular experiment and its data is the PI or TL and his coworkers, and since the NSSDC cannot possibly supply the qualified personnel needed to write this documentation comprehensively, it is the responsibility of the PI or TL to provide the essential documentation. The NSSDC will support this effort by defining what is needed, by reviewing what is provided, and by reproducing and distributing the resulting documentation with the data. For a high-use data set, the NSSDC may publish the documentation as a Data Users Note; for a low-use data set, the NSSDC may distribute a Xerox, microfilm, or microfiche copy of the documentation.

  19. Guidelines for Hanford Site implementation of the National Environmental Policy Act

    SciTech Connect

    King, S.E.

    1989-03-01

    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.

  20. Treatment of Anemia in Patients with Heart Disease: A Clinical Practice Guideline

    MedlinePlus

    ... of Internal Medicine Summaries for Patients Treatment of Anemia in Patients With Heart Disease: A Clinical Practice ... Physicians The full report is titled “Treatment of Anemia in Patients With Heart Disease: A Clinical Practice ...

  1. Diabetes Guidelines May Delay Timely Adjustments During Treatment and Might Contribute to Clinical Inertia

    PubMed Central

    Zanella, Maria Teresa

    2014-01-01

    Abstract Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. The same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. The main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases. PMID:24892463

  2. Guidelines of the Brazilian Dermatology Society for diagnosis, treatment and follow up of primary cutaneous melanoma - Part I.

    PubMed

    Castro, Luiz Guilherme Martins; Messina, Maria Cristina; Loureiro, Walter; Macarenco, Ricardo Silvestre; Duprat Neto, João Pedreira; Giacomo, Thais Helena Bello Di; Bittencourt, Flávia Vasques; Bakos, Renato Marchiori; Serpa, Sérgio Schrader; Stolf, Hamilton Ometto; Gontijo, Gabriel

    2015-12-01

    The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In the first part, the following clinical questions were answered: 1) The use of dermoscopy for diagnosis of primary cutaneous melanoma brings benefits for patients when compared with clinical examination? 2) Does dermoscopy favor diagnosis of nail apparatus melanoma? 3) Is there a prognostic difference when incisional or excisional biopsies are used? 4) Does revision by a pathologist trained in melanoma contribute to diagnosis and treatment of primary cutaneous melanoma? What margins should be used to treat lentigo maligna melanoma and melanoma in situ? PMID:26734867

  3. Guidelines of the Brazilian Dermatology Society for diagnosis, treatment and follow up of primary cutaneous melanoma - Part I*

    PubMed Central

    Castro, Luiz Guilherme Martins; Messina, Maria Cristina; Loureiro, Walter; Macarenco, Ricardo Silvestre; Duprat Neto, João Pedreira; Giacomo, Thais Helena Bello Di; Bittencourt, Flávia Vasques; Bakos, Renato Marchiori; Serpa, Sérgio Schrader; Stolf, Hamilton Ometto; Gontijo, Gabriel

    2015-01-01

    The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In the first part, the following clinical questions were answered: 1) The use of dermoscopy for diagnosis of primary cutaneous melanoma brings benefits for patients when compared with clinical examination? 2) Does dermoscopy favor diagnosis of nail apparatus melanoma? 3) Is there a prognostic difference when incisional or excisional biopsies are used? 4) Does revision by a pathologist trained in melanoma contribute to diagnosis and treatment of primary cutaneous melanoma? What margins should be used to treat lentigo maligna melanoma and melanoma in situ? PMID:26734867

  4. [Adherence to the international guidelines on the treatment of diabetic leg syndrome--options available in the Czech Republic].

    PubMed

    Jirkovská, A

    2011-11-01

    Possibilities of fulfilling of the practical guidelines on the management of the diabetic foot in the Czech Republic are limited by lack of experts and specialized place of work in podiatry, inconsiderable are economic problems, too. Foot care is of highest quality when is directed by a multidisciplinary foot team. In the Czech Republic, there is an urgent need for podiatry training programme and foot clinic support. Investing in diabetic foot programme can be one of the most cost-effective forms of healthcare expenditure, provided the programme is goal-focused and properly implemented. Paper deal with key points of the podiatry programme--organization, health care education and effective prevention and risk patients follow-up, rational surgical treatment and foot infection management, extension of up-to-date methods of PAD treatment, and effective economic approach to foot care especially considering DRG system during hospitalization. PMID:22165694

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

    NASA Astrophysics Data System (ADS)

    Lober, Terence

    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.

  6. NHS funded fertility treatment--a national service in name only?

    PubMed

    O'Donnell, Claire; Manché, Marioth; Kingsland, Charles; Haddad, Nabil; Brickwood, Paul

    2005-12-01

    The variable nature of NHS provision of fertility services has again been highlighted by the response of commissioners to the recent guidance from the National Institute of Clinical Excellence. This paper describes an evidence-based model for policy aimed at minimising inequity across one Strategic Health Authority. The paper highlights the difficulties resulting from the current Department of Health guidance on targeting those in greatest need. A different way of describing this group is proposed, namely, defining childlessness in terms of parental status alone. This is clear to both patient and clinician at the outset, not subject to variable interpretation and because it is quantifiable for any given population, facilitates the commissioning of a level of service provision that reflects expressed need. A clinical audit suggests that the annual incidence of fertility problems prompting attendance at secondary care clinics is similar to levels observed nearly 20 years ago, at around 98 per 10,000 of the fertile population (proxy denominator, women aged 25 - 39). Our model further indicates that, for the more complex treatments, if both partners were required to be childless and treatments were to be delivered within 12 - 18 months of listing, commissioners would need to fund treatment for around 15 - 20 patients per 10,000 of the fertile population. If only one partner was required to be childless this figure would rise by 15 - 20%. We argue that despite the clinical guidelines, fertility treatments will remain a 'postcode lottery' unless central government addresses the priority to be given to fertility treatment on a national basis. PMID:16393821

  7. 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

    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

    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

  8. [National guidelines for the management of patients with chronic lymphocytic leukemia. Sociedad Espan˜ola de Hematologı´a y Hemoterapia and Grupo Espan˜ol de Leucemia Linfocı´tica Cro´ nica].

    PubMed

    García Marco, José A; Giraldo Castellano, Pilar; López Jiménez, Javier; Ríos Herranz, Eduardo; Sastre Moral, José Luis; Terol Casterá, M José; Bosch Albareda, Francesc

    2013-08-17

    Chronic lymphocytic leukemia is the most common chronic lymphoproliferative disorder in Spain. The clinical management of this entity varies widely. Currently, in Spain, there are no national consensus guidelines, such as those published in other countries, to guide the diagnosis and treatment of this malignancy and the use of prognostic scores. This article reviews the current scientific literature and addresses issues on the diagnosis of chronic lymphocytic leukemia, the spread of the disease, the presence of comorbidities, the classification of prognostic scores, the common treatment regimens stratified by risk factors, and the management of complications associated with both the disease and its treatment, as well as the various controversies related to this entity. This document was drafted with the collaboration of national experts and aims to establish practical guidelines with their corresponding levels of evidence and grades of recommendation to guide the diagnosis, treatment and follow-up of patients with chronic lymphocytic leukemia. PMID:23830547

  9. Treatment in Kenyan rural health facilities: projected drug costs using the WHO-UNICEF integrated management of childhood illness (IMCI) guidelines.

    PubMed Central

    Boulanger, L. L.; Lee, L. A.; Odhacha, A.

    1999-01-01

    Guidelines for the integrated management of childhood illness (IMCI) in peripheral health facilities have been developed by WHO and UNICEF to improve the recognition and treatment of common causes of childhood death. To evaluate the impact of the guidelines on treatment costs, we compared the cost of drugs actually prescribed to a sample of 747 sick children aged 2-59 months in rural health facilities in western Kenya with the cost of drugs had the children been managed using the IMCI guidelines. The average cost of drugs actually prescribed per child was US$ 0.44 (1996 US$). Antibiotics were the most costly component, with phenoxymethylpenicillin syrup accounting for 59% of the cost of all the drugs prescribed. Of the 295 prescriptions for phenoxymethylpenicillin syrup, 223 (76%) were for treatment of colds or cough. The cost of drugs that would have been prescribed had the same children been managed with the IMCI guidelines ranged from US$ 0.16 per patient (based on a formulary of larger-dose tablets and a home remedy for cough) to US$ 0.39 per patient (based on a formulary of syrups or paediatric-dose tablets and a commercial cough preparation). Treatment of coughs and colds with antibiotics is not recommended in the Kenyan or in the IMCI guidelines. Compliance with existing treatment guidelines for the management of acute respiratory infections would have halved the cost of the drugs prescribed. The estimated cost of the drugs needed to treat children using the IMCI guidelines was less than the cost of the drugs actually prescribed, but varied considerably depending on the dosage forms and whether a commercial cough preparation was used. PMID:10593034

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

    PubMed Central

    Espie, Jonathan; Eisler, Ivan

    2015-01-01

    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

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

    PubMed

    Espie, Jonathan; Eisler, Ivan

    2015-01-01

    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

  12. Epidemiology and Treatment Guidelines of Negative Symptoms in Schizo-phrenia in Central and Eastern Europe: A Literature Review

    PubMed Central

    Szkultecka-Dębek, Monika; Walczak, Jacek; Augustyńska, Joanna; Miernik, Katarzyna; Stelmachowski, Jarosław; Pieniążek, Izabela; Obrzut, Grzegorz; Pogroszewska, Angelika; Paulić, Gabrijela; Damir, Marić; Antolić, Siniša; Tavčar, Rok; Indrikson, Andra; Aadamsoo, Kaire; Jankovic, Slobodan; Pulay, Attila J; Rimay, József; Varga, Márton; Sulkova, Ivana; Veržun, Petra

    2015-01-01

    Aim : To gather and review data describing the epidemiology of schizophrenia and clinical guidelines for schizophrenia therapy in seven Central and Eastern European countries, with a focus on negative symptoms. Methods : A literature search was conducted which included publications from 1995 to 2012 that were indexed in key databases. Results : Reports of mean annual incidence of schizophrenia varied greatly, from 0.04 to 0.58 per 1,000 population. Lifetime prevalence varied from 0.4% to 1.4%. One study reported that at least one negative symptom was present in 57.6% of patients with schizophrenia and in 50–90% of individuals experiencing their first episode of schizophrenia. Primary negative symptoms were observed in 10–30% of patients. Mortality in patients with schizophrenia was greater than in the general population, with a standardized mortality ratio of 2.58–4.30. Reasons for higher risk of mortality in the schizophrenia population included increased suicide risk, effect of schizophrenia on lifestyle and environment, and presence of comorbidities. Clinical guidelines overall supported the use of second-generation antipsychotics in managing negative symptoms of schizophrenia, although improved therapeutic approaches are needed. Conclusion : Schizophrenia is one of the most common mental illnesses and poses a considerable burden on patients and healthcare resources alike. Negative symptoms are present in many patients and there is an unmet need to improve treatment offerings for negative symptoms beyond the use of second-generation antipsychotics and overall patient outcomes. PMID:26535049

  13. Peroxisome biogenesis disorders in the Zellweger spectrum: An overview of current diagnosis, clinical manifestations, and treatment guidelines.

    PubMed

    Braverman, Nancy E; Raymond, Gerald V; Rizzo, William B; Moser, Ann B; Wilkinson, Mark E; Stone, Edwin M; Steinberg, Steven J; Wangler, Michael F; Rush, Eric T; Hacia, Joseph G; Bose, Mousumi

    2016-03-01

    Peroxisome biogenesis disorders in the Zellweger spectrum (PBD-ZSD) are a heterogeneous group of genetic disorders caused by mutations in PEX genes responsible for normal peroxisome assembly and functions. As a result of impaired peroxisomal activities, individuals with PBD-ZSD can manifest a complex spectrum of clinical phenotypes that typically result in shortened life spans. The extreme variability in disease manifestation ranging from onset of profound neurologic symptoms in newborns to progressive degenerative disease in adults presents practical challenges in disease diagnosis and medical management. Recent advances in biochemical methods for newborn screening and genetic testing have provided unprecedented opportunities for identifying patients at the earliest possible time and defining the molecular bases for their diseases. Here, we provide an overview of current clinical approaches for the diagnosis of PBD-ZSD and provide broad guidelines for the treatment of disease in its wide variety of forms. Although we anticipate future progress in the development of more effective targeted interventions, the current guidelines are meant to provide a starting point for the management of these complex conditions in the context of personalized health care. PMID:26750748

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

    PubMed Central

    Marion, Donald W.

    2014-01-01

    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

  15. The National Institute for Health and Clinical Excellence (NICE) to Hospital Elder Life Program (HELP): Operationalizing Nice Guidelines to Improve Clinical Practice

    PubMed Central

    Yue, Jirong; Tabloski, Patricia; Dowal, Sarah L.; Puelle, Margaret R.; Nandan, Rakesh; Inouye, Sharon K.

    2014-01-01

    The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom developed guidelines for the diagnosis, prevention, and management of delirium in July, 2010, which included 10 recommendations for delirium prevention. The Hospital Elder Life Program (HELP) is a targeted multicomponent strategy which has proven effective and cost-effective to prevent functional and cognitive decline in hospitalized older persons. HELP provided much of the basis for 7/10 (70%) of the NICE recommendations. Given interest by new HELP sites to meet NICE guidelines, we developed 3 new protocols which were not previously included in the HELP program, addressing hypoxia, infection, and pain. Additionally, the NICE dehydration guideline included constipation, which was not specifically addressed in the HELP protocols. This project describes the systematic development of 3 new protocols (hypoxia, infection, and pain) and the expansion of an existing HELP protocol (constipation/dehydration) to achieve alignment between the HELP protocols and NICE guidelines. Following the Institute of Medicine recommendations for developing trustworthy guidelines, we undertook a systematic review of current literature by an interdisciplinary group of experts, rated the quality of the evidence, developed intervention protocols based on the highest quality evidence, and submitted the protocols first to internal review, then external review by an interdisciplinary panel of experts. The protocols were revised based on the review process, and were incorporated into the HELP materials. Inclusion of these protocols enhances the scope of the HELP program, and allows fulfillment of NICE guideline recommendations for delirium prevention. The rigorous process we applied may provide a useful example for updating existing guidelines or protocols, which may be applicable to a broad range of clinical applications. PMID:24697606

  16. Impact of a Standardized Treatment Guideline for Pediatric Iatrogenic Opioid Dependence: A Quality Improvement Initiative

    PubMed Central

    Reyburn-Orne, Teri; Youssef, Tarek H.; Haddad, Imad Y.; Gerkin, Richard D.

    2016-01-01

    OBJECTIVES: To determine whether utilization of a hospital-based clinical practice guideline for the care of pediatric iatrogenic opioid dependence (IOD) would promote a decrease in opioid exposure and improve management of opioid abstinence syndrome (AS). METHODS: This study is a retrospective chart review of critically ill patients from a tertiary care children's hospital. Inclusion criteria included mechanically ventilated patients up to 18 years of age who received continuous opioid infusions for at least 7 days and any length of methadone administration. Data on IOD patients from January 2005 to June 2010 was divided into 3 periods: baseline, phase 1, and phase 2. Primary outcome was decrease in opioid exposure, measured by methadone duration of use and any additional opioid bolus doses used in AS management. Documentation of additional opioid bolus doses was regarded as a surrogate measure of AS. Secondary outcomes included total cumulative fentanyl dose, continuous fentanyl infusion duration of use, and hospital and pediatric intensive care unit length of stay. RESULTS: There was a significant decrease in methadone duration of use in IOD patients from 15.3 ± 8.7 days at baseline to 9.5 ± 3.7 days during phase 1 (p = 0.002), to 8.1 ± 3.7 days on phase 2 (reduction not significant, p = 0.106) of this evaluation. Additional opioid bolus doses were significantly lower from baseline to phase 1 (5.5 ± 5.1 vs. 1.8 ± 2.3, p = 0.001) and from phase 1 to phase 2 (1.8 ± 2.3 vs. 0.2 ± 1.5, p = 0.003). For the remaining outcomes, differences were not observed among the evaluation periods, except for the total cumulative fentanyl dose, which was reduced from 2.8 ± 3.7 mg/kg at baseline to 1 ± 1 mg/kg only during phase 1 (p = 0.017). CONCLUSIONS: Introduction of a standardized, hospital-based clinical practice guideline for children with IOD reduced the length of exposure to opioids and improved opioid AS management. PMID:26997929

  17. [Practice guideline for diagnosis and treatment of craniopharyngioma and parasellar tumors of the pituitary gland].

    PubMed

    Venegas, Eva; Concepcion, Blanco; Martin, Tomas; Soto, Alfonso

    2015-01-01

    Craniopharyngiomas are rare, locally aggressive epithelial tumors usually located in the sellar and suprasellar region. Diagnosis of craniopharyngioma is usually suggested by clinical and radiological findings that should be confirmed histologically. Surgery is the treatment of choice for most patients. The goal of surgery is to relieve compressive symptoms and to remove as much tumor as safely possible. Radiation therapy is the usual treatment to control postoperative tumor remnants and local recurrences. Parasellar lesions are low prevalent lesions and include neoplastic, inflammatory, infectious, developmental, and vascular diseases. Both their diagnosis and treatment depend on the type of lesion. PMID:25066506

  18. Polish consensus guidelines on the use of acyclovir in the treatment and prevention of VZV and HSV infections.

    PubMed

    Szenborn, Leszek; Kraszewska-Głomba, Barbara; Jackowska, Teresa; Duszczyk, Ewa; Majda-Stanisławska, Ewa; Marczyńska, Magdalena; Ołdak, Elżbieta; Pawłowska, Małgorzata; Służewski, Wojciech; Wysocki, Jacek; Stryczyńska-Kazubska, Joanna; Kuchar, Ernest

    2016-02-01

    A physician has to perform a benefit-risk assessment each time acyclovir is prescribed "off label" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological. PMID:26643900

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

    SciTech Connect

    Cheng, S.-J.; Lee, J.-J.; Ting, L.-L.; Tseng, I.-Y.; Chang, H.-H.; Chen, H.-M.; Kuo, Y.-S.; Hahn, L.-J.; Kok, S.-H. . E-mail: kok@ha.mc.ntu.edu.tw

    2006-01-01

    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.

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

    USGS Publications Warehouse

    Knapton, J.R.

    1985-01-01

    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)

  1. Guidelines for the evaluation and treatment of muscle dysfunction in patients with chronic obstructive pulmonary disease.

    PubMed

    Barreiro, Esther; Bustamante, Víctor; Cejudo, Pilar; Gáldiz, Juan B; Gea, Joaquim; de Lucas, Pilar; Martínez-Llorens, Juana; Ortega, Francisco; Puente-Maestu, Luis; Roca, Josep; Rodríguez-González Moro, José Miguel

    2015-08-01

    In patients with chronic obstructive pulmonary disease (COPD), skeletal muscle dysfunction is a major comorbidity that negatively impacts their exercise capacity and quality of life. In the current guidelines, the most recent literature on the various aspects of COPD muscle dysfunction has been included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) scale has been used to make evidence-based recommendations on the different features. Compared to a control population, one third of COPD patients exhibited a 25% decline in quadriceps muscle strength, even at early stages of their disease. Although both respiratory and limb muscles are altered, the latter are usually more severely affected. Numerous factors and biological mechanisms are involved in the etiology of COPD muscle dysfunction. Several tests are proposed in order to diagnose and evaluate the degree of muscle dysfunction of both respiratory and limb muscles (peripheral), as well as to identify the patients' exercise capacity (six-minute walking test and cycloergometry). Currently available therapeutic strategies including the different training modalities and pharmacological and nutritional support are also described. PMID:26072153

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

    SciTech Connect

    Hoffman, D.P.; Gibson, L.V. Jr.; Hermes, W.H.; Bastian, R.E.; Davis, W.T.

    1994-01-01

    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.

  3. SEOM clinical guidelines for the treatment of follicular non-Hodgkin's lymphoma.

    PubMed

    Provencio Pulla, M; Alfaro Lizaso, J; de la Cruz Merino, L; Gumá I Padró, J; Quero Blanco, C; Gómez Codina, J; Llanos Muñoz, M; Martinez Banaclocha, N; Rodriguez Abreu, D; Rueda Domínguez, A

    2015-12-01

    Follicular non-Hodgkin's lymphoma (FL) is a nodal B lymphoid malignancy that originates from the germinal center of a lymph node. FL is the second most frequent lymphoma subtype. The course of the disease is usually characterised by a typically indolent clinical course, with a median survival rate of 8-10 years, although most patients relapse after treatment. Diagnosis should always be based on a surgical specimen like an excisional node lymph biopsy. The first-line treatment of FL will depend of extension disease, tumour burden, patient symptoms, performance status and also patient decision. The addition of rituximab to conventional chemotherapy has improved ORR, PFS and OS. As first line in patients that need treatment, a combination of chemotherapy with rituximab induction followed by 2 years of rituximab maintenance is the best option. High-dose chemotherapy with autologous stem-cell transplantation in first line has not shown improvement and is not recommended as first-line therapy. Before any treatment decision in relapsed patients, a repeat biopsy is mandatory to rule out a transformation into large cell aggressive lymphoma. Standard treatment is controversial, depends on the efficacy of prior treatment, duration of the time-to-relapse, patient's age and histological findings at relapse. PMID:26586117

  4. EBMPracticeNet: A Bilingual National Electronic Point-Of-Care Project for Retrieval of Evidence-Based Clinical Guideline Information and Decision Support

    PubMed Central

    2013-01-01

    Background In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, evidence-based medicine (EBM) partners, and vendors of electronic health records (EHR) is unique to this project. All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. Objective The objective of this paper was to describe the development strategy, the overall content, and the management of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. Methods Several candidate providers of comprehensive guideline solutions were evaluated and one database was selected. Translation of the guidelines to Dutch and French was done with translation software, post-editing by translators and medical proofreading. A strategy is determined to adapt the guideline content to the Belgian context. Acceptance of the computerized clinical decision support tool has been tested and a randomized controlled trial is planned to evaluate the effect on process and patient outcomes. Results Currently, EBMPracticeNet is in "work in progress" state. Reference is made to the results of a pilot study and to further planned research including a randomized controlled trial. Conclusions The collaboration of government, health care providers, EBM partners, and vendors of EHRs is unique. The potential value of the project is great. The link between all the EHRs from different vendors and a national database held on a single platform that is controlled by all EBM organizations in Belgium are the strengths of EBMPracticeNet. PMID:23842038

  5. National Guideline Clearinghouse

    MedlinePlus

    ... the video: My NGC Personalization Already have an account? Sign In... E-mail: Password: Remember Me Forgot your password? New User? Create an account... Password should contain 8 characters minimum At least ...

  6. National Athletic Trainers' Association Releases New Guidelines for Exertional Heat Illnesses: What School Nurses Need to Know.

    PubMed

    VanScoy, Rachel M; DeMartini, Julie K; Casa, Douglas J

    2016-05-01

    Exertional heat illnesses (EHI) occur in various populations and settings. Within a school setting, there are student athletes who take part in physical activity where the risk of EHI is increased. The National Athletic Trainers' Association (NATA) released an updated position statement on EHI in September of 2015. This article is a summary of the position statement. The sports medicine team, including school nurses and athletic trainers, provides quality health care to these physically active individuals. Thus, it is important for school nurses to understand the prevention, recognition, and treatment of EHI. PMID:26941054

  7. A national survey of substance abuse treatment for juvenile offenders.

    PubMed

    Young, Douglas W; Dembo, Richard; Henderson, Craig E

    2007-04-01

    Despite consensus about the value of substance abuse treatment for delinquent youth, information about its prevalence and availability is inadequate and inconsistent. This article presents findings about treatment and other correctional service provision from a national survey of directors of 141 juvenile institutional and community corrections (CC) facilities. Educational/General Educational Development programming and drug and alcohol education were the most prevalent types of correctional and substance abuse services. Other common services included physical health services and mental health assessment, provided to about 60% of youth across facilities, and mental health counseling, life and communication skills, and anger management, provided to about half of the youth. Substance abuse treatment, as with most other services, were more prevalent in large, state-funded residential facilities (where 66% provided treatment) than in local detention centers (20%) and CC facilities (56%). More detailed data showed that the number of youth attending treatment in all types of facilities on any given day was very low. PMID:17383550

  8. How To Use the Guidelines.

    ERIC Educational Resources Information Center

    American Journal on Mental Retardation, 2000

    2000-01-01

    This article introduces this special issue focused on application of guidelines based on the consensus of experts to the treatment of psychiatric and behavioral problems in persons with mental retardation. It explains the method of developing the guidelines, the limitations and advantages of the guidelines, and the organization of the guidelines.…

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

    PubMed Central

    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

    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

  10. [The BCTRIMS Expanded Consensus on treatment of multiple sclerosis: III. Evidence and recommendation-based guidelines].

    PubMed

    Lana-Peixoto, Marco Aurélio; Callegaro, Dagoberto; Moreira, Marcos Aurélio; Campos, Gilberto Belisário; Marchiori, Paulo Eurípedes; Gabbai, Alberto Alain; Bacheschi, Luiz Alberto; Arruda, Walter Oleschko; Gama, Paulo Diniz; Melo, Aílton Souza; Rocha, Fernando Coronetti Gomes; Lino, Angelina Maria Martins; Ferreira, Maria Lúcia Brito; Ataide, Luiz

    2002-09-01

    There has been unprecedented advances in knowledge of multiple sclerosis (MS) in the last few years. A new set of criteria for its diagnosis and a bunch of recent clinical trials with disease-modifying agents (DMA) have been published. All of that has made it necessary to update and expand the previous consensus for MS treatment as formulated by the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) two years ago. The BCTRIMS Expanded Consensus emphasizes the need to (1) consider MS treatment on an individual basis; (2) educate patients about the potential benefits and risks of treatment; (3) monitor drugs side effects; (4) have a signed Informed Consent Form; (5) consider the relative cost of the drug. The various clinical possibilities and the indications of the DMA and other immunointerventions are considered according to classes of evidences and types of recommendations. The BCTRIMS Expanded Consensus on Treatment of MS may turn out to be a model to other developing countries. PMID:12364967

  11. [Treatment of anemia in chronic kidney disease--position statement of the Croatian Society for Nephrology, Dialysis and Transplantation and review of the KDIGO and ERPB guidelines].

    PubMed

    Rački, Sanjin; Bašić-Jukić, Nikolina; Kes, Petar; Ljutić, Dragan; Lovčić, Vesna; Prkačin, Ingrid; Radić, Josipa; Vujičić, Božidar; Bubić, Ivan; Jakić, Marko; Belavić, Žarko; Sefer, Siniša; Pehai, Mario; Klarić, Dragan; Gulin, Marijana

    2014-04-01

    Renal anemia is the result of chronic kidney disease (CKD) and deteriorates with disease progression. Anemia may be the first sign of kidney disease. In all patients with anemia and CKD, diagnostic evaluation is required. Prior to diagnosing renal anemia, it is necessary to eliminate the other possible causes. Direct correlation between the concentration of hemoglobin and the stage of renal failure is well known. Early development of anemia is common in diabetic patients. Correction of anemia may slow the progression of CKD. Anemia is an independent risk factor for developing cardiovascular disease in patients with CKD. Treatment of anemia in patients with CKD is based on current guidelines. Recently, the Kidney Disease: Improving Global Outcomes (KDIGO) group has produced comprehensive clinical practice guidelines for the management of anemia in CKD patients and ERBP (European Renal Best Practice) group its position statement and comments on the KDIGO guidelines. The Croatian Society of Nephrology, Dialysis and Transplantation (HDNDT) has already published its own guidelines based on the recommendations and positive experience of European and international professional societies, as well as on own experience. The latest version of Croatian guidelines was published in 2008. Since then, on the basis of research and clinical practice, there have been numerous changes in the modern understanding of the treatment of anemia in CKD. Consequently, HDNDT hereby publishes a review of the recent recommendations of international professional societies, expressing the attitude about treating anemia in CKD as a basis for new guidelines tailored to the present time. PMID:26012163

  12. Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis

    PubMed Central

    Walensky, Rochelle P.; Wood, Robin; Ciaranello, Andrea L.; Paltiel, A. David; Lorenzana, Sarah B.; Anglaret, Xavier; Stoler, Adam W.; Freedberg, Kenneth A.

    2010-01-01

    Background The new 2010 World Health Organization (WHO) HIV treatment guidelines recommend earlier antiretroviral therapy (ART) initiation (CD4<350 cells/µl instead of CD4<200 cells/µl), multiple sequential ART regimens, and replacement of first-line stavudine with tenofovir. This paper considers what to do first in resource-limited settings where immediate implementation of all of the WHO recommendations is not feasible. Methods and Findings We use a mathematical model and local input data to project clinical and economic outcomes in a South African HIV-infected cohort (mean age = 32.8 y, mean CD4 = 375/µl). For the reference strategy, we assume that all patients initiate stavudine-based ART with WHO stage III/IV disease and receive one line of ART (stavudine/WHO/one-line). We rank—in survival, cost-effectiveness, and equity terms—all 12 possible combinations of the following: (1) stavudine replacement with tenofovir, (2) ART initiation (by WHO stage, CD4<200 cells/µl, or CD4<350 cells/µl), and (3) one or two regimens, or lines, of available ART. Projected life expectancy for the reference strategy is 99.0 mo. Considering each of the guideline components separately, 5-y survival is maximized with ART initiation at CD4<350 cells/µl (stavudine/<350/µl/one-line, 87% survival) compared with stavudine/WHO/two-lines (66%) and tenofovir/WHO/one-line (66%). The greatest life expectancies are achieved via the following stepwise programmatic additions: stavudine/<350/µl/one-line (124.3 mo), stavudine/<350/µl/two-lines (177.6 mo), and tenofovir/<350/µl/two-lines (193.6 mo). Three program combinations are economically efficient: stavudine/<350/µl/one-line (cost-effectiveness ratio, US$610/years of life saved [YLS]), tenofovir/<350/µl/one-line (US$1,140/YLS), and tenofovir/<350/µl/two-lines (US$2,370/YLS). Conclusions In settings where immediate implementation of all of the new WHO treatment guidelines is not feasible, ART initiation at CD4<350 cells/µl provides the greatest short- and long-term survival advantage and is highly cost-effective. Please see later in the article for the Editors' Summary PMID:21209794

  13. Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections.

    PubMed

    2012-08-10

    Gonorrhea is a major cause of serious reproductive complications in women and can facilitate human immunodeficiency virus (HIV) transmission. Effective treatment is a cornerstone of U.S. gonorrhea control efforts, but treatment of gonorrhea has been complicated by the ability of Neisseria gonorrhoeae to develop antimicrobial resistance. This report, using data from CDC's Gonococcal Isolate Surveillance Project (GISP), describes laboratory evidence of declining cefixime susceptibility among urethral N. gonorrhoeae isolates collected in the United States during 2006-2011 and updates CDC's current recommendations for treatment of gonorrhea. Based on GISP data, CDC recommends combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days as the most reliably effective treatment for uncomplicated gonorrhea. CDC no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections. If cefixime is used as an alternative agent, then the patient should return in 1 week for a test-of-cure at the site of infection. PMID:22874837

  14. Italian Society for the Study of Diabetes (SID)/Italian Endocrinological Society (SIE) guidelines on the treatment of hyperglycemia in Cushing's syndrome and acromegaly.

    PubMed

    Baroni, M G; Giorgino, F; Pezzino, V; Scaroni, C; Avogaro, A

    2016-02-01

    Hyperglycemia is a common feature associated with states of increased growth hormone secretion and glucocorticoid levels. The purpose of these guidelines is to assist clinicians and other health care providers to take evidence-based therapeutic decisions for the treatment of hyperglycemia in patients with growth hormone and corticosteroid excess. Both the SID and SIE appointed members to represent each society and to collaborate in Guidelines writing. Members were chosen for their specific knowledge in the field. Each member agreed to produce-and regularly update-conflicts of interest. The authors of these guidelines prepared their contributions following the recommendations for the development of Guidelines, using the standard classes of recommendation shown below. All members of the writing committee provided editing and systematic review of each part of the manuscript, and discussed the grading of evidence. Consensus was guided by a systematic review of all available trials and by interactive discussions. PMID:26718207

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

    PubMed

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

    2016-01-01

    This EFOMP Policy Statement is an update of Policy Statement No. 6 first published in 1994. The present version takes into account the European Union Parliament and Council Directive 2013/55/EU that amends Directive 2005/36/EU on the recognition of professional qualifications and the European Union Council Directive 2013/59/EURATOM laying down the basic safety standards for protection against the dangers arising from exposure to ionising radiation. The European Commission Radiation Protection Report No. 174, Guidelines on Medical Physics Expert and the EFOMP Policy Statement No. 12.1, Recommendations on Medical Physics Education and Training in Europe 2014, are also taken into consideration. The EFOMP National Member Organisations are encouraged to update their Medical Physics registration schemes where these exist or to develop registration schemes taking into account the present version of this EFOMP Policy Statement (Policy Statement No. 6.1"Recommended Guidelines on National Registration Schemes for Medical Physicists"). PMID:26851162

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

    PubMed Central

    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

    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

  17. Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy-Induced Nausea and Vomiting in Children With Cancer.

    PubMed

    Flank, Jacqueline; Robinson, Paula D; Holdsworth, Mark; Phillips, Robert; Portwine, Carol; Gibson, Paul; Maan, Cathy; Stefin, Nancy; Sung, Lillian; Dupuis, L Lee

    2016-07-01

    This clinical practice guideline provides an approach to the treatment of breakthrough chemotherapy-induced nausea and vomiting (CINV) and the prevention of refractory CINV in children. It was developed by an international, interprofessional panel and is based on systematic literature reviews. Evidence-based interventions for the treatment of breakthrough and prophylaxis of refractory CINV are recommended. Gaps in the evidence used to support the recommendations made in this clinical practice guideline were identified. The contribution of these recommendations to breakthrough and refractory CINV control in children requires prospective evaluation. PMID:26960036

  18. 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...

  19. Practical Guidelines for Monitoring Treatment of Attention-Deficit/Hyperactivity Disorder.

    ERIC Educational Resources Information Center

    Katisyannis, Antonis; Landrum, Timothy J.; Vinton, Lori

    1997-01-01

    First identifies salient features of attention deficit/hyperactivity disorder (ADHD) and then offers a model for diagnosis, treatment, and monitoring of students with ADHD. The model assumes cooperation of parent, teacher, and physician, and data-based decisions concerning use and ongoing monitoring of stimulant medication or other…

  20. Don't Drink and Drive. Completion of Treatment Guidelines. Driver Education Evaluation Programs.

    ERIC Educational Resources Information Center

    Tremper, Mel

    This booklet sets forth a common framework within which providers of substance abuse services approved by the Maine Division of Driver Education Evaluation Programs (DEEP) can evaluate, treat, and certify the completion of treatment of persons convicted of operating under the influence. It presents criteria for classifying individuals according to

  1. Assessment and Treatment of Recurrent Abdominal Pain: Guidelines for the School Psychologist.

    ERIC Educational Resources Information Center

    McMahon, Colleen; And Others

    1990-01-01

    Notes that somatic complaints without clear organic origin are also primary indicators for both anxiety and depression in childhood and adolescence. Review of literature provides school psychologists with basic information regarding prevalence, assessment, and treatment of one of most common types of somatic complaints: recurrent abdominal pain.

  2. [Guidelines for management of epilepsy--commentary on Scottish ("SIGN") guidelines].

    PubMed

    Planjar-Prvan, Miljenka; Granić, Davorka

    2005-01-01

    The choice of AED (antiepileptic drug), worldwide and in Croatia, is been still based on the physician's subjective decision, personal experience, knowledge and marketing pressure made by big pharmaceutical industries. Therefore, according to some opinions, there is a need of treatment guidelines for epilepsy that would provide relevant information based on scientific evidence on the efficacy, tolerability and safety of AEDs. The guidelines, published by a competent source, should be designed as to allow for easy access to the information on the best practice in specific cases. An extensive background literature review was made to identify such a type of guidelines for the management of epilepsy. The literature review revealed a number of references with the recommendations for treating epilepsy in different groups of patients and from various, specific aspects of epilepsy treatment. However, only one comprehensive set of guidelines for the diagnosis and treatment of epilepsy treatment was found, i.e. the evidence-based guidelines published by the Scottish Intercollegiate Guidelines Network (SIGN). The development of this set of guidelines is quite extensively described in order to illustrate how rigorous and long-lasting the process was, including a great number of health professionals at the national level. Such a type of well designed guidelines facilitates access to highest educational standards for all professionals involved in the primary and secondary care of people with epilepsy. However, it is clear that guidelines can fully replace the standards of clinical practice based on critical evaluation and integration of all clinical data of each individual patient. No guidelines can replace the physician's obligation to keep informed of the novel achievements in the epileptology either. PMID:15813360

  3. [Treatment of arterial hypertension in pregnancy in relation to current guidelines of the Polish Society of Arterial Hypertension from 2011].

    PubMed

    Szczepaniak-Chicheł, Ludwina; Tykarski, Andrzej

    2012-10-01

    Arterial hypertension concerns 7-10% of pregnancies and leads to an increased risk of complications for both, the mother and the child. This rate will probably rise in the years to come due to the notable tendency among women to delay the decision to become pregnant - values of blood pressure and occurrence of arterial hypertension increase with age, as well as due to the growing problem of obesity resulting from inappropriate dietary habits and lack of regular everyday physical activity. Difficulties with management of that clinical condition are partly related with lack of unified and widely accepted guidelines. Different opinions in the subject of terminology and classification of pregnancy hypertension or indications for pharmacotherapy as well as choice of the optimal antihypertensive drug, emerge from objective causes such as combination of various pathogenetic factors typical for arterial hypertension itself and those connected with pregnancy elsewhere stressed priorities of therapy from the point of view of the health of the mother and of the fetus, as well as lack of randomized clinical trials due to obvious ethical purposes, but also from the fact that pregnancy hypertension is a focus of attention for different specialists - obstetricians, hypertensiologists and perinatologists. A good cooperation regarding experience and information among all of these specializations would be the most beneficial for pregnant women and their children. Lack of new modern antihypertensive agents, safe and effective in pregnancy while the older ones are being withdrawn from the market as their production is no longer cost-effective for pharmacological companies, has become an increasing problem in many countries, and Poland among them. The aim of the following publication was to present the statement on management of pregnancy hypertension from the current guidelines of the Polish Society of Arterial Hypertension 2011 to gynecologists and obstetricians, with a commentary According to the guidelines, methyldopa, labetalol (or metoprolol), long-acting nifedipine or verapamil should be used in the therapy of mild and moderate pregnancy hypertension, preferably in the given order In case of severe and life-threatening arterial hypertension, labetalol intravenously should be administered and if it is still not sufficient, eventually sodium nitroprusside or hydralazine could be ordered, bearing in mind their possible adverse effects. Unfortunately labetalol, nifedipine, hydralazine and sodium nitroprusside are no longer available in Poland, which significantly narrows the practical treatment possibilities in the pregnant population. Inhibitors of angiotensin converting enzyme and angiotensin II receptor blockers are contraindicated during pregnancy and breastfeeding, as well as aldosteron inhibitors, as suggest in the guidelines. In the paper the authors present the guidelines and also, based on the information available to date in medical journals, other hypertension pharmacotherapeutic options possible for consideration in pregnancy which could be helpful in management of severe arterial hypertension in pregnancy. PMID:23383565

  4. Withholding/withdrawing treatment from neonates: legislation and official guidelines across Europe.

    PubMed Central

    McHaffie, H E; Cuttini, M; Brölz-Voit, G; Randag, L; Mousty, R; Duguet, A M; Wennergren, B; Benciolini, P

    1999-01-01

    Representatives from eight European countries compared the legal, ethical and professional settings within which decision making for neonates takes place. When it comes to limiting treatment there is general agreement across all countries that overly aggressive treatment is to be discouraged. Nevertheless, strong emphasis has been placed on the need for compassionate care even where cure is not possible. Where a child will die irrespective of medical intervention, there is widespread acceptance of the practice of limiting aggressive treatment or alleviating suffering even if death may be hastened as a result. Where the infant could be saved but the future outlook is bleak there is more debate, but only two countries have tested the courts with such cases. When it comes to the active intentional ending of life, the legal position is standard across Europe; it is prohibited. However, recognising those intractable situations where death may be lingering and unpleasant, Dutch paediatricians have reported that they do sometimes assist babies to die with parental consent. Two cases have been tried through the courts and recent official recommendations have set out standards by which such actions may be assessed. PMID:10635495

  5. Guidelines for diagnosis and treatment of Hunter Syndrome for clinicians in Latin America

    PubMed Central

    Giugliani, Roberto; Villarreal, Martha Luz Solano; Valdez, C. Araceli Arellano; Hawilou, Antonieta Mahfoud; Guelbert, Norberto; Garzón, Luz Norela Correa; Martins, Ana Maria; Acosta, Angelina; Cabello, Juan Francisco; Lemes, Aída; Santos, Mara Lucia Schmitz Ferreira; Amartino, Hernán

    2014-01-01

    This review aims to provide clinicians in Latin America with the most current information on the clinical aspects, diagnosis, and management of Hunter syndrome, a serious and progressive disease for which specific treatment is available. Hunter syndrome is a genetic disorder where iduronate-2-sulfatase (I2S), an enzyme that degrades glycosaminoglycans, is absent or deficient. Clinical manifestations vary widely in severity and involve multiple organs and tissues. An attenuated and a severe phenotype are recognized depending on the degree of cognitive impairment. Early diagnosis is vital for disease management. Clinical signs common to children with Hunter syndrome include inguinal hernia, frequent ear and respiratory infections, facial dysmorphisms, macrocephaly, bone dysplasia, short stature, sleep apnea, and behavior problems. Diagnosis is based on screening urinary glycosaminoglycans and confirmation by measuring I2S activity and analyzing I2S gene mutations. Idursulfase (recombinant I2S) (Elaprase®, Shire) enzyme replacement therapy (ERT), designed to address the underlying enzyme deficiency, is approved treatment and improves walking capacity and respiratory function, and reduces spleen and liver size and urinary glycosaminoglycan levels. Additional measures, responding to the multi-organ manifestations, such as abdominal/inguinal hernia repair, carpal tunnel surgery, and cardiac valve replacement, should also be considered. Investigational treatment options such as intrathecal ERT are active areas of research, and bone marrow transplantation is in clinical practice. Communication among care providers, social workers, patients and families is essential to inform and guide their decisions, establish realistic expectations, and assess patients’ responses. PMID:25071396

  6. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population.

    PubMed

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-11-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES-in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective-Threshold-Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr(-1)). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  7. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population

    PubMed Central

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-01-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES—in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective–Threshold–Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr−1). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  8. Practice Guidelines for the Assessment of Clinically Significant Treatment Outcomes in the Children's Mental Health System.

    PubMed

    Chomycz, Suzanne; Schmidt, Fred

    2016-01-01

    The use of program evaluation to monitor client change and improve intervention effectiveness is gaining increasing importance in the mental health field. However, there is a lack of literature available in community-based clinics for those who desire to evaluate the effectiveness of services. Through this article the authors review the literature on the best methods to assess clinically significant treatment outcomes in community-based children's mental health services. The strengths and weaknesses of commonly recommended methods of evaluating change are discussed (i.e., reliable change index, percentage of improvement, normative comparisons, and effect size) using a dataset from a community-based parenting program (N=308). PMID:26086975

  9. Analysis of Recurrence Patterns in Acral versus Non-Acral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?

    PubMed Central

    Gumaste, Priyanka V.; Fleming, Nathaniel H.; Silva, Ines; Shapiro, Richard L.; Berman, Russell S.; Zhong, Judy; Osman, Iman; Stein, Jennifer A.

    2015-01-01

    Background Current surgical treatment of primary melanoma is uniform for all histo-subtypes, although certain types of melanoma, such as acral lentiginous melanoma (ALM), carry a poor prognosis. No study has explored the effectiveness of standard melanoma treatment guidelines in ALM compared to non-acral melanoma (NAM). Methods Study subjects were identified from a prospectively enrolled database of primary melanoma patients at Blinded for Review Purposes. ALM patients were matched to NAM patients (1:3) by gender and melanoma stage, including substage (ALM=61, NAM=183). All patients received standard of care treatment. Recurrence and survival outcomes in both cohorts were compared. Results ALM histologic subtype was an independent negative predictor of recurrence-free survival (HR = 2.45, p < 0.001) and melanoma-specific survival (HR= 2.64, p = 0.001) compared to NAM. Recurrence was significantly more common in ALM compared to NAM (49% versus 30%, p=0.007). In tumors less than 2mm in thickness, there was a significantly higher recurrence rate in ALM versus NAM (p=0.048). There was no significant difference in recurrence in tumors greater than 2mm (p= 0.12). Of note, the rate of loco-regional recurrence was nearly double in ALM compared to NAM (p=0.001). Conclusions Our data revealed a high rate of loco-regional failure in ALM compared to NAM when controlling for AJCC stage. Our results question whether ALM may require more aggressive surgical treatment than non- acral cutaneous melanomas of equal thickness, particularly in tumors less than 2mm thick. Revision of surgical margin recommendations based on larger multicenter cohorts may need to be considered. PMID:25505211

  10. 78 FR 15961 - Center for Substance Abuse Treatment National Advisory Council; Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-13

    ... Treatment National Advisory Council; Meeting Pursuant to Public Law 92-463, notice is hereby given of the... Abuse Treatment National Advisory Council on April 10, 2013. The meeting is open to the public and will... Abuse Treatment National Advisory Council. Date/Time/Type: April 10, 2013 9:00 a.m.-4:30 p.m....

  11. Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions

    PubMed Central

    Liddle, Jacki; Hall, Wayne; Chenery, Helen

    2015-01-01

    Mobile phones and other remote monitoring devices, collectively referred to as "mHealth," promise to transform the treatment of a range of conditions, including movement disorders, such as Parkinson’s disease. In this viewpoint paper, we use Parkinson’s disease as an example, although most considerations discussed below are valid for a wide variety of conditions. The ability to easily collect vast arrays of personal data over long periods will give clinicians and researchers unique insights into disease treatment and progression. These capabilities also pose new ethical challenges that health care professionals will need to manage if this promise is to be realized with minimal risk of harm. These challenges include privacy protection when anonymity is not always possible, minimization of third-party uses of mHealth data, informing patients of complex risks when obtaining consent, managing data in ways that maximize benefit while minimizing the potential for disclosure to third parties, careful communication of clinically relevant information gleaned via mHealth technologies, and rigorous evaluation and regulation of mHealth products before widespread use. Given the complex array of symptoms and differences in comfort and literacy with technology, it is likely that these solutions will need to be individualized. It is therefore critical that developers of mHealth apps engage with patients throughout the development process to ensure that the technology meets their needs. These challenges will be best met through early and ongoing engagement with patients and other relevant stakeholders. PMID:26474545

  12. Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions.

    PubMed

    Carter, Adrian; Liddle, Jacki; Hall, Wayne; Chenery, Helen

    2015-01-01

    Mobile phones and other remote monitoring devices, collectively referred to as "mHealth," promise to transform the treatment of a range of conditions, including movement disorders, such as Parkinson's disease. In this viewpoint paper, we use Parkinson's disease as an example, although most considerations discussed below are valid for a wide variety of conditions. The ability to easily collect vast arrays of personal data over long periods will give clinicians and researchers unique insights into disease treatment and progression. These capabilities also pose new ethical challenges that health care professionals will need to manage if this promise is to be realized with minimal risk of harm. These challenges include privacy protection when anonymity is not always possible, minimization of third-party uses of mHealth data, informing patients of complex risks when obtaining consent, managing data in ways that maximize benefit while minimizing the potential for disclosure to third parties, careful communication of clinically relevant information gleaned via mHealth technologies, and rigorous evaluation and regulation of mHealth products before widespread use. Given the complex array of symptoms and differences in comfort and literacy with technology, it is likely that these solutions will need to be individualized. It is therefore critical that developers of mHealth apps engage with patients throughout the development process to ensure that the technology meets their needs. These challenges will be best met through early and ongoing engagement with patients and other relevant stakeholders. PMID:26474545

  13. Romanian guidelines on the diagnosis and treatment of exocrine pancreatic insufficiency.

    PubMed

    Gheorghe, Cristian; Seicean, Andrada; Saftoiu, Adrian; Tantau, Marcel; Dumitru, Eugen; Jinga, Mariana; Negreanu, Lucian; Mateescu, Bogdan; Gheorghe, Liana; Ciocirlan, Mihai; Cijevschi, Cristina; Constantinescu, Gabriel; Dima, Simona; Diculescu, Mircea

    2015-03-01

    In assessing exocrine pancreatic insufficiency (EPI), its diverse etiologies and the heterogeneous population affected should be considered. Diagnosing this condition remains a challenge in clinical practice especially for mild-to-moderate EPI, with the support of the time-consuming breath test or the coefficient of fat absorption. The fecal elastase-1 test, less precise for the diagnosis, cannot be useful for assessing treatment efficacy. Pancreatic enzyme replacement therapy (PERT) is the mainstay of treatment, whereby enteric-coated mini-microspheres are taken with every meal, in progressive doses based on an individual's weight and clinical symptoms. The main indication for PERT is chronic pancreatitis, in patients who have clinically relevant steatorrhea, abnormal pancreatic function test or abnormal function tests associated with symptoms of malabsorption such as weight loss or meteorism. While enzyme replacement therapy is not recommended in the initial stages of acute pancreatitis, pancreatic exocrine function should be monitored for at least 6-18 months. In the case of unresectable pancreatic cancer, replacement enzyme therapy helps to maintain weight and improve overall quality of life. It is also indicated in patients with celiac disease, who have chronic diarrhea (in spite of gluten-free diet), and in patients with cystic fibrosis with proven EPI. PMID:25822444

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

    PubMed Central

    2010-01-01

    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

  15. [Technical guidelines for the prevention, diagnosis and treatment of Zika virus infection].

    PubMed

    Barrera-Cruz, Antonio; Díaz-Ramos, Rita Delia; López-Morales, Ana Belem; Grajales-Muñiz, Concepción; Viniegra-Osorio, Arturo; Zaldívar-Cervera, Jaime Antonio; Arriaga-Dávila, José Jesús

    2016-01-01

    Infection Zika virus is an emerging disease in the Americas region, which is caused by Zika virus (ZIKV), an arbovirus of the flavivirus genus. The ZIKV is transmitted by the bite of Aedes mosquitoes, both in urban and jungle area. After the mosquito bite, the disease symptoms usually appear after an incubation period of three to twelve days. The infection may be asymptomatic or presented with fever and not purulent conjunctivitis, headache, myalgia, arthralgia, asthenia, maculopapular rash, edema in lower limbs and, less frequently, retro-orbital pain, anorexia, vomiting, diarrhea or pain abdominal. Symptoms last for 4-7 days and are self-limiting. Neurological and autoimmune complications are rare. Since 2014 it has been detected native circulation of Zika virus in the Americas. So far, there is no specific antiviral treatment or effective vaccine, so it´s giving priority symptomatic and supportive treatment for the acute phase and make an early diagnosis of atypical and severe forms. PMID:26960050

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

    SciTech Connect

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

    1994-12-01

    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.

  17. Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda

    PubMed Central

    Mutimura, Eugene; Addison, Diane; Anastos, Kathryn; Hoover, Donald; Dusingize, Jean Claude; Karenzie, Ben; Izimukwiye, Isabelle; Mutesa, Leo; Nsanzimana, Sabin; Nashi, Denis

    2015-01-01

    Background Initiation of antiretroviral therapy (ART) in the advanced stages of HIV infection remains a major challenge in sub-Saharan Africa. This study was conducted to better understand barriers and enablers to timely ART initiation in Rwanda where ART coverage is high and national ART eligibility guidelines first expanded in 2007–2008. Methods Using data on 6326 patients (≥15 years) at five Rwandan clinics, we assessed trends and correlates of CD4+ cell count at ART initiation and the proportion initiating ART with advanced HIV disease (CD4+ <200 cells/µl or WHO stage IV). Results Out of 6326 patients, 4486 enrolling in HIV care initiated ART with median CD4+ cell count of 211 cells/µl [interquartile range: 131–300]. Median CD4+ cell counts at ART initiation increased from 183 cells/µl in 2007 to 293 cells/µl in 2011–2012, and the proportion with advanced HIV disease decreased from 66.2 to 29.4%. Factors associated with a higher odds of advanced HIV disease at ART initiation were male sex [adjusted odds ratios (AOR) = 1.7; 95% confidence interval (CI): 1.3–2.1] and older age (AOR46–55+ vs. <25 = 2.3; 95% CI: 1.2–4.3). Among those initiating ART more than 1 year after enrollment in care, those who had a gap in care of 12 or more months prior to ART initiation had higher odds of advanced HIV disease (AOR = 5.2; 95% CI: 1.2–21.1). Conclusion Marked improvements in the median CD4+ cell count at ART initiation and proportion initiating ART with advanced HIV disease were observed following the expansion of ART eligibility criteria in Rwanda. However, sex disparities in late treatment initiation persisted through 2011–2012, and appeared to be driven by later diagnosis and/or delayed linkage to care among men. PMID:25562492

  18. The emerging problem of biological treatment in migrant and travelling populations: it is time to extend guidelines for the screening of infectious diseases.

    PubMed

    Bartalesi, F; Bartoloni, A; Bisoffi, Z; Spinicci, M; Giménez Sánchez, F; Muñoz, J; Richi, P; Minisola, G; Muñoz-Fernandez, S; Matucci-Cerinic, M

    2014-05-01

    The use of biological agents in the treatment of rheumatic diseases has been widely associated with an increased risk of reactivation of several latent infections. National and international guidelines recommend screening for infectious diseases before starting these drugs. In Western countries screening is limited to latent tuberculosis infection, HIV and viral hepatitis. However, the increasing globalisation and the remarkable number of migrating and travelling people worldwide make this approach no longer adequate. The Italian and Spanish Societies of Rheumatology and Tropical Medicine wish to issue a warning about the need to improve awareness of doctors about the risk of reactivation of infectious tropical diseases in migrant or travelling patients who undergo biological therapy. Thus, the Italian and Spanish Societies are now planning to issue specific recommendations, based on a multidisciplinary contribution and a systematic review of the literature, for screening and follow-up of active and latent chronic infections in candidate patients for biological agents, taking into account the patient's area of origin and risk of infectious diseases. PMID:24335919

  19. When Depression Complicates Childbearing: Guidelines for Screening and Treatment during Antenatal and Postpartum Obstetric Care

    PubMed Central

    Muzik, Maria; Marcus, Sheila M.; Heringhausen, Julie E.; Flynn, Heather

    2015-01-01

    Synopsis Prevalence studies show that one in five women experience an episode of major depressive disorder during their lifetime. The peripartum period constitutes a prime time for symptom exacerbation and relapse of depressive episodes. It is important for health care providers, specifically those in obstetric care, to be aware of (1) the frequency of depression in pregnant and postpartum women; (2) signs, symptoms, and appropriate screening methods; and (3) the health risks for the mother and growing fetus if depression is undetected or untreated. Because management of depressed peripartum women also includes care of a growing fetus or breastfeeding infant, treatment may be complex and requires input from a multidisciplinary team, including an obstetrician, psychiatrist, and pediatrician, to provide optimal care. PMID:19944300

  20. Guidelines for treatment of open fractures and infected pseudarthroses by external fixation.

    PubMed

    Vidal, J; Buscayret, C; Connes, H; Melka, J; Orst, G

    1983-11-01

    There are three phases in the treatment of open fractures and infected pseudarthroses by the Hoffmann external fixator. During the initial phase a careful surgical debridement is performed in the bony tissues, and the external fixator is applied in a manner appropriate to the type and level of the lesion site (double- or triple-frame mounting; additional anchorages; neutralization, compression, or distraction; ligamentotaxis). During the intermediate phase both the nursing of the patient and care of the apparatus are critical for the avoidance of complications; it is during this period that granulation tissue must develop and bone infections must be controlled. In the final phase the loss of osseous substance must be treated by various means (regular tightening of the external fixator; Papineau's technique; intertibiofibular graft; free microvascular bone transplantation technique. PMID:6354550

  1. SEOM clinical guidelines for the treatment of follicular non-Hodgkin's lymphoma.

    PubMed

    Rodrguez-Abreu, Delvys; Llanos Muoz, Marta; Provencio Pulla, Mariano; Rueda Domnguez, Antonio; Isla Casado, Dolores

    2010-11-01

    Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin's lymphoma (NHL) in the Western world. FL constitutes the most frequent indolent lymphoma, well characterized by its clinical presentation related to nodal involvement and its morphologic and biologic features. It is often managed as an incurable disease. However, several active therapeutic approaches from the "wait and watch" strategy to the allogeneic transplantation are available for management of patients with FL and clearly have changed the natural history of this disease, achieving a long-term disease-free survival. Therapeutic decision is mostly conditioned by patient's characteristics, stage, histological grade, tumor burden, and risk-predicting factors. This article try to summarizes the diagnosis and treatment of this heterogeneous group of patients. PMID:20974569

  2. The Chain of Actions in Special Education--The Relationship between National Guidelines and Municipal Follow-Up: An Evaluation Based on a Case Study from One Norwegian Municipality

    ERIC Educational Resources Information Center

    Nilsen, Sven

    2011-01-01

    This article discusses the chain of actions in special education in Norwegian compulsory school. An analysis is made of how the municipality follows up national guidelines relevant to the chain of actions through its own guidelines to the schools. The analysis gives the general impression that the local authority is facilitating guidance to the…

  3. 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

    Songhua, Tan; Wang, Catherine Yan

    2012-01-01

    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…

  4. How well are national guidelines relating to the general sales of aspirin and paracetamol, adhered to by retail stores: a mystery shopper study

    PubMed Central

    Molloy, Phillip; Chambers, Ruth; Cork, Tania

    2016-01-01

    Objective To determine whether non-pharmaceutical retail outlets are aboding to the current Medicines and Healthcare products Regulatory Agency (MHRA) national guidelines for over-the-counter (OTC) sales of aspirin and paracetamol. Methods Stages 1 and 2 of the study deployed eight and four medical students, respectively, to undertake a mystery shopper style investigation. Stage 1: eight medical students attempted to buy ≥96 tablets/capsules aspirin or paracetamol in one transaction in 62 shops. Stage 2: four medical students attempted to purchase 32 paracetamol 500 mg along with a ‘flu remedy preparation also containing paracetamol, in 54 shops. Results Stage 1 data revealed that 58% and 57% retailers sold more than the MHRA guidelines recommended for paracetamol and aspirin, respectively. We observed that 23% and 28% retailers were willing to sell ≥96 tablets of paracetamol or aspirin with no questions asked. Stage 2 results showed that 57% retailers sold 32×500 mg paracetamol in conjunction with a paracetamol-containing ‘flu preparation; while 98% shops sold 16×paracetamol 500 mg along with a paracetamol-containing ‘flu remedy, with no questions asked of the shopper or advice given. Discussion MHRA national guidelines for OTC medicines sales appear to be poorly adhered to in non-pharmacy shops. Sales of aspirin and paracetamol OTC must be better regulated in the UK to ultimately reduce morbidity and mortality rates of deliberate and accidental overdoses. PMID:26781508

  5. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds.

    PubMed

    Giammarile, Francesco; Bodei, Lisa; Chiesa, Carlo; Flux, Glenn; Forrer, Flavio; Kraeber-Bodere, Françoise; Brans, Boudewijn; Lambert, Bieke; Konijnenberg, Mark; Borson-Chazot, Françoise; Tennvall, Jan; Luster, Markus

    2011-07-01

    Primary liver cancers (i.e. hepatocellular carcinoma or cholangiocarcinoma) are worldwide some of the most frequent cancers, with rapidly fatal liver failure in a large majority of patients. Curative therapy consists of surgery (i.e. resection or liver transplantation), but only 10-20% of patients are candidates for this. In other patients, a variety of palliative treatments can be given, such as chemoembolization, radiofrequency ablation or recently introduced tyrosine kinase inhibitors, e.g. sorafenib. Colorectal cancer is the second most lethal cancer in Europe and liver metastases are prevalent either at diagnosis or in follow-up. These patients are usually treated by a sequence of surgery, chemotherapy and antibody therapy [Okuda et al. (Cancer 56:918-928, 1985); Schafer and Sorrell (Lancet 353:1253-1257, 1999); Leong et al. (Arnold, London, 1999)]. Radioembolization is an innovative therapeutic approach defined as the injection of micron-sized embolic particles loaded with a radioisotope by use of percutaneous intra-arterial techniques. Advantages of the use of these intra-arterial radioactive compounds are the ability to deliver high doses of radiation to small target volumes, the relatively low toxicity profile, the possibility to treat the whole liver including microscopic disease and the feasibility of combination with other therapy modalities. Disadvantages are mainly due to radioprotection constraints mainly for (131)I-labelled agents, logistics and the possibility of inadvertent delivery or shunting [Novell et al. (Br J Surg 78:901-906, 1991)]. The Therapy, Oncology and Dosimetry Committees have worked together in order to revise the European Association of Nuclear Medicine (EANM) guidelines on the use of the radiopharmaceutical (131)I-Lipiodol (Lipiocis®, IBA, Brussels, Belgium) and include the newer medical devices with (90)Y-microspheres. (90)Y is either bound to resin (SIR-Spheres®, Sirtex Medical, Lane Cove, Australia) or embedded in a glass matrix (TheraSphere®, MDS Nordion, Kanata, ON, Canada). Since (90)Y-microspheres are not metabolized, they are not registered as unsealed sources. However, the microspheres are delivered in aqueous solution: radioactive contamination is a concern and microspheres should be handled, like other radiopharmaceuticals, as open sources. The purpose of this guideline is to assist the nuclear medicine physician in treating and managing patients undergoing such treatment. PMID:21494856

  6. [Review and guidelines on the prevention, diagnosis and treatment of post-natal cytomegalovirus infection].

    PubMed

    Alarcón Allen, A; Baquero-Artigao, F

    2011-01-01

    Postnatal cytomegalovirus (CMV) infection in the newborn can occur from exposure to maternal cervical secretions during birth, ingestion of breast milk, transfusion of blood products or transmission by body fluids of infected people. Breast milk is the main source of infection, given the high rate of CMV-positive mothers excreting CMV in milk. Freezing reduces the risk of CMV transmission by breastfeeding, although it does not eliminate it completely. Pasteurisation prevents such transmission, but it can alter the immunological properties of breast milk. Postnatal CMV infection is usually asymptomatic, as it normally results from viral reactivation in the mother, and the neonate is born with protective antibodies. However, in the very low birth weight premature infant the amount of transferred antibodies is smaller and a symptomatic infection can occur. Symptomatic post-natal CMV infection in the newborn typically causes hepatitis, neutropenia, thrombocytopenia or sepsis-like syndrome. Pneumonitis and enteritis are less common, but very characteristic. Diagnosis is based on urine virus detection at the time of onset of symptoms. Postnatal CMV infection in the newborn generally resolves spontaneously without antiviral treatment. Ganciclovir should be reserved for severe cases. Unlike congenital CMV disease, post-natal CMV infection in the preterm infant does not seem to be associated with hearing loss or abnormal neuro-development in long term follow-up. PMID:20630814

  7. Guidelines for Prevention and Treatment of Cognitive Impairment in the Elderly

    PubMed Central

    Brodziak, Andrzej; Wolińska, Agnieszka; Kołat, Estera; Różyk-Myrta, Alicja

    2015-01-01

    The aim of this study is to present the available and verified methods of prevention of cognitive decline in healthy older adults and to review clinical trials of therapies to improve impaired cognitive performance. We discuss data about the actual possibility of pharmacological treatment, usefulness of physical exercises, and effectiveness of different cognitive training methods. In a separate chapter we discuss why older people cope much better in life challenges then it would appear from the measurements made by use of neuro-psychological tests. We also discuss the so-called issue of transfers, ie, the question of how certain cognitive characteristics, improved through cognitive training, are transferred to other mental skills. We distinguish between simple and sophisticated (usually computerized) forms of cognitive training and pay particular attention to methods that are simple and easy to use. In particular, we discuss the so-called “learning therapy”, which amounts to “reading aloud and simple arithmetic calculations”, the method based on “switching between words and imagination”, and also the method consisting of personal counseling, support, and assistance in learning, especially in the form of home visits. In the final chapter we formulate practical advice, not only for individuals who want to undertake the preventing or correction activities alone with eventual help of medical professionals, but also for the members of health institutions that wish to implement preventive and therapeutic actions directed to a chosen population. We also discuss the indications and rationale for further research and clinical trials. PMID:25708246

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

    PubMed

    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

    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

  9. Calcium hydroxylapatite associated soft tissue necrosis: a case report and treatment guideline.

    PubMed

    Tracy, Lauren; Ridgway, James; Nelson, J Stuart; Lowe, Nelson; Wong, Brian

    2014-04-01

    We present an uncommon case of nasal alar and facial necrosis following calcium hydroxylapatite filler injection performed elsewhere without direct physician supervision. The patient developed severe full-thickness necrosis of cheek and nasal alar skin 24 h after injections into the melolabial folds. Management prior to referral included oral antibiotics, prednisone taper, and referral to a dermatologist (day 3) who prescribed valacyclovir for a presumptive herpes zoster reactivation induced by the injection. Referral to our institution was made on day 11, and after herpetic outbreak was ruled out by a negative Tzanck smear, debridement with aggressive local wound care was initiated. After re-epithelialization and the fashioning of a custom intranasal stent to prevent vestibular stenosis, pulsed dye laser therapy was performed for wound modification. The patient healed with an acceptable cosmetic outcome. This report underscores the importance of facial vasculature anatomy, injection techniques, and identification of adverse events when using fillers. A current treatment paradigm for such events is also presented. PMID:23993752

  10. 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...

  11. Overuse and Underuse of Antiosteoporotic Treatments According to Highly Influential Osteoporosis Guidelines: A Population-Based Cross-Sectional Study in Spain

    PubMed Central

    Sanfélix-Gimeno, Gabriel; Hurtado, Isabel; Sanfélix-Genovés, José; Baixauli-Pérez, Cristóbal; Rodríguez-Bernal, Clara L.; Peiró, Salvador

    2015-01-01

    Inappropriate prescribing of antiosteoporotic medications has been observed; however, the joint study of both overuse and underuse has barely been attempted. Spain, with its high utilization rates, constitutes a good example to assess differences in over and under use according to diverse highly-influential osteoporosis guidelines (HIOG) worldwide. We used data of a population-based cross-sectional study including 824 post-menopausal women ≥50 years old living in the city of Valencia, Spain and aimed to estimate the percentage of women eligible for treatment, and the proportion of overuse and underuse of antiosteoporotic treatment according to HIOG. The prevalence of antiosteoporotic treatment in postmenopausal women ≥ 50 in Valencia was 20.9% (95%CI:17.6–24.4). The type of antiosteoporotic drugs prescribed varied greatly depending on the medical specialty responsible of the initial prescription. When applying the HIOG, the percentage of women 50 and over who should be treated varied from less than 9% to over 44%. In real terms, from the approximately eight million women of 50 years old and over in Spain, the number eligible for treatment would range from 0.7 to 3.8 million, depending on the guideline used. A huge proportion of inappropriate treatments was found when applying these guidelines to the Spanish population, combining a high overuse (42–78% depending on the guideline used) and underuse (7–41%). In conclusion, we found that the pharmacological management of osteoporosis in women of 50 and over in this population combines an important overuse and, to a lesser extent, underuse, although the level of inappropriateness varied strikingly depending on the CPG used. It seems urgent to reduce treatment overuse without neglecting underuse, as is urgent an attempt to reach wider agreement worldwide regarding osteoporosis management, in order to facilitate appropriate treatment and development of policies to reduce effectively treatment inappropriateness. PMID:26317872

  12. ABM Clinical Protocol #1: Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014

    PubMed Central

    Wight, Nancy

    2014-01-01

    A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. PMID:24823918

  13. Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records

    PubMed Central

    Tell, David; Engström, Sven; Mölstad, Sigvard

    2015-01-01

    Objective To study how prescription patterns concerning respiratory tract infections differ between interns, residents, younger general practitioners (GPs), older GPs and locums. Design Retrospective study of structured data from electronic patient records. Setting Data were obtained from 53 health centres and 3 out-of-hours units in Jönköping County, Sweden, through their common electronic medical record database. Participants All physicians working in primary care during the 2-year study period (1 November 2010 to 31 October 2012). Outcome measures Physicians’ adherence to current guidelines for respiratory tract infections regarding the use of antibiotics. Results We found considerable differences in prescribing patterns between physician categories. The recommended antibiotic, phenoxymethylpenicillin, was more often prescribed by interns, residents and younger GPs, while older GPs and locums to a higher degree prescribed broad-spectrum antibiotics. The greatest differences were seen when the recommendation in guidelines was to refrain from antibiotics, as for acute bronchitis. Interns and residents most often followed guidelines, while compliance in descending order was: young GPs, older GPs and locums. We also noticed that male doctors were somewhat overall more restrictive with antibiotics than female doctors. Conclusions In general, primary care doctors followed national guidelines on choice of antibiotics when treating respiratory tract infections in children but to a lesser degree when treating adults. Refraining from antibiotics seems harder. Adherence to national guidelines could be improved, especially for acute bronchitis and pneumonia. This was especially true for older GPs and locums whose prescription patterns were distant from the prevailing guidelines. PMID:26179648

  14. Early presentation of hemispheric intracerebral hemorrhage: prediction of outcome and guidelines for treatment allocation.

    PubMed

    Lisk, D R; Pasteur, W; Rhoades, H; Putnam, R D; Grotta, J C

    1994-01-01

    Criteria for selecting patients for possible surgery in the management of intracerebral hemorrhage (ICH) are needed to plan a prospective therapeutic evaluation of surgical intervention. This study specifically addressed patients seen in the emergency room within a few hours of the ictus, many of whom were still awake, to identify and subsequently exclude from surgical procedure those expected to recover completely and those expected to die regardless of treatment. We retrospectively studied 75 patients evaluated at a mean time of 3 hours and 37 minutes after hemispheric ICH to determine factors that would predict both good and poor outcomes at the time of discharge. Eighty percent of our patients presented within 6 hours of symptom onset. These patients were younger and had more severe lesions than did those presenting later, yet most were still awake (mean admission Glasgow Coma Scale [GCS] score = 11.0). Using multivariate regression, we created two models. The first model predicts independent outcome, ie, Rankin 0 to 2, of all patients with a GCS score greater than 9 on admission who do not undergo surgery. The significant factors in this model were hemorrhage diameter, intraventricular extension, and age. The second model predicts poor outcome, ie, Rankin 5 and death, of all patients. GCS score, hemorrhage volume, age, and gender were the important factors in this model. We conclude that ICH patients presenting early to the emergency room have more severe lesions radiologically, although their initial clinical status may not be different from those seen late. Our models should identify and thus exclude those with very good and very poor prognoses from future randomized surgical trials. PMID:8290048

  15. [Guidelines for the treatment of invasive fungal disease by Aspergillus spp. and other fungi issued by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). 2011 Update].

    PubMed

    Fortún, Jesús; Carratalá, Jordi; Gavaldá, Joan; Lizasoain, Manuel; Salavert, Miguel; de la Cámara, Rafael; Borges, Marcio; Cervera, Carlos; Garnacho, José; Lassaleta, Álvaro; Lumbreras, Carlos; Sanz, Miguel Ángel; Ramos, José T; Torre-Cisneros, Julián; Aguado, José M; Cuenca-Estrella, Manuel

    2011-01-01

    The guidelines on the treatment of invasive fungal disease by Aspergillus spp. and other fungi issued by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) are presented. These recommendations are focused on four clinical categories: oncology-haematology patients, solid organ transplant recipients, patients admitted to intensive care units, and children. An extensive review is made of therapeutical advances and scientific evidence in these settings. These guidelines have been prepared according the SEIMC consensus rules by a working group composed of specialists in infectious diseases, clinical microbiology, critical care medicine, paediatrics and oncology-haematology. Specific recommendations on the prevention of fungal infections in these patients are included. PMID:21474210

  16. Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes

    PubMed Central

    Aguiar, Carlos; Ferreira, Jorge; Mimoso, Jorge; Monteiro, Sílvia; Seixo, Filipe; Santos, José Ferreira

    2014-01-01

    Background Although the proven efficacy of evidence-based therapy in patients with cardiovascular diseases, the recommendations are not always instituted. We aimed to analyse the compliance of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients with treatment guidelines and to assess the impact of these measures in hospital death during the index hospitalization. Population and methods All consecutive patients (pts) included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between January 1, 2002 and August 31, 2011 were analysed. Compliance with Guidelines for the management of NSTE-ACS was evaluated with a 6-point therapeutic score (ThSc), comprising the treatment with: aspirin, clopidogrel, heparin, beta-blocker, angiotensin-converting enzyme inhibitor and statin. One point was assigned for each drug prescribed and zero if not given. The total therapeutic compliance was defined as ThSc =6 points. Results The final analysis comprised 14,276 pts (67.1% male; mean age 67.6±12.3 years), most of them admitted with non-ST elevation myocardial infarction (77.4%). The mean value of ThSc was 4.9±1.1 and total compliance occurred in 36.7% pts. Centres with percutaneous coronary intervention (PCI) capacity had a statistically significant higher ThSc (5.0±1.0 vs. 4.8±1.1, P<0.001) and were associated with higher total compliance [OR 1.53, 95% confidence intervals (CI), 1.42-1.65, P<0.001]. In-hospital mortality was 2.4% (354 deaths). Compared to pts who died, the survivors had a higher ThSc (4.9±1.1 vs. 4.2±1.3, P<0.001) and this score was independently associated with lower risk of in-hospital mortality (OR 0.70, 95% CI, 0.64-0.77, P<0.001). Receiver operating characteristics curve analysis showed a good accuracy of ThSc for the occurrence of in-hospital mortality with the area under the curve (AUC) 0.82 (95% CI, 0.80-0.84, P<0.001), sensitivity 71.6% and specificity 78.0%. Age, peripheral artery disease, Killip-Kimball class >I, electrocardiogram (ECG) with ST-segment depression and positive troponin were other independent predictors of in-hospital mortality. Conclusions In the present study, patients with NSTE-ACS who received medications recommended by guidelines had better in-hospital outcomes. These findings highlight the need to clarify the clinical recommendations and to develop approaches for quality improvement in this subset of patients. PMID:24649420

  17. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline.

    PubMed

    Mathus-Vliegen, Elisabeth M H

    2012-01-01

    The prevalence of obesity is rising progressively, even among older age groups. By the year 2030-2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity - a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone - is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded. PMID:22797374

  18. Defining ‘elderly’ in clinical practice guidelines for pharmacotherapy

    PubMed Central

    Singh, Shamsher; Bajorek., Beata

    2014-01-01

    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. PMID:25580172

  19. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children.

    PubMed

    Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John

    2009-09-01

    SUMMARY AND KEY RECOMMENDATIONS: The aim of these guidelines is to describe a practical but evidence-based approach to the diagnosis and treatment of central nervous system tuberculosis in children and adults. We have presented guidance on tuberculous meningitis (TBM), intra-cerebral tuberculoma without meningitis, and tuberculosis affecting the spinal cord. Our key recommendations are as follows: 1. TBM is a medical emergency. Treatment delay is strongly associated with death and empirical anti-tuberculosis therapy should be started promptly in all patients in whom the diagnosis of TBM is suspected. Do not wait for microbiological or molecular diagnostic confirmation. 2. The diagnosis of TBM is best made with lumbar puncture and examination of the cerebrospinal fluid (CSF). Suspect TBM if there is a CSF leucocytosis (predominantly lymphocytes), the CSF protein is raised, and the CSF:plasma glucose is <50%. The diagnostic yield of CSF microscopy and culture for Mycobacterium tuberculosis increases with the volume of CSF submitted; repeat the lumbar puncture if the diagnosis remains uncertain. 3. Imaging is essential for the diagnosis of cerebral tuberculoma and tuberculosis involving the spinal cord, although the radiological appearances do not confirm the diagnosis. A tissue diagnosis (by histopathology and mycobacterial culture) should be attempted whenever possible, either by biopsy of the lesion itself, or through diagnostic sampling from extra-neural sites of disease e.g. lung, gastric fluid, lymph nodes, liver, bone marrow. 4. Treatment for all forms of CNS tuberculosis should consist of 4 drugs (isoniazid, rifampicin, pyrazinamide, ethambutol) for 2 months followed by 2 drugs (isoniazid, rifampicin) for at least 10 months. Adjunctive corticosteroids (either dexamethasone or prednisolone) should be given to all patients with TBM, regardless of disease severity. 5. Children with CNS tuberculosis should ideally be managed by a paediatrician with familiarity and expertise in paediatric tuberculosis or otherwise with input from a paediatric infectious diseases unit. The Children's HIV Association of UK and Ireland (CHIVA) provide further guidance on the management of HIV-infected children (www.chiva.org.uk). 6. All patients with suspected or proven tuberculosis should be offered testing for HIV infection. The principles of CNS tuberculosis diagnosis and treatment are the same for HIV infected and uninfected individuals, although HIV infection broadens the differential diagnosis and anti-retroviral treatment complicates management. Tuberculosis in HIV infected patients should be managed either within specialist units by physicians with expertise in both HIV and tuberculosis, or in a combined approach between HIV and tuberculosis experts. The co-administration of anti-retroviral and anti-tuberculosis drugs should follow guidance issued by the British HIV association (www.bhiva.org). PMID:19643501

  20. Guideline 7: Medication Dosing.

    ERIC Educational Resources Information Center

    American Journal on Mental Retardation, 2000

    2000-01-01

    The last 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 medication dosing. The guidelines cover classes of medication, specific medications, usual starting daily dose, and usual daily dose range. (DB)

  1. Caring for Our Children. National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.

    ERIC Educational Resources Information Center

    American Public Health Association, Washington, DC.

    This document presents a set of standards to be used in planning and establishing a high quality child care program. The standards are based on the recommendations of technical panels that studied particular facets in child care and are intended to serve as goals for practice and guidelines for implementation. The nine chapters of the text address…

  2. Incontinence-associated dermatitis: consensus statements, evidence-based guidelines for prevention and treatment, and current challenges.

    PubMed

    Doughty, Dorothy; Junkin, Joan; Kurz, Peter; Selekof, Joan; Gray, Mikel; Fader, Mandy; Bliss, Donna Z; Beeckman, Dimitri; Logan, Susan

    2012-01-01

    In 2010, an international consensus conference was held to review current evidence regarding the pathology, prevention, and management of incontinence-associated dermatitis (IAD). The results of this literature review were published in a previous issue of this Journal. This article summarizes key consensus statements agreed upon by the panelists, evidence-based guidelines for prevention and management of IAD, and a discussion of the major challenges currently faced by clinicians caring for these patients. The panelists concur that IAD is clinically and pathologically distinct from pressure ulcers and intertriginous dermatitis, and that a consistently applied, structured, or defined skin care program is effective for prevention and management of IAD. They also agreed that differential assessment of IAD versus pressure ulceration versus intertriginous dermatitis remains a major challenge. Panel members also concur that evidence is lacking concerning which products and protocols provide the best outcomes for IAD prevention and treatment in individual patients. Issues related to differential assessment, product labeling and utilization, staff education, and cost of care are the primary focus of this article. PMID:22572899

  3. Deficiencies and Missed Opportunities to Formulate Clinical Guidelines in Australia for Withholding or Withdrawing Life-Sustaining Treatment in Severely Disabled and Impaired Infants.

    PubMed

    Bhatia, Neera; Tibballs, James

    2015-09-01

    This paper examines the few, but important legal and coronial cases concerning withdrawing or withholding life-sustaining treatment from severely disabled or critically impaired infants in Australia. Although sparse in number, the judgements should influence common clinical practices based on assessment of "best interests" but these have not yet been adopted. In particular, although courts have discounted assessment of "quality of life" as a legitimate component of determination of "best interests," this remains a prominent component of clinical guidelines. In addition, this paper highlights the lack of uniform clinical guidelines available to medical professionals and parents in Australia when making end-of-life decisions for severely ill infants. Thus, it is argued here that there is a need for an overarching prescriptive uniform framework or set of guidelines in end-of-life decision-making for impaired infants. This would encourage greater transparency, consistency, and some degree of objectivity in an area that often appears subjective. PMID:25173981

  4. Nationally-representative trends and geographic variation in treatment of localized prostate cancer: the Urologic Diseases in America Project

    PubMed Central

    Cary, K. Clint; Punnen, Sanoj; Odisho, Anobel Y.; Litwin, Mark S.; Saigal, Christopher S.; Cooperberg, Matthew R.

    2015-01-01

    Introduction Several treatment options for clinically localized prostate cancer currently exist under established guidelines. We aim to assess nationally-representative trends in treatment over time and determine potential geographic variation using two large national claims registries. Methods Men with prostate cancer insured by Medicare (1998–2006) or a private insurer (Ingenix database, 2002–2006) were identified using ICD-9 and CPT-4 codes. Geographic variation and trends in the type of treatment utilized over time were assessed. Geographic data was mapped using the GeoCommons online mapping platform. Predictors of any treatment were determined using a hierarchical generalized linear mixed model using the logit link function. Results The use of radical prostatectomy (RP) increased, 33% to 48%, in the privately insured i3 database, while remaining stable at 12% in the Medicare population. There was a rapid uptake in the use of newer technologies over time in both the Medicare and i3 cohorts. The use of laparoscopic assisted prostatectomy increased from 1% in 2002 to 41% in 2006 in i3 patients, while the incidence increased from 3% in 2002 to 35% in 2006 for Medicare patients. The use of neoadjuvant/adjuvant androgen deprivation therapy (ADT) was lower in the i3 cohort and has decreased over time in both i3 and Medicare. Physician density had an impact on type of primary treatment received in the New England region, however, this trend was not seen in the Western or Southern regions of the United States. Conclusion Using two large national claims registries, we have demonstrated trends over time and substantial geographic variation in the type of primary treatment used for localized prostate cancer. Specifically, there has been a large increase in the use of newer technologies, (i.e. laparoscopic-assisted prostatectomy and IMRT). These results elucidate the need for improved data collection on prostate cancer treatment outcomes to reduce unwarranted variation in care. PMID:25667110

  5. A New Guideline on Treatment of Hypertension in Those with Coronary Artery Disease: Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension About Treatment of Hypertension in Patients with Coronary Artery Disease.

    PubMed

    Jennings, Garry L R

    2015-11-01

    Hypertension is a major risk factor for coronary artery disease (CAD) and the two frequently coexist. The peak cardiology and hypertension societies of the United States recently published new guidelines on the treatment of hypertension in people with CAD. The guidelines update those previously issued eight years previously in the light of new trial data. However, for the most part they will validate what cardiologists are already doing in these patients. The major change is resetting of the blood pressure general treatment target for most people with hypertension and CAD from 130/80mm Hg to 140/90mm Hg. It is arguable that the evidence supporting the new target is any stronger than that supporting the old. While this will remain controversial in the absence of good data on the relative benefits of different treatment targets in hypertension it is in line with trends from a number of other general hypertension guidelines. PMID:26205991

  6. Adding Genetic Testing to Evidence-Based Guidelines to Determine the Safest and Most Effective Chronic Pain Treatment for Injured Workers

    PubMed Central

    Meshkin, Brian; Lewis, Katrina; Kantorovich, Svetlana; Anand, Natasha; Davila, Lisa

    2015-01-01

    Published guidelines for treating injured workers include the need for personalized treatment to manage chronic pain symptoms and increase functional status. However, they often fail to clarify how to objectively personalize these treatments. Further, certain patients need analgesic relief beyond the short term. In these cases, it is not sufficient or reasonable to utilize the typical broad protocol-based justifications for reduction of opioids and other medications in a haphazard manner based purely on poor response, without attempting to elucidate possible pharmacogenetic reasons for this. These guidelines acknowledge the problem of substance abuse and set forth methods for treatment and prevention. Although it has been established in the scientific community that an individual’s experience of pain and likelihood for addiction both have genetic components, genetic testing is not routinely included as part of the overall treatment plan for injured workers with chronic pain. Because decisions in cases of workplace injury should be based on scientific evidence, genetic testing results can add some objective information to the existing subjective and objective clinical data; help ascertain the efficacy and potential for toxicity of treatment; and therefore provide more information for accurate clinical decisions. We propose the addition of genetic testing to consensus guidelines for treating injured workers in order to improve patients’ functional status, increase productivity, improve safety of prescribing, decrease the likelihood of substance abuse, and save on overall healthcare costs. PMID:26759531

  7. Adding Genetic Testing to Evidence-Based Guidelines to Determine the Safest and Most Effective Chronic Pain Treatment for Injured Workers.

    PubMed

    Meshkin, Brian; Lewis, Katrina; Kantorovich, Svetlana; Anand, Natasha; Davila, Lisa

    2015-12-01

    Published guidelines for treating injured workers include the need for personalized treatment to manage chronic pain symptoms and increase functional status. However, they often fail to clarify how to objectively personalize these treatments. Further, certain patients need analgesic relief beyond the short term. In these cases, it is not sufficient or reasonable to utilize the typical broad protocol-based justifications for reduction of opioids and other medications in a haphazard manner based purely on poor response, without attempting to elucidate possible pharmacogenetic reasons for this. These guidelines acknowledge the problem of substance abuse and set forth methods for treatment and prevention. Although it has been established in the scientific community that an individual's experience of pain and likelihood for addiction both have genetic components, genetic testing is not routinely included as part of the overall treatment plan for injured workers with chronic pain. Because decisions in cases of workplace injury should be based on scientific evidence, genetic testing results can add some objective information to the existing subjective and objective clinical data; help ascertain the efficacy and potential for toxicity of treatment; and therefore provide more information for accurate clinical decisions. We propose the addition of genetic testing to consensus guidelines for treating injured workers in order to improve patients' functional status, increase productivity, improve safety of prescribing, decrease the likelihood of substance abuse, and save on overall healthcare costs. PMID:26759531

  8. General design, construction, and operation guidelines: Constructed wetlands wastewater treatment systems for small users including individual residences. Second edition

    SciTech Connect

    Steiner, G.R.; Watson, J.T.

    1993-05-01

    One of the Tennessee Valley Authority`s (TVA`s) major goals is cleanup and protection of the waters of the Tennessee River system. Although great strides have been made, point source and nonpoint source pollution still affect the surface water and groundwater quality in the Tennessee Valley and nationally. Causes of this pollution are poorly operating wastewater treatment systems or the lack of them. Practical solutions are needed, and there is great interest and desire to abate water pollution with effective, simple, reliable and affordable wastewater treatment processes. In recognition of this need, TVA began demonstration of the constructed wetlands technology in 1986 as an alternative to conventional, mechanical processes, especially for small communities. Constructed wetlands can be downsized from municipal systems to small systems, such as for schools, camps and even individual homes.

  9. How can information extraction ease formalizing treatment processes in clinical practice guidelines? A method and its evaluation☆

    PubMed Central

    Kaiser, Katharina; Akkaya, Cem; Miksch, Silvia

    2010-01-01

    Summary Objective: Formalizing clinical practice guidelines (CPGs) for a subsequent computer-supported processing is a challenging, but burdensome and time-consuming task. Existing methods and tools to support this task demand detailed medical knowledge, knowledge about the formal representations, and a manual modeling. Furthermore, formalized guideline documents mostly fall far short in terms of readability and understandability for the human domain modeler. Methods and material: We propose a new multi-step approach using information extraction methods to support the human modeler by both automating parts of the modeling process and making the modeling process traceable and comprehensible. This paper addresses the first steps to obtain a representation containing processes which