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1

National Guideline Clearinghouse (NGC)  

NSDL National Science Digital Library

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

1999-01-01

2

[ISKRA guidelines on antimicrobial treatment and prophylaxis of urinary tract infections--Croatian national guidelines].  

PubMed

These guidelines refer to diagnosis, antimicrobial treatment and prophylaxis of urinary tract infections in adults and children older than 12 years of age and cover lower urinary tract in females, uncomplicated pyelonephritis, complicated UTI with or without pyelonephritis, asymptomatic bacteriuria and recurrent UTI. These guidelines do not cover sexually transmitted diseases. The guidelines are primarily intended for use by general practitioners and specialists working in primary health care and hospitals. The members of the Working Group for the development of guidelines on antimicrobial treatment and prophylaxis of urinary tract infections were appointed by the Croatian Ministry of Health and Social Welfare. The project was financially supported by the Dutch government and professional assistance was provided by international consultants. The evidence for this guidelines is based on a systematic review of the literature, local antibiotic resistance data, the existing clinical protocols on the treatment and prophylaxis of UTIs, as well as suggestions and comments made by colleagues physicians during more than 50 continuous medical education courses held in the last three years on antimicrobial treatment and prophylaxis of UTIs. Draft version of the guidelines was available for comments on the web site http://iskra.bfm.hr and during the two-month piloting period the guidelines were widely presented to general practitioners, specialists working in primary care and hospitals--urologists, gynecologists, infectious disease specialists, nephrologists. The final version of the guidelines was approved by the Intersectoral Coordination Mechanism for the Control of Antimicrobial Resistance (ISKRA) Board. PMID:19642528

Skerk, Visnja; Andrasevi?, Arjana Tambi?; Andrasevi?, Sasa; Susi?, Edita; Dzepina, Ana Mlinari?; Madari?, Vesna; Milutinovi?, Slobodan; Krhen, Ivan; Peri?, Ljiljana; Bagatin, Jugoslav; Cori?, Mario; Ferlin, Daniel; Cazin, Irina; Tomac, Gordana

3

National Bookmobile Guidelines, 1992.  

ERIC Educational Resources Information Center

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

Ohio State Library, Columbus.

4

National Bookmobile Guidelines, 1992.  

ERIC Educational Resources Information Center

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

Ohio State Library, Columbus.

5

Statin treatment and adherence to national cholesterol guidelines after ischemic stroke  

Microsoft Academic Search

Background: National cholesterol guidelines have defined high vascular risk individuals as those who could potentially benefit most from statin therapy. The authors aimed to determine the rate of statin use, its predictors, and the achievement of national guideline target lipid goals among ischemic stroke survivors. Methods: The authors abstracted data from the Vitamin Intervention for Stroke Prevention (VISP) study database

B. Ovbiagele; J. L. Saver; H. Bang; L. E. Chambless; A. Nassief; J. Minuk; J. F. Toole; J. R. Crouse

2006-01-01

6

Does methadone maintenance treatment based on the new national guidelines work in a primary care setting?  

PubMed Central

BACKGROUND: General practitioners (GPs) are being encouraged to treat more drug users but there are few studies to demonstrate the effectiveness of primary care treatment. AIM: To determine whether patients retained on methadone maintenance treatment for one year in a modern British primary care setting, with prescribing protocols based on the new national guidelines, can achieve similar harm reduction outcomes to those demonstrated in other settings, using objective outcome measures where available. DESIGN OF STUDY: Longitudinal cohort study. SETTING: The Primary Care Clinic for Drug Dependence, Sheffield. METHOD: The intervention consisted of a methadone maintenance treatment provided by GPs with prescribing protocols based on the 1999 national guidelines. The first 96 eligible consenting patients entering treatment were recruited; 65 completed the study. Outcome measures were current drug use, HIV risk-taking behaviour, social functioning, criminal activity, and mental and physical health, supplemented by urinalysis and criminal record data. RESULTS: Frequency of heroin use was reduced from a mean of 3.02 episodes per day (standard deviation [SD] = 1.73) to a mean of 0.22 episodes per day (SD = 0.54), (chi 2 = 79.48, degrees of freedom [df] = 2, P < 0.001), confirmed by urinalysis. Mean numbers of convictions and cautions were reduced by 62% (z = 3.378, P < 0.001) for all crime. HIV risk-taking behaviour, social functioning, and physical and psychological wellbeing all showed significant improvements. CONCLUSION: Patients retained on methadone maintenance treatment for one year in a primary care setting can achieve improvements on a range of harm reduction outcomes similar to those shown by studies in other, often more highly structured programmes.

Keen, Jenny; Oliver, Phillip; Rowse, Georgina; Mathers, Nigel

2003-01-01

7

The relative influence of secondary versus primary prevention using the National Cholesterol Education Program Adult Treatment Panel II guidelines  

Microsoft Academic Search

OBJECTIVESThis study was undertaken to project the population-wide effect of full implementation of the Adult Treatment Panel (ATP) II guidelines of the National Cholesterol Education Program (NCEP).BACKGROUNDThe ATP II has proposed guidelines for cholesterol reduction, but the long-term epidemiologic influence of its components has not been fully examined.METHODSWe used a calibrated, validated simulation of the U.S. population, aged 35 to

Lee Goldman; Pamela Coxson; Maria G. M Hunink; Paula A Goldman; Anna N. A Tosteson; Murray Mittleman; Lawrence Williams; Milton C Weinstein

1999-01-01

8

Guideline 3: Psychosocial Treatment.  

ERIC Educational Resources Information Center

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

American Journal on Mental Retardation, 2000

2000-01-01

9

Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012.  

PubMed

(1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients as possible with sleep apnoea recover, (3) to maintain capacity for work and functional capacity of patients with sleep apnoea, (4) to reduce the percentage of patients with severe sleep apnoea, (5) to decrease the number of sleep apnoea patients requiring hospitalisation and (6) to improve cost effectiveness of prevention and treatment of sleep apnoea. (6) The following means are suggested for achieving the goals: (1) to promote prevention of obesity, weight loss and weight control; (2) to promote securing of nasal respiration in child patients and removal of obstructing redundant soft tissues; (3) to promote the correction of children's malocclusions, (4) to enhance knowledge about risk factors and treatment of sleep apnoea in key groups, (5) to promote early diagnosis and active treatment, (6) to commence rehabilitation early and individually as a part of treatment and (7) to encourage scientific research. (7) On the national level, the occurrence of sleep apnoea can be prevented, for example, by encouraging weight control. The programme gives examples of such measures and appeals to various authorities and voluntary organisations to reinforce their collaboration. Preventive measures should be individualised, and based on due consideration. (8) The efficacy of diagnosing sleep apnoea should be increased. Attention should be paid to the symptoms of risk group patients at different units of the primary and occupational health care. Even mild forms of the disease should be treated appropriately. Diagnosis and treatment of the disease involve cooperation between the primary and specialised health-care sectors. Methods of treatment are (1) treatment of obesity, (2) positional therapy, (3) reduction of the use of medicines impairing the central nervous system, (4) reduction of smoking and the consumption of alcohol, (5) devices affecting the position of the tongue and lower jaw, (6) treatment with Continuous Positive Airway Pressure (CPAP-treatment), (7) surgical methods of treatment and (8) rehabilitation. (9) The hierarchy of referrals in the prevention and treat

Laitinen, L A; Anttalainen, U; Pietinalho, A; Hämäläinen, P; Koskela, K

2003-04-01

10

Protocol Development — Guidelines for Treatment Regimens  

Cancer.gov

All protocols sponsored by the Division of Cancer Treatment and Diagnosis (DCTD), National Cancer Institute (NCI), are reviewed for safety and scientific integrity. Cancer Therapy Evaluation Program (CTEP) staff have developed standardized guidelines to express chemotherapy regimens in a uniform, clear and consistent manner. The intention of the guidelines is to minimize undue risks to patients on DCTD sponsored investigational clinical trials. DCTD-sponsored protocols will not be approved unless they comply with the Guidelines for Treatment Regimen Expression and Nomenclature.

11

Waiting for the National Cholesterol Education Program Adult Treatment Panel IV Guidelines, and in the meantime, some challenges and recommendations.  

PubMed

The National Cholesterol Education Program Adult Treatment Panel (ATP) has provided education and guidance for decades on the management of hypercholesterolemia. Its third report (ATP III) was published 10 years ago, with a white paper update in 2004. There is a need for translation of more recent evidence into a revised guideline. To help address the significant challenges facing the ATP IV writing group, this statement aims to provide balanced recommendations that build on ATP III. The authors aim for simplicity to increase the likelihood of implementation in clinical practice. To move from ATP III to ATP IV, the authors recommend the following: (1) assess risk more accurately, (2) simplify the starting algorithm, (3) prioritize statin therapy, (4) relax the follow-up interval for repeat lipid testing, (5) designate <70 mg/dl as an "ideal" low-density lipoprotein cholesterol target, (6) endorse targets beyond low-density lipoprotein cholesterol, (7) refine therapeutic target levels to the equivalent population percentile, (8) remove misleading descriptors such as "borderline high," and (9) make lifestyle messages simpler. In conclusion, the solutions offered in this statement represent ways to translate the totality of published reports into enhanced hyperlipidemia guidelines to better combat the devastating impact of hyperlipidemia on cardiovascular health. PMID:22497674

Martin, Seth S; Metkus, Thomas S; Horne, Aaron; Blaha, Michael J; Hasan, Rani; Campbell, Catherine Y; Yousuf, Omair; Joshi, Parag; Kaul, Sanjay; Miller, Michael; Michos, Erin D; Jones, Steven R; Gluckman, Ty J; Cannon, Christopher P; Sperling, Laurence S; Blumenthal, Roger S

2012-04-10

12

76 FR 22342 - National Standard 10 Guidelines  

Federal Register 2010, 2011, 2012, 2013

...110218147-1199-01] RIN 0648-BA74 National Standard 10 Guidelines AGENCY: National Marine Fisheries...potential adjustments to the National Standard 10 Guidelines. DATES: Written comments regarding...Conservation and Management Act (MSA) contains 10 national standards (NS) with which...

2011-04-21

13

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

PubMed Central

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

2011-01-01

14

Treatment for Neuropathic Pain in Patients with Cancer: Comparative Analysis of Recommendations in National Clinical Practice Guidelines from European Countries.  

PubMed

INTRODUCTION: Neuropathic pain is a common symptom, present in 39% of the patients with cancer pain. Treating this type of pain is challenging, as this patient group is often frail and has comorbidities which increase the risk of side events and hence influences their quality of life. Clinical practice guidelines (CPGs) can be helpful for clinicians, especially when scientific evidence is uncertain or weak. In this study, we focused on the quality of the review of the literature used in treatment recommendations in the selected European CPGs. METHODS: In a previous study, 9 CPGs from European countries that contained at least one paragraph on treatment for neuropathic pain in cancer were included. Recommendations with their grade (according SIGN 55 classification) and supporting literature (first author, patients' population, year and type of publication) were compared between CPGs. RESULTS: In all CPGs, amitriptylin was mentioned as the drug of first choice. Six guidelines proposed also gabapentinoids. Only 30 of the 163 citations (18%) were based on studies in patients with cancer. Seven CPGs did not argue the indirect evidence due to extrapolation of study results from non-cancer to patients with cancer. CONCLUSION: The majority of guideline development groups extrapolated their results from non-cancer publications to formulate recommendations. Consequently, these guidelines fail to address important issues such as altered kinetics and side effect profiles in these patients. We recommend creating specific recommendations by an international expert group for the treatment for neuropathic pain in patients with cancer supported by targeted research in patients with cancer. PMID:23360414

Piano, Virginie; Verhagen, Stans; Schalkwijk, Annelies; Hekster, Yechiel; Kress, Hans; Lanteri-Minet, Michel; Burgers, Jako; Treede, Rolf-Detlef; Engels, Yvonne; Vissers, Kris

2013-01-30

15

Rhegmatogenous retinal detachment treatment guidelines.  

PubMed

This paper outlines general guidelines following the initial diagnosis of rhegmatogenous retinal detachment. These include preoperative evaluation, treatment, possible intra- and post-operative complications, retinal re-detachment, and all therapeutic options available for each case. Treatment of the traumatic retinal detachment is also described, due to its importance and peculiarities. Treatment or prophylactic guidelines are suggested for the different types of retinal detachment described. These are based on both the experience of the ophthalmologists that have participated in preparing the guidelines, and also on evidence-based grading linked to bibliographical sources. However, these guidelines should not be interpreted as being mandatory. Given that there is a wide spectrum of options for treatment of retinal detachment, the surgeons' experience with one or other surgical technique will be of utmost importance in obtaining the best surgical result. As guidelines, they are intended as an additional aid to the surgeon during the decision-making process, with the expectation that the final choice will still be left to the surgeon's judgment and past experience. PMID:23414946

García-Arumí, J; Martínez-Castillo, V; Boixadera, A; Blasco, H; Marticorena, J; Zapata, M Á; Macià, C; Badal, J; Distéfano, L; Rafart, J M; Berrocal, M; Zambrano, A; Ruíz-Moreno, J M; Figueroa, M S

2012-09-20

16

Chronic bronchitis and chronic obstructive pulmonary disease: Finnish National Guidelines for Prevention and Treatment 1998–2007  

Microsoft Academic Search

1.1. A national recommendation for the promotion of prevention, treatment and rehabilitation in relation to chronic bronchitis and COPD from 1998 to 2007 has been prepared on the basis of extensive collaboration by order of the Ministry of Social Affairs and Health. The Programme needs to be revised as necessary, because of rapid developments in medical knowledge, and in drug

Lauri A. Laitinen; Kaj Koskela

1999-01-01

17

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

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.

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

2008-01-01

18

MAOIs and depression treatment guidelines.  

PubMed

Monoamine oxidase inhibitors (MAOIs) have proven efficacy for treating depression, particularly in patients with atypical depression, high levels of anxiety, anergic bipolar depression, and treatment-resistant depression. However, MAOIs are not supported as first-line treatments due to safety and tolerability concerns and the need for dietary restrictions; instead, current guidelines recommend MAOIs as third-, fourth-, or fifth-line treatments. However, a newer, transdermal MAOI formulation limits the need for dietary restrictions and has fewer sexual and metabolic effects than some of the newer antidepressants. PMID:22901357

Thase, Michael E

2012-07-01

19

The 1998 CDC sexually transmitted diseases treatment guidelines  

Microsoft Academic Search

Health care providers who evaluate persons who have or are at risk for sexually transmitted diseases (STDs) should be aware\\u000a of current national guidelines for STD treatment and should provide assessment and treatment according to these recommendations.\\u000a The Centers for Disease Control and Prevention STD Treatment Guidelines were developed by using an evidence-based approach\\u000a incorporating available scientific evidence, specialist knowledge,

Kimberly A. Workowski

2000-01-01

20

A survey of tobacco dependence treatment guidelines in 31 countries  

PubMed Central

Aims The Framework Convention on Tobacco Control (FCTC) asks countries to develop and disseminate comprehensive evidence based guidelines and promote adequate treatment for tobacco dependence, yet to date no summary of the content of existing guidelines exists. This paper describes national tobacco dependence treatment guidelines of 31 countries. Design, setting, participants A questionnaire on tobacco dependence treatment guidelines was sent by email to a convenience sample of contacts working in tobacco control in 31 countries in 2007. Completed questionnaires were received from respondents in all 31 countries. During the course of these enquiries we also made contact with people in 14 countries that did not have treatment guidelines and sent them a short questionnaire asking about their plans to produce guidelines. Measurements The survey instrument was a seventeen item questionnaire asking the following key questions: do the guidelines recommend brief interventions, intensive behavioural support, medications; which medications; do the guidelines apply to the whole healthcare system and all professionals; do they explicitly refer to the Cochrane database; are they based on another country's guidelines; are they national or more local; are they formally endorsed by government; did they go through peer review; who funded them; where were they published; do they include evidence on cost effectiveness of treatment. Findings According to respondents, all of their countries' guidelines recommended brief advice, intensive behavioural support, and nicotine replacement therapy (NRT); 84% recommended bupropion; 19% recommended varenicline; and 35% recommended telephone quitlines. Nearly half (48%) included cost effectiveness evidence. Seventy one percent were formally supported by their government and 65% were financially supported by the government. Most (84%) used the Cochrane reviews as a source of evidence, 84% went through a peer review process, and 55% were based on the guidelines of other countries, most often the US and England. Conclusion Overall, the guidelines reviewed closely followed the evidence base, recommending brief interventions, intensive behavioural support and NRT, and most recommended bupropion. Varenicline was not on the market in most of the countries in this survey when their guidelines were written, illustrating the need for guidelines to be periodically updated. None recommended interventions not proven to be effective, and some explicitly recommended against specific interventions (for lack of evidence). Most were peer reviewed, many through lengthy and rigorous procedures, and most were formally endorsed or supported by their governments. Some countries that did not have guidelines expressed a need for technical support, emphasising the need for countries to share experience, something the FCTC process is well placed to support.

Raw, Martin; Regan, Susan; Rigotti, Nancy A.; McNeill, Ann

2009-01-01

21

76 FR 30308 - National Standard 10 Guidelines; Public Meetings  

Federal Register 2010, 2011, 2012, 2013

...Administration RIN 0648-BA74 National Standard 10 Guidelines; Public Meetings AGENCY: National...potential revisions to the National Standard 10 (NS10) Guidelines and announced a public...presentations will be given on the National Standard 10 ANPR. The public will be allowed to...

2011-05-25

22

Narcotic Treatment Programs: Best Practice Guideline.  

National Technical Information Service (NTIS)

The NTP guidelines that follow represent a joint initiative between DEA and the American Methodone Treatment Association. Their development grew out of the need to provide guidance to NTPs throughout the United States regarding common sense practices for ...

2000-01-01

23

Management and adherence to VTE treatment guidelines in a national prospective cohort study in the Canadian outpatient setting. The Recovery Study.  

PubMed

Documenting patterns and outcomes of venous thromboembolism (VTE) management and degree of adherence by clinicians to treatment guidelines could help identify remediable gaps in patient care. Prospective, clinical practice-based data from Canadian outpatient settings on management of VTE, degree of adherence with treatment guidelines and frequency of recurrent VTE and bleeding during follow-up was obtained in a multicentre, prospective observational study. From 12 Canadian centres, we assessed 868 outpatients with acute symptomatic VTE who received the low-molecular-weight heparin (LMWH) enoxaparin alone or with vitamin K antagonists (VKA), at baseline and at six months (or at the end of treatment, whichever came first). Index VTE was limb deep venous thrombosis (DVT) in 583 (67.2%) patients, pulmonary embolism (PE) with or without DVT in 262 (30.2%) patients, and unusual site DVT in 23 (2.6%) patients. VTE was unprovoked in 399 (46.0%) patients, associated with cancer in 74 (8.5%) patients, transient risk factors in 327 (37.7%) patients and hormonal factors in 68 (7.8%) patients.With regard to guideline adherence, 58 (7.3%) patients received <5 days LMWH and 114 (14.5%) had overlap <1 day. Among patients with cancer-related VTE, 59.5% were prescribed LMWH monotherapy and 43.2% received such treatment for >3 months. Only 38.1% of patients with transient VTE risk factors had received thromboprophylaxis. Our study provides useful information on clinical presentation, management and related outcomes in Canadian outpatients with VTE. Our results suggest there may be important gaps in use of thromboprophylaxis to prevent VTE and use of LMWH monotherapy to treat cancer-related VTE. PMID:22782073

Kahn, Susan R; Springmann, Vicky; Schulman, Sam; Martineau, Josée; Stewart, John A; Komari, Nelly; McLeod, Anne; Strulovitch, Carla; Blostein, Mark; Faucher, Jacques-Philippe; Gamble, Greg; Gordon, Wendy; Kagoma, Peter K; Miron, Marie-José; Laverdière, David; Game, Melaku; Mills, Allan

2012-07-10

24

Treatment Guidelines for Children and Adolescents With Bipolar Disorder  

Microsoft Academic Search

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

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

2005-01-01

25

Updated current (2012) national guidelines for paediatric tuberculosis in India.  

PubMed

A national consultation was organised in January 2012, in order to reconcile between global and national guidelines, to review the evidence base and update the RNTCP guidelines in consensus with Indian Academy of Paediatrics. The consultation had come up with wider recommendations in diagnosing and treating paediatric tuberculosis patients which has been incorporated in the programme. PMID:23785927

Kumar, Ashok; Gupta, Devesh; Nagaraja, Sharath Burugina; Singh, Varinder; Sethi, G R; Prasad, Jagadish

2012-11-01

26

Updated treatment guidelines for gonorrhea infections.  

PubMed

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

Fantasia, Heidi Collins

27

Disability guideline, role conflicts, and treatment records.  

PubMed

The AAPL Practice Guidelines for the Forensic Evaluation of Psychiatric Disability reminds treating psychiatrists as well as forensic examiners of the potential for role conflicts and of numerous factors related to handling of treatment records. This commentary suggests ways of more completely avoiding role conflicts, including those related to payment, and elaborates on implementation of requirements of the HIPAA Privacy Rules applicable to independent examination by third parties. PMID:19767506

Edwards, H Berryman

2009-01-01

28

Diagnostic assessment of nonpalpable breast cancer-the difference in diagnostic approach for the clinical treatment of breast cancer between the japanese guidelines and the national comprehensive cancer network (USA) guidelines  

Microsoft Academic Search

The detection of non-palpating breast cancer might improve the survival of patients with whole breast cancer because it can\\u000a be diagnosed at an early stage. Therefore, to standardize the quality of patient care, a published assessment guideline is\\u000a necessary in a clinical setting. For this purpose, Japan and USA have independent guidelines with different approaches. “The\\u000a evidence-based guideline for clinical

Hiroko Tsunoda-Shimizu; Seigo Nakamura

2005-01-01

29

74 FR 18578 - Draft National Institutes of Health Guidelines for Human Stem Cell Research Notice  

Federal Register 2010, 2011, 2012, 2013

...Institutes of Health Guidelines for Human Stem Cell Research Notice SUMMARY: The National...Institutes of Health Guidelines for Human Stem Cell Research'' (Guidelines). The...intramural NIH research involving human stem cells. These draft Guidelines would...

2009-04-23

30

[The practice guideline 'Treatment of tobacco addiction'].  

PubMed

The practice guidelines 'Treatment of tobacco dependence' are drawn up by collaboration of all medical and paramedical professional associations and aim at assisting patients who would like to quit smoking. The dental team has a barrier-free opportunity to discuss smoking habits. The relation between smoking and oral health is quite obvious. Dental practitioners should ask about smoking habits regularly and smokers should be advised at least once a year to stop smoking. More intensive strategies for treatment of tobacco addiction in dental settings will be developed in the near future. PMID:15981694

Allard, R H B

2005-06-01

31

Application of the National Osteoporosis Foundation Guidelines to Postmenopausal Women and Men: The Framingham Osteoporosis Study  

PubMed Central

Purpose Little is known about the public health impact of the National Osteoporosis Foundation (NOF) Guidelines. Therefore, we determined the proportion of U.S. Caucasians recommended for treatment of osteoporosis according to NOF Guidelines (2003 & 2008). Methods 1,946 postmenopausal women and 1,681 men ? age 50 years from the Framingham Study with information on BMD (1987-2001). Information on clinical predictors was used to estimate the 10-year probability of hip and major osteoporotic fracture by FRAX® (version 3.0). Results Overall proportion of women meeting treatment criterion was less when the 2008 NOF Guidelines were applied (41.1%) compared with 2003 Guidelines (47.8%). The proportion of women < age 65 years meeting treatment criterion was much less when applying 2008 Guidelines (23.1% in 2003, 8.3% in 2008), whereas the proportion of women > age 75 years increased slightly (78.3% in 2003, 86.0% in 2008). 17.0% of men ? age 50 years met treatment criterion (2.5% aged 50-64 years, 49.8% > age 75 years). Conclusions Nearly one-half of Caucasian post-menopausal women and one-sixth of men aged 50 years and older would be recommended for osteoporosis treatment according to 2008 NOF Guidelines. Given the high proportion of persons recommended for treatment, NOF Guidelines may need to be re-evaluated with respect to budget impact.

Berry, Sarah D.; Kiel, Douglas P.; Donaldson, Megan G.; Cummings, Steven R.; Kanis, John A.; Johansson, Helena; Samelson, Elizabeth J.

2010-01-01

32

Treatment Guidelines for Children and Adolescents with Bipolar Disorder  

ERIC Educational Resources Information Center

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

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

2005-01-01

33

Treatment Guidelines for Children and Adolescents with Bipolar Disorder  

ERIC Educational Resources Information Center

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

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

2005-01-01

34

Guidelines for the treatment of antiphospholipid syndrome.  

PubMed

The antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by arterial and venous thrombosis, gestational morbidity and presence of elevated and persistently positive serum titers of antiphospholipid antibodies. The treatment of APS is still controversial, because any therapeutic decision potentially faces the risk of an insufficient or excessive antithrombotic coverage associated with anticoagulation and its major adverse effects. This guideline was elaborated from nine relevant clinical questions related to the treatment of APS by the Committee of Vasculopathies of the Brazilian Society of Rheumatology. Thus, this study aimed at establishing a guideline that included the most relevant and controversial questions in APS treatment, based on the best scientific evidence available. The questions were structured by use of the PICO (patient, intervention or indicator, comparison and outcome) process, enabling the generation of search strategies for evidence in the major primary scientific databases (MEDLINE/PubMed, Embase, Lilacs, Scielo, Cochrane Library, Premedline via OVID). A manual search for evidence and theses was also conducted (BDTD and IBICT). The evidence retrieved was selected based on critical assessment by using discriminatory instruments (scores) according to the category of the therapeutic question (JADAD scale for randomized clinical trials and Newcastle-Ottawa scale for non-randomized studies). After defining the potential studies to support the recommendations, they were selected according to level of evidence and grade of recommendation, according to the Oxford classification. PMID:23856795

Danowski, Adriana; Rego, Jozelia; Kakehasi, Adriana M; Funke, Andreas; Carvalho, Jozelio Freire de; Lima, Isabella V S; Souza, Alexandre Wagner Silva de; Levy, Roger A

2013-04-01

35

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

Federal Register 2010, 2011, 2012, 2013

...adjustments to the National Standard 1 Guidelines, one of 10 national standards for fishery conservation and...as any additional ideas and solutions that could improve provisions of the National Standard 1 Guidelines. DATES:...

2012-05-03

36

63 FR 15006 - National Emission Standards for Hazardous Air Pollutants and Control Techniques Guideline...  

Federal Register 2010, 2011, 2012, 2013

...National Emission Standards for Hazardous Air Pollutants and Control Techniques Guideline...National Emission Standards for Hazardous Air Pollutants and Control Techniques Guideline...national emission standards for hazardous air pollutants (NESHAP) for aerospace...

1998-03-27

37

Marking Guidelines for Writing. The National Literacy Strategy.  

ERIC Educational Resources Information Center

Teaching modeling, sharing, tutoring, and working with children on their writing has been explored in England's recent National Literacy Strategy publications. These guidelines, produced in collaboration with Qualifications and Curriculum Authority (QCA), suggest ways of analyzing children's writing to obtain more diagnostic information about…

Department for Education and Skills, London (England).

38

Guidelines for Preparing Export License Applications Involving Foreign Nationals.  

National Technical Information Service (NTIS)

BXA has prepared these guidelines for exporters to use in submitting license applications for foreign nationals pursuant to the deemed export rule. Section 734.2(b)(ii) of the Export Administration Regulations (EAR) defines export to include a release of ...

2010-01-01

39

74 FR 32170 - National Institutes of Health Guidelines for Human Stem Cell Research  

Federal Register 2010, 2011, 2012, 2013

...Institutes of Health Guidelines for Human Stem Cell Research SUMMARY: The National Institutes...Institutes of Health Guidelines for Human Stem Cell Research'' (Guidelines). On...Scientific Research Involving Human Stem Cells. The Executive Order states...

2009-07-07

40

[Guideline based treatment of invasive aspergillosis].  

PubMed

Invasive fungus infections caused by aspergillus spp. occur most frequently in immunocompromised patients. A high infection-associated death rate of up to and over 50% is attributed even today to these fungi. The disease in humans is caused mainly by Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger. Other species, for example, Aspergillus terreus or Aspergillus nidulans are quantitatively less prevalent. Evidence based treatment of invasive aspergillosis has become safer and more effective within the last ten years through the introduction of the new azoles and the echinocandines. Voriconazole has become the medication of choice for initial therapy. The efficacy of voriconazole is well documented, to include the treatment of disseminated infections of the central nervous system. Amphotericin B-desoxycholate is associated with definite side-effects in intravenous therapy. On the grounds of its substantial toxicity, the North American Infectious Disease Society's (IDSA) Guidelines of 2008 recommend amphotericin B-desoxycholate for regions with restricted resources only, which could be the case in underdeveloped countries. Liposomal amphotericin B in the daily standard dose of 3 mg/kg offers a rate of response similar to the one with voriconazole in the first-line treatment of invasive aspergillosis. However, a direct comparison with voriconazole on the basis of randomized studies is not available. As a secondary therapeutic treatment, in case of failure or intolerance of the primary treatment, caspofungin, micafungin and posaconazole have recently been under study. Both the echinocandines and posaconazole have proven effective in daily clinical practise. In refractory cases of invasive aspergillosis a combination therapy has been employed clinically. The results of prospective comparative controlled studies on combination therapy versus monotherapy will not be available until after 2010. PMID:20433655

Karthaus, M

2010-05-01

41

Comparison of coronary artery calcification scores and National Cholesterol Education Program guidelines for coronary heart disease risk assessment and treatment paradigms in individuals with chronic traumatic spinal cord injury  

PubMed Central

Objective To investigate the risk of coronary heart disease (CHD) in individuals with spinal cord injury (SCI) according to the National Cholesterol Educational Program (NCEP) guidelines and CT coronary artery calcium scores (CCS). Research Cross-sectional study of consecutive sample of males with SCI presenting to a single site for CHD risk assessment. Participants/methods Males age 45–70 with traumatic SCI (American Spinal Injury Association (ASIA) A, B, and C) injured for at least 10 years with no prior history of clinical CHD. Medical history, blood-pressure, and fasting lipid panel were used to calculate risk for CHD with the use of the Framingham risk score (FRS). Risk and treatment eligibility status was assessed based on NCEP/FRS recommendations and by presence and amount of CCS. Percent agreement (PA) and kappa were calculated between the two algorithms. Spearman correlations were calculated between CCS and FRS and individual risk factors. Results A total of 38 men were assessed; 18 (47.4%) had CCS > 0. The PA between NCEP/FRS assessment and CCS was 18% with a kappa of ?0.03. 11 (28.9%) had CCS > 100 or >75th percentile for their age, sex, and race, which might qualify them for lipid-lowering treatment. Only 26 were placed into the same treatment category by NCEP/FRS and CCS, for a PA of 68% with a kappa of 0.35. In all, 20 (52.6%) were eligible for lipid-lowering treatment by either NCEP/FRS (n = 9) or CCS (n = 11). Seven subjects were above the treatment threshold based on CCS, but not NCEP/FRS and five subjects were above the NCEP/FRS threshold, but not CCS. Just four subjects were eligible by both algorithms. CCS only correlated with FRS (r = 0.508, P = 0.001) and age (r = 0.679, P < 0.001).

Lieberman, Jesse A.; Hammond, Flora M.; Barringer, Thomas A.; Norton, H. J.; Goff, David C.; Bockenek, William L.; Scelza, William M.

2011-01-01

42

77 FR 58086 - Fisheries of the United States; National Standard 1 Guidelines; Reopening of Public Comment Period  

Federal Register 2010, 2011, 2012, 2013

...Guidelines, one of 10 national standards for fishery conservation...adjustments to the National Standard 1 Guidelines. The ANPR...any additional ideas and solutions that could improve provisions of the National Standard 1 Guidelines. The...

2012-09-19

43

77 FR 39459 - Fisheries of the United States; National Standard 1 Guidelines; Extension of Public Comment Period  

Federal Register 2010, 2011, 2012, 2013

...Guidelines, one of 10 national standards for fishery conservation...adjustments to the National Standard 1 Guidelines. The ANPR...any additional ideas and solutions that could improve provisions of the National Standard 1 Guidelines. NMFS...

2012-07-03

44

Unifying acute stroke treatment guidelines for a bayesian belief network.  

PubMed

With the large number of clinical practice guidelines available, there is an increasing need for a comprehensive unified model for acute ischemic stroke treatment to assist in clinical decision making. We present a unified treatment model derived through review of existing clinical practice guidelines, meta-analyses, and clinical trials. Using logic from the treatment model, a Bayesian belief network was defined and fitted to data from our institution's observational quality improvement database for acute stroke patients. The resulting network validates known relationships between variables, treatment decisions and outcomes, and enables the exploration of new correlative relationships not defined in current guidelines. PMID:23920786

Love, Alexa; Arnold, Corey W; El-Saden, Suzie; Liebeskind, David S; Andrada, Lewellyn; Saver, Jeffrey; Bui, Alex A T

2013-01-01

45

Antimalarial Prescriptions for Children Presenting with Uncomplicated Malaria to a Teaching Hospital in Nigeria after the Change of National Guidelines for Malaria Treatment  

Microsoft Academic Search

Malaria is still a major public health problem in Nigeria. It is the leading cause of infant and childhood mortality in Nigeria. The cornerstones of its management are prevention, early and appropriate diagnosis and prompt, adequate and appropriate treatment. The conformity of the prescribed antimalarials for the children that presented to the paediatric outpatient clinic to the World Health Organisation's

K. A. Oshikoya

46

National survey of guideline-compliant COPD management among pneumologists and primary care physicians.  

PubMed

The aim of this survey was to investigate guideline-compliant COPD management among pneumologists and primary care physicians (PCPs). A multiple-choice questionnaire was sent out to 1836 PCPs and 863 pneumologists in Germany. The questions focused on the key aspects of current national and international COPD guidelines. Four hundred eighty-six PCPs and 359 pneumologists participated in the study. It was found that pneumologists held the GOLD guideline in high regard (60.4%), while PCPs tended to follow the German National COPD guideline (66.5%). Differences were also found with regard to diagnosis and classification of COPD on the basis of spirometric and clinical criteria. The current GOLD classification of moderate and severe COPD was used by 36.2% and 23.4% of the pneumologists, respectively, and by 32.1% and 20.2% of the PCPs. Although PCPs and pneumologists endorsed educational measures to help patients quit smoking, implementation was still inadequate. The two most important therapeutic goals were to improve quality of life and prevent exacerbations. Except for the criteria for the use of steroids and the implementation of pulmonary rehabilitation measures, treatment of COPD based on severity class was largely in compliance with guidelines. However, appreciably more PCPs than pneumologists incorrectly assessed the evidence-based clinical benefits of various therapeutic measures. The study shows that, despite the popularity of COPD guidelines, deficits exist among pneumologists and PCPs with respect to diagnosis and treatment of COPD and practical implementation of educational measures. These deficiencies in guideline conformity might be best addressed through targeted continuing-education measures. PMID:17240616

Glaab, Thomas; Banik, Norbert; Rutschmann, Olivier T; Wencker, Marion

2006-08-01

47

A systematic review of treatment guidelines for metastatic colorectal cancer  

PubMed Central

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

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

2012-01-01

48

[Treatment guidelines for acute and preventive treatment of cluster headache].  

PubMed

The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated both the acute and the preventive treatments for cluster headache now being used in Taiwan, based on the principles of evidence- based medicine. We assessed the quality of clinical trials and levels of evidence, and referred to other treatment guidelines proposed by other countries. Throughout several panel discussions, we merged opinions from the subcommittee members and proposed a consensus on the major roles, recommended levels, clinical efficacy, adverse events and cautions of clinical practice regarding acute and preventive treatments of cluster headache. The majority of Taiwanese patients have episodic cluster headaches, because chronic clusters are very rare. Cluster headache is characterized by severe and excruciating pain which develops within a short time and is associated with ipsilateral autonomic symptoms. Therefore, emergency treatment for a cluster headache attack is extremely important. Within the group of acute medications currently available in Taiwan, the subcommittee determined that high-flow oxygen inhalation has the best evidence of effectiveness, followed by intranasal triptans. Both are recommended as first-line medical treatments for acute attacks. Oral triptans were determined to be second-line medications. For transitional prophylaxis, oral corticosteroids are recommended as the first-line medication, and ergotamine as the second-line choice. As for maintenance prophylaxis, verapamil has the best evidence and is recommended as the first-line medication. Lithium, melatonin, valproic acid, topiramate and gabapentin are suggested as the second-line preventive medications. Surgical interventions, including occipital nerve stimulation, deep brain stimulation, radiofrequency block of the sphenopalatine ganglion, percutaneous radiofrequency rhizotomy and trigeminal nerve section, are invasive and their long-term efficacy and adverse events are still not clear in Taiwanese patients; therefore, they are not recommended currently by the subcommittee. The transitional and maintenance prophylactic medications can be used together to attain treatment efficacy. Once the maintenance prophylaxis achieves efficacy, the transitional prophylactic medications can be tapered gradually. We suggest the corticosteroids be used within two weeks, if possible. The duration of maintenance treatment depends on the individual patient's clinical condition, and the medications can be tapered off when the cluster period is over. PMID:22009127

Chen, Ping-Kun; Chen, Hsi-Ming; Chen, Wei-Hung; Chen, Yeng-Yu; Fuh, Jong-Ling; Lee, Lian-Hui; Liao, Yi-Chu; Lin, Kao-Chang; Tseng, Hung-Ping; Tsai, Jing-Jane; Wang, Po-Jen; Wang, Shuu-Jiun; Yang, Chun-Pai; Yiu, Chun-Hing; Wu, Zin-An

2011-09-01

49

Treatment Guidelines for Alzheimer's Disease: Redefining Perceptions in Primary Care  

PubMed Central

Background: Current treatment guidelines for Alzheimer's disease (AD) do not reflect more recently collected data on therapeutic outcomes other than cognitive function and memory, and this has led to a limited understanding of the value of drug therapy in AD. Objectives: To evaluate the need to revise treatment guidelines for AD, to review data that have become available since the publication of current guidelines, and to communicate how existing guidelines and relevant new data can be valuable to the primary care provider who assesses and treats patients with AD. Data Sources: A MEDLINE search was conducted to identify existing treatment guidelines using the MeSH headings Alzheimer disease–drug therapy AND practice guidelines. The alternative terms treatment guidelines, practice parameter, and practice recommendation were also searched in conjunction with the MeSH term Alzheimer disease–drug therapy. Additionally, MEDLINE was searched using the term dementia and publication type “practice guideline.” All searches were limited to articles published within the last 10 years, in English. A total of 116 articles were identified by these searches. Additional publications were identified by manually searching the reference lists of these articles and of published clinical trials of AD therapies. Study Selection and Data Extraction: Current AD treatment guidelines and clinical trial results for AD treatment options were extracted, reviewed, and summarized to meet the objectives of this article. Data Synthesis: Current guidelines support the use of cholinesterase inhibitors in patients with mild to moderate AD. More recent clinical research indicates that cholinesterase inhibitor treatment provides effectiveness across a wide range of dementia severity and multiple symptom domains. These medications also significantly decrease caregiver burden and may lower the risk for nursing home placement. Conclusions: The expanding literature on AD medications suggests that treatment guidelines need to be reexamined. Recent data emphasize preservation of abilities and delay of adverse outcomes in AD patients rather than short-term improvements in cognitive test scores. Treatment appears to provide the greatest benefit when it is initiated early in the course of the disease and maintained over the long term. Revised treatment guidelines should address newer medications and more recent outcomes considerations, as well as provide guidance on how long to continue and when to discontinue pharmacotherapy for AD.

Geldmacher, David S.

2007-01-01

50

Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment  

Microsoft Academic Search

Objective: To describe the content of guidelines on the use of anticoagulant treatment in patients with atrial fibrillation and the impact of variations in guidelines on treatment. Design: Postal survey of guidelines, semistructured interview with lead developers of guidelines, and application of guidelines to patient sample. Subjects: 15 lead developers of the 20 guidelines identified in the postal survey were

Richard Thomson; Helen McElroy; Mark Sudlow

1998-01-01

51

Practical Guidelines for the Assessment and Treatment of Selective Mutism  

Microsoft Academic Search

ObjectiveTo provide practical guidelines for the assessment and treatment of children with selective mutism, in light of the recent hypothesis that selective mutism might be best conceptualized as a childhood anxiety disorder.

SARA P. DOW; BARBARA C. SONIES; DONNA SCHEIB; SHARON E. MOSS; HENRIETTA L. LEONARD

1995-01-01

52

Shipboard Fuel Handling and Treatment: Guidelines for Onboard Conditioning.  

National Technical Information Service (NTIS)

This report provides guidelines and recommendations for the shipboard treatment and conditioning of fuel oils. Four different types of propulsion systems with a broad range of fuels are considered in this study. Specifically these are; Steam Turbine with ...

M. F. Winkler T. J. Pakula

1982-01-01

53

[ISKRA guidelines on sore throat: diagnostic and therapeutic approach--Croatian national guidelines].  

PubMed

Sore throat is most commonly caused by viruses, but when caused by bacteria, the most important is group A streptococcus (GAS). The aim of these guidelines is to determine optimal treatment for streptococcal sore throat and reasonable indications for tonsillectomy, as well as recommend how to differentiate streptococcal infection for which antibiotics are justified, from numerous other sore throats where antibiotics wont have a significant effect on disease course, but might contribute to bacterial resistance to antibiotics. The development of the guidelines was initiated by the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the Croatian Ministry of Health and Social Welfare in accordance with the principles of AGREE (Appraisal of Guidelines for Research and Evaluation) methodology which means that the guidelines are the result of consensus between all interested professional societies and institutions. For streptococcal sore throat diagnostics, the Working Group recommends evaluation of clinical presentation according to Centor criteria and for patients with Centor score 0-1, antibiotic therapy is not recommended nor bacteriological testing, while for patients with Centor score 2-4 bacteriological testing is recommended (rapid test or culture) as well as antibiotic therapy in case of positive result. The drug of choice for the treatment of streptococcal tonsillopharyngitis is oral penicillin taken for ten days (penicillin V) or in case of poor patient compliance benzathine penicillin G can be administered parenterally in a single dose. Other antibiotics (macrolides, clindamycin, cephalosporins, co-amoxiclav) are administered only in case of hypersensitivity to penicillin or in recurrent infections. Tonsillectomy is a widely accepted surgical procedure that decreases the number of sore throats in children and should be performed only if indications for this procedure are established. Absolute indications include five or more streptococcal infections per year, tonsillitis complications, permanent respiratory tract obstruction, obstructive sleep apnea syndrome and suspected tonsillar malignancy. Relative indications include chronic tonsillitis and occlusion disturbances. PMID:19769278

Andrasevi?, Arjana Tambi?; Baudoin, Tomislav; Vukeli?, Dalibor; Matanovi?, Suzana Mimica; Bejuk, Danijela; Puzevski, Diana; Abram, Maja; Tesovi?, Goran; Grgurev, Zdravko; Tomac, Gordana; Pristas, Irina

54

National Ignition Facility Shot Data Analysis Module Guidelines  

SciTech Connect

This document provides the guidelines for software development of modules to be included in Shot Data Analysis (SDA) for the National Ignition Facility (NIF). An Analysis Module is a software entity that groups a set of (typically cohesive) functions, procedures and data structures for performing an analysis task relevant to NIF shot operations. Each module must have its own unique identification (module name), clear interface specifications (data inputs and outputs), and internal documentation. It is vitally important to the NIF Program that all shot-related data be processed and analyzed in a consistent way that is reviewed by scientific and engineering experts. SDA is part of a NIF Integrated Product Team (IPT) whose goal is to provide timely and accurate reporting of shot results to NIF campaign experimentalists. Other elements of the IPT include the Campaign Management Tool (CMT) for configuring experiments, a data archive and provisioning system called CMS, a calibration and configuration database (CDMS), and a shot data visualization tool (SDV). We restrict our scope at this time to guidelines for modules written in Interactive Data Language, or IDL1. This document has sections describing example IDL modules and where to find them, how to set up a development environment, IDL programming guidelines, shared IDL procedures for general use, and revision control.

Azevedo, S; Glenn, S; Lopez, A; Warrick, A; Beeler, R

2007-10-03

55

National Synchrotron Light Source guidelines for the conduct of operations  

SciTech Connect

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

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

1998-01-01

56

[Revised guideline 'Diabetic retinopathy: screening, diagnosis and treatment'].  

PubMed

The revised evidence-based guideline 'Diabetic retinopathy: screening, diagnosis and treatment' contains important recommendations concerning screening, diagnosis and treatment of diabetic retinopathy. Regular screening and the treatment of risk factors, such as hyperglycemia, hypertension, adipositas and dyslipidemia, can prevent retinopathy and slow down its development. Fundus photography is recommended as a screening method. If necessary, diagnosis by biomicroscopy and a treatment consisting of photocoagulation and/or vitrectomy should be performed by the ophthalmologist. The reassessment of responsibilities is a vital component of the implementation of the guideline bearing in mind that the screening in particular, can be performed by personnel other than ophthalmologists. PMID:19055140

Polak, B C P; Hartstra, W W; Ringens, P J; Scholten, R J P M

2008-11-01

57

[Guidelines for the diagnosis, prevention and treatment of osteoporosis, 2012].  

PubMed

Osteoporosis is a constantly growing disease which affects over 200 million people worldwide. The present recommendations are guidelines for its diagnosis, prevention and treatment, but they do not constitute standards for clinical decisions in individual patients. The physician must adapt them to individual patients and special situations, incorporating personal factors that transcend the limits of these guidelines and are dependent on the knowledge and art of the physician. These guidelines should be reviewed and updated periodically as new, better and more effective diagnostic and therapeutic tools become available. PMID:23335710

Schurman, León; Bagur, Alicia; Claus-Hermberg, Haraldo; Messina, Osvaldo D; Negri, Armando L; Sánchez, Ariel; González, Claudio; Diehl, María; Rey, Paula; Gamba, Julieta; Chiarpenello, Javier; Moggia, María Susana; Mastaglia, Silvina

2013-01-01

58

[Useful guideline for treatment of pain in vulnerable elderly people].  

PubMed

Forty to fifty percent of elderly people (> 70 years of age) appear to have pain that interferes with daily life. The frail elderly, described as elderly people who are vulnerable, mostly chronically ill, with physical, and psychological, as well as social, and communicative disabilities, are often inadequately treated for pain. This interdisciplinary guideline aims to improve recognition and treatment of chronic pain in frail elderly patients and is therefore very useful in clinical practice. Interventional, minimally invasive pain treatment is not described in this guideline, although for a number of pain syndromes this could be an evidence-based potential treatment. PMID:22929752

van Kleef, Maarten; Geurts, José W

2012-01-01

59

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

Microsoft Academic Search

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

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

60

Guidelines for graduate students in the Environmental Sciences Division, Oak Ridge National Laboratory  

Microsoft Academic Search

The purpose of these guidelines is to outline the Environmental Sciences Division policies on the selection, placement, and research activities of graduate students. These guidelines have evolved through experience and in conformance with Oak Ridge National Laboratory (ORNL) policies. This edition of the Guidelines is a revision of one printed in June 1979, which had been prepared several years earlier

Millemann

1983-01-01

61

Auditing national HIV guidelines and policies: The United Kingdom CD4 Surveillance Scheme.  

PubMed

The United Kingdom's CD4 surveillance scheme monitors CD4 cell counts among HIV patients and is a national resource for HIV surveillance. It has driven public health policy and allowed auditing of national HIV testing, treatment and care guidelines. WE DEMONSTRATE ITS UTILITY THROUGH FOUR EXAMPLE OUTPUTS: median CD4 count at HIV diagnosis; late HIV diagnosis and short-term mortality; the timing of first CD4 count to indicate entry into HIV care; and the proportion of patients with CD4 counts <350 cells/mm3 receiving anti-retroviral therapy (ARV). In 2009, 95% (61,502/64,420) of adults living with diagnosed HIV infection had CD4 counts available. The median CD4 count at diagnosis increased from 276 to 335 cells/mm3 between 2000 and 2009, indicating modest improvements in HIV testing. In 2009, 52% of patients were diagnosed at a late stage of HIV infection (CD4 <350 cells/mm(3)); these individuals had a ten-fold risk of dying within a year of their diagnosis compared to those diagnosed promptly. In 2008, the national target of performing a CD4 count within 14 days of diagnosis was met for 61% of patients. National treatment guidelines have largely been met with 83% patients with CD4 <350 cells/mm(3) receiving ARV. The monitoring of CD4 counts is critical to HIV surveillance in the United Kingdom enabling the close monitoring of efforts to reduce morbidity and mortality associated with late diagnosis and underpins the auditing of policies and guidelines. These routine surveillance outputs can be generated at national and local levels to drive and monitor public health policy and prevention efforts. PMID:23049663

Brown, Alison E; Kall, Meaghan M; Smith, Ruth D; Yin, Zheng; Hunter, Alan; Hunter, Alan; Delpech, Valerie C

2012-09-07

62

[Infective endocarditis. Guidelines for diagnosis and treatment].  

PubMed

After careful review of evidence-based literature, clinical and laboratory criteria for diagnosis of bacterial and fungal endocarditis are examined. The choice criteria for therapy of bacterial endocarditis, both empiric and directed against a specific pathogen, are reviewed, on the basis of the clinical and epidemiological context (prosthetic or native valve, left or right heart, drug addiction). Different treatment options are proposed, based on results of antibiotic resistance testing. Indications and contraindications for a parenteral home treatment and those for surgical treatment are examined, also according to the results of ultrasonography. PMID:15666493

Boumis, Evangelo; Alba, Lucia; Cicalini, Stefania; De Marco, Michele; Festa, Anna; Macrì, Giulia; Vincenzi, Laura; Petrosillo, Nicola

2004-12-01

63

[Lymphedema--guidelines for evaluation and treatment].  

PubMed

Lymphedema is the "neglected vascular disease". A lot has been written about arterial and venous pathologies but our knowledge, as physicians, about the pathophysiology on the one hand and about the treatment, on the other hand, is scarce. Lymphedema is subdivided into primary and secondary disease. The primary lymphedema is further subdivided to congenital, praecox and tarda. Conservative treatment is the first line of therapy. Surgery has not been proven as a good solution for this disease, and furthermore, even when operations are being conducted, conservative treatment should be continued on a daily basis. It seems that further research about this "forgotten disease" should be designed in order to improve the treatment of these complicated patients. PMID:23717853

Heldenberg, Eitan; Bass, Arie

2013-03-01

64

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

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 preventin

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

65

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

Federal Register 2010, 2011, 2012, 2013

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

2012-02-22

66

Osteoporosis: the need for comprehensive treatment guidelines  

Microsoft Academic Search

Osteoporosis is a debilitating disease that results in nearly 1.3 million fractures per year in the United States. The cost of treating these fractures has been estimated to be as high as $10 billion per year. These costs are expected to more than double during the next 50 years unless comprehensive programs of prevention and treatment are initiated. Both pharmacologic

Thomas A. Abbott; Bryan J. Lawrence; Stanley Wallach

1996-01-01

67

Influencing Patient Adherence to Treatment Guidelines  

Microsoft Academic Search

BACKGROUND: As chronic disease continues to weigh more heavily on health care resources, lifestyle management and compliance to treatment become paramount to patient care and care coordination. Although a wealth of information is available to the public regarding the basic tenets on exercise, nutrition, weight management, power of medications, and so forth, patients do not always modify their behavior accordingly

Susan W. Butterworth

2008-01-01

68

Guidelines for treatment of liver cancer  

Microsoft Academic Search

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

Tito Livraghi

2001-01-01

69

Successful implementation of spacer treatment guideline for acute asthma  

PubMed Central

AIMS—To develop and implement an evidence based guideline for the treatment of acute asthma using a metered dose inhaler and spacer combination.?METHODS—Defined strategies were used for the development and implementation of a guideline, assessed by a prospective, descriptive, study using notes review, and patient, nursing, and medical staff telephone contact. The setting was a tertiary referral hospital in Victoria, Australia with 25 000 yearly admissions, and asthma accounting for about 7% of total. The first 200 children and families to use the guideline after its introduction were evaluated.?RESULTS—A total of 191 (95.5%) children were treated according to the guideline. Six (3.0%) children were given nebulisers appropriately based on severity; five (2.5%) were given nebulisers at parental or child choice; and four (2.0 %) who did not have severe asthma, received nebulised treatment inappropriately.?CONCLUSIONS—Successful implementation of a new evidence based guideline can be achieved using specific strategies for promoting the application of research findings in the clinical arena.??

Powell, C; Maskell, G; Marks, M; South, M; Robertson, C; LENNEY, W.

2001-01-01

70

Assessment and treatment of neuropathic cancer pain following WHO guidelines  

Microsoft Academic Search

Neuropathic pain syndromes are one of the major problems of cancer pain treatment. The present study surveys 593 cancer patients treated by a pain service following the WHO guidelines for relief of cancer pain. Of these, 380 presented with nociceptive, 32 with neuropathic and 181 with mixed (nociceptive and neuropathic) pain. In patients with nociceptive, mixed and neuropathic pain, the

Stefan Grond; Lukas Radbruch; Thomas Meuser; Rainer Sabatowski; Georg Loick; Klaus A Lehmann

1999-01-01

71

Rheumatoid Arthritis: Biologic Treatment Advances and Guideline Interpretation  

Microsoft Academic Search

The practical management of patients with rheumatoid arthritis (RA), including the use of tumor necrosis factor- alpha (TNF-?) inhibitor therapy, is the focus of this issue of PCE Updates in Rheumatology. Early diagnosis is an important factor in selecting and implementing the most effective treatment. Clinical guidelines that identify early symptoms of RA are necessary tools for rheumatologists, nurse practitioners

Martin J. Bergman

72

[Guidelines for substitution treatments in prison populations].  

PubMed

Care access for the drug addict patients in prison (in particular for the treatments of substitution) in France is very unequal from one establishment to another. This reflects the great variability of the practices of substitution and especially the absence of consensus on the methods of adaptation of these practices to the prison environment. Because of difficulties expressed by prisoners and medical staff on this subject and of stakes (let us recall that approximately 30% of the prisoners are dependent or abusers of one or more psychoactive substances), the formulation of recommendations or of a good practices guide of substitution in prison appeared necessary. Work that we detail here answers a ordering of the Advisory Commission of the Treatments of Substitution (September 2001) whose authors are members. It was presented at the session April 2003. It results from the confrontation of a review of the literature (including legal texts and official reports concerning substitution, the organization of the care in prison environment and the lawful framework), with a vast investigation. The latter was carried out near medical staff (22 prisons), penitentiary staff (3 prisons, 27 people met including directors of these establishments) and prisoners (7 establishments, 28 prisoners met) in the form of individual talks (semi-directing interviews with evaluation of the type of existing device and its knowledge by the penitentiary staff and the prisoners; statement of the suggestions, needs and requests of the medical, penitentiary staffs and of the prisoners). In the whole visited prisons, 7.8% (870) of the prisoners received substitution treatments (6.35% by buprenorphine, 1.44% by methadone), representing a proportion of substituted drug addicts (870 substituted for an evaluation of 3,350 prisoners drug addicts among the 11,168 prisoners of the 22 visited prisons) notably lower than that in free environment (56%, ie 96,000 substituted for an evaluated population of drug addicts for heroin of 160,000). There are however considerable variations (from 0 to 16.2%) of the proportion of substituted of one establishment for the other according to the type of prison, of its size, its localization and the type of medical device present. If a consensus exists for methadone (daily delivery with sanitary control), the organization of the care relating to the buprenorphine is extremely variable from one establishment to another, often putting in difficulty as well the medical teams as the prisoners. One recommendation is essential: the formulation of an individualized therapeutic project. Thirteen other recommendations are made in the following fields: renewal of substitution treatments, initiation of substitution treatments, urinary controls, methods of prescription, methods of delivery, co-prescriptions, global care, confidentiality, files, exits and transfers, extractions, formation, accompaniment of the teams. These recommendations being formulated, many medical concerns remain present and several questions open. The report of joint mission IGAS/IGSJ of June 2001 on the health of the prisoners underlines the principal persistent gaps: hygiene and public health, treatment of the mental disorders, the follow-up of the sexual delinquents, handling ageing, handicap and the end of lifetime. In the same way, the difficulties listed in prison environment concerning substitution are only the exacerbation of those existing outside: the misuses and traffics are common in free environment, risk reduction in prison, as outside, handle with obstacles related to the penalization of the drug use and can hardly evolve except questioning the law of 1970. The prison practice opens also questions: that of the "duration" of the substitution, frequently posed by the prisoners; concern to see the prison becoming a privileged place of access to the care, combining sanction and care whereas the law of 1970 allows the alternative (care or sanction); that of the clinic of the misuse, particularly "readable" in prison environment; and fina

Michel, L; Maguet, O

73

Current Consensus Guidelines for Treatment of Neurocysticercosis  

PubMed Central

Taenia solium neurocysticercosis is a common cause of epileptic seizures and other neurological morbidity in most developing countries. It is also an increasingly common diagnosis in industrialized countries because of immigration from areas where it is endemic. Its clinical manifestations are highly variable and depend on the number, stage, and size of the lesions and the host's immune response. In part due to this variability, major discrepancies exist in the treatment of neurocysticercosis. A panel of experts in taeniasis/cysticercosis discussed the evidence on treatment of neurocysticercosis for each clinical presentation, and we present the panel's consensus and areas of disagreement. Overall, four general recommendations were made: (i) individualize therapeutic decisions, including whether to use antiparasitic drugs, based on the number, location, and viability of the parasites within the nervous system; (ii) actively manage growing cysticerci either with antiparasitic drugs or surgical excision; (iii) prioritize the management of intracranial hypertension secondary to neurocysticercosis before considering any other form of therapy; and (iv) manage seizures as done for seizures due to other causes of secondary seizures (remote symptomatic seizures) because they are due to an organic focus that has been present for a long time.

Garcia, Hector H.; Evans, Carlton A. W.; Nash, Theodore E.; Takayanagui, Osvaldo M.; White, A. Clinton; Botero, David; Rajshekhar, Vedantam; Tsang, Victor C. W.; Schantz, Peter M.; Allan, James C.; Flisser, Ana; Correa, Dolores; Sarti, Elsa; Friedland, Jon S.; Martinez, S. Manuel; Gonzalez, Armando E.; Gilman, Robert H.; Del Brutto, Oscar H.

2002-01-01

74

Quality of care for dialysis patients: national initiative focuses on improved treatment.  

PubMed

The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) is a groundbreaking project established to develop evidence-based dialysis treatment guidelines. Highlights of the guidelines were presented to the renal community in November 1996 at the National Kidney Foundation's Annual Scientific Meeting in New Orleans. PMID:9188324

Zarbock, S F

1997-04-01

75

Measuring adherence to depression treatment guidelines in a VA primary care clinic  

Microsoft Academic Search

The primary objectives of this pilot study were to develop a measure of adherence for depression practice guidelines and to assess the degree to which providers and patients adhere to guidelines in a VA primary care setting. The Depression Guideline Measure (DGM) is based on three national guidelines. The DGM was used to review medical records of 111 patients with

Steven K Dobscha; Martha S Gerrity; Kathryn Corson; Alison Bahr; Nancy M Cuilwik

2003-01-01

76

Treatment - National Cancer Institute  

Cancer.gov

The challenge during the creation of the CCOP program in the early 1980s was to design and implement a program to assure that cancer patients treated in their communities had access to clinical trial quality medical care. By introducing up-to-date cancer management into the community in the form of research clinical trials, community physicians would also be more ready and able to apply the proven treatment regimens to all their patients.

77

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

PubMed

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

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

2008-08-01

78

65 FR 51976 - National Institutes of Health Guidelines for Research Using Human Pluripotent Stem Cells  

Federal Register 2010, 2011, 2012, 2013

...Research Using Human Pluripotent Stem Cells and Notification of Request for Emergency...Research Using Human Pluripotent Stem Cells SUMMARY: The National Institutes...Research Using Human Pluripotent Stem Cells.'' The Guidelines establish...

2000-08-25

79

Guidelines for the diagnosis and treatment of vitiligo in Japan.  

PubMed

Vitiligo is an acquired pigment disorder in which depigmented macules result from the loss of melanocytes from the involved regions of skin and hair. The color dissimilarity on the cosmetically sensitive regions frequently induces quality of life impairment and high willingness to pay for treatment in patients with vitiligo. The Vitiligo Japanese Task Force was organized to overcome this situation and to cooperate with the Vitiligo Global Issues Consensus Conference. This guideline for the diagnosis and treatment of vitiligo in Japan is proposed to improve the circumstances of Japanese individuals with vitiligo. Its contents include information regarding the diagnosis, pathogenesis, evaluation of disease severity and effectiveness of treatment, and evidence-based recommendations for the treatment of vitiligo. The therapeutic algorithm based on the proposed recommendation is designed to cure and improve the affected lesions and quality of life of individuals with vitiligo. PMID:23441960

Oiso, Naoki; Suzuki, Tamio; Wataya-Kaneda, Mari; Tanemura, Atsushi; Tanioka, Miki; Fujimoto, Tomoko; Fukai, Kazuyoshi; Kawakami, Tamihiro; Tsukamoto, Katsuhiko; Yamaguchi, Yuji; Sano, Shigetoshi; Mitsuhashi, Yoshihiko; Nishigori, Chikako; Morita, Akimichi; Nakagawa, Hidemi; Mizoguchi, Masako; Katayama, Ichiro

2013-02-27

80

Longitudinal patterns of antidepressant prescribing in primary care in the UK: comparison with treatment guidelines.  

PubMed

The objective of this study was to determine whether patients beginning therapy on the most common tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) differed in their likelihood of having antidepressant treatment that was consistent with recommended treatment guidelines in the UK. An analytical file constructed from a large general practitioner medical records database (DIN-LINK) from the UK for the years 1992-97 was constructed. A total of 16,204 patients with a new episode of antidepressant therapy who initiated therapy on one of the most often prescribed TCAs (amitriptyline, dothiepin, imipramine and lofepramine) or SSRIs (fluoxetine, paroxetine and sertraline) were analysed. A dichotomous measure was defined to indicate whether subjects were prescribed at least 120 days of antidepressant therapy at an adequate average daily dose within the first 6 months after initiation of therapy. Only 6.0% of patients initiating therapy on aTCA and 32.9% of patients initiating therapy on a SSRI were prescribed antidepressant treatment that was consistent with treatment guidelines. After controlling for observable characteristics, patients who initiated therapy on a SSRI were much more likely (odds ratio=7.473, p<0.001) to have a prescribed average daily dose and duration consistent with recommended treatment guidelines within the first 6 months of initiating therapy than were patients who initiated therapy on a TCA. These findings suggest that initial antidepressant selection is an important determinant of whether the subsequent course of treatment is consistent with current national guidelines for the treatment of depression in the UK. PMID:10475718

Dunn, R L; Donoghue, J M; Ozminkowski, R J; Stephenson, D; Hylan, T R

1999-01-01

81

The role of monoamine oxidase inhibitors in depression treatment guidelines.  

PubMed

Monoamine oxidase inhibitors (MAOIs) have proven efficacy for treating depression and for decades have been a preferred treatment for patients with atypical depression, high levels of anxiety, anergic bipolar depression, and treatment-resistant depression. However, MAOIs are infrequently used due to safety and tolerability concerns and the need for dietary restrictions. Current guidelines, which are reviewed here, recommend MAOIs as third-, fourth-, or fifth-line treatments due to these concerns. However, a transdermal formulation of selegiline limits the need for dietary restrictions and has fewer side effects than many more widely used antidepressants. The availability of a safer and more tolerable formulation gives clinicians another option in their armamentarium for treating depression. PMID:22951237

Thase, Michael E

2012-01-01

82

Evidence-based guideline: Treatment of painful diabetic neuropathy  

PubMed Central

Objective: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). Methods: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: “What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?” Results and Recommendations: Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.

Bril, V.; England, J.; Franklin, G.M.; Backonja, M.; Cohen, J.; Del Toro, D.; Feldman, E.; Iverson, D.J.; Perkins, B.; Russell, J.W.; Zochodne, D.

2011-01-01

83

Documentation of torture and cruel, inhuman or degrading treatment of children: A review of existing guidelines and tools.  

PubMed

The documentation of individual cases of child torture is of paramount importance to bring justice to, and help heal, individuals and sensitize societies. Our objective is to systematically review medical guidelines for the recording of individual cases of child torture or cruel, inhuman or degrading treatment (CIDT). We searched CINAHL, Embase, the Guidelines International Network, Lilacs, Medline, the National Guideline Clearinghouse, PsychInfo and all websites of the organizations participating in the updating of the Istanbul Protocol for guidelines or studies on how to document torture, CIDT or abuse in persons under 18 years. We did not find a comprehensive guideline that encompassed all aspects of the documentation of child torture, as does the Istanbul Protocol for adults. An expert opinion guideline on how to document sexual torture in children was found, and in addition we identified 13 consensus-based guidelines for the evaluation of abuse in children or specific aspects thereof. We strongly recommend a child specific, comprehensive guideline on the documentation of torture and CIDT in children. PMID:23199437

den Otter, Joost Jan; Smit, Yolba; dela Cruz, Loreine B; Ozkalipci, Onder; Oral, Resmiye

2012-11-29

84

[Guidelines of treatment for non-bleeding peptic ulcer disease].  

PubMed

Over the past century, since the introduction of non steroidal anti-inflammatory drugs (NSAID), antacid, histamine H2-receptor antagonists (H2RA), proton pump inhibitors (PPI), and discovery of Helicobacter pylori infection, the paradigm of peptic ulcer disease has changed with marked decrease in morbidity and mortality. However, peptic ulcer disease still occupies a position as a major health problem with increase of aged population and NSAIDs usage. In daily general practice, the management of peptic ulcer disease is directed according to the presence of bleeding or not. For non-bleeding peptic ulcer disease, proper acid suppression and the correction of underlying causes such as Helicobacter pylori infection and NSAID use is the main stay of treatment. Though a complete understanding of pathophysiology and a perfect treatment strategy are still a challenge, this guideline aims to provide practical recommendations based on evidences or consensus of experts through in-depth literature review and expert meeting. PMID:19934610

Cheung, Dae Young; Jung, Hwoon Yong; Song, Ho June; Jung, Sung Woo; Jung, Hyun Chae

2009-11-01

85

Swedish guidelines for diagnosis and treatment of infective endocarditis.  

PubMed

Swedish guidelines for diagnosis and treatment of infective endocarditis (IE) by consensus of experts are based on clinical experience and reports from the literature. Recommendations are evidence based. For diagnosis 3 blood cultures should be drawn; chest X-ray, electrocardiogram, and echocardiography preferably transoesophageal should be carried out. Blood cultures should be kept for 5 d and precede intravenous antibiotic therapy. In patients with native valves and suspicion of staphylococcal aetiology, cloxacillin and gentamicin should be given as empirical treatment. If non-staphylococcal etiology is most probable, penicillin G and gentamicin treatment should be started. In patients with prosthetic valves treatment with vancomycin, gentamicin and rifampicin is recommended. Patients with blood culture negative IE are recommended penicillin G (changed to cefuroxime in treatment failure) and gentamicin for native valve IE and vancomycin, gentamicin and rifampicin for prosthetic valve IE, respectively. Isolates of viridans group streptococci and enterococci should be subtyped and MIC should be determined for penicillin G and aminoglycosides. Antibiotic treatment should be chosen according to sensitivity pattern given 2-6 weeks intravenously. Cardiac valve surgery should be considered early, especially in patients with left-sided IE and/or prosthetic heart valves. Absolute indications for surgery are severe heart failure, paravalvular abscess, lack of response to antibiotic therapy, unstable prosthesis and multiple embolies. Follow-up echocardiography should be performed on clinical indications. PMID:18027277

Westling, Katarina; Aufwerber, Ewa; Ekdahl, Christer; Friman, Göran; Gårdlund, Bengt; Julander, Inger; Olaison, Lars; Olesund, Christina; Rundström, Hanna; Snygg-Martin, Ulrika; Thalme, Anders; Werner, Maria; Hogevik, Harriet

2007-01-01

86

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

SciTech Connect

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

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

2011-08-12

87

Guidelines for the treatment of autoimmune neuromuscular transmission disorders.  

PubMed

Important progress has been made in our understanding of the cellular and molecular processes underlying the autoimmune neuromuscular transmission (NMT) disorders; myasthenia gravis (MG), Lambert-Eaton myasthenic syndrome (LEMS) and neuromyotonia (peripheral nerve hyperexcitability; Isaacs syndrome). To prepare consensus guidelines for the treatment of the autoimmune NMT disorders. References retrieved from MEDLINE, EMBASE and the Cochrane Library were considered and statements prepared and agreed on by disease experts and a patient representative. The proposed practical treatment guidelines are agreed upon by the Task Force: (i) Anticholinesterase drugs should be the first drug to be given in the management of MG (good practice point). (ii) Plasma exchange is recommended as a short-term treatment in MG, especially in severe cases to induce remission and in preparation for surgery (level B recommendation). (iii) Intravenous immunoglobulin (IvIg) and plasma exchange are equally effective for the treatment of MG exacerbations (level A Recommendation). (iv) For patients with non-thymomatous autoimmune MG, thymectomy (TE) is recommended as an option to increase the probability of remission or improvement (level B recommendation). (v) Once thymoma is diagnosed TE is indicated irrespective of the severity of MG (level A recommendation). (vi) Oral corticosteroids is a first choice drug when immunosuppressive drugs are necessary in MG (good practice point). (vii) In patients where long-term immunosuppression is necessary, azathioprine is recommended together with steroids to allow tapering the steroids to the lowest possible dose whilst maintaining azathioprine (level A recommendation). (viii) 3,4-diaminopyridine is recommended as symptomatic treatment and IvIg has a positive short-term effect in LEMS (good practice point). (ix) All neuromyotonia patients should be treated symptomatically with an anti-epileptic drug that reduces peripheral nerve hyperexcitability (good practice point). (x) Definitive management of paraneoplastic neuromyotonia and LEMS is treatment of the underlying tumour (good practice point). (xi) For immunosuppressive treatment of LEMS and NMT it is reasonable to adopt treatment procedures by analogy with MG (good practice point). PMID:16834699

Skeie, G O; Apostolski, S; Evoli, A; Gilhus, N E; Hart, I K; Harms, L; Hilton-Jones, D; Melms, A; Verschuuren, J; Horge, H W

2006-07-01

88

Guidelines for a National Nutrition Policy. A Working Paper.  

ERIC Educational Resources Information Center

|The Select Committee on Nutrition and Human Needs is charged with the investigation and development of a comprehensive National Nutrition Policy for the United States. The National Nutrition Consortium--representing four major scientific and professional societies, the membership of which have responsibilities for developing, through research,…

Congress of the U.S., Washington, DC. Senate Select Committee on Nutrition and Human Needs.

89

The Process of Developing National Standards That Meet ANSI Guidelines  

Microsoft Academic Search

American national standards for evaluations of educational programs have been developed by the joint committee on Standards for Educational Evaluation. These standards have been approved by the American National Standards Institute (ANSI). In the article, the standard-setting process developed by the joint committee and approved by ANSI is described. The process involves the following steps: (a) initiation of projects, (b)

James R. Sanders

1994-01-01

90

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

PubMed

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

Lee, Paul R; Kossoff, Eric H

2011-04-21

91

Association of adherence to the seventh report of the Joint National Committee guidelines with hypertension in Korean men and women.  

PubMed

Whether the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines can be applied to the Asian population remains unclear. We aim to test the hypothesis that adherence to the JNC-7 guidelines is associated with hypertension in a representative sample of the Korean population in the fourth Korea National Health and Nutrition Examination Survey. Participants completed a non-quantitative food frequency questionnaire and 24-hour diet recall through interviews. Blood pressure, height, and weight were directly measured, and questions about physical activity and other lifestyle factors were administered. A total of 500 hypertensive and 4567 normotensive participants were identified. We estimated the odds ratio and 95% confidence intervals using a multivariate logistic regression. The following components of the JNC-7 guidelines were considered: dietary approaches to stop a hypertension style diet, moderate consumption of alcohol, adequate physical activity, and a normal body mass index. Those individuals who fell in the low-risk category for all 4 lifestyle components had an odds ratio of 0.48 (95% confidence interval, 0.30-0.78) compared with the remainder of the participants. In conclusion, we found an inverse association between adherence to the JNC-7 guidelines and hypertension prevalence among Korean adults, suggesting the importance of lifestyle modification for the prevention and management of hypertension. PMID:24074736

Kim, Hye In; Song, Yoonju; Kim, Woo-Young; Lee, Jung Eun

2013-08-29

92

European AIDS Clinical Society (EACS) guidelines for the clinical management and treatment of HIV-infected adults.  

PubMed

A working group of the European AIDS Clinical Society (EACS) have developed these guidelines for European clinicians to help them in the treatment of adults with HIV infection. This third version of the guidelines includes, as new topics, the assessment of patients at initial and subsequent clinic visits as well as post-exposure prophylaxis. A revision of the 2005 guidelines based on current data includes changes in the sections on primary HIV infection, when to initiate therapy, which drug combinations are preferred as initial combination regimens for antiretroviral-naïve patients, how to manage virological failure and the treatment of HIV during pregnancy. In Europe, there is a wide range of clinical practices in antiretroviral therapy depending on various factors such as drug registration, national policies, local availability, reimbursement and access to treatment. These can vary greatly from one country to another, especially in Central and Eastern parts of Europe. These guidelines are intended to help clinicians achieve the best care for their patients. In some countries, particularly where the quality of and access to care are not optimal, these guidelines should help AIDS societies and physicians or patient group organizations to negotiate with their national health authorities with a view to implementing what should be the standard of care for HIV-infected patients all over Europe. PMID:18257769

Clumeck, N; Pozniak, A; Raffi, F

2008-02-01

93

Guideline for the surgical treatment of atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and its prevalence is ?1-2% of the general population, but higher with increasing age and in patients with concomitant heart disease. The Cox-maze III procedure was a groundbreaking development and remains the surgical intervention with the highest cure rate, but due to its technical difficulty alternative techniques have been developed to create the lesions sets. The field is fast moving and there are now multiple energy sources, multiple potential lesion sets and even multiple guidelines addressing the issues surrounding the surgical treatment of AF both for patients undergoing this concomitantly with other cardiac surgical procedures and also as stand-alone procedures either via sternotomy or via videothoracoscopic techniques. The aim of this document is to bring together all major guidelines in this area into one resource for clinicians interested in surgery for AF. Where we felt that guidance was lacking, we also reviewed the evidence and provided summaries in those areas. We conclude that AF surgery is an effective intervention for patients with all types of AF undergoing concomitant cardiac surgery to reduce the incidence of AF, as demonstrated in multiple randomized studies. There is some evidence that this translates into reduced stroke risk, reduced heart failure risk and longer survival. In addition, symptomatic patients with AF may be considered for surgery after failed catheter intervention or even as an alternative to catheter intervention where either catheter ablation is contraindicated or by patient choice. PMID:23956274

Dunning, Joel; Nagendran, Myura; Alfieri, Ottavio R; Elia, Stefano; Kappetein, A Pieter; Lockowandt, Ulf; Sarris, George E; Kolh, Phillippe H

2013-08-16

94

The clinical guidelines usage towards the diagnosis and treatment of H1N1  

Microsoft Academic Search

In medical clinics, guidelines are the best ways for practitioners to make good decisions on patient's medical problems. There are different kinds of symptoms at all kinds of illnesses and this will affect the medicians' decision on the diagnosis\\/treatment. These guidelines are the results of an algorithm to follow and the ways to defeat the illness. These guidelines are developed

S. Koç; G. Yilmaz; Y. Kabak

2010-01-01

95

United Nations Documentation: Guidelines to a Study on Usage  

ERIC Educational Resources Information Center

|Discusses the difficulties in controlling the output of documents of the United Nations and suggests that a study of their users is essential to determine the basis for more effective control of output. (Author/JB)|

El-Ayouty, Yassin

1974-01-01

96

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

PubMed Central

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.

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

2012-01-01

97

[Hungarian consensus guideline for the diagnosis and treatment of B, C, and D viral hepatitis].  

PubMed

More than 1% of the Hungarian population is infected with hepatitis B, C, or D viruses. Since 2006 the diagnostics and therapy of these infections are carried out in treatment centers according to national guidelines - since 2010 according to financial protocols. The consensus-based guidelines for 2012 are published in this paper. The guidelines stress the importance of quick and detailed virologic evaluations, the applicability of transient elastography as an acceptable alternative of liver biopsy in this regard, as well as the relevance of appropriate consistent follow up schedule for viral response during therapy. The first choice of therapy in chronic hepatitis B infection is pegylated interferon for 48 weeks or continuous entecavir therapy. The later must be continued for at least 6 months after hepatitis B surface antigen (HBsAg) seroconversion. Tenofovir disoproxil fumarat is not yet reimbursed by the National Health Insurance Fund. Adefovir dipivoxil is recommended mainly in combination therapy. Lamivudine is no longer a first choice; patients currently taking lamivudine must switch if response is inadequate. Appropriate treatment of patients taking immunosuppressive medications is highly recommended. Pegylated interferon based therapy is recommended for the treatment of concomitant hepatitis D infection. Treatment naive chronic hepatitis C patients should initially receive pegylated interferon and ribavirin dual combination therapy. In genotype 1 infection if response is insufficient at 4 or 12 weeks one of the two new direct acting antivirals (boceprevir or telaprevir) should be added. The length of treatment is usually 48 weeks; in cases of extended early viral response shorter courses are recommended. Previous treatment failure patients with genotype 1 infection should receive a protease inhibitor backed triple combination therapy, mostly for 48 weeks. However, relapsers without cirrhosis and with extended rapid viral response, shorter telaprevir based combination therapy is sufficient. Drug-drug interactions as well as emergence of viral resistance are of particular importance. For genotype 2 or 3 HCV infections 24 weeks, for genotype 4 infections 24, 48 or 72 weeks of pegylated interferon plus ribavirin therapy is recommended in general. The guidelines published here become protocols when published as official publications of the Hungarian Health Authority. PMID:22370225

Makara, Mihály; Horváth, Gábor; Gervain, Judit; Pár, Alajos; Szalay, Ferenc; Telegdy, László; Tornai, István; Ujhelyi, Eszter; Hunyady, Béla

2012-03-11

98

Community pharmacists' involvement in smoking cessation: familiarity and implementation of the National smoking cessation guideline in Finland  

Microsoft Academic Search

BACKGROUND: Guidelines on smoking cessation (SC) emphasize healthcare cooperation and community pharmacists' involvement. This study explored the familiarity and implementation of the National SC Guideline in Finnish community pharmacies, factors relating to Guideline familiarity, implementation and provision of SC services. METHODS: A nationwide mail survey was sent to a systematic, sample of community pharmacy owners and staff pharmacists (total n

Terhi Kurko; Kari Linden; Kirsi Pietilä; Patrick Sandström; Marja Airaksinen

2010-01-01

99

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

ERIC Educational Resources Information Center

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

Xiaobing, Sun

2012-01-01

100

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

ERIC Educational Resources Information Center

|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…

Liang, Ling L.; Yuan, Haiquan

2008-01-01

101

Planning, Teaching and Assessing the Curriculum for Pupils with Learning Difficulties: Curriculum Guidelines To Support the Revised National Curriculum.  

ERIC Educational Resources Information Center

This commentary discusses publication of QCA guidelines on developing the curriculum for pupils with learning difficulties. It links the guidelines to the recent review of the National Curriculum and identifies some of the contributions these guidelines can make to planning, teaching, and assessment. Challenges for practice and research are…

Colwill, Ian; Peacey, Nick

2001-01-01

102

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

ERIC Educational Resources Information Center

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…

Liang, Ling L.; Yuan, Haiquan

2008-01-01

103

The Process of Developing National Standards That Meet ANSI Guidelines.  

ERIC Educational Resources Information Center

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

Sanders, James R.

104

Guidelines for screening, prophylaxis and critical information prior to initiating anti-TNF-alpha treatment.  

PubMed

These national clinical guidelines outlining the screening, prophylaxis and critical information required prior to initiating anti-TNF-alpha treatment have been approved by the Danish Society for Gastroenterology. Anti-TNF-alpha therapy is widely used in gastroenterology (for inflammatory bowel disease), rheumatology (for rheumatoid arthritis, psoriatic arthritis and spondyloarthropathies) and dermatology (for psoriasis). With this background, the Danish Society for Gastroenterology established a group of experts to assess evidence for actions recommended before treatment with anti-TNF-alpha agents. Screening should take place for both active tuberculosis and latent tuberculosis. Screening must evaluate the risk of hepatitis B exposure/infection and that of other viral infections such as human immunodeficiency virus (HIV) and varicella zoster virus (VZV). The assessment should include a history of previous malignancies (cases of malignant disease within 5 years of anti-TNF-alpha treatment should be carefully considered). The physical examination should include lung/heart auscultation and lymph node examination, and the paraclinical investigations should include chest X-rays and laboratory tests, including an interferon gamma release assay, a hepatitis B test, an HIV test and, when prior VZV infection is uncertain, a VZV antibody test. Prophylaxis: Isoniazid should be administered in cases of suspected latent TB infection. Antiviral treatment is recommended in HBsAg-positive patients at the start of anti-TNF-alpha treatment. Before anti-TNF-alpha therapy, vaccination with 23-valent pneumococcal vaccine is recommended, and HBV vaccination may be considered in seronegative patients. Annual vaccination against seasonal influenza is recommended. Human papilloma virus vaccination should be administered in accordance with the guidelines of the National Board of Health of Denmark. In patients without a prior VZV infection, VZV vaccination may be considered. Information for patients: Anti-TNF-alpha treatment results in a generally increased risk of infection and latent tuberculosis flare-up. Women are advised to comply with the national guidelines for screening for cervical cancer, and their HPV immunisation status should be clarified. An increased risk of lymphoma with biological therapy in combination with thiopurines should be mentioned. Patients are advised to seek medical advice in case of herpes zoster infection. PMID:22759856

Nordgaard-Lassen, Inge; Dahlerup, Jens Frederik; Belard, Erika; Gerstoft, Jan; Kjeldsen, Jens; Kragballe, Knud; Ravn, Pernille; Sørensen, Inge Juul; Theede, Klaus; Tjellesen, Lone

2012-07-01

105

Standards for Indexing: Revising the American National Standard Guidelines Z39.4.  

ERIC Educational Resources Information Center

Discusses standards as tools to promote compatibility and improve practice, the role of research versus expert opinion in creating standards, and the changing scope of indexing standards. The current draft of the NISO (National Information Standards Organization) American Standard Guidelines for Indexes in Information Retrieval (Z39.4) is…

Anderson, James D.

1994-01-01

106

Personal respiratory protection and tuberculosis: national evidence-based guidelines in England and Wales  

Microsoft Academic Search

In our review published in the previous issue, we noted that contradictory infection prevention and control recommendations have resulted in confusion in practice and inconsistent use of personal respiratory protection when caring for patients with infectious respiratory tuberculosis in hospitals and other healthcare facilities. Recent national evidence-based guidelines in England and Wales have sought to clarify this issue by making

RJ Pratt; ET Curran

2006-01-01

107

Guidelines for the Preparation of General Guides to National Archives: A RAMP Study.  

ERIC Educational Resources Information Center

Based on a comparative study of guides from the Bahamas, Barbados, France, Italy, the Netherlands, Rhodesia, Spain, the United Kingdom, the United States, West Germany, and Zambia, this handbook provides guidelines for the organization and content of a general guide to archives, particularly national archives. It is noted that the handbook is…

Hildesheimer, Francoise

108

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

ERIC Educational Resources Information Center

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

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

109

Guidelines for the Preparation of General Guides to National Archives: A RAMP Study.  

ERIC Educational Resources Information Center

|Based on a comparative study of guides from the Bahamas, Barbados, France, Italy, the Netherlands, Rhodesia, Spain, the United Kingdom, the United States, West Germany, and Zambia, this handbook provides guidelines for the organization and content of a general guide to archives, particularly national archives. It is noted that the handbook is…

Hildesheimer, Francoise

110

Is it 'too bloody late'? Older people's response to the National Physical Activity Guidelines  

Microsoft Academic Search

The National Physical Activity Guidelines (NPAGs) are the evidencebased recommendations on physical activity for all Australians. This study examines the attitudes of older people to the NPAGs with the aim of identifying communication objectives for social marketing practitioners when designing messages about physical activity specifically targeted at older people. Eight focus groups were conducted at the Positive Ageing Foundation’s conference

Nadine Henley; Joan Jackson

2006-01-01

111

The development of a treatment guideline for childhood malaria in rural Southwest Nigeria using participatory approach  

Microsoft Academic Search

Objective To describe the development of a treatment guideline for the effective case management of malaria in children at the home level.Methods Thirty-three mothers selected from 11 communities in a rural health district, community members and the research team developed a guideline for treatment of malaria at home by caregivers using a participatory approach. This was done in phases using

Ikeoluwapo O. Ajayi; Oladimeji Oladepo; Catherine O. Falade; E. Afolabi Bamgboye; Oladele Kale

2009-01-01

112

Unnecessary Child Care Exclusions in a State That Endorses National Exclusion Guidelines  

PubMed Central

OBJECTIVE No study has evaluated the association between state endorsement of American Academy of Pediatrics (AAP) and American Public Health Association (APHA) national guidelines and unnecessary exclusion decisions. We sought to determine the rate of unnecessary exclusion decisions by child care directors in a state that endorses AAP/APHA guidelines and to identify factors that are associated with higher unnecessary exclusion decisions. METHODS A telephone survey was administered to directors in metropolitan Milwaukee, Wisconsin. Directors were randomly sampled from a list of 971 registered centers. Director, center, and neighborhood characteristics were obtained. Directors reported whether immediate exclusion was indicated for 5 vignettes that featured children with mild illness that do not require exclusion by AAP/APHA guidelines. Weighted data were summarized by using descriptive statistics. Regression analysis was used to identify factors that were associated with directors’ exclusion decisions. RESULTS A total of 305 directors completed the survey. Overall, directors would unnecessarily exclude 57% of children. More than 62% had never heard of the AAP/APHA guidelines. Regression analysis showed fewer exclusions among more experienced compared with less experienced directors, among larger centers compared with smaller centers, and among centers that were located in areas with a higher percentage of female heads of household. Centers with ?10% children on state-assisted tuition excluded more. CONCLUSIONS High rates of inappropriate exclusion persist despite state endorsement of AAP/APHA guidelines. Focused initial and ongoing training of directors regarding AAP/APHA guidelines may help to reduce high rates of unnecessary exclusions.

Hashikawa, Andrew N.; Juhn, Young J.; Nimmer, Mark; Copeland, Kristen; Shun-Hwa, Li; Simpson, Pippa; Stevens, Martha W.; Brousseau, David C.

2011-01-01

113

EFNS guidelines on diagnosis and treatment of primary dystonias.  

PubMed

OBJECTIVES: to provide a revised version of earlier guidelines published in 2006. BACKGROUND: primary dystonias are chronic and often disabling conditions with a widespread spectrum mainly in young people. DIAGNOSIS: primary dystonias are classified as pure dystonia, dystonia plus or paroxysmal dystonia syndromes. Assessment should be performed using a validated rating scale for dystonia. Genetic testing may be performed after establishing the clinical diagnosis. DYT1 testing is recommended for patients with primary dystonia with limb onset before age 30, and in those with an affected relative with early-onset dystonia. DYT6 testing is recommended in early-onset or familial cases with cranio-cervical dystonia or after exclusion of DYT1. Individuals with early-onset myoclonus should be tested for mutations in the DYT11 gene. If direct sequencing of the DYT11 gene is negative, additional gene dosage is required to improve the proportion of mutations detected. A levodopa trial is warranted in every patient with early-onset primary dystonia without an alternative diagnosis. In patients with idiopathic dystonia, neurophysiological tests can help with describing the pathophysiological mechanisms underlying the disorder. TREATMENT: botulinum toxin (BoNT) type A is the first-line treatment for primary cranial (excluding oromandibular) or cervical dystonia; it is also effective on writing dystonia. BoNT/B is not inferior to BoNT/A in cervical dystonia. Pallidal deep brain stimulation (DBS) is considered a good option, particularly for primary generalized or cervical dystonia, after medication or BoNT have failed. DBS is less effective in secondary dystonia. This treatment requires a specialized expertise and a multidisciplinary team. PMID:20482602

Albanese, A; Asmus, F; Bhatia, K P; Elia, A E; Elibol, B; Filippini, G; Gasser, T; Krauss, J K; Nardocci, N; Newton, A; Valls-Solé, J

2011-01-01

114

Federal Guidelines - Operation and Maintenance of Wastewater Treatment Facilities.  

ERIC Educational Resources Information Center

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

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

115

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Acute treatment of schizophrenia  

Microsoft Academic Search

These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically

Peter Falkai; Thomas Wobrock; Jeffrey Lieberman; Birte Glenthoj; Wagner F. Gattaz; Hans-Jürgen Möller

2005-01-01

116

[Practice guideline. Diagnosis and treatment of type 2 diabetes mellitus].  

PubMed

Our objective was to develop a guide based on the best available evidence that allow family physicians to establish criteria for screening, diagnosis, prevention, treatment of disease, early detection and management of complications; to standardize the organizing processes of the diabetic patient's care in the primary care level; and to achieve lifestyle modification for patients and promote self-care. Clinical questions were stated according to the diagram and structured patient-intervention-comparison-outcome. We used a mixed methodology-adoption adjustment, and include 32 guides. For recommendations not included in these, the search process was conducted in PubMed and Cochrane Library Plus with these terms: diabetes mellitus type 2, epidemiology, detection and diagnosis, classification, drug therapy, effects, prevention, control and complication. The clinical practice guideline emphasizes the fundamental change in lifestyle (diet and exercise), self-care and proactive participation of the patient, in addition to the dynamic prescription of medications that would achieve metabolic control in order to reduce late complications. PMID:23550415

Gil-Velázquez, Luisa Estela; Sil-Acosta, María Juana; Domínguez-Sánchez, Elia R; Torres-Arreola, Laura del Pilar; Medina-Chávez, Juan Humberto

117

The epic project: developing national evidence-based guidelines for preventing healthcare associated infections. Phase I: Guidelines for preventing hospital-acquired infections. Department of Health (England).  

PubMed

In 1998, the Department of Health (England) commissioned the first phase of national evidence-based guidelines for preventing healthcare associated infections. These focused on developing a set of standard principles for preventing infections in hospitals together with guidelines for preventing hospital-acquired infections (HAI) associated with the use of short-term indwelling ureteral catheters in acute care and with central venous catheters in acute care. These guidelines are systematically developed broad statements (principles) of good practice that all practitioners can use and which can be incorporated into local protocols. A nurse-led, multi-professional team composed of infection prevention practitioners, clinical microbiologists/retrovirologist, epidemiologists, and researchers developed the guidelines. A rigorous guideline development process was used to inform the systematic reviews, the clinical and critical appraisal of relevant evidence, and linking that evidence to evolving guidelines. Both general and specialist clinical practitioners were involved in all stages of developing these guidelines, as were representatives from relevant Royal Colleges, learned societies, other professional organisations and key stakeholders. The introduction to these guidelines describes a robust and validated guideline development model that can be used by others to develop future guidelines. This model is described in more detail in the associated technical reports that can be found on the project web site http://www.epic.tvu.ac.uk. Locating and appropriately using good quality evidence to inform guideline development in this field is challenging. Evidence from rigorously conducted experimental studies was frequently limited and consequently a range of other types of evidence were systematically retrieved and carefully appraised. The concluding discussion on implementation highlights potential issues for clinical governance and areas for future research and suggests issues that need to be addressed to allow practitioners to successfully incorporate these guidelines into routine clinical practice. PMID:11161888

Pratt, R J; Pellowe, C; Loveday, H P; Robinson, N; Smith, G W; Barrett, S; Davey, P; Harper, P; Loveday, C; McDougall, C; Mulhall, A; Privett, S; Smales, C; Taylor, L; Weller, B; Wilcox, M

2001-01-01

118

[S3 guideline--Diagnosis and treatment of colorectal carcinoma: relevance for radiologic imaging and interventions].  

PubMed

The new German S3 guideline "Colorectal Carcinoma" was created as part of the German Guideline Program in Oncology of the Association of the Scientific Medical Societies in Germany, the German Cancer Society and the German Cancer Aid under the auspices of the German Society for Digestive and Metabolic Diseases and replaces the guideline from 2008. With its evidence-based treatment recommendations, the guideline contains numerous updates and detailed definitions regarding the diagnosis and treatment of colon and rectal cancer. In particular, consensus-based recommendations regarding early detection, preoperative diagnostic method selection, and the use of interventional radiological treatment methods are detailed. The guideline also includes quality indicators so that standardized quality assurance methods can be used to optimize patient-related processes.The present article discusses the significance of the current recommendations for radiological diagnosis and treatment and is intended to enhance the quality of patient information and care by increasing distribution. PMID:23804154

Vogl, T J; Schmiegel, W; Pox, C; Pereira, P L; Brambs, H J; Lux, P; Fischer, S

2013-06-26

119

[Guideline conformity and outcome of inpatient treatment for schizophrenia. A clinical comparison].  

PubMed

Patient outcome and guideline conformity in inpatient schizophrenia treatment was systematically evaluated and compared with 597 patients across seven psychiatric hospitals. Patient structure and treatment processes showed a great variability between hospitals. Patient characteristics, especially mental state, and the chronicity of the disease were the strongest predictors of clinical outcome. Outcome evaluation using quality indicators is only possible after case-mix adjustment taking into account prognostic factors. A poorer average clinical outcome was associated with lower guideline conformity in a variety of treatment domains. After case-mix adjustment, benchmarking is an opportunity to improve quality of treatment and promote guideline conformity. PMID:15759161

Janssen, B; Weinmann, S; Berger, M; Härter, M; Held, T; Leipert, M; Luderer, H J; Schwarz, M; Steinert, T; Gaebel, W

2005-03-01

120

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

PubMed

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

Fernandes, Josicelia Dumêt; Rebouças, Lyra Calhau

2013-09-01

121

What to Know: ASCO's Guideline on Epoetin and Darbepoetin Treatment  

MedlinePLUS

... and darbepoetin are given as a series of injections (shots) and can reduce the need for red ... called clinical practice guidelines. Due to the rapid flow of scientific information in oncology, new evidence may ...

122

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

PubMed

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

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

2007-02-01

123

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

PubMed

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

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

124

Dutch nursing home policies and guidelines on physician-assisted death and decisions to forego treatment  

Microsoft Academic Search

Objective: The purpose of this study was to describe: (a) the prevalence and content of policies on euthanasia or assisted suicide (EAS) in three different types of nursing homes; (b) specific content items of written guidelines for EAS; and (c) the prevalence of guidelines on withholding or withdrawing treatment from severely demented patients and patients in a persistent vegetative state

I Haverkate; G van der Wal

1998-01-01

125

Quality of after-hours primary care in the Netherlands: adherence to national guidelines  

Microsoft Academic Search

ObjectiveTo assess the quality of after-hours clinical care as delivered by general practitioner (GP) cooperatives in the Netherlands.MethodsA cross-sectional analysis was undertaken of patient health records of five GP cooperatives during 1 year. We used quality indicators derived from national guidelines for the appropriate prescription of pain medication and antibiotics, clinical performance in emergency cases and referral to medical specialists.

Maartje Willekens; Paul Giesen; Erik Plat; Henk Mokkink; Jako Burgers; Richard Grol

2011-01-01

126

National Institutes of Health: Mixed waste minimization and treatment  

SciTech Connect

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.

NONE

1995-08-01

127

Treatment of depression in women: a summary of the expert consensus guidelines.  

PubMed

Women constitute two-thirds of patients suffering from common depressive disorders, making the treatment of depression in women a substantial public health concern. However, high-quality, empirical data on depressive disorders specific to women are limited, and there are no comprehensive evidence-based practice guidelines on the best treatments for these illnesses. To bridge the gap between research evidence and key clinical decisions, the authors developed a survey of expert opinion concerning treatment of four depressive conditions specific to women: premenstrual dysphoric disorder, depression in pregnancy, postpartum depression in a mother choosing to breast-feed, and depression related to perimenopause/menopause. The survey asked about 858 treatment options in 117 clinical situations and included a broad range of pharmacological, psychosocial, and alternative medicine approaches. The survey was sent to 40 national experts on women's mental health issues, 36 (90%) of whom completed it. The options, scored using a modified version of the RAND Corporation's 9-point scale for rating appropriateness of medical decisions, were assigned one of three categorical rankings-first line/preferred choice, second line/alternate choice, third line/usually inappropriate-based on the 95% confidence interval of each item's mean rating. The expert panel reached consensus (defined as a non-random distribution of scores by chi-square "goodness-of-fit" test) on 76% of the options, with greater consensus in situations involving severe symptoms. Guideline tables indicating preferred treatment strategies were then developed for key clinical situations. The authors summarize the expert consensus methodology they used and then, for each of the four key areas, review the treatment literature and summarize the experts' recommendations and how they relate to the research findings. For women with severe symptoms in each area we asked about, the first-line recommendation was antidepressant medication combined with other modalities (generally psychotherapy). These recommendations parallel existing guidelines for severe depression in general populations. For initial treatment of milder symptoms in each situation, the panel was less uniform in recommending antidepressants, and either gave equal endorsement to other treatment modalities (e.g., nutritional or psychobehavioral approaches in PMDD; hormone replacement in perimenopause) or preferred psychotherapy over medication (during conception, pregnancy, or lactation). In all milder cases, however, antidepressants were recommended as at least second-line options. Among antidepressants, selective serotonin reuptake inhibitors (SSRIs) were recommended as first-line treatment in all situations. The specific SSRIs that were preferred depended on the particular clinical situation. Tricyclic antidepressants were highly rated alternatives to SSRIs in pregnancy and lactation. In evaluating many of the treatment options, the experts had to extrapolate beyond controlled data in comparing treatment options with each other or in combination. Within the limits of expert opinion and with the expectation that future research data will take precedence, these guidelines provide some direction for addressing common clinical dilemmas in women, and can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions. PMID:15990522

Altshuler, L L; Cohen, L S; Moline, M L; Kahn, D A; Carpenter, D; Docherty, J P; Ross, R W

2001-05-01

128

1998 Guidelines for the Treatment of Sexually Transmitted Disease  

NSDL National Science Digital Library

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

1998-01-01

129

Risk profiles of prostate cancers identified from UK primary care using national referral guidelines  

PubMed Central

Objective: Prostate cancer in the United Kingdom is mainly diagnosed from primary care referrals based on national guidelines published by the Department of Health. Here we investigated the characteristics of cancers detected through the use of these guidelines. Methods: A prospective two-centre study was established to assess men referred from the primary care based on the UK national guidelines. Results: The overall cancer detection rate was 43% (169 out of 397) with 15% (26 out of 169) of all cancers metastatic at presentation. Amongst 50–69-year-old men these rates were 34% (68 out of 200) and 15% (10 out of 68). Only 21% (25 out of 123) of men with local cancers had low-risk disease. In comparison to a historical cohort from 2001 (n=137) we found no overall differences in rates of metastatic disease, locally advanced tumours, or risk categories. Amongst 50–69-year-old men with local disease, however, we observed an increase in detection of low-risk cancers in a contemporary cohort (P=0.04). This was primarily because of the increased detection of low-stage organ-confined tumours in this group (P=0.02). Conclusion: Use of the UK prostate cancer guidelines detects a high proportion of clinically significant cancers. Use of the guidelines does not seem to have led to an overall change in the clinical characteristics of presenting cancers. There may, however, be a specific benefit in detecting more low-risk disease in younger men.

Serag, H; Banerjee, S; Saeb-Parsy, K; Irving, S; Wright, K; Stearn, S; Doble, A; Gnanapragasam, V J

2012-01-01

130

The gap between guidelines and reality: Type 2 diabetes in a National Diabetes Register 1996-2003.  

PubMed

Guidelines for the treatment of risk factors in diabetes care have been updated recently, due to indisputable results from clinical end-point trials. This study evaluates risk factor control compared with current national and international targets during the period 1996-2003 in Type 2 diabetes (DM2). Patients were registered in primary-care and hospital outpatient clinics using computer software, or via the Internet. The clinical characteristics of the patients, treatment, HbA(1c), and risk factors were reported after screening by local methods. The numbers of cases of DM2 reported were 17547 in 1996 and 57119 in 2003. The mean HbA(1c) decreased from 7.8 to 7.2%, while blood pressure decreased from 150/82 to 143/78 mmHg during the same period. Longitudinal analysis of results was performed in 5356 patients repeatedly reported, showing slightly lower effects. The new European treatment targets of HbA(1c)< or = 6.1%, blood pressure < 130/80 mmHg and total cholesterol < 4.5 mmol/l were attained by 16, 13 and 28% of the patients in 2003, respectively. The prevalence of the metabolic syndrome in 2003 was 77%. Aspirin was prescribed in 36% of cases. Lipid-lowering, anti-hypertensive drugs, and treatment with oral hypoglycaemic agents in combination with insulin were increasingly employed during the period studied. Risk factor control in DM2 reported to the National Diabetes Register (NDR) is slowly improving, although multiple risk factors and the metabolic syndrome are found in most patients. The majority of subjects do not achieve current target levels for HbA(1c), blood pressure and blood lipids. Thus, giving up smoking and increased use of aspirin are called for, as well as more aggressive treatment of hyperglycaemia, elevated blood pressure and blood lipid levels, in accordance with updated international guidelines. PMID:16176206

Eliasson, B; Cederholm, J; Nilsson, P; Gudbjörnsdóttir, S

2005-10-01

131

Do general practitioners adhere to the guideline on infectious conjunctivitis? Results of the Second Dutch National Survey of General Practice  

Microsoft Academic Search

BACKGROUND: In 1996 the guideline 'The Red Eye' was first published by the Dutch College of General Practitioners. The extent to which general practitioners adhere to this guideline is unclear. Recently, data on the management of infectious conjunctivitis by general practitioners became available from the Second Dutch National Survey of General Practice. We measured the age-specific incidence of infectious conjunctivitis,

Remco P Rietveld; Gerben ter Riet; Patrick JE Bindels; François G Schellevis; Henk CPM van Weert

2007-01-01

132

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

ERIC Educational Resources Information Center

|The "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)" (hereafter abbreviated as the "Guideline"), 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…

Liansheng, Yuan

2012-01-01

133

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

ERIC Educational Resources Information Center

The "National Medium- and Long-Term Educational Reform and Development Guideline (2010-20)" (hereafter abbreviated as the "Guideline"), 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…

Liansheng, Yuan

2012-01-01

134

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

PubMed Central

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

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

2000-01-01

135

Retinopathy of prematurity: guidelines for screening and treatment  

Microsoft Academic Search

Following the report that severe retinopathy of prematurity (ROP) can be treated effectively, a working party of the Royal College of Ophthalmologists and the British Association of Perinatal Medicine was convened in 1990 to draw up guidelines for screening [1]. These have been revised by a reconvened working party (Appendix D) and the document expanded to include other relevant issues

1996-01-01

136

Towards a Clinical Practice Guideline Implementation for Asthma Treatment  

Microsoft Academic Search

There is a tremendous amount of effort involved in the definition of Clinical Practice Guidelines (CPG) by physicians. Because the quality of medical assistance is highly impacted by the use of CPG, and establishing their use is difficult, we consider necessary to develop an ef fective solution that implements CPG through Decision Support Systems (DSS). Among the many existing representation

Francisco Javier Sobrado; Juan Manuel Pikatza; Iker Unai Larburu; Diego López De Ipiña

2003-01-01

137

EAU Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Treatment of Clinically Localised Disease  

Microsoft Academic Search

ObjectiveOur aim was to present a summary of the 2010 version of the European Association of Urology (EAU) guidelines on the screening, diagnosis, and treatment of clinically localised cancer of the prostate (PCa).

Axel Heidenreich; Joaquim Bellmunt; Michel Bolla; Steven Joniau; Malcolm Mason; Vsevolod Matveev; Nicolas Mottet; Hans-Peter Schmid; Theo van der Kwast; Thomas Wiegel; Filliberto Zattoni

138

The role of self-treatment guidelines in self-management education for adult asthmatics  

Microsoft Academic Search

Guidelines on asthma management have changed considerably in the last two decades. Patient education has gained in popularity and especially asthma self-management training is thought to be essential in the treatment of adult asthma. Since 1989 many researchers have added self-treatment guidelines to self-management programmes and several studies have found improvements in health outcomes, such as lung function, quality of

J. van der Palen; J. J. Klein; G. A. Zielhuis; C. L. A. van Herwaarden

1998-01-01

139

Guidelines for the treatment of acidaemia with THAM.  

PubMed

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

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

140

65 FR 5359 - Extension of Public Comment Period on Draft National Institutes of Health Guidelines for Research...  

Federal Register 2010, 2011, 2012, 2013

...Research Involving Human Pluripotent Stem Cells (December 1999) The National Institutes...Research Involving Human Pluripotent Stem Cells (December 1999) for three weeks...Comments should be addressed to: Stem Cell Guidelines, NIH Office of...

2000-02-03

141

The current situation regarding the establishment of national ethical guidelines for biomedical research in Thailand and its neighboring countries.  

PubMed

This study discusses the establishment of ethical guidelines for ethical review for biomedical research performed in Thailand, and to some extent, in neighboring countries. There are differences, from country to country, at national and institutional levels regarding guidelines for ethical review committees. Only a handbook issued by Mahidol University describes guidelines for human genetic research and on research dealing with reproductive technology. Both these areas require special consideration to avoid violating human dignity, rights, and confidentiality. This indicates that further efforts should be made to establish research guidelines and/or principles dealing with the human genome. PMID:16124447

Kojima, Somei; Waikagul, Jitra; Rojekittikhun, Wichit; Keicho, Naoto

2005-05-01

142

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. Morbidity and Mortality Weekly Report, Vol. 58, No. RR-4, April 10, 2009.  

National Technical Information Service (NTIS)

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 1317 years), last published in 200...

2009-01-01

143

Evidence-based strategies for achieving treatment goals in bipolar disorder: A review and synthesis of contemporary treatment guidelines  

Microsoft Academic Search

The fundamental goals of treatment in bipolar disorder are full remission of acute mood episodes and prevention of future\\u000a episodes. Contemporary treatment guidelines recommend a number of intermediate goals to facilitate remission and maintenance\\u000a of bipolar disorder. These goals vary somewhat between guidelines, and the rationale behind them and strategies for achieving\\u000a them often receive little discussion. We therefore reviewed

Roy H. Perlis; Michael Ostacher; Heather M. Schloss

2003-01-01

144

Treatment of venous thromboembolism: guidelines translated for the clinician  

Microsoft Academic Search

Venous thromboembolism is a major cause of morbidity and mortality affecting over 2 million people in the United States each\\u000a year. The American College of Chest Physicians (ACCP) published their first consensus statement on antithrombotic therapy\\u000a in 1986, and the most recent guidelines from the ACCP on this topic were released in 2008. We aim to summarize the most recent

M. Houman Fekrazad; Renato D. Lopes; Gregg J. Stashenko; John H. Alexander; David Garcia

2009-01-01

145

World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects.  

PubMed

Abstract These updated guidelines are based on a first edition of the World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia published in 2006. For this 2012 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations that are clinically and scientifically meaningful. They are intended to be used by all physicians diagnosing and treating people suffering from schizophrenia. Based on the first version of these guidelines, a systematic review of the MEDLINE/PUBMED database and the Cochrane Library, in addition to data extraction from national treatment guidelines, has been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into six levels of evidence (A-F) and five levels of recommendation (1-5) ( Bandelow et al. 2008a ,b, World J Biol Psychiatry 9:242, see Table 1 ). This second part of the updated guidelines covers long-term treatment as well as the management of relevant side effects. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication and other pharmacological treatment options) of adults suffering from schizophrenia. PMID:23216388

Hasan, Alkomiet; Falkai, Peter; Wobrock, Thomas; Lieberman, Jeffrey; Glenthoj, Birte; Gattaz, Wagner F; Thibaut, Florence; Möller, Hans-Jürgen

2012-12-06

146

Treatment of Congestive Heart Failure Guidelines for the Primary Care Physician and the Heart Failure Specialist  

Microsoft Academic Search

uring the past 10 years, the philosophy of heart failure treatment has evolved from symptom control to a combined prevention and symptom-management strategy. Re- cent clinical trials have proved that early detection can delay progression. Treatment of asymptomatic left ventricular dysfunction is as important as treatment of symp- tomatic disease. The purpose of this review is to simplify recent guidelines

Mardi Gomberg-Maitland; David A. Baran; Valentin Fuster

2001-01-01

147

External beam radiation for retinoblastoma: Results, patterns of failure, and a proposal for treatment guidelines  

Microsoft Academic Search

Purpose: To analyze treatment results and patterns of failure following external beam radiation for retinoblastoma and propose treatment guidelines according to specific clinical variables.Methods and Materials: We analyzed 27 patients (34 eyes) with retinoblastoma who received external beam radiation as initial treatment at Hahnemann University Hospital from October 1980 to December 1991 and have been followed for at least 1

J. Carlos Hernandez; Luther W. Brady; Jerry A. Shields; Carol L. Shields; Patrick DePotter; Ulf L. Karlsson; Arnold M. Markoe; Beatriz E. Amendola; Arun Singh

1996-01-01

148

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

PubMed

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

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

2012-10-05

149

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

SciTech Connect

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.

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

1996-11-01

150

Comparison of the five 2011 guidelines for the treatment of carotid stenosis.  

PubMed

In 2011, five independent, international guideline committees reported their recommendations for the management of symptomatic and asymptomatic carotid artery stenosis. These included the American College of Cardiology/American Heart Association, the Society for Vascular Surgery, the European Society of Cardiology, the Australasian, and the UK National Institute of Health and Clinical Excellence. As the recommendations of these five guideline committees were based on the same published literature, it would be expected that they are similar, at least to a large extent. Surprisingly, there were considerable differences between the five guidelines regarding the management of both symptomatic and asymptomatic carotid patients. The differences in the recommendations between the five Guideline Committees are analyzed and discussed. PMID:22542347

Paraskevas, Kosmas I; Mikhailidis, Dimitri P; Veith, Frank J

2012-05-01

151

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

PubMed Central

Despite their rarity in incidence and prevalence, gastrointestinal stromal tumors (GISTs) have emerged as a distinct and noteworthy pathogenetic entity. The clinical management of GISTs has rapidly evolved due to the recent elucidation of their oncogenic signal transduction pathway and the introduction of molecular-targeted therapies. Successful management of GISTs requires a multidisciplinary approach firmly based on an accurate histopathologic diagnosis. In 2007, the Korean GIST study group published the first guideline for optimal diagnosis and treatment of GISTs in Korea. The second version of the guideline was published in 2010. Herein, we provide the results of relevant clinical studies for the purpose of further revision to the guideline. We expect this new guideline will enhance the accuracy of diagnosis, as performed by members of the Korean associate of physicians involved in GIST patient care, thus improving the efficacy of treatment.

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

2012-01-01

152

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

PubMed Central

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

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

153

Operational guidelines for assistance centers of the National Water Data Exchange  

USGS Publications Warehouse

The National Water Data Exchange (NAWDES) is a nationwide program managed by the U.S. Geological Survey to assist users of water data and water-related data in identifying, locating, and acquiring needed data. NAWDEX services are available through a program office located in the Geological Survey 's National Center in Reston, Va., and a network of assistance centers established in 45 States and in Puerto Rico to provide local and cnvenient access to NAWDEX facilities. This manual presents operational guidelines for the operation of these assistance centers to accomplish the expeditious flow of data from holder to user. These guildlines will be occasionally modified and supplemented to accomodate new concepts and techniques that may be needed. (USGS)

Edwards, Melvin D.; Thompson, Gerald L.

1980-01-01

154

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

ERIC Educational Resources Information Center

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

World Health Organization, Geneva (Switzerland).

155

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Personality Disorders  

Microsoft Academic Search

These practical guidelines for the biological treatment of personality disorders in primary care settings were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). They embody the results of a systematic review of all available clinical and scientific evidence pertaining to the biological treatment of three specific personality disorders, namely borderline, schizotypal and

Sabine C. Herpertz; Mary Zanarini; Charles S. Schulz; Larry Siever; Klaus Lieb; Hans-Jürgen Möller

2007-01-01

156

Advancing survivorship care through the National Cancer Survivorship Resource Center: developing American Cancer Society guidelines for primary care providers.  

PubMed

The National Cancer Survivorship Resource Center (The Survivorship Center) began in 2010 as a collaboration between the American Cancer Society and the George Washington University Cancer Institute and was funded by the Centers for Disease Control and Prevention. The Survivorship Center aims to improve the overall health and quality of life of posttreatment cancer survivors. One key to addressing the needs of this ever-growing population is to develop clinical follow-up care guidelines that emphasize not only the importance of surveillance for cancer recurrence, but also address the assessment and management of the physical and psychosocial long-term and late effects that may result from having cancer and undergoing cancer treatment as well as highlight the importance of healthy behaviors that can reduce the risk of cancer recurrence, second primary cancers, and other chronic diseases. Currently, The Survivorship Center is coordinating the work of experts in oncology, primary care, and other health care professions to develop follow-up care guidelines for 10 priority cancer sites. PMID:23512728

Cowens-Alvarado, Rebecca; Sharpe, Katherine; Pratt-Chapman, Mandi; Willis, Anne; Gansler, Ted; Ganz, Patricia A; Edge, Stephen B; McCabe, Mary S; Stein, Kevin

2013-03-19

157

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

PubMed

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

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

2012-10-03

158

Development of sexually transmitted diseases treatment guidelines, 1993. New methods, recommendations, and research priorities. STD Treatment Guidelines Project Team and Consultants.  

PubMed

To develop the 1993 Sexually Transmitted Diseases Treatment Guidelines, experts from the Centers for Disease Control and Prevention reviewed the literature on sexually transmitted disease treatment, assembled tables of evidence, and listed key questions on therapeutic outcome: microbiologic cure, alleviation of symptoms, and prevention of sequelae and transmission. At a meeting with external experts, evidence was systematically assessed and guidelines developed. Quality of evidence for microbiologic cure was generally good for gonorrhea and chlamydia, poor for syphilis, and fair for most other diseases. Evidence on preventing sequelae and transmission was limited. The Guidelines include new recommendations for single-dose oral therapy of gonorrhea (cefixime, ciprofloxacin, and ofloxacin), chlamydia (azithromycin), and chancroid (azithromycin); outpatient therapy of pelvic inflammatory disease (ofloxacin and either clindamycin or metronidazole); and patient-applied therapy of genital warts (podofilox). Syphilis therapy did not change substantially. Several global issues that emerged during the development of the World Health Organization Recommendations for the Management of Sexually Transmitted Diseases also are discussed. This evidence-based approach clarified important treatment issues and the rationale for recommendations, and identified research priorities. PMID:8042129

Levine, W C; Berg, A O; Johnson, R E; Rolfs, R T; Stone, K M; Hook, E W; Handsfield, H H; Holmes, K K; Islam, M Q; Piot, P

159

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

Microsoft Academic Search

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

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

1996-01-01

160

Commentary: Treatment Guidelines for Child and Adolescent Bipolar Disorder  

ERIC Educational Resources Information Center

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

McClellan, Jon

2005-01-01

161

Commentary: Treatment Guidelines for Child and Adolescent Bipolar Disorder  

ERIC Educational Resources Information Center

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

McClellan, Jon

2005-01-01

162

Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment  

ERIC Educational Resources Information Center

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

Choate, Laura H.; Gintner, Gary G.

2011-01-01

163

Review of treatment guidelines for community-acquired pneumonia  

Microsoft Academic Search

Community-acquired pneumonia (CAP) is a costly disease that is associated with significant morbidity and mortality. The growing prevalence of this disease has resulted in various advances in diagnosis and treatment. The most common pathogens of CAP include Streptococcus pneumoniae, Haemophilus influenzae, and atypical pathogens; however, the underlying pathogen often is unknown. Treatment of CAP has evolved because of changing etiologic

Michael S Niederman

2004-01-01

164

Dietary treatments for epilepsy: Management guidelines for the general practitioner  

Microsoft Academic Search

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

Paul R. Lee; Eric H. Kossoff

2011-01-01

165

Use of the Delphi Technique for developing national clinical guidelines for prescription of lower-limb prostheses.  

PubMed

The aim of this project was the development of evidence- and consensus-based clinical practice guidelines for lower-limb prosthesis prescription for achieving transparency and consensus among clinicians, manufacturers, and insurance companies. This article describes a modified Delphi Technique, which is based on different methods of collecting evidence, and its role in the development of national clinical guidelines for prosthesis prescription. We used a multimethod approach to develop guidelines for the clinical practice of prosthesis prescription for lower-limb amputees. The Delphi Technique was central in the process, and the panel was made up of experts from three key disciplines on a national level. Our approach involved various methods: a systematic review, a survey of national clinical practice on prosthesis prescription, and interviews with experts. These activities resulted in 45 postulates about prosthesis prescription. The views of the national expert panel were then presented at a consensus development conference. The participants in the Delphi Technique sessions reached a consensus on 37 of the postulates on prosthesis prescription for lower-limb amputees. The postulates were categorized according to amputation level and partitioned into different domains. The total process resulted in the development of draft clinical guidelines comprising guidance for prescribing prostheses for the lower limb. The scope and applicability of these guidelines will have to be measured and evaluated in future work. PMID:16586195

van der Linde, Harmen; Hofstad, Cheriel J; van Limbeek, Jacques; Postema, Klaas; Geertzen, Jan H B

166

First update of the Lebanese guidelines for osteoporosis assessment and treatment.  

PubMed

With the ageing of the population worldwide, the human, social and economic costs of osteoporosis will continue to rise. It is estimated that the magnitude of the problem is larger in developing countries, including those in the Middle East. In April 2002, a multidisciplinary panel of experts met and discussed practice guidelines for osteoporosis assessment and treatment in Lebanon: "Who to test, what measures to use, and when to treat ?" They were subsequently endorsed by the Lebanese scientific societies of Endocrinology, Rheumatology, Orthopedics, Obstetrics & Gynecology, Radiology and by the Eastern Mediterranean Regional Office (EMRO), branch of the World Health Organization (WHO). In April 2006, the Guidelines Committee and the Lebanese Society for Osteoporosis and Metabolic Bone Disorders (OSTEOS) led an initiative to update several recommendations detailed in the original guidelines document, based on relevant new local and international data. Revisited guidelines included recommendations regarding the normative database to be used, the specific skeletal sites to be evaluated, recommendations in men and recommendations in premenopausal women. The experts also sought an evaluation of the relevance of the specific risk factors, used in the WHO fracture risk assessment model, to fracture risk assessment in the Lebanese. The purpose of the update of the guidelines was to reevaluate the rationale for the recommendations using further evidence when available and to position the Lebanese Osteoporosis Guidelines in relation to the WHO initiative for global fracture risk assessment. PMID:18782973

Fuleihan, Ghada El-Hajj; Baddoura, Rafic; Awada, Hassane; Okais, Asma Arabi

167

[Prevention of ventilator-associated pneumonia: review of national and international guidelines].  

PubMed

Both in the USA and in Europe the most frequent hospital-acquired infection in intensive care units is the ventilator-associated pneumonia. Particularly, patients with artificial respiration are at risk. Their risk to acquire a nosocomial pneumonia is six to twenty-one times higher than for patients breathing without artificial help. Established risk factors are, amongst others, old age, tracheotomy or reintubation, defective immune functions, already existing pulmonary infections and lifestyle-dependent factors like smoking. Recent scientific results indicate that endogenous infections are the most important reason for the development of a ventilator-associated pneumonia. Infections are initiated by microaspiration of bacteria from the oropharynx. Bacterial colonisation of the mouth is often favoured by an increased gastric pH-value, a secondary effect of the accompanying medicinal therapy. On a national as well as an international level there are evidence-based guidelines for the prevention of ventilator-associated pneumonia available. A comparison of guidelines of the US-American "Centers for Disease Control and Prevention" (CDC) with those of the German "Robert Koch-Institut" reveals deviating recommendations. Differences concern especially the changing of respiratory tubes, the use of filters and of closed humidifying systems. Additionally there are not yet recommendations for every aspect of infection prevention. However, recent studies show that regular surveillance of infections, further training of staff members and critically considering the invasive use of medical devices are able to reduce the rate of nosocomial infections and especially ventilator-associated pneumonia. PMID:16955599

Panknin, Hardy-Thorsten

2006-08-01

168

Audit to monitor the uptake of national mouth care guidelines for children and young people being treated for cancer  

Microsoft Academic Search

Purpose  The aim of this study is to review current oral care practices in children being treated for cancer against audit criteria\\u000a derived from national guidelines, and to compare findings with data from a baseline survey carried out in 2002 prior to implementation\\u000a of the national guidelines.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A telephone survey was carried out of all 21 haematology–oncology (HO) centres and seven

Jean V. Craig; Faith Gibson; Anne-Marie Glenny

2011-01-01

169

Physician Peer Assessments for Compliance with Methadone Maintenance Treatment Guidelines  

ERIC Educational Resources Information Center

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

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

2007-01-01

170

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

PubMed Central

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

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

2012-01-01

171

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

PubMed Central

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

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

2012-01-01

172

Update on pharmacotherapy guidelines for treatment of neuropathic pain  

Microsoft Academic Search

Neuropathic pain encompasses a myriad of painful disease states that are often hard to treat, especially with one single medication.\\u000a In the comprehensive treatment of neuropathic pain, the concept of complex polypharmacy is a rational approach, accompanied\\u000a by physical and mental health therapies. Medications primarily used for neuropathic pain generally fall into the categories\\u000a of anticonvulsants, antidepressants, opioids, and topical

J. Mark Wallace; George E. Whalen; Mark Wallace

2007-01-01

173

Medical and Surgical Treatment of Parapneumonic Effusions* An Evidence-Based Guideline  

Microsoft Academic Search

Objective: A panel was convened by the Health and Science Policy Committee of the American College of Chest Physicians to develop a clinical practice guideline on the medical and surgical treatment of parapneumonic effusions (PPE) using evidence-based methods. Options and outcomes considered: Based on consensus of clinical opinion, the expert panel developed an annotated table for evaluating the risk for

Gene L. Colice; Anne Curtis; Jean Deslauriers; John Heffner; Richard Light; Benjamin Littenberg; Steven Sahn; Robert A. Weinstein; Roger D. Yusen

174

First Update of the Lebanese Guidelines for Osteoporosis Assessment and Treatment  

Microsoft Academic Search

With the demographic explosion, the human, social, and economic costs of osteoporosis in developing countries, including the Middle East, will continue to rise. In 2002, the Lebanese Guidelines for Osteoporosis Assessment and Treatment were developed to optimize quality of osteoporosis care in Lebanon and the region. They were endorsed by 5 Lebanese medical scientific societies, and by the Eastern Mediterranean

Ghada El-Hajj Fuleihan; Rafic Baddoura; Hassane Awada; Asma Arabi; Jad Okais

2008-01-01

175

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

PubMed

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

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

2007-05-12

176

Best Practices for Mental Health in Child Welfare: Screening, Assessment, and Treatment Guidelines  

ERIC Educational Resources Information Center

|The Best Practices for Mental Health in Child Welfare Consensus Conference focused on developing guidelines in five key areas (screening and assessment, psychosocial interventions, psychopharmacologic treatment, parent engagement, and youth empowerment) related to children's mental health. This paper provides an overview of issues related to the…

Romanelli, Lisa Hunter; Landsverk, John; Levitt, Jessica Mass; Leslie, Laurel K.; Hurley, Maia M.; Bellonci, Christopher; Gries, Leonard T.; Pecora, Peter J.; Jensen, Peter S.

2009-01-01

177

A Dutch guideline for the treatment of scoliosis in neuromuscular disorders  

PubMed Central

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.

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

178

Formalization of treatment guidelines using Fuzzy Cognitive Maps and semantic web tools  

Microsoft Academic Search

Therapy decision making and support in medicine deals with uncertainty and needs to take into account the patient’s clinical parameters, the context of illness and the medical knowledge of the physician and guidelines to recommend a treatment therapy. This research study is focused on the formalization of medical knowledge using a cognitive process, called Fuzzy Cognitive Maps (FCMs) and semantic

Elpiniki I. Papageorgiou; Jos De Roo; Csaba Huszka; Dirk Colaert

179

EACTS\\/ESCVS best practice guidelines for reporting treatment results in the thoracic aorta  

Microsoft Academic Search

Summary Endovascular treatment of the thoracic aorta (TEVAR) is rapidly expanding, with new devices and techniques, combined with classical surgical approachesin hybridprocedures.Thepresentguidelinesprovidea standardformatfor reporting resultsoftreatmentinthe thoracicaorta, andto facilitate analysis of clinical results in various therapeutic approaches. These guidelines specify the essential information and definitions, which should be provided in each article about TEVAR: Definitions of disease conditions Extent of the

Marko Ivan Turina; Hani Shennib; Joel Dunning; Davy Cheng; Janet Martin; Claudio Muneretto; Stephan Schueler; Ludwig von Segesser; Paul T. Sergeant

2010-01-01

180

Diretrizes para a prevenção, diagnóstico e tratamento da hiperidrose compensatória* Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis  

Microsoft Academic Search

With the objective of establishing guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis, consensus meetings were held. Attendees included a general surgeon and thoracic surgeons affiliated with the Brazilian Society of Thoracic Surgery. The topics addressed were those that would ostensibly broaden multidisciplinary knowledge. Based on recent guidelines for the prevention, diagnosis and (clinical and surgical) treatment of

Roberto de Menezes Lyra; José Ribas; Milanez de Campos; Davi Wen; Wei Kang; Marcelo de Paula Loureiro; Marcos Bessa Furian; Mário Gesteira Costa; Marlos de Souza Coelho

2008-01-01

181

Rise, Development and Changing Conceptions of Curriculum Administration and Curriculum Guidelines in Norway: The National-Local Dilemma.  

ERIC Educational Resources Information Center

|The current move toward decentralized curriculum work throughout the western world marks a reversal of a historical trend: the gradual shifting from local to national control. In Norway, this trend is manifested by the emergence of changing conceptions of curriculum work, curriculum administration, and the nature of curriculum guidelines as…

Gundem, Bjorg B.

182

[Research and analysis to Shui nationality medicine treatment orthopedics & traumatology].  

PubMed

To investigated Shui nationality folk medicine's awareness to orthopedics & traumatology, the history of orthopedics & traumatology treatment, Shui nationality folk doctors' practicing medicine, heritage, diagnosis and treatment methods and tools, etc, through investigated drug resources category and distribution characteristics of Shui nationality medicine to orthopedics & traumatology treatment, explored and finished Shui nationality medicine orthopedics & traumatology treatment theoretical system. After more than 5 years' exploration and finishing, preliminarily formed the theoretical system framework and medicine application characteristics of Shui nationality medicine treating orthopedics & traumatology. Shui nationality medicine treatment orthopedics & traumatology has distinctive national style, and worthy to further exploration and research. PMID:23947150

Hu, Jian-Shan; Li, Pu; Yang, Yong; Chen, Xin-Chun; Lin, Li

2013-05-01

183

Water Pollution: EPA Has Improved Its Review of Effluent Guidelines but Could Benefit from More Information on Treatment Technologies.  

National Technical Information Service (NTIS)

The Environmental Protection Agency (EPA) uses a two-phase process to identify industrial categories potentially needing new or revised effluent guidelines to help reduce their pollutant discharges. EPAs 2002 draft Strategy for National Clean Water Indust...

2012-01-01

184

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

SciTech Connect

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.

Wheeler, W.

1998-12-01

185

Implementation of Unclassified Controlled Nuclear Information guidelines for fixed-site safeguards and security (FSSS) at Los Alamos National Laboratory  

SciTech Connect

Unclassified Controlled Nuclear Information (UCNI) is one type of sensitive information that DOE employees, including computer users, must now identify and protect. Guidelines to identify information as UCNI are gradually being put in place. The publication of Unclassified Controlled Nuclear Information Topical Guideline for Fixed-Site Safeguards and Security, TG-FSSS-1, is a major step in the development of UCNI guidelines. This DOE published guide cuts across and addresses many different programmatic areas including automated data processing. Our local guideline, Los Alamos National Laboratory Unclassified Controlled Nuclear Information Guideline for Fixed-Site Safeguards and Security, IG-LAFSSS-1, is based on TG-FSSS-1. In this paper, I plan to discuss the background of UCNI, the definition of UCNI, information that qualifies as UCNI, the consequences of information being UCNI, the development of UCNI guidelines, TG-FSSS-1 and IG-LAFSSS-1, the relationship of UCNI to classification, and the implementation of the IG-LAFSSS-1 at Los Alamos.

Rood, P.L.

1995-02-01

186

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 2: Long-term treatment of schizophrenia  

Microsoft Academic Search

These guidelines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically

Peter Falkai; Thomas Wobrock; Jeffrey Lieberman; Birte Glenthoj; Wagner F. Gattaz; Hans-Jürgen Möller

2006-01-01

187

Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis.  

PubMed

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents. Immunomodulatory drugs are used frequently in its treatment. Using the nominal group technique (NGT) and Delphi method, we created a multidisciplinary, evidence- and consensus-based treatment guideline for JIA based on a systematic literature analysis and three consensus conferences. Conferences were headed by a professional moderator and were attended by representatives who had been nominated by their scientific societies or organizations. 15 statements regarding drug therapy, symptomatic and surgical management were generated. It is recommended that initially JIA is treated with NSAID followed by local glucocorticoids and/or methotrexate if unresponsive. Complementing literature evidence with long-standing experience of caregivers allows creating guidelines that may potentially improve the quality of care for children and adolescents with JIA. PMID:22154868

Dueckers, Gregor; Guellac, Nihal; Arbogast, Martin; Dannecker, Guenther; Foeldvari, Ivan; Frosch, Michael; Ganser, Gerd; Heiligenhaus, Arnd; Horneff, Gerd; Illhardt, Arnold; Kopp, Ina; Krauspe, Ruediger; Markus, Barbara; Michels, Hartmut; Schneider, Matthias; Singendonk, Wolfram; Sitter, Helmut; Spamer, Marianne; Wagner, Norbert; Niehues, Tim

2011-10-26

188

National committee on radiation protection, 1928-1960: from professional guidelines to government regulation  

SciTech Connect

The National Committee on Radiation Protection is a private, self-perpetuating body of radiation experts founded in 1928 which, except during World War II, has established the basic guidelines for radiation safety in the United States. This dissertation examines three themes in its history from 1928 to 1960. On an intellectual level, how do scientists make judgments when called upon to perform a legal function, instead of conduct research. On an institutional level, how does a scientific committee develop when it serves a medical, industrial, and legal constituency larger than the research community of the scientist themselves. On a political level, how has the development of atomic energy influenced both the intellectual content of the radiation safety standards and the institutional form of the NCRP. Institutional and political concerns were found to play a significant role in the NCRP's intellectual work from 1928 to 1960. The time span can be divided into three periods, revealing a growing politicization of radiation safety: professional self-regulation (1928-1941), government advisory committee (1946-1954), and public controversy and increasing legislation (1954-1960). In 1959, political controversy led to the establishment of the Federal Radiation Council, a government agency which was to replace the NCRP.

Whittemore, G.F.

1986-01-01

189

Provision of investigational drug after clinical research: review of literature, national and international guidelines.  

PubMed

The post-trial access to investigational drugs has been the object of discussion since the late 1980s at least, initially linked to trials carried out in acquired immunodeficiency syndrome and, particularly, in developing countries, where the concern with patient vulnerability is more important. National and international guidelines do mention the subject; however, the complexity of the issue is not easily addressed and usually requires additional and specific discussions. The decision on providing the investigational drug after the trial shall rest on at least two dimensions: efficacy and safety assessments, as the new drug is still on the experimental phase. Each clinical trial shall have its own assessment, taking into account the disease being studied, as well as the study population and their specific needs. Therefore, the nature of post-trial obligations cannot be considered the same in all situations and contexts; nevertheless, it should be assured that the relationship developed between investigators and patients during the study must be always terminated with respect and responsibility. PMID:22249554

Dainesi, Sonia Mansoldo; Goldbaum, Moisés

190

Fabry disease practice guidelines: recommendations of the national society of genetic counselors.  

PubMed

Identification and comprehensive care of individuals who have Fabry disease (FD) requires a multidisciplinary approach inclusive of genetic testing, test interpretation, genetic counseling, long term disease symptom monitoring, treatment recommendations, and coordination of therapy. The purpose of this document is to provide health care professionals with guidelines for testing, care coordination, identification of psychosocial issues, and to facilitate a better understanding of disease treatment expert recommendations for patients with Fabry disease. These recommendations are the opinions of a multicenter working group of genetic counselors, medical geneticists, and other health professionals with expertise in Fabry disease counseling, as well as representatives/founders of the two United States based Fabry disease patient advocacy groups who are themselves affected by Fabry disease. The recommendations are U.S. Preventive Task Force Class III, and they are based on clinical experience, a review of pertinent English-language articles, and reports of expert committees. This document reviews the genetics of Fabry disease, the indications for genetic testing, interpretation of results, psychosocial considerations, and references to professional and patient resources. PMID:23860966

Laney, Dawn A; Bennett, Robin L; Clarke, Virginia; Fox, Angela; Hopkin, Robert J; Johnson, Jack; O'Rourke, Erin; Sims, Katherine; Walter, Gerald

2013-07-17

191

The National Emphysema Treatment Trial (NETT)  

PubMed Central

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.

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

2011-01-01

192

Home treatment for Fabry disease: practice guidelines based on 3 years experience in The Netherlands  

Microsoft Academic Search

Introduction. Recently, chronic supplementation with a-galactosidase A (aGal A) has been approved as a treatment modality for Fabry disease. The aim of the current study was to investigate the feasibility of home therapy for Fabry disease during a follow-up of >3 years and to make a proposal for practice guidelines. Methods. Based on experience in previous clinical trials, an algorithm

Gabor E. Linthorst; Anouk C. Vedder; Els E. Ormel; Johannes M. F. G. Aerts; Carla E. M. Hollak

2006-01-01

194

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

PubMed

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

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

2011-04-01

195

Use of Medicines and Adherence to Standard Treatment Guidelines in Rural Community Health Centers, Timor-Leste.  

PubMed

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

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

2012-05-01

196

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

PubMed Central

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

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

2005-01-01

197

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

ERIC Educational Resources Information Center

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…

Acoustical Society of America, Melville, New York.

198

Social Aspects and Communication Regarding Alcohol and Health via National Drinking Guidelines  

Microsoft Academic Search

This paper looks at definitions of ‘drinks’ and ‘low risk’ or responsible drinking guidelines from different countries and how to balance a message—based on the Canadian, UK, WHO and US guidelines—that accepts that drinking in moderation can form part of a healthy diet and lifestyle. It should be noted that commercial communications regarding the benefits of moderate consumption are banned

Helena Conibear

2011-01-01

199

Regional variation and adherence to guidelines for drug treatment of asthma  

Microsoft Academic Search

Aims  To describe the utilization of antiasthmatic drugs in Sweden and to explore regional variations in drug utilization and adherence\\u000a to guidelines for rational drug prescribing of antiasthmatics and their rationale.\\u000a \\u000a \\u000a \\u000a Methods  Data on antiasthmatic drugs dispensed between July 2005 and December 2008 to all Swedish citizens aged between 18 and 44 years\\u000a were obtained from the Swedish National Prescribed Drug Register. The

Marianne Heibert Arnlind; Björn Wettermark; Mika Nokela; Paul Hjemdahl; Clas Rehnberg; Eva Wikström Jonsson

2010-01-01

200

Quality improvement guidelines for imaging detection and treatment of endoleaks following endovascular aneurysm repair (EVAR).  

PubMed

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. PMID:22833173

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

2012-07-26

201

[Treatment of primary urethral carcinoma. Guidelines from the French Urological Association. Cancer committee].  

PubMed

The litterature dealing with the treatment of primary uretral carcinoma is very limited. Most of it is based on small series, case report or expert opinions. These guidelines are level IV. The treatment modality is mainly based on the lesion topography and not on the histology. For anterior T1 or 2 lesions, surgery is the most often used modality. In women, radiotherapy might be an attractive option. For more advanced lesions, the combination of radiotherapy and chemotherapy is the standard of care. The optimal protocol remains to be defined. Intradiverticular lesions in women are mainly adenocarcimoma. Surgery only is often inadequate. PMID:19268254

Iborra, F; Rigaud, J; Bastide, C; Mottet, N

2009-02-10

202

Osteoporosis guidelines.  

PubMed

The Position Statement from the International Menopause Society (IMS) in 2004 recommends the use of hormone therapy for the 'avoidance of bone-wasting and fractures'. It also states that 'prevention, not treatment, is the most feasible goal'. In updating the Statement, this paper considers the relevance of Osteoporosis Guidelines. Relevant documents will be of two broad types. These may be consensus statements/position statements that summarize the 'state of the art' for practitioners, based on the work of expert groups, or they may be formal Guidelines generated through formal 'evidence-based' methodology. The former approach is generally used by Societies and can be generated through relatively efficient consensus processes. The latter approach will normally involve extensive work and cost, necessarily becomes very detailed, involving systematic review and technology appraisal and can lead to highly specific recommendations on intervention thresholds. For the revision of the general IMS Position Statement, the specific IMS Paper on Postmenopausal Osteoporosis (2005) must be a key reference document. This provides a description of the international consensus on the management of osteoporosis up to late 2004 and which remains relevant today. Additionally, other consensus statements and systematic guidelines need to be considered. Across these documents providing guidance, the substantial influence of the International Osteoporosis Foundation/National Osteoporosis Foundation Position Paper, defining a 'New approach to the development of assessment guidelines for osteoporosis', can be seen. This flagged the importance of a shift from guidance, tying the diagnostic threshold to the intervention threshold, and instead advised linking the intervention threshold to estimated fracture risk probability. This moves the intervention decision away from a simple bone density threshold to a more complex, but more realistic, threshold estimate, taking into account a range of important clinical risk factors and bone mineral density. This thinking is reflected in the IMS Paper on Postmenopausal Osteoporosis (2005). PMID:17882679

Barlow, D H

2007-10-01

203

Guidelines for the treatment of Alzheimer's disease from the Italian Association of Psychogeriatrics.  

PubMed

A committee of experts from the Italian Association of Psychogeriatrics compiled the following report, which was then approved by a Steering Committee (comprising 20 specialists in neurology, psychiatry or geriatrics) from the Association and by two Alzheimer associations representing patients and families: the Italian Association for Alzheimer's Disease and the Italian Federation for Alzheimer's Disease. The report is based on a comprehensive review of the scientific literature on the treatment of Alzheimer's disease, discusses methodological aspects of dementia management, and details the limitations of current therapies. These guidelines are, in general, consistent with the principles of evidence-based medicine; however, for some controversial or poorly investigated issues, the guidelines integrate scientific evidence with experience and opinions from experts working in the clinical setting. In particular, the clinical experience of experts has been used to define recommendations for starting and interrupting pharmacotherapy, and to critically review evidence about the efficacy of non-pharmacological interventions. The principal pharmacotherapeutic interventions covered in the guidelines are acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine, and tacrine) and memantine. The main non-pharmacological interventions reviewed are memory training, reality orientation therapy, and combined non-pharmacological interventions. Other issues covered are opportunities for Alzheimer's disease prevention, various modalities of care, and the treatment of comorbidities. PMID:16506439

Caltagirone, Carlo; Bianchetti, Angelo; Di Luca, Monica; Mecocci, Patrizia; Padovani, Alessandro; Pirfo, Elvezio; Scapicchio, Pierluigi; Senin, Umberto; Trabucchi, Marco; Musicco, Massimo

2005-01-01

204

Adequacy of reporting monitoring regimens of risk factors for cardiovascular disease in clinical guidelines: systematic review  

Microsoft Academic Search

Objective To assess the reporting of monitoring recommendations in guidelines on the prevention and treatment of cardiovascular disease.Data sources Medline, Trip database, National Guideline Clearinghouse, and databases containing guidelines published from January 2002 to February 2010.Data selection Three major risk factors for cardiovascular disease: cholesterol level, smoking, and hypertension. The primary outcome was the frequency with which the guidelines dealt

Ivan Moschetti; Daniel Brandt; Rafael Perera; M Clarke; Carl Heneghan

2011-01-01

205

European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment.  

PubMed

To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce. PMID:21445724

Roessner, Veit; Plessen, Kerstin J; Rothenberger, Aribert; Ludolph, Andrea G; Rizzo, Renata; Skov, Liselotte; Strand, Gerd; Stern, Jeremy S; Termine, Cristiano; Hoekstra, Pieter J

2011-04-01

206

Guideline adherence and patient satisfaction in the treatment of inflammatory bowel disorders - an evaluation study  

PubMed Central

Background Crohn's disease (CD) and ulcerative colitis (UC) are the most frequent inflammatory bowel disorders (IBD). IBD cause a significant burden to society due to extensive health care utilization from the first clinical symptoms until diagnosis and thereafter due to direct and indirect costs. Besides the socio-economic impact of CD and UC, gastrointestinal and extraintestinal symptoms affect quality of life, but there is remarkably little data about the quality of treatment as assessed by patient satisfaction, quality of life and adherence to guidelines. Thus the aim of this study was to identify variables that influence quality of treatment and quality of life as well as patient satisfaction. Methods The Essener Zirkel Study was a cross sectional study of 86 IBD-patients with a confirmed diagnosis of CD or UC. They were recruited at primary, secondary and tertiary care settings. Quality of treatment, quality of life and patient satisfaction were evaluated. Consulting behaviour and number of examinations, duration of disease and variables regarding adherence to guidelines were evaluated, too. Results 59 (69%) patients had CD and 27 had UC (31%). 19% spent more than four years until the suspected diagnosis of IBD was confirmed and visited more than five physicians. All patients showed a significantly reduced quality of life compared to the 1998 German normative population. In spite of being under medical treatment, nearly half of the patients suffered from strong quality of life restricting symptoms. Over all, 35% described their treatment as moderate or bad. Patients who consulted psychotherapists and non-medical practitioners suffered significantly less from depression. Conclusion Besides structural deficiencies due to the health care policy, we revealed the adherence to guidelines to be a problem area. Our findings support the assumption, that providing better health care and especially maintaining constant patient-physician communication improves patient satisfaction.

Pieper, Claudia; Haag, Sebastian; Gesenhues, Stefan; Holtmann, Gerald; Gerken, Guido; Jockel, Karl-Heinz

2009-01-01

207

Japanese pediatric guidelines for the treatment and management of bronchial asthma 2008.  

PubMed

Abstract The fourth version of the Japanese Pediatric Guidelines for the Treatment and Management of Bronchial Asthma 2008 (JPGL 2008) was published by the Japanese Society of Pediatric Allergy and Clinical Immunology in December 2008. In JPGL 2008, the recommendations were revised on the basis of the JPGL 2005. The JPGL 2008 is different to the Global Initiative for Asthma guideline in that it contains the following items: a classification system of asthma severity; recommendations for long-term management organized by age; a special mention of infantile asthma; and an emphasis on prevention and early intervention. Here we show a summary of the JPGL 2008 revising our previous report concerning JPGL 2005. PMID:19968817

Kondo, Naomi; Nishimuta, Toshiyuki; Nishima, Sankei; Morikawa, Akihiro; Aihara, Yukoh; Akasaka, Toru; Akasawa, Akira; Adachi, Yuichi; Arakawa, Hirokazu; Ikarashi, Takao; Ikebe, Toshiichi; Inoue, Toshishige; Iwata, Tsutomu; Urisu, Atsuo; Ebisawa, Motohiro; Ohya, Yukihiro; Okada, Kenji; Odajima, Hiroshi; Katsunuma, Toshio; Kameda, Makoto; Kurihara, Kazuyuki; Kohno, Yoichi; Sakamoto, Tatsuo; Shimojo, Naoki; Suehiro, Yutaka; Tokuyama, Kenichi; Nambu, Mitsuhiko; Hamasaki, Yuhei; Fujisawa, Takao; Matsui, Takehiko; Matsubara, Tomoyo; Mayumi, Mitsufumi; Mukoyama, Tokuko; Mochizuki, Hiroyuki; Yamaguchi, Koichi; Yoshihara, Shigemi

2009-11-24

208

Quality Control Guidelines for National Committee for Clinical Laboratory Standards Recommended Broth Macrodilution Testing of Amphotericin B, Fluconazole, and Flucytosine  

Microsoft Academic Search

Amphotericin B, fluconazole, and flucytosine (5FC) were tested in a multilaboratory study to establish quality control (QC) guidelines for yeast antifungal susceptibility testing. Ten candidate QC strains were testedinaccordancewithNationalCommitteeforClinicalLaboratoryStandardsM27-Pguidelinesagainstthe three antifungal agents in each of six laboratories. Each laboratory was assigned a unique lot of RPMI 1640 broth medium as well as a lot of RPMI 1640 common to all

M. A. PFALLER; M. BALE; B. BUSCHELMAN; M. LANCASTER; A. ESPINEL-INGROFF; J. H. REX; M. G. RINALDI; C. R. COOPER; R. MCGINNIS

1995-01-01

209

Behavioural effect of self-treatment guidelines in a self-management program for adults with asthma  

Microsoft Academic Search

To assess the efficacy of self-management programs it is important to know what behavioural changes take place. This paper assesses whether including self-treatment guidelines (action plans) in a self-management program for adult asthmatics, leads to greater behavioural changes than a program without these guidelines. Patients were randomised into a self-treatment group (n=123) or an active control group (n=122). All subjects

Job van der Palen; Jakob J. Klein; Gerhard A. Zielhuis; Cees L. A van Herwaarden; Erwin R. Seydel

2001-01-01

210

Grounding Guidelines: Practical Examples for Power Systems at LLNL (Lawrence Livermore National Laboratory).  

National Technical Information Service (NTIS)

Guidelines are given for equipment grounds to protect personnel and equipment from electrical hazards. The importance of equipment grounding to safety is briefly described. Several electrical grounding schemes are described and recommended for utility pow...

B. Jensen R. Epps

1983-01-01

211

Guideline: American National Dictionary for Information Processing Systems. Category: Software. Subcategory: Documentation.  

National Technical Information Service (NTIS)

This publication adopts X3TR-1-82 as a FIPS Guideline. It provides a common reference within the Federal Government for terms and definitions used in such information processing activities as the representation, communication, interpretation and processin...

J. L. Walkowicz

1982-01-01

212

64 FR 67576 - Draft National Institutes of Health Guidelines for Research Involving Human Pluripotent Stem...  

Federal Register 2010, 2011, 2012, 2013

...Research Involving Human Pluripotent Stem Cells (December 1999...Research Involving Human Pluripotent Stem Cells (December 1999).'' The purpose...research using human pluripotent stem cells until final guidelines are...

1999-12-02

213

66 FR 57107 - National Institutes of Health Guidelines for Research Using Human Pluripotent Stem Cells  

Federal Register 2010, 2011, 2012, 2013

...Research Using Human Pluripotent Stem Cells ACTION: Notice; withdrawal of NIH...Guidelines for Research Using Pluripotent Stem Cells Derived from Human Embryos (published...Research Using Human Pluripotent Stem Cells,...

2001-11-14

214

65 FR 69951 - National Institutes of Health Guidelines for Research Using Human Pluripotent Stem Cells; Correction  

Federal Register 2010, 2011, 2012, 2013

...Research Using Human Pluripotent Stem Cells; Correction ACTION: Notice; correction...Research Using Human Pluripotent Stem Cells (65 FR 51976). The final Guidelines...notice, are available on the NIH stem cell information web site...

2000-11-21

215

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania  

Microsoft Academic Search

These updated guidelines are based on a first edition that was published in 2003, and have been edited and updated with the available scientific evidence until end of 2008. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the treatment of acute mania in adults. The data used for these guidelines have been extracted from

Heinz Grunze; Eduard Vieta; Guy M. Goodwin; Charles Bowden; Rasmus W. Licht; Hans-Jürgen Möller; Siegfried Kasper

2009-01-01

216

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2010 on the treatment of acute bipolar depression  

Microsoft Academic Search

Objectives. These guidelines are based on a fi rst edition that was published in 2002, and have been edited and updated with the available scientifi c evidence until September 2009. Their purpose is to supply a systematic overview of all scientifi c evidence pertaining to the treatment of acute bipolar depression in adults. Methods. The data used for these guidelines

Heinz Grunze; Eduard Vieta; Guy M. Goodwin; Charles Bowden; Rasmus W. Licht; Hans-Jürgen Möller; Siegfried Kasper

2010-01-01

217

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

PubMed

Over the past 2-3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis. PMID:17620160

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

2007-08-01

218

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

ERIC Educational Resources Information Center

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

Kai, Jiang

2012-01-01

219

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

|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…

Mingming, Ji

2012-01-01

220

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

SciTech Connect

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

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

2010-10-15

221

Adherence to hypertension treatment guidelines in state facilities in KwaZulu-Natal, South Africa.  

PubMed

Rationale, aims and objectives The province of KwaZulu-Natal, South Africa, embarked on the Essential Drugs Programme (EDP) consisting of standard treatment guidelines (STGs) and essential drugs lists in May 1999. The use of these tools was aimed at promoting rational drug use. This study sought to determine the percentage of compliance to the STGs of the EDP in the treatment of hypertension in patients in the district of eThekwini. Methods A retrospective cross-sectional randomized sampling of 100 prescriptions for hypertension per 21 health facility was conducted for the period of 3 months in 2007. Each prescription was assessed against modified World Health Organization indicators to determine compliance to STGs. Results The mean age of the sample was 55.235 years (+/-0.62). Hypertension featured as the most common diagnosis in the sample (57.5%). The mean result of compliance to the STGs for the eThekwini District was 22.05% (+/-20.03). The results of the multiple linear regression equation suggest that the variables selected in this study explain 86.79% of the variables impacting on treatment guideline adherence. Conclusion The low mean results for compliance to the STGs was due mainly to the absence of a diagnosis recorded on the prescription, and the addition of a new drug for each symptom without due consideration of polypharmacy, drug-disease and drug-drug interactions. PMID:20367708

Cassimjee, Mariam; Suleman, Fatima

2009-12-01

222

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

PubMed Central

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

Fagan, Mark; Maehlen, Marthe; Lindbaek, Morten; Berild, Dag

2012-01-01

223

Five Year Outcomes of the China National Free Antiretroviral Treatment Program  

PubMed Central

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

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

2009-01-01

224

Management of suspected viral encephalitis in adults--Association of British Neurologists and British Infection Association National Guidelines.  

PubMed

In the 1980s the outcome of patients with herpes simplex encephalitis was shown to be dramatically improved with aciclovir treatment. Delays in starting treatment, particularly beyond 48 h after hospital admission, are associated with a worse prognosis. Several comprehensive reviews of the investigation and management of encephalitis have been published. However, their impact on day-to day clinical practice appears to be limited. The emergency management of meningitis in children and adults was revolutionised by the introduction of a simple algorithm as part of management guidelines. In February 2008 a group of clinicians met in Liverpool to begin the development process for clinical care guidelines based around a similar simple algorithm, supported by an evidence base, whose implementation is hoped would improve the management of patients with suspected encephalitis. PMID:22120595

Solomon, T; Michael, B D; Smith, P E; Sanderson, F; Davies, N W S; Hart, I J; Holland, M; Easton, A; Buckley, C; Kneen, R; Beeching, N J

2011-11-18

225

Experience with the European quality assurance guidelines for digital mammography systems in a national screening programme.  

PubMed

The transition to a fully digital breast screening programme, utilising three different full-field digital mammography (FFDM) systems has presented many challenges to the implementation of the European guidelines for physico-technical quality assurance (QA) testing. An analysis of the QA results collected from the FFDM systems in the screening programme over a 2-y period indicates that the three different systems have similar QA performances. Generally, the same tests were failed by all systems and failure rates were low. The findings provide some assurance that the QA guidelines are being correctly implemented. They also suggest that there is more scope for the development of the relevance of the guidelines with respect to modern FFDM systems. This study has also shown that a summary review of the QA data can be achieved by simple organisation of the QA data storage and by automation of data query and retrieval using commonly available software. PMID:23173219

McCullagh, J; Keavey, E; Egan, G; Phelan, N

2012-11-21

226

Clinical practice guidelines for the care and treatment of breast cancer: 16. Locoregional post-mastectomy radiotherapy  

Microsoft Academic Search

Objective: To provide information and recommendations to assist women with breast cancer and their physicians in making de- cisions regarding the use of locoregional post-mastectomy ra- diotherapy (PMRT). Outcomes: Locoregional control, disease-free survival, overall survival and treatment-related toxicities. Evidence: This guideline is based on a review of all meta-analyses, consensus statements and other guidelines published between 1966 and November 2002.

Pauline T. Truong; Ivo A. Olivotto; Timothy J. Whelan; Mark Levine

227

Hospital guidelines for diagnosis-related groups/osteopathic manipulative treatment.  

PubMed

The DRG/OMT [Diagnosis-Related Groups/Osteopathic Manipulative Treatment] Master Matrix is a tabulated guideline for helping osteopathic physicians and hospitals document their unique form of health-care. The DRG/OMT Master Matrix is a quality management tool designed for osteopathic physician care of hospitalized patients. It furnishes a mechanism for relating various diagnostic entities to probable areas of somatic dysfunction. This matrix and the accompanying patient record aid the physician in recording diagnosis and treatment, thus providing the hospital with documentation of osteopathic patient care's competitive advantage. In a hospital record review, OMT use increased from 5% to 15% of patients after the DRG/OMT Master Matrix was introduced. PMID:7591882

Feely, R A

1995-09-01

228

[Guidelines on biologic drugs for the treatment of children with juvenile idiopathic arthritis (JIA)].  

PubMed

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children, and one of the major causes of short-term or long-term disability, and impairment of quality of life in childhood. Without early and adequate treatment the disease will progress and result with irreparable joint damage. The choice of therapy depends on the JIA subtype, disease activity index, prognostic factors, and prooven efficacy and probable side-effects of the drugs. The goal of modern JIA therapy is the achievement of complete disease remission, and not only the improvement of symptoms and temporarily inflammation control. The implementation of biologics significantly altered therapeutic approach to children with resistant JIA. We present Croatian guidelines on biologic drugs for the treatment of patients with JIA. PMID:24003687

Bukovac, Lana Tambi?; Vidovi?, Mandica; Lamot, Lovro; Perica, Marija; Harjacek, Miroslav

2013-01-01

229

The Gap between Tobacco Treatment Guidelines, Health Service Organization, and Clinical Practice in Comprehensive Cancer Centres  

PubMed Central

Smoking cessation is necessary to reach a higher quality of life, and, for a cancer patient, it represents an important step in improving the outcome of both prognosis and therapy. Being a cancer patient addicted to nicotine may be a critical situation. We conducted a survey to monitor how many comprehensive cancer centres in Italy have an outpatient smoker clinic and which kinds of resources are available. We also inquired about inpatient services offering psychological and pharmacological support for smoking cessation, reduction, or care of acute nicotine withdrawal symptoms. What we have witnessed is a significant gap between guidelines and services. Oncologists and cancer nurses are overscheduled, with insufficient time to engage in discussion on a problem that they do not consider directly related to cancer treatment. Furthermore, smoking habits and limited training in tobacco dependence and treatment act as an important barrier and lead to the undervaluation of smokers' needs.

Mazza, R.; Lina, M.; Invernizzi, G.; Pierotti, M.; De Marco, C.; Borreani, C.; Boffi, R.

2011-01-01

230

Performance Assessment Model for Guideline-Recommended Pharmacotherapy in the Secondary Prevention of Coronary Artery Disease and Treatment of Left Ventricular Dysfunction  

Microsoft Academic Search

The Agency for Health Care Policy and Research, the National Heart Lung and Blood Institute of the National Institutes of Health, the American Heart Association, and the American College of Cardiology have all developed guidelines for improving the care of patients with cardiovascular disease. The guidelines include recommendations for intensive lipid-lowering therapy in patients with coronary artery disease (CAD) and

Ross J. Simpson; Carla A. Sueta; Stephen J. Boccuzzi; Ash Lulla; David Biggs; Anil Londhe; Sidney C. Smith

1997-01-01

231

Communication between secondary and primary care following self-harm: are National Institute of Clinical Excellence (NICE) guidelines being met?  

PubMed Central

Background Most patients contact their general practitioner (GP) following presentation to an Emergency Department (ED) after a self-harm incident, and strategies to help GPs manage these patients include efficient communication between services. The aim of this study was to assess the standard of documentation and communication to primary care from secondary care as recommended by the National Institute of Clinical Excellence (NICE) guidelines on the short-term management of people who self-harm. Methods An audit of medical records (ED and Psychiatric) on people aged 16 years and over who had presented to the ED following self-harm, benchmarked according to government guidelines, was performed. Data were collected over a 4-week period at a general teaching hospital. Results We collected data on 93 consecutive episodes of self-harm; 62% of episodes were communicated to primary care, 58% of these communications were within 24 h and most within 3 days. Patient identifying details and follow-up arrangements were specified in most cases. Communication via psychiatric staff was most detailed. ED clinicians provided few communications and were of limited content. Communication with the patient's GP was not made in half of those cases seen by a mental health specialist. Conclusion Government guidelines are only partially being met. Reliance on communication by ED staff would leave a substantial proportion of patients discharged from the ED with no or minimal communication to primary care. Psychiatric services need to improve the rate of communication to the patient's GP following assessment A national sample of National Health Service (NHS) trusts would establish if this is a problem elsewhere.

Cooper, Jayne; Murphy, Elizabeth; Jordan, Rita; Mackway-Jones, Kevin

2008-01-01

232

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

PubMed Central

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.

2012-01-01

233

The Rationale for Differing National Recommendations for the Treatment of Hypertension  

Microsoft Academic Search

This article examines the rationale for the differences in the guidelines for hypertension management of four national or international bodies: the Joint National Committee (JNC-V), The World Health Organization\\/International Society of Hypertension (WHO-ISH), the British Hypertension Society (BHS), and the New Zealand guidelines.These guidelines agree on many aspects of management, but differ on two very important points—the drugs of first

Lawrence E Ramsay; Erica J Wallis; Wilfred W Yeo; Peter R Jackson

1998-01-01

234

Ethical and practical guidelines for reporting genetic research results to study participants: updated guidelines from a National Heart, Lung, and Blood Institute working group.  

PubMed

In January 2009, the National Heart, Lung, and Blood Institute convened a 28-member multidisciplinary Working Group to update the recommendations of a 2004 National Heart, Lung, and Blood Institute Working Group focused on Guidelines to the Return of Genetic Research Results. Changes in the genetic and societal landscape over the intervening 5 years raise multiple questions and challenges. The group noted the complex issues arising from the fact that technological and bioinformatic progress has made it possible to obtain considerable information on individuals that would not have been possible a decade ago. Although unable to reach consensus on a number of issues, the working group produced 5 recommendations. The working group offers 2 recommendations addressing the criteria necessary to determine when genetic results should and may be returned to study participants, respectively. In addition, it suggests that a time limit be established to limit the duration of obligation of investigators to return genetic research results. The group recommends the creation of a central body, or bodies, to provide guidance on when genetic research results are associated with sufficient risk and have established clinical utility to justify their return to study participants. The final recommendation urges investigators to engage the broader community when dealing with identifiable communities to advise them on the return of aggregate and individual research results. Creation of an entity charged to provide guidance to institutional review boards, investigators, research institutions, and research sponsors would provide rigorous review of available data, promote standardization of study policies regarding return of genetic research results, and enable investigators and study participants to clarify and share expectations for the handling of this increasingly valuable information with appropriate respect for the rights and needs of participants. PMID:21156933

Fabsitz, Richard R; McGuire, Amy; Sharp, Richard R; Puggal, Mona; Beskow, Laura M; Biesecker, Leslie G; Bookman, Ebony; Burke, Wylie; Burchard, Esteban Gonzalez; Church, George; Clayton, Ellen Wright; Eckfeldt, John H; Fernandez, Conrad V; Fisher, Rebecca; Fullerton, Stephanie M; Gabriel, Stacey; Gachupin, Francine; James, Cynthia; Jarvik, Gail P; Kittles, Rick; Leib, Jennifer R; O'Donnell, Christopher; O'Rourke, P Pearl; Rodriguez, Laura Lyman; Schully, Sheri D; Shuldiner, Alan R; Sze, Rebecca K F; Thakuria, Joseph V; Wolf, Susan M; Burke, Gregory L

2010-12-01

235

Wilderness medical society practice guidelines for treatment of exercise-associated hyponatremia.  

PubMed

Exercise-associated hyponatremia (EAH) typically occurs during or up to 24 hours after prolonged physical activity, and is defined by a serum or plasma sodium concentration below the normal reference range of 135 mEq/L. It is also reported to occur in individual physical activities or during organized endurance events conducted in austere environments in which medical care is limited or often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to ensure a positive outcome. Failure in this regard is a recognized cause of event-related fatality. In an effort to produce best practice guidelines for EAH in the austere environment, the Wilderness Medical Society convened an expert panel. The panel was charged with the development of evidence-based guidelines for management of EAH. Recommendations are made regarding the situations when sodium concentration can be assessed in the field and when these values are not known. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. PMID:23590928

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

2013-04-13

236

Journey in guidelines for lipid management: From adult treatment panel (ATP)-I to ATP-III and what to expect in ATP-IV  

PubMed Central

Adult Treatment Panel (ATP), an expert panel to supervise cholesterol management was set up under the aegis of National Cholesterol Education Program (NCEP) in 1985. Since then NCEP-ATP has been revising and framing guidelines to enable clinician to deliver better treatment to cardiovascular patients and to educate general people. As a result, considerable reduction in cardiovascular related deaths has been observed in recent times. All three ATP guidelines viz. ATP-I, ATP-II and ATP-III have targeted low density lipoprotein as their primary goal. The ATP-III guideline was updated in the light of evidences from 5-major clinical trials and was released in 2004. It added therapeutic lifestyle changes, concept of risk equivalents, Framingham CHD-risk score non-high density lipoprotein cholesterol (non-HDL-C) as secondary target and gave strong emphasis on metabolic risk factors. The earlier treat-to-target paradigm faced fierce criticism from clinicians across the globe because of insufficient proof of safety and benefits of treating patients with respect to an individual's low density lipoprotein (LDL) level. Further, demonstration of non-HDL-C and total cholesterol/HDL-C ratio as strong predictors of overall cardiovascular risk foresees new guidelines. A tailored-treatment approach was suggested instead of LDL-C target based treatment approach which was soundly based on direct clinical trials evidences and proposes treatment based on individual's overall 5- to 10-year cardiovascular risk irrespective of LDL-C level, leading to lower number of people on high dose/s of statins. Recent report of the Cholesterol Treatment Trialist's Collaborators meta-analysis strongly supported primary prevention of LDL with statins in low risk individuals and showed that its benefits completely outweighed its known hazards. Markers other than LDL-C like apolipoprotein B, non-HDL-C and total cholesterol/HDL-C ratio would take precedence in the risk assessment and strong emphasis would be given on tailored-treatment approach in the upcoming ATP-IV guideline.

Talwalkar, P. G.; Sreenivas, C. G.; Gulati, Ashish; Baxi, Hemang

2013-01-01

237

Journey in guidelines for lipid management: From adult treatment panel (ATP)-I to ATP-III and what to expect in ATP-IV.  

PubMed

Adult Treatment Panel (ATP), an expert panel to supervise cholesterol management was set up under the aegis of National Cholesterol Education Program (NCEP) in 1985. Since then NCEP-ATP has been revising and framing guidelines to enable clinician to deliver better treatment to cardiovascular patients and to educate general people. As a result, considerable reduction in cardiovascular related deaths has been observed in recent times. All three ATP guidelines viz. ATP-I, ATP-II and ATP-III have targeted low density lipoprotein as their primary goal. The ATP-III guideline was updated in the light of evidences from 5-major clinical trials and was released in 2004. It added therapeutic lifestyle changes, concept of risk equivalents, Framingham CHD-risk score non-high density lipoprotein cholesterol (non-HDL-C) as secondary target and gave strong emphasis on metabolic risk factors. The earlier treat-to-target paradigm faced fierce criticism from clinicians across the globe because of insufficient proof of safety and benefits of treating patients with respect to an individual's low density lipoprotein (LDL) level. Further, demonstration of non-HDL-C and total cholesterol/HDL-C ratio as strong predictors of overall cardiovascular risk foresees new guidelines. A tailored-treatment approach was suggested instead of LDL-C target based treatment approach which was soundly based on direct clinical trials evidences and proposes treatment based on individual's overall 5- to 10-year cardiovascular risk irrespective of LDL-C level, leading to lower number of people on high dose/s of statins. Recent report of the Cholesterol Treatment Trialist's Collaborators meta-analysis strongly supported primary prevention of LDL with statins in low risk individuals and showed that its benefits completely outweighed its known hazards. Markers other than LDL-C like apolipoprotein B, non-HDL-C and total cholesterol/HDL-C ratio would take precedence in the risk assessment and strong emphasis would be given on tailored-treatment approach in the upcoming ATP-IV guideline. PMID:23961478

Talwalkar, P G; Sreenivas, C G; Gulati, Ashish; Baxi, Hemang

2013-07-01

238

The impact of new national guidelines on screening for gestational diabetes mellitus.  

PubMed

Gestational diabetes mellitus (GDM) has important maternal and fetal implications. In 2010, the Health Service Executive published guidelines on GDM. We examined the impact of the new guidelines in a large maternity unit. In January 2011, the hospital replaced the 100 g Oral Glucose Tolerance Test (OGTT) with the new 75 g OGTT. We compared the first 6 months of 2011 with the first 6 months of 2010. The new guidelines were associated with a 22% increase in women screened from 1375 in 2010 to 1679 in 2011 (p < 0.001). Of the women screened, the number diagnosed with GDM increased from 10.1% (n=139) to 13.2% (n=221) (p<0.001).The combination of increased screening and a more sensitive OGTT resulted in the number of women diagnosed with GDM increasing 59% from 139 to 221 (p = 0.02).This large increase has important resource implications but, if clinical outcomes are improved, there should be a decrease in long-term costs. PMID:23472391

Ali, F M; Farah, N; O'Dwyer, V; O'Connor, C; Kennelly, M M; Turner, M J

2013-02-01

239

Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia  

Microsoft Academic Search

Purpose: We developed a pneumonia guideline at Intermountain Health Care that included admission decision support and recommendations for antibiotic timing and selection, based on the 1993 American Thoracic Society guideline. We hypothesized that guideline implementation would decrease mortality.Subjects and methods: We included all immunocompetent patients >65 years with community-acquired pneumonia from 1993 through 1997 in Utah; nursing home patients were

Nathan C Dean; Michael P Silver; Kim A Bateman; Brent James; Carol J Hadlock; David Hale

2001-01-01

240

Therapist knowledge, adherence and use of low back pain guidelines to inform clinical decisions--a national survey of manipulative and sports physiotherapists in New Zealand.  

PubMed

Identifying factors which influence guideline-informed clinical decisions by therapists will help tailor implementation strategies to improve guideline use. The aims of this study were to investigate; the extent to which current physiotherapy practice in New Zealand adheres to low back pain (LBP) guidelines and the factors which influence the use of guidelines to inform clinical decisions for patients with non-specific low back pain (NSLBP). A cross-sectional on-line survey of NZ physiotherapists (n = 1039) was conducted which included the guideline adherence measures, therapists' treatment orientation about NSLBP and a question on the perceived helpfulness of guidelines in decisions for patients with NSLBP. Data from 170 physiotherapists were analysed descriptively and univariate and multivariate associations were conducted for therapist factors (predictor variables) which predicted guidelines being helpful in decisions for management of patients with NSLBP (Y|N). The majority of respondents provided advice which was broadly inline with guideline recommendations [work (60%), activity (87.6%), and bed rest (63%)]. A lower biomedical belief orientation for LBP, higher reported LBP caseload and postgraduate qualifications demonstrated significant univariate associations (P ? 0.20) for guidelines being helpful to inform decisions for a patient with NSLBP. The only significant (P = 0.043) predictor variable in the multivariate model was the therapists' biomedical treatment orientation (Exp (B): odd ratio: 1.56). Differences between behaviours and beliefs in guideline use were found. A lower focus on a biomedical model for LBP influenced usage of LBP guidelines to inform clinical decisions for patients with LBP. Implications for improving guideline usage are discussed. PMID:23047043

Hendrick, Paul; Mani, Ramakrishnan; Bishop, Annette; Milosavljevic, Stephan; Schneiders, Anthony G

2012-10-06

241

Improving outpatient treatment in schizophrenia: effects of computerized guideline implementation—results of a multicenter-study within the German Research Network on Schizophrenia  

Microsoft Academic Search

Schizophrenia clinical practice guidelines are developed to provide expert- and evidence-based advice to practicing psychiatrists\\u000a in order to improve the management of this disorder. However, the application of these guidelines in everyday health care\\u000a can still be described as nonsatisfying. Within the project “Guideline-supported quality management in outpatient treatment”,\\u000a we investigated whether guideline adherence and quality of outcome can be

B. Janssen; S. Ludwig; H. Eustermann; R. Menke; M. Haerter; M. Berger; G. Adam; U. Seemann; W. Kissling; W. Gaebel

2010-01-01

242

AMA diagnostic and treatment guidelines concerning child abuse and neglect. Council on Scientific Affairs.  

PubMed

Child maltreatment is a serious and pervasive problem. Every year, more than a million children in the United States are abused, and between 2,000 and 5,000 die as a result of their injuries. Physicians are in a unique position to detect child abuse and neglect and are mandated by law to report such cases. These guidelines were developed to assist primary care physicians in the identification and management of the various forms of child maltreatment. A brief historical introduction and specific information about vulnerable families and children are presented. The physical and behavioral diagnostic signs of physical abuse, physical neglect, sexual abuse, and emotional maltreatment are delineated. Information about specific techniques for interviewing the abused child and family, case management objectives, reporting requirements, and trends in treatment and prevention are also provided. PMID:4009914

1985-08-01

243

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

PubMed Central

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

Prandoni, Paolo

2008-01-01

244

Caesarean section on maternal request for non-medical reasons: putting the UK National Institute of Health and Clinical Excellence guidelines in perspective.  

PubMed

The past decade has seen an unprecedented rise in the demand for caesarean sections on maternal request (CSMR), in the absence of any medical or obstetric indication. Much of this rise is the result of the perceived myth of safety of caesarean sections and the changing attitudes of society and the medical profession to childbirth. The debate on the medical, ethical and cost implications of rising rates of caesarean section on maternal request have prompted the issuing of numerous guidelines over the past few years, including one by the National Institute of Health and Clinical Excellence (NICE) in the UK. All these guidelines are uniformly less critical of CSMR than guidelines issued even a decade ago, and suggest valid management strategies. In this chapter, I explore the reasons behind the increase in CSMR and review the current published research, including the risks, benefits, controversies, cost and ethics surrounding CSMR. I then discuss various guidelines, putting the NICE guidelines in perspective. PMID:23116717

D'Souza, Rohan

2012-10-30

245

Estimating dissemination of Centers for Disease Control and Prevention Sexually Transmitted Disease Treatment Guidelines from a survey of physicians.  

PubMed

Periodically, the Centers for Disease Control and Prevention (CDC) produce guidelines for the treatment of sexually transmitted diseases (STDs) in the USA. To date, few evaluations of the dissemination of these guidelines exist. A paper and pencil survey was distributed via priority mail to a sample of Atlanta-area physicians, 416 (34%) of whom responded with complete data. Physicians were drawn from private practice, managed-care settings and public settings. In all, 85% of respondents treated STD, with a further 10% referring cases. Of those treating STD, 56% owned a copy of the 2002 CDC Treatment Guidelines, and 26% knew how to access them. The corresponding figures for physicians not treating STD were 25% and 30%. Of the physicians who did have copies, half had accessed the internet for their copies. Acquisition of, or the knowledge of how to acquire, the CDC STD Treatment Guidelines was widespread. The internet may be an effective and cost-saving means of disseminating the guidelines, although the continued need for print distribution should not be discounted. PMID:17524191

Hogben, Matthew; Wimberly, Yolanda H; Moore, Sandra

2007-05-01

246

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

PubMed

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

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

2012-02-24

247

ICNA regional workshops — using national evidence-based guidelines to reduce the risk of catheter-related urinary tract infections: report of post-workshop activities and outcomes  

Microsoft Academic Search

ollowing the publication in 2001 of national evidence-based guidelines for preventing healthcare-associated infections, a series of one-day workshops were conducted throughout ICNA regions. These aimed to support key healthcare professionals to use the guidelines as a catalyst to develop local strategies to promote clinical effectiveness and reduce the incidence of catheter-associated urinary tract infections in acute care settings. Almost 600

C. M. Pellowe; R. J. Pratt

2004-01-01

248

Knowledge of Energy Balance Guidelines and Associated Clinical Care Practices: The U.S. National Survey of Energy Balance Related Care among Primary Care Physicians  

PubMed Central

Objective To assess primary care physicians’ (PCPs) knowledge of energy balance related guidelines and the association with sociodemographic characteristics and clinical care practices. Method As part of the 2008 U.S. nationally representative National Survey of Energy Balance Related Care among Primary Care Physicians (EB-PCP), 1,776 PCPs from four specialties who treated adults (n=1,060) or children and adolescents (n=716) completed surveys on sociodemographic information, knowledge of energy balance guidelines, and clinical care practices. Results EB-PCP response rate was 64.5%. For PCPs treating children, knowledge of guidelines for healthy BMI percentile, physical activity, and fruit and vegetables intake was 36.5%, 27.0%, and 62.9%, respectively. For PCPs treating adults, knowledge of guidelines for overweight, obesity, physical activity, and fruit and vegetables intake was 81.4%, 81.3%, 70.9%, and 63.5%, respectively. Generally, younger, female physicians were more likely to exhibit correct knowledge. Knowledge of weight-related guidelines was associated with assessment of body mass index (BMI) and use of BMI-for-age growth charts. Conclusion Knowledge of energy balance guidelines among PCPs treating children is low, among PCPs treating adults it appeared high for overweight and obesity-related clinical guidelines and moderate for physical activity and diet, and was mostly unrelated to clinical practices among all PCPs.

Pronk, Nicolaas P.; Krebs-Smith, Susan M.; Galuska, Deborah A.; Liu, Benmei; Kushner, Robert F.; Troiano, Richard P.; Clauser, Steven B.; Ballard-Barbash, Rachel; Smith, Ashley Wilder

2012-01-01

249

Insulin initiation in patients with type 2 diabetes mellitus: treatment guidelines, clinical evidence and patterns of use of basal vs premixed insulin analogues.  

PubMed

This review addresses the apparent disconnect between international guideline recommendations, real-life clinical practice and the results of clinical trials, with regard to the initiation of insulin using basal (long-acting) or premixed insulin analogues in patients with type 2 diabetes (T2D). English language guidelines vary considerably with respect to recommended glycaemic targets, the selection of human vs analogue insulin, and choice of insulin regimen. Randomised trials directly comparing insulin initiation between basal and premixed analogues are scarce, and hard endpoint outcome data are inadequate. The evidence presented suggests that a major component of the HbA1c not being attained in every day clinical practice may be a result of factors that are not adequately addressed in forced titration trials of highly motivated patients, including failure to comply with complex treatment and monitoring regimens. Enforced intensification of unrealistic complex treatment regimens and glycaemic targets may theoretically worsen the psychological well-being in some patients. More simple and sustainable treatment regimens and guidelines are urgently needed. As for the use of insulin in T2D, there is limited evidence to convincingly support that initiation of insulin using basal insulin analogues is superior to initiation using premixed insulin analogues. While awaiting improved clinical efficacy and cost-effectiveness data, practical guidance from national and international diabetes organisations should consider more carefully the importance of: i) being clear and consistent; and ii) the early implementation of sustainable and cost-effective insulin treatment regimens with an emphasis on optimising treatment ease of use and patient compliance. PMID:21930715

Vaag, Allan; Lund, Søren S; Lund, Sørens

2011-09-19

250

THERAPY OF ENDOCRINE DISEASE: Insulin initiation in patients with type 2 diabetes mellitus: treatment guidelines, clinical evidence and patterns of use of basal vs premixed insulin analogues  

PubMed Central

This review addresses the apparent disconnect between international guideline recommendations, real-life clinical practice and the results of clinical trials, with regard to the initiation of insulin using basal (long-acting) or premixed insulin analogues in patients with type 2 diabetes (T2D). English language guidelines vary considerably with respect to recommended glycaemic targets, the selection of human vs analogue insulin, and choice of insulin regimen. Randomised trials directly comparing insulin initiation between basal and premixed analogues are scarce, and hard endpoint outcome data are inadequate. The evidence presented suggests that a major component of the HbA1c not being attained in every day clinical practice may be a result of factors that are not adequately addressed in forced titration trials of highly motivated patients, including failure to comply with complex treatment and monitoring regimens. Enforced intensification of unrealistic complex treatment regimens and glycaemic targets may theoretically worsen the psychological well-being in some patients. More simple and sustainable treatment regimens and guidelines are urgently needed. As for the use of insulin in T2D, there is limited evidence to convincingly support that initiation of insulin using basal insulin analogues is superior to initiation using premixed insulin analogues. While awaiting improved clinical efficacy and cost-effectiveness data, practical guidance from national and international diabetes organisations should consider more carefully the importance of: i) being clear and consistent; and ii) the early implementation of sustainable and cost-effective insulin treatment regimens with an emphasis on optimising treatment ease of use and patient compliance.

Vaag, Allan; Lund, S?rens

2012-01-01

251

Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience  

PubMed Central

The Improving Access to Psychological Therapies (IAPT) programme is a large-scale initiative that aims to greatly increase the availability of NICE recommended psychological treatment for depression and anxiety disorders within the National Health Service in England. This article describes the background to the programme, the arguments on which it is based, the therapist training scheme, the clinical service model, and a summary of progress to date. At mid-point in a national roll-out of the programme progress is generally in line with expectation, and a large number of people who would not otherwise have had the opportunity to receive evidence-based psychological treatment have accessed, and benefited from, the new IAPT services. Planned future developments and challenges for the programme are briefly described.

Clark, David M

2011-01-01

252

The Health Protection Act, national guidelines for indoor air quality and development of the national indoor air programs in Finland.  

PubMed Central

This article presents the current handling of disease related to moldy buildings in Finland as an example of an integrated health strategy. It describes the role of the Finnish Health Protection Act for indoor environments and how cases of indoor air problems are dealt with by local, regional, and national authorities.

Husman, T M

1999-01-01

253

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

Microsoft Academic Search

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

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

2005-01-01

254

Morbidity and Mortality Weekly Report. Volume 47. Number RR-1. 1998 Guidelines for Treatment of Sexually Transmitted Diseases.  

National Technical Information Service (NTIS)

The MMWR series of publications is published by the Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. These guidelines for the treatment of patients who have sex...

1998-01-01

255

[Practice guideline and trends for immunosuppressive treatment of glomerulonephritides according to KDIGO (Clinical Practice Guideline for Glomerulonephritis)].  

PubMed

We summarize recommendations for glomerulonephritis treatment, established by internationally recognized experts in the field and sponsored by KDIGO (Kidney Disease Improving Global Outcomes). Up till now, the KDIGO review has been the most prestigious analysis of therapeutic trials on immunosuppressive treatment of glomerulonephritides. The 167 recommendations addresses the following forms of glomerulopathies: steroid-sensitive nephrotic syndrome and steroid resistant nephrotic syndrome in children; minimal change disease and idiopathic focal segmental glomerulosclerosis in children and adults; idiopathic membranous nephropathy; idiopathic membranoproliferative glomerulonephritis; glomerulonephritis associated with infection; immunoglobulin A nephropathy and Henoch-Schönlein purpura nephritis; lupus nephritis; pauci-immune focal and segmental necrotizing glomerulonephritis; and anti--glomerular basement membrane antibody glomerulonephritis. We focused our attention on progress in this topic in the last decade. PMID:23461400

Podracká, L; Matoušovic, K

2013-02-01

256

Evidence-based medicine, appropriate-use criteria, and sports medicine: how best to develop meaningful treatment guidelines.  

PubMed

We propose using appropriate-use criteria (AUC) as the methodology of choice for formulating and disseminating evidence-based medicine guidelines in sports medicine and arthroscopy. AUC provide a structured process for integrating findings from the scientific literature with clinical judgment to produce explicit criteria for determining the appropriateness of specific treatments. The use of AUC will enable surgeons to treat patients in a more consistent manner based on expert clinical consensus and evidence-based medicine. This methodology also will ensure that guidelines represent all stakeholders and available evidence. PMID:23510944

McIntyre, Louis F; Beach, William R; Higgins, Laurence D; Mordin, Margaret M; Mauskopf, Josephine; Sweeney, Carolyn T; Copley-Merriman, Catherine

2013-03-16

257

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Substance Use and Related Disorders, Part 1: Alcoholism  

Microsoft Academic Search

These practice guidelines for the biological treatment of substance use disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of substance use disorders, and to reach a consensus on a series of

Michael Soyka; Henry R. Kranzler; Mats Berglund; David Gorelick; Victor Hesselbrock; Bankole A. Johnson; Hans-Jürgen Möller

2008-01-01

258

[The German Guideline Clearinghouse on Breast Cancer: the need for frequent updating of breast cancer guidelines requires effective guideline updating procedures].  

PubMed

In order to promote the quality of health care and guidelines in Germany the German Guideline Clearinghouse (Sponsors: German Medical Association, National Association of the Statutory Health Insurance Physicians, German Hospital Federation, Associations of the Sickness Funds and the Statutory Pension Insurance) was established at the Agency for Quality in Medicine (AQuMed) in 1999. The results of the 10th Guideline Clearing Project, the Guideline Clearing Report "Breast Cancer", were published in December 2003. In a systematic search using English/German language guideline databases and literature databases (Medline, Healthstar, Embase), 16 national guidelines were identified which were in accordance to the inclusion criteria (breast cancer treatment; German or English language; published after 1992; new guideline or genuine update (no adaptation); recommended for country-wide implementation). The methodological quality of these 16 guidelines was evaluated using the appraisal instrument of the German Guideline Clearinghouse, the checklist "Methodological Quality of Clinical Practice Guidelines". A peer review of the guidelines was performed by a multidisciplinary focus group of experts (intended guideline users from clinical and ambulatory settings as well as patients). This group consented comments and recommendations for actions of health care policy makers in Germany for a German breast cancer guideline based on examples from the appraised guidelines. None of the identified guidelines contained information about all of the 24 key topics that the focus group considered to be relevant for a German national guideline. The selected exemplary text extracts from the evaluated guidelines can be used as benchmarks and example sources for the development of a national German breast cancer guideline. From the beginning, patients should be involved in the development process within a multidisciplinary team. Due to the rapid emergence of new evidence, oncology guidelines need an effective procedure for updating in order to ensure that they are able to promote health care quality by giving current recommendations based on best available evidence. International networks such as the Guidelines International Network (G-I-N) will be helpful to collect and appraise the evidence for the national guideline development groups in an effective way. PMID:15487388

Weingart, Olaf; Sonntag, Dietrich; Trapp, Henrike; Bartsch, Hans-Helge; Baumeister, Rüdiger G H; Goerke, Kay; Giersiepen, Klaus; Hindenburg, Hans-Joachim; Ming, Karin; Schulz-Wendtland, Rüdiger; Störkel, Stephan; Kober, Thilo; Thole, Henning; Kirchner, Hanna; Ollenschläger, Günter

2004-08-01

259

Medical Staff Guidelines for Periviability Pregnancy Counseling and Medical Treatment of Extremely Premature Infants  

Microsoft Academic Search

OBJECTIVES. The goal of this report is to describe the collaborative formation of rational, practical, medical staff guidelines for the counseling and subsequent care of extremely early-gestation pregnancies and premature infants between 22 and 26 weeks. The purposes of the guidelines were to improve knowledge regarding neonatal outcomes, to provide consistency in periviability counseling, and to promote informed, supportive, responsible

Joseph W. Kaempf; Mark Tomlinson; Cindy Arduza; Shelly Anderson; Betty Campbell; Linda A. Ferguson; Mara Zabari; Valerie T. Stewart

2010-01-01

260

Development of Records Management and Archives Services within United Nations Agencies: A RAMP Study with Guidelines.  

ERIC Educational Resources Information Center

|This study is intended primarily to assist administrative officials and those responsible for administrative and management services in United Nations agencies, as well as similar officials in other international and regional organizations, both governmental and non-governmental, in the establishment and development of modern records management…

Stark, Marie Charlotte

261

Guidelines for case classification for the national birth defects prevention study  

Microsoft Academic Search

BACKGROUND: Previous studies have suggested that etiologic heterogeneity may complicate epidemiologic analyses designed to identify risk factors for birth defects. Case classification uses knowledge of embryologic and pathogenetic mechanisms to make case groups more homogeneous and is important to the success of birth defects studies. METHODS: The goal of the National Birth Defects Prevention Study (NBDPS), an ongoing multi-site case-

Sonja A. Rasmussen; Richard S. Olney; Lewis B. Holmes; Angela E. Lin; Kim M. Keppler-Noreuil; Cynthia A. Moore

2003-01-01

262

Reduction in the use of surgery for glue ear: did national guidelines have an impact?  

Microsoft Academic Search

Background: It is widely accepted that the passive dissemination of national clinical guidance has little or no impact on practice.Objective: To assess the impact in England of an Effective Health Care bulletin on childhood surgery for glue ear issued in 1992 and to understand the reasons for any change (or lack of change) in practice that ensued.Method: Time series analysis

N Black; A Hutchings

2002-01-01

263

A National Survey of Independent Living Donor Advocates: The Need for Practice Guidelines  

PubMed Central

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.

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

264

[Goiter and nodular thyroid disease: clinical guidelines for diagnosis and treatment. (Waiting? Hormone therapy? Surgery? radioiodine?)].  

PubMed

Nodular thyroid disease is a common problem. We present clinical guidelines for the management of patients with thyroid nodules, multinodular goiters and thyroid cysts for use by primary physicians. In the initial evaluation ultrasonography of the thyroid and fine-needle aspiration biopsy (FNAB) is recommended. FNAB has become the cornerstone in the evaluation of solitary thyroid nodules, cysts and dominant nodules within multinodular goiters. If the procedure is done properly, it should have a false-negative rate of less than 5% and a false-positive rate of not more than 1%. Thyroid radionuclide scans are less frequently used in the initial evaluation of a nodular goiter. Surgery is the primary therapy for patients with nodular thyroid disease. Other available treatment options are radioiodine and TSH-suppression with thyroxine. The main indications for surgery in euthyroid patients with thyroid nodule or with nontoxic multinodular goiter are recently documented or suspected malignancy, compression of the trachea and esophagus, significant growth of the nodule, recurrence of a cyst after aspiration, neck discomfort and cosmetic concern. PMID:10434771

Cattaneo, F; Bürgi, U; Mueller, B

1999-07-01

265

[Guidelines for delineation of pelvic lymph nodes in anal cancer treatment].  

PubMed

Squamous cell anal cancer is a rare malignancy, its incidence increases due to higher exposure of the young adults to risk factors. The current management is based on chemoradiotherapy, which is highly effective and achieves locoregional control but causes important morbidity. Improvement of radiation technique such as intensity modulated radiation therapy has led to reduce acute toxicities, but also requires an accurate delineation of the target volumes in order not to underestimate potential and pathological sites resulting in an increase of the locoregional failures. PET scanner has an important place in the pretreatment work-up for staging and targeting the delineation of the volumes, allowing to select patients with localized disease, avoid geographic miss and appropriately boost nodal disease. The study of recurrences sites has not yet provided a real mapping of the recurrences depending on the treatment volumes. Different radiation oncologist cooperative groups have published guidelines and tools for delineation, in order to provide homogeneity but also customize the management of anal carcinoma. PMID:23993061

Vendrely, V; Galland-Girodet, S; Orré, M; Maire, J-P

2013-08-28

266

Global guidelines for treatment of tuberculosis among persons living with HIV: unresolved issues.  

PubMed

The Revised National Tuberculosis Control Programme (RNTCP) in India uses a fully intermittent thrice-weekly rifampicin-containing regimen for all tuberculosis (TB) patients, including those who are human immunodeficiency virus (HIV) infected, whereas the World Health Organization (WHO) recommends daily anti-tuberculosis treatment at least during the intensive phase. The WHO recommendation was based on the results of a meta-analysis demonstrating increased risk of recurrence and failure among HIV-infected TB patients receiving intermittent TB treatment compared to a daily regimen. Review of the primary evidence indicates limited, low-quality information on intermittency, mostly from observational studies in the pre-antiretroviral treatment (ART) era. Molecular epidemiology in India indicates that most of the recurrences and many of the failures result from exogenous re-infection, suggesting poor infection control and high transmission rather than poor regimen efficacy. Subsequently published studies have shown acceptable treatment outcomes among HIV-infected TB patients receiving intermittent anti-tuberculosis regimens with concomitant ART. Treatment outcomes among HIV-infected TB patients treated under programmatic conditions show low failure rates but high case fatality; death has been associated with lack of ART. The highest priority is therefore to reduce mortality by linking all HIV-infected TB patients to ART. While urgently seeking to reduce death rates among HIV-infected TB patients, given the poor evidence for change and operational advantages of an intermittent regimen, the RNTCP intends to collect the necessary evidence to inform national policy decisions through randomised clinical trials. PMID:22507931

Kumar, A; Kumar, A M V; Gupta, D; Kanchar, A; Mohammed, S; Srinath, S; Tripathy, S; Rajasekaran, S; Chan, P-L; Swaminathan, S; Dewan, P K

2012-05-01

267

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

PubMed Central

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.

Mailis, Angela; Taenzer, Paul

2012-01-01

268

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

SciTech Connect

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

Kielusiak, C.

1993-02-01

269

Intermittent auscultation of fetal heart rate during labour - a widely accepted technique for low risk pregnancies: but are the current national guidelines robust and practical?  

PubMed

Intermittent auscultation of fetal heart rate is an accepted practice in low risk labours in many countries. National guidelines on intrapartum fetal monitoring were critically reviewed regarding timing and frequency of intermittent auscultation. Hypothetical but plausible examples are presented to illustrate that it may be possible to miss significant fetal distress with strict adherence to current guidelines. Opinion is forwarded that intermittent auscultation should be performed for 60 seconds before and after three contractions over about 10 min every half an hour in the first stage of labour. Reasons are put forward to show how this could be more practical and patient friendly and at the same time could improve detection of fetal distress. The current recommendation of intermittent auscultation every 15 min in the first stage is associated with poor compliance and leads to unnecessary burden, stress and medicolegal liability for birth attendants. Modification of current national guidelines would be desirable. PMID:20701496

Sholapurkar, S L

2010-01-01

270

Lipid-Lowering Medication for Secondary Prevention of Coronary Heart Disease in a German Outpatient Population: The Gap Between Treatment Guidelines and Real Life Treatment Patterns  

Microsoft Academic Search

Background. Few published data in particular from the United States indicate that the implementation of guidelines for prevention of coronary heart disease (CHD) is far from optimal. The objective of our study was to identify the type and prevalence of lipid-lowering medications in a German outpatient CHD population and to examine the impact of applied treatment regimens on serum lipid

J. Ruof; G. Klein; W. März; H. Wollschläger; A. Neiss; M. Wehling

2002-01-01

271

The Child's Right To Grow Up in a Family: Guidelines for Practice on National and Intercountry Adoption and Foster Family Care.  

ERIC Educational Resources Information Center

This document (also in Spanish, Portuguese, and Russian language versions) provides guidelines for practice on national and intercountry adoption and foster family care, developed under the aegis of the International Council on Social Welfare and incorporating the work of over 200 practitioners, experts, and government officials representing…

Nayak, Nina P.

272

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

|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…

Haycock, Ken; Cavill, Pat

273

The Child's Right To Grow Up in a Family: Guidelines for Practice on National and Intercountry Adoption and Foster Family Care.  

ERIC Educational Resources Information Center

|This document (also in Spanish, Portuguese, and Russian language versions) provides guidelines for practice on national and intercountry adoption and foster family care, developed under the aegis of the International Council on Social Welfare and incorporating the work of over 200 practitioners, experts, and government officials representing…

Nayak, Nina P.

274

Do general practitioners follow treatment recommendations from guidelines in their decisions on heart failure management? A cross-sectional study  

PubMed Central

Objective To investigate whether general practitioners (GPs) follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients, and assess whether doctors’ characteristics are related to their decisions. Design Cross-sectional vignette study. Setting Continuing Medical Education meeting. Participants 451 Dutch GPs. Main outcome measures Answers to four multiple-choice treatment decisions in clinical vignettes of a patient with heart failure and a reduced ejection fraction. With univariable and multivariable regression analyses, respondent characteristics were related to optimal treatment decisions. Results Of the 451 GPs, none took four optimal decisions: 7% considered stopping statin treatment, 36% initiated ?-blocker treatment at a low-dose and 4% doubled the ?-blocker in the up-titration phase. Finally, for our vignette patient now also suffering from chronic obstructive pulmonary disease, 45% of the GPs continued ?-blocker therapy even when they considered prescribing a long-acting ?2-agonist. While the relation between respondent characteristics and each decision was very different, none was independently associated with all four decisions. Giving priority to evidence-based medicine was independently related to stopping statin treatment and doubling the ?-blocker in the up-titration phase. Conclusions GPs seem not to follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients. The recommendations from guidelines may appear counterintuitive when statin treatment needs to be stopped when a patient feels comfortable, or when a ?-blocker should be up-titrated in patients who experience more symptoms. Giving priority to evidence-based medicine is possibly positively related to difficult treatment decisions.

Swennen, Maartje H J; Rutten, Frans H; Kalkman, Cor J; van der Graaf, Yolanda; Sachs, Alfred P E; van der Heijden, Geert J M G

2013-01-01

275

Availability of stage at diagnosis, cancer treatment delay and compliance with cancer guidelines as cancer registry indicators for cancer care in Europe: Results of EUROCHIP-3 survey.  

PubMed

EUROCHIP (European Cancer Health Indicators Project) focuses on understanding inequalities in the cancer burden, care and survival by the indicators "stage at diagnosis," "cancer treatment delay" and "compliance with cancer guidelines" as the most important indicators. Our study aims at providing insight in whether cancer registries collect well-defined variables to determine these indicators in a comparative way. Eighty-six general European population-based cancer registries (PBCR) from 32 countries responded to the questionnaire, which was developed by EUROCHIP in collaboration with ENCR (European Network of Cancer Registries) and EUROCOURSE. Only 15% of all the PBCR in EU had all three indicators available. The indicator "stage at diagnosis" was gathered for at least one cancer site by 81% (using TNM in 39%). Variables for the indicator "cancer treatment delay" were collected by 37%. Availability of type of treatment (30%), surgery date (36%), starting date of radiotherapy (26%) and starting date of chemotherapy (23%) resulted in 15% of the PBCRs to be able to gather the indicator "compliance to guidelines". Lack of data source access and qualified staff were the major reasons for not collecting all the variables. In conclusion, based on self-reporting, a few of the participating PBCRs had data available which could be used for clinical audits, evaluation of cancer care projects, survival and for monitoring national cancer control strategies. Extra efforts should be made to improve this very efficient tool to compare cancer burden and the effects of the national cancer plans over Europe and to learn from each other. PMID:23180472

Siesling, Sabine; Kwast, Annemiek; Gavin, Anna; Baili, Paolo; Otter, Renee

2012-12-13

276

Adherence to treatment guidelines and survival in triple-negative breast cancer: a retrospective multi-center cohort study with 9156 patients  

PubMed Central

Background Triple-negative breast cancer (TNBC) remains a challenging topic for clinical oncologists. This study sought to evaluate TNBC versus other breast cancer subtypes with respect to survival parameters. We evaluated possible differences in survival in TNBC by age and by the extent to which evidence-based treatment guidelines were adhered. Methods This German retrospective multi-center cohort study included 9156 patients with primary breast cancer recruited from 1992 to 2008. Results The rates of guideline adherence are significantly lower in TNBC compared to non-TNBC subtypes. These lower rates of guideline adherence can be observed in all age groups and are most pronounced in the >65 subgroup [<50 (20.9% vs. 42.0%), 50–64 (25.1% vs. 51.1%), and >65 (38.4% vs. 74.6%)]. In TNBC patients of all age groups, disease-free survival and overall survival were associated with an improvement by 100% guideline-adherent adjuvant treatment compared to non-adherence. Furthermore, TNBC patients of all ages had similar outcome parameters if 100% guideline-adherent adjuvant treatment was applied. Conclusion The rates of guideline-adherent treatment were significantly lower in TNBC, even though guideline adherence was strongly associated with improved survival. In the case of 100% guideline-adherent treatment, no difference in survival was observed over all the age groups examined, even in the group of >65-year-old TNBC patients.

2013-01-01

277

The impact of new insights and revised practice guidelines on prescribing drugs in the treatment of Type 2 diabetes mellitus  

PubMed Central

Aims The aim of this study was to investigate the impact of new insights and revised guidelines on initial and follow-up treatment with antihyperglycaemic drugs over the period 1998–2003. Methods The InterAction Database (IADB), which contains pharmacy dispensing data from 53 community pharmacies in the Northern and Eastern part of the Netherlands, was used in this study. Prevalence and incidence rates of oral antihyperglycaemic drug use were calculated for each year. Follow-up treatment was compared for two cohorts of initial users of oral antihyperglycaemic drugs, starting treatment either 1 year before or 1 year after guideline revision. Results The prevalence and incidence rate of oral antihyperglycaemic drug use increased over the study period from 1.8% to 2.4% (P < 0.001) and 0.3% to 0.4% (P= 0.04). The proportion of metformin as initial treatment increased rapidly in the observation period from 14% to 50% (P < 0.001). Initial users of metformin in 2000 received additional treatment with a sulphonylurea in the follow-up period less often compared with those who started metformin in 1998 (46%vs. 60%, P < 0.004). In contrast, initial users of sulphonylurea in 2000 received additional treatment with metformin more often compared with those who started a sulphonylurea in 1998 (42%vs. 36%, P < 0.008). The new drugs, thiazolidinediones and meglitinides, were seldom used as initial treatment Conclusions New insights and the revision of the practice guideline were followed by a significant increase in both initial and follow-up treatment with metformin among patients with Type 2 diabetes mellitus.

Lub, Rene; Denig, Petra; van den Berg, Paul B; Hoogenberg, Klaas; de Jong-van den Berg, Lolkje T W

2006-01-01

278

Treatment planning guidelines regarding the use of CT\\/PET-guided IMRT for cervical carcinoma with positive paraaortic lymph nodes  

Microsoft Academic Search

PurposeComputed tomography (CT)\\/positron emission tomography (PET)-guided intensity-modulated radiotherapy of the paraaortic lymph nodes (PALNs) has been proposed for patients with cervical carcinoma and paraaortic metastasis. This investigation attempted to determine the guidelines regarding the selection of appropriate treatment parameters (e.g., number of beams, beam geometry) and organ-specific parameters (e.g., importance weighting and tolerance dose) for intensity-modulated radiotherapy planning for the

Jacqueline Esthappan; Sasa Mutic; Robert S Malyapa; Perry W Grigsby; Imran Zoberi; Farrokh Dehdashti; Tom R Miller; Walter R Bosch; Daniel A Low

2004-01-01

279

Treatment Guidelines for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: When Can We Operate or Observe?  

Microsoft Academic Search

Background  The objectives of this study were to investigate the clinicopathological features of branch intraductal papillary mucinous\\u000a neoplasm (IPMN) and to determine safe criteria for its observation. Most clinicians agree that surgical resection is required\\u000a to treat main duct-type IPMN because of its high malignancy rate. However, no definite treatment guideline (with respect to\\u000a surgery or observation) has been issued on

Jin-Young Jang; Sun-Whe Kim; Seung Eun Lee; Sung Hoon Yang; Kuhn Uk Lee; Young Joo Lee; Song Chul Kim; Duck Jong Han; Dong Wook Choi; Seong Ho Choi; Jin Seok Heo; Baik Hwan Cho; Hee Chul Yu; Dong Sup Yoon; Woo Jung Lee; Hee-Eun Lee; Gyeong Hoon Kang; Jeong Min Lee

2008-01-01

280

[S3 guideline on treatment of polytrauma/severe injuries. Initial surgical phase: significance--possibilities--difficulties?].  

PubMed

There is no universal, generally established strategy for polytrauma management in Germany until now. The new S3 guideline on polytrauma patient care is the first high-level evidence-based compendium consented to by all major medical societies in Germany. This report emphasises all new guideline recommendations concerning the early operative care of multiply injured patients. With regard to the available evidence in the literature this report shows that the assessment of key recommendations is often difficult due to a lack of data. For guideline explanations with the highest grade of recommendation however it can be assumed that there is no alternative and that these will be implemented nationwide. This study also shows that the absolute and relative number of recommendations and the corresponding grade of recommendation do not correlate with the frequency and severity of injuries in an average polytrauma patient. It will now become a major challenge in German trauma care to incorporate all S3 guideline recommendations into the local treatment algorithms. Regional trauma networks could play a key role in this crucial task. PMID:22274600

Rixen, D; Steinhausen, E; Dahmen, J; Bouillon, B

2012-01-01

281

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

PubMed Central

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

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

1998-01-01

282

Guidelines for Hanford Site implementation of the National Environmental Policy Act  

SciTech Connect

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

King, S.E.

1989-03-01

283

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

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.

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. [University of Texas South West Medical Center Dallas, Dallas, TX (United States)

2009-04-15

284

Problem Gambling Treatment within the British National Health Service  

ERIC Educational Resources Information Center

|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…

Rigbye, Jane; Griffiths, Mark D.

2011-01-01

285

Successful Waste Treatment Methods at Sandia National Laboratories  

Microsoft Academic Search

During the remediation of the waste landfills at Sandia National Laboratory in Albuquerque, New Mexico nine drums of mock high explosives were generated. This mixed waste stream was proposed to several offsite vendors for treatment and prices ranged from $2.50 to $10 per gram a total cost estimated to be in excess of $2 million dollars. This cost represents more

D. M. Rast; J. J. Thompson; T. W. Cooper; D. J Stockham

2007-01-01

286

Recommendations for the treatment of hypertension in the elderly and very elderly--a scotoma within international guidelines.  

PubMed

The recommendations of international scientific societies for the treatment of hypertension in the geriatric population are different. Lack of outcome trials, non-standardised terminology as well as differing levels of evidence contribute to the inconsistencies in the guidelines. This review article compares six international guidelines (ESH-ESC 2007/2009, SHG 2009, DHL 2008, CHEP 2010, NICE 2011 and JNC7 2003) as well as the consensus document of the ACCF/AHA 2011 in terms of their recommendations of drug classes, target blood pressure values and the use of combination therapy. Generally, antihypertensive therapy appears to be clinically beneficial in geriatric patients. Target blood pressure values of <140-150/90 mm Hg and <140/90 mm Hg can be used as a general guideline for octogenarians (80-89 yrs) and septuagenarians (70-79 yrs) respectively. While angiotensin-II converting enzyme inhibitors and diuretics appear to be advantageous in treating combined systolic-diastolic hypertension, calcium-channel blockers and diuretics are to be recommended in the management of isolated systolic hypertension. Combination therapy often increases the efficacy of the treatment as well as patient medication adherence. Furthermore, by making the most of drug combination synergy, lower doses may be used resulting in fewer side-effects. PMID:22573500

Schäfer, Hans-Hendrik; De Villiers, Jacob N; Sudano, Isabella; Dischinger, Sandra; Theus, Gian-Reto; Zilla, Peter; Dieterle, Thomas

2012-05-09

287

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

PubMed Central

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

2013-01-01

288

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

PubMed Central

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

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

2006-01-01

289

American Burn Association Practice guidelines for prevention, diagnosis, and treatment of ventilator-associated pneumonia (VAP) in burn patients.  

PubMed

The purpose of this guideline is to review the available published literature on ventilator-associated pneumonia (VAP) as it pertains to the burn patient. It provides an evidence-based recommendation for the prevention, diagnosis, and treatment of VAP in adult burn patients. This guideline is designed to assist all healthcare providers caring for adult burn patients with suspected VAP. Summary recommendations were made using the following grading scale: grade A--supported by at least one well-designed prospective trial with clear-cut results; grade B--supported by several small prospective trials with a similar conclusion; and grade C--supported by a single small prospective trial, retrospective analyses, cases studies, and expert opinions based on investigators' practices. PMID:19826271

Mosier, Michael J; Pham, Tam N

290

Guideline for the diagnosis, prevention and treatment of paediatric ventilator-associated pneumonia  

Microsoft Academic Search

Objective. Ventilator-associated pneumonia (VAP) has been poorly studied in South Africa, but is likely to be a significant problem, with resulting increased morbidity and mortality in the paediatric intensive care unit population. This guideline is intended to review the evidence and recommendations for prevention and management of VAP in children and to provide, where possible, clear advice to aid the

B M Morrow; A C Argent; P M Jeena; R J Green

2009-01-01

291

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

ERIC Educational Resources Information Center

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

Slenker, Suzanne E.; And Others

1985-01-01

292

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

ERIC Educational Resources Information Center

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

Slenker, Suzanne E.; And Others

1985-01-01

293

European S3-guidelines on the systemic treatment of psoriasis vulgaris  

Microsoft Academic Search

Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a

D. Pathirana; A. D. Ormerod; P. Saiag; C. Smith; P. I. Spuls; A. Nast; J. Barker; J. D. Bos; G. R. Burmester; S. Chimenti; L. Dubertret; B. Eberlein; R. Erdmann; J. Ferguson; G. Girolomoni; P. Gisondi; A. Giunta; C. Griffiths; H. Honigsmann; M. Hussain; R. Jobling; S. L. Karvonen; L. Kemeny; I. Kopp; C. Leonardi; M. Maccarone; A. Menter; U. Mrowietz; L. Naldi; T. Nijsten; J. P. Ortonne; H. D. Orzechowski; T. Rantanen; K. Reich; N. Reytan; H. Richards; H. B. Thio; B. Rzany

2009-01-01

294

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

ERIC Educational Resources Information Center

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

Barker, Lauren N.; Ziino, Carlo

2010-01-01

295

EAU Guidelines on Diagnosis and Treatment of Upper Urinary Tract Transitional Cell Carcinoma  

Microsoft Academic Search

Objectives: On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of upper urinary tract transitional cell carcinoma (UUTT) patients were established. Criteria for recommendations are based of level 2 only, as large randomised clinical trials have not been performed in this type of disease.Method: A systematic literature research using Medline Services was conducted. References

W Oosterlinck; E Solsona; A. P. M van der Meijden; R Sylvester; A Böhle; E Rintala; B Lobel

2004-01-01

296

Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands  

PubMed Central

To optimize appropriate antimicrobial use in a university hospital and identify barriers hampering implementation strategies, physicians were interviewed regarding their opinions on antimicrobial policies. Results indicated that effective strategies should include regular updates of guidelines that incorporate the views of relevant departments and focus on addressing senior staff and residents because residents do not make independent decisions in a teaching-hospital setting.

Rutten, Willem J.M.J.; Gans, Rijk O.B.; Degener, John E.; Haaijer-Ruskamp, Flora M.

2004-01-01

297

Coordinated, Collaborative and Coherent: Developing and Implementing E-Learning Guidelines within a National Tertiary Education System  

ERIC Educational Resources Information Center

|Purpose: The paper aims to discusses two complementary initiatives focussed on developing and implementing e-learning guidelines to support good pedagogy in e-learning practice. Design/methodology/approach: The first initiative is the development of a coherent set of open access e-learning guidelines for the New Zealand tertiary sector. The…

Suddaby, Gordon; Milne, John

2008-01-01

298

A National Survey of Substance Abuse Treatment for Juvenile Offenders  

PubMed Central

Despite consensus about the value of substance abuse treatment for delinquent youth, information about its prevalence and availability is inadequate and inconsistent. This paper presents findings about treatment and other correctional service provision from a national survey of directors of 141 juvenile institutional and community corrections facilities. Educational/GED 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 the youth. Substance abuse treatment, as with most other services, were more prevalent in large, state-funded residential facilities (where 66% provided treatment), than local detention centers (20%) and community corrections 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.

Young, Douglas W.; Dembo, Richard; Henderson, Craig E.

2008-01-01

299

Osteoporosis: therapeutic guidelines. Guidelines for practice management of osteoporosis.  

PubMed

Therapeutic guidelines of osteoporosis are reviewed from North American Menopause Society, American Association of Clinical Endocrinologists, American College of Obstetrics and Gynecology, and the National Osteoporosis Foundation. The various guidelines are compared and discussed. PMID:24177062

Khan, Sana N; Craig, Latasha; Wild, Robert

2013-12-01

300

Genetic counseling and testing for FMR1 gene mutations: practice guidelines of the national society of genetic counselors.  

PubMed

Fragile X syndrome (FXS) is one of several clinical disorders associated with mutations in the X-linked Fragile X Mental Retardation-1 (FMR1) gene. With evolving knowledge about the phenotypic consequences of FMR1 transcription and translation, sharp clinical distinctions between pre- and full mutations have become more fluid. The complexity of the issues surrounding genetic testing and management of FMR1-associated disorders has increased; and several aspects of genetic counseling for FMR1 mutations remain challenging, including risk assessment for intermediate alleles and the widely variable clinical prognosis for females with full mutations. FMR1 mutation testing is increasingly being offered to women without known risk factors, and newborn screening for FXS is underway in research-based pilot studies. Each diagnosis of an FMR1 mutation has far-reaching clinical and reproductive implications for the extended family. The interest in large-scale population screening is likely to increase due to patient demand and awareness, and as targeted pharmaceutical treatments for FXS become available over the next decade. Given these developments and the likelihood of more widespread screening, genetic counselors across a variety of healthcare settings will increasingly be called upon to address complex diagnostic, psychosocial, and management issues related to FMR1 gene mutations. The following guidelines are intended to assist genetic counselors in providing accurate risk assessment and appropriate educational and supportive counseling for individuals with positive test results and families affected by FMR1-associated disorders. PMID:22797890

Finucane, Brenda; Abrams, Liane; Cronister, Amy; Archibald, Alison D; Bennett, Robin L; McConkie-Rosell, Allyn

2012-07-14

301

[Critical remarks regarding guidelines based on scientific research].  

PubMed

National and international guidelines for diagnosis and treatment are increasingly applied as standards for medical interventions. Evidence-based consensus guidelines are not consistently based on the outcome of scientific studies. Recent research yielding inherent low-grade evidence is liable to be overruled by personal impressions, sentiments and common sense. Guidelines are based on the average patient, with a certain range. With increasing specialisation, one increasingly sees that doctors justifiably digress from a guideline when a patient differs substantially from the average. PMID:17624155

Nieweg, O E

2007-06-01

302

National Youth Court Guidelines.  

ERIC Educational Resources Information Center

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

Godwin, Tracy M.

303

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

ERIC Educational Resources Information Center

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

Songhua, Tan; Wang, Catherine Yan

2012-01-01

304

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

|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…

Nilsen, Sven

2011-01-01

305

Eating and physical activity practices in risk of overweight and overweight children: compliance with US Department of Agriculture food guide pyramid and with National Association for Sport and Physical Activity guidelines for children  

Microsoft Academic Search

The purpose of this study was to identify eating and physical activity patterns associated with overweight elementary school children in Fort Worth, Tex, by comparing those with the US Department of Agriculture (USDA) dietary guidelines and National Association for Sport and Physical Activity guidelines for children. Among 1018 participants, 56% were girls; the percentages of normal, risk of overweight, and

Aewha Ha; Sejong Bae; Ximena Urrutia-Rojas; Karan P. Singh

2005-01-01

306

Comparison of appropriateness of cholesterol testing in general practice with the recommendations of national guidelines: an audit of patient records in 20 general practices.  

PubMed Central

OBJECTIVE: To compare the profiles of those patients selected by general practitioners for measurement of serum cholesterol with the recommended profiles for opportunistic cholesterol testing described in the national practice guidelines published by the Dutch College of General Practitioners. DESIGN: Retrospective audit of general practitioners' records. MATERIALS: Practice records of 3577 adult patients systematically sampled from 20 general practices. MAIN MEASURES: With criteria set by the national guidelines, the proportion of patients per practice (a) for whom cholesterol testing would be considered justified, and (b) for whom cholesterol testing would be considered unjustified, and the proportion of patients within each of these groups who had had a cholesterol measurement recorded. RESULTS: Cholesterol tests were performed on 415 (11.7%) of the 3577 patients. National guidelines on the management of hypercholesterolaemia state that a positive cardiovascular risk profile is an indication for cholesterol measurement. Just under one fifth (668) of the patients in this study were recorded as having a positive cardiovascular risk profile, but only 31% of these had had their cholesterol measured. Of the patients without recorded evidence of a positive cardiovascular risk profile cholesterol had been measured in 8%. Restricting the analyses to the age group 18-65 (n = 3060) of whom 12.5% had a positive risk profile, did not improve the results. In practices with a computerised information system 37% of patients with recorded evidence of a positive cardiovascular risk profile had had their cholesterol measured. CONCLUSIONS: Cholesterol testing was not targeted as selectively as recommended by the national guidelines. The major problem was failure to test those likely to benefit. Improving the targeting of cholesterol measurements would undoubtedly increase the workload of general practitioners. If the national guidelines are to have an effect on health promotion the first step must be to increase the proportion of patients with positive cardiovascular risk profiles who get their cholesterol tested. A major factor in successfully selecting cases seems to be that practices are equipped with a computerised medical information system.

van der Weijden, T; Dansen, A; Schouten, B J; Knottnerus, J A; Grol, R P

1996-01-01

307

Assessment of the implementation and knowledge of the UK National Guidelines for HIV Testing (2008) in key conditions at a UK district general hospital.  

PubMed

The objective of this study is to audit the implementation and knowledge of the British HIV Association (BHIVA) UK National guidelines for HIV testing (2008) in key conditions at Basildon & Thurrock University Hospital. Basildon Hospital is a district general hospital, serving over 400,000 patients in south-west Essex. A total of 348 patients were assessed through electronic to pathology data and patients' notes to investigate if they had been tested for HIV when diagnosed with the following conditions: tuberculosis (TB), hepatitis B and C, cervical intraepithelial neoplasia grade II/III, lymphoma, anal cancer, seminoma or Castleman's disease. The physicians involved were questioned as to their knowledge of the HIV testing guidelines. Of the 348 patients who were identified as having the above mentioned conditions, only 13.8% of those with any of the key conditions had received an HIV test. Only one non-HIV physician was aware of the guidelines. Knowledge of the 2008 BHIVA HIV testing guidelines is scanty among non-HIV-trained physicians. Health-care professionals in the field, irrespective of their role, should work harder to disseminate information and reduce prejudice that decreases testing of at-risk individuals. PMID:21427432

Gupta, N D; Lechelt, M

2011-02-01

308

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

SciTech Connect

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

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

1994-12-01

309

The new hypertension guidelines.  

PubMed

The Canadian Hypertension Education Program (CHEP) has published guidelines annually since 2000. The CHEP guidelines are a model of concise, comprehensive, up-to-date, evidence-rated guidelines for physicians who diagnose and treat hypertension. The guidelines address measurement of blood pressure and the definition of hypertension, secondary hypertension evaluation and treatment, and blood pressure targets and medication choices in patients with and without compelling indications. This review describes CHEP's process for developing guidelines and provides an overview of the 2013 recommendations. PMID:24088284

H Stern, Ralph

2013-07-22

310

The National Emphysema Treatment Trial: summary and update.  

PubMed

Surgery for severe emphysema involves a cohort of patients who are already at risk for increased perioperative morbidity and mortality. Through the careful screening and selection process, improved intraoperative techniques and rigorous attention to postoperative care, the NETT managed to yield acceptable improvements in survival and functional outcomes in this fragile patient cohort and these benefits were sustained over the long-term. Identification of the characteristics associated with a higher risk of death has provided tangible patient selection criteria for the ongoing application of LVRS. Because the NETT was such a large-scale study, the protocols that were developed had to be standardized across several centers. This produced reliable and reproducible standards for evaluation and treatment that can be applied to the surgical treatment of emphysema. When considering these criteria, although individualized patient selection is important, only patients with upper-lobe predominant disease on chest CT and possibly those with non-upper-lobe predominant disease who also have low baseline exercise capacity are appropriate candidates for LVRS. Expectedly, questions remain regarding the exact mechanism whereby the benefits derived from LVRS are obtained. Additionally, the benefit of LVRS in patients with heterogeneous but non-upper-lobe predominant disease remains to be further elucidated. In spite of the limitations of the study, the NETT, through a tremendous coordinated effort, provided valuable outcomes data, answered the pressing questions regarding lung volume reduc-tion surgery that existed at the time, and provided valuable insight into other facets of emphysema physiology and management through direct observation. Based on the NETT findings, in November 2003, CMS published criteria for expanded coverage for LVRS to include non-high-risk patients who demonstrated either upper-lobe predominant emphysema, or non-upper-lobe predominant emphysema and low baseline exercise capacity and who met the screening guidelines.29 This study not only provided data regarding the clinical efficacy of LRVS, but it was instrumental in determining health policy guidelines for the surgical management of emphysema. PMID:19662959

Edwards, Melanie A; Hazelrigg, Stephen; Naunheim, Keith S

2009-05-01

311

Family-based treatment of children and adolescents with anorexia nervosa: Guidelines for the community physician  

Microsoft Academic Search

Anorexia nervosa (AN) is a serious life-threatening illness that typi- cally has its onset during the adolescent years. Evidence regarding the optimal treatment of AN in children and teenagers is growing; how- ever, much remains unknown. Although current treatment approaches vary in Canada and elsewhere, the evidence to date indicates that family-based treatment (FBT) is the most effective treatment for

S Findlay; J Pinzon; D Taddeo; DK Katzman

312

Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children.  

PubMed

Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures. PMID:21208910

Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E; Daum, Robert S; Fridkin, Scott K; Gorwitz, Rachel J; Kaplan, Sheldon L; Karchmer, Adolf W; Levine, Donald P; Murray, Barbara E; J Rybak, Michael; Talan, David A; Chambers, Henry F

2011-01-04

313

Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary.  

PubMed

Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures. PMID:21217178

Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E; Daum, Robert S; Fridkin, Scott K; Gorwitz, Rachel J; Kaplan, Sheldon L; Karchmer, Adolf W; Levine, Donald P; Murray, Barbara E; J Rybak, Michael; Talan, David A; Chambers, Henry F

2011-02-01

314

Is point of care testing in Irish hospitals ready for the laboratory modernisation process? An audit against the current national Irish guidelines.  

PubMed

BACKGROUND: The Laboratory modernisation process in Ireland will include point of care testing (POCT) as one of its central tenets. However, a previous baseline survey showed that POCT was under-resourced particularly with respect to information technology (IT) and staffing. AIMS: An audit was undertaken to see if POCT services had improved since the publication of National Guidelines and if such services were ready for the major changes in laboratory medicine as envisaged by the Health Service Executive. METHODS: The 15 recommendations of the 2007 Guidelines were used as a template for a questionnaire, which was distributed by the Irish External Quality Assessment Scheme. RESULTS: Thirty-nine of a possible 45 acute hospitals replied. Only a quarter of respondent hospitals had POCT committees, however, allocation of staff to POCT had doubled since the first baseline survey. Poor IT infrastructure, the use of unapproved devices, and low levels of adverse incident reporting were still major issues. CONCLUSIONS: Point of care testing remains under-resourced, despite the roll out of such devices throughout the health service including primary care. The present high standards of laboratory medicine may not be maintained if the quality and cost-effectiveness of POCT is not controlled. Adherence to national Guidelines and adequate resourcing is essential to ensure patient safety. PMID:23575628

O'Kelly, R A; Byrne, E; Mulligan, C; Mulready, K J; O'Gorman, P; O'Shea, P; Boran, G

2013-04-11

315

Quality Assessment of Physical Activity Recommendations Within Clinical Practice Guidelines for the Prevention and Treatment of Cardio-metabolic Risk Factors in People With Schizophrenia  

Microsoft Academic Search

The aim of this review was to assess the quality of physical activity recommendations within clinical practice guidelines\\u000a for the prevention and treatment of the cardio-metabolic risk factors in schizophrenia. Several databases were searched from\\u000a their inception through July 2010. The Appraisal of Guidelines for Research and Evaluation instrument was used for the quality\\u000a assessment. Twelve recommendations met all the

Davy Vancampfort; Kim Sweers; Michel Probst; Alex J. Mitchell; Jan Knapen; Marc De Hert

316

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

PubMed Central

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

Jindal, SK

2011-01-01

317

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

PubMed

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

Jakubczyk, Andrzej; Wojnar, Marcin

318

The US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) prevalence of the metabolic syndrome in a Chinese population  

Microsoft Academic Search

To assess the prevalence of the metabolic syndrome disease cluster in the Hong Kong Chinese population we applied the US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) guidelines. This was present if ?3 of the following conditions were present: Hypertension (?130\\/85mmHg); fasting plasma glucose was ?6.1mmol\\/L; fasting plasma triglycerides ?1.69mmol\\/L; fasting HDL-cholesterol <1.04 or <1.29mmol in

G. Neil Thomas; Sai-Yin Ho; Edward D. Janus; Karen S. L. Lam; Anthony J. Hedley; Tai Hing Lam

2005-01-01

319

Reflections on the United States National Institutes of Health draft guidelines for research involving human pluripotent stem cells--theological perspective.  

PubMed

Since the human embryonic stem cell research involves destruction of human embryos and, therefore, hinges on the fundamental question of the status of the embryo, it is essential to examine this status carefully in order to establish fitting guidelines for research. The US National Institutes of Health has proposed its own guidelines on the matter recently (1999). The document, rooted in current pluralistic perspectives in moral philosophy (or bioethics), is criticised in this paper as morally inadequate. The argumentation of the criticism stems from the theological perspective on human personhood, which focuses on a continuity of personal identity from embryos to adult human beings. An additional concern for the author is the moral complicity in which the research dependent upon the destruction of human embryonic life is sanctioned. PMID:11933979

Sotis, J J

2000-01-01

320

Chemoprevention of breast cancer: A joint guideline from the Canadian Task Force on Preventive Health Care and the Canadian Breast Cancer Initiative's Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer  

PubMed Central

Objective To assist women and their physicians in making decisions regarding the prevention of breast cancer with tamoxifen and raloxifene. Evidence Systematic review of English-language literature published from 1966 to August 2000 retrieved from MEDLINE, HealthSTAR, Current Contents and Cochrane Library. Values The strength of evidence was evaluated using the methods of the Canadian Task Force on Preventive Health Care and the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Recommendations · Women at low or normal risk of breast cancer (Gail risk assessment index < 1.66% at 5 years): There is fair evidence to recommend against the use of tamoxifen to reduce the risk of breast cancer in women at low or normal risk of the disease (grade D recommendation). · Women at higher risk of breast cancer (Gail index ? 1.66% at 5 years): Evidence supports counselling women at high risk on the potential benefits and harms of breast cancer prevention with tamoxifen (grade B recommendation). The cutoff for defining high risk is arbitrary, but the National Surgical Adjuvant Breast and Bowel Project P-1 Study included women with a 5-year projected risk of at least 1.66% according to the Gail index, and the average risk of patients entered in the trial was 3.2%. Examples of high-risk clinical situations are 2 first-degree relatives with breast cancer, a history of lobular carcinoma in situ or a history of atypical hyperplasia. As the risk of breast cancer increases above 5% and the benefits outweigh the harms, a woman may choose to take tamoxifen. The duration of tamoxifen use in such situations is 5 years based on the results from trials of tamoxifen involving women with early breast cancer. If a woman raises concerns or has already been evaluated and is calculated to be at high risk, then individuals experienced and skilled in counselling may discuss the potential benefits and harms of tamoxifen use. Important additional issues · Prevention of breast cancer with raloxifene: Current evidence does not support recommending chemoprevention of breast cancer with raloxifene outside of a clinical trial setting. · Screening using the Gail risk assessment index: This index was the main eligibility criterion for enrolling women in the one study that showed potential benefit from chemoprevention. However, it has not been evaluated for use as a routine screening or case-finding instrument; validation of the index is required. Overall, current evidence does not support a shift to its routine use in physicians' offices for screening or case finding. However, when a woman or her physician is concerned about the woman's increased risk of breast cancer, the index can be a useful tool in deciding whether to pursue an in-depth discussion of the potential benefits and harms of chemoprevention. Hence, the approach to identifying women at higher risk who warrant counselling and shared decision-making will vary across practices. (The risk assessment index is available online at http://bcra.nci.nih.gov/brc/). [A patient version of these guidelines appears in Appendix 2.] Validation The authors' original text was revised by both the Canadian Task Force on Preventive Health Care and the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. The final document reflects a consensus of these contributors. Sponsor Health Canada. Completion date February 2001.

Levine, Mark; Moutquin, Jean-Marie; Walton, Ruth; Feightner, John

2001-01-01

321

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

PubMed

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

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

2011-11-18

322

Guidelines for Selecting Control and Treatment Options for Contaminated Dredged Material.  

National Technical Information Service (NTIS)

Alternative technologies and alternative strategies for dredging, transport, and disposal of contaminated dredged material are reviewed. Contaminant control/treatment during three basic operations are discussed. These include contaminant control/treatment...

M. J. Cullinane D. E. Averett R. A. Shafer

1986-01-01

323

Informatics issues in the national dissemination of a computer-based clinical guideline: a case study in childhood immunization.  

PubMed

IMM/Serve is a computer-based guideline that provides patient-specific recommendations regarding childhood immunization. IMM/Serve is currently installed at an estimated 75 sites within the US Indian Health Service (IHS), with plans to extend its use to roughly 150 additional sites nationwide by the end of the year 2000. The dissemination of IMM/Serve within the IHS provides a case study with concrete examples that illustrate the diverse informatics issues that arise in the widespread dissemination of a computer-based clinical guideline. PMID:11079950

Miller, P L; Frawley, S J; Sayward, F G

2000-01-01

324

[Idiopathic pulmonary fibrosis: modern guideline-concordant diagnostics and innovative treatment].  

PubMed

Interstitial lung diseases are a heterogenic group of diseases who share in common manifestation of the disease process in the distal airways and alevolo-capilary membrane. Idiopathic pulmonary fibrosis (IPF) is of special interest as it is the most prevalent entity within the idiopathic interstitial pneumonias and it is associated with the worst prognosis. Diagnosis of IPF necessitates confirmation of a "usual interstitial pneumonia" (UIP) pattern on high-resolution computed tomography or on histology from a surgical lung biopsy. The recently published evidence-based IPF-guidelines for the first time define radiologic criteria for a UIP pattern and thus allow to make an IPF diagnosis in the absence of a surgical lung biopsy. Moreover, an IPF diagnosis can be made only after exclusion of any other cause for an interstitial lung disease.In the new IPF-guideline no medical therapy has received a positive recommendation. Based on the available evidence only pirfenidone has been shown to attenuate disease progression in mild to moderate IPF populations, with low-moderate quality of evidence. Pirfenidone has been approved for mild-moderate IPF in the European Union in February 2011 and is approved in Japan since 2009. In IPF-patients who cannot receive pirfenidone high-dose N-acetylcysteine is an "off-label-use" option that also has been shown to slow disease progression, however, based on low quality of evidence only. Recent studies suggest that anti-inflammatory therapies (prednione, azathioprine) may be harmful in IPF patients and cannot be recommended. Besides medical therapies IPF patients should receive best supportive care, which includes long-term oxygen therapy in hypoxemic patients and pulmonary rehabilitation as well as lung transplantation for eligible patients. PMID:22415624

Behr, J

2012-03-13

325

Addition of high-risk HPV testing improves the current guidelines on follow-up after treatment for cervical intraepithelial neoplasia  

Microsoft Academic Search

We assessed a possible role for high-risk human papillomavirus (HPV) testing in the policy after treatment for cervical intraepithelial neoplasia (CIN) 2 or 3 (moderate to severe dysplasia). According to the Dutch guidelines follow-up after treatment consists of cervical cytology at 6, 12 and 24 months. Colposcopy is only performed in case of abnormal cervical cytology. In this observational study

M A E Nobbenhuis; C J L M Meijer; A J C van den Brule; L Rozendaal; F J Voorhorst; E K J Risse; R H M Verheijen; T J M Helmerhorst

2001-01-01

326

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

PubMed

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

Shekelle, Paul; Woolf, Steven; Grimshaw, Jeremy M; Schünemann, Holger J; Eccles, Martin P

2012-07-04

327

Treatment Programs in the National Drug Abuse Treatment Clinical Trials Network  

PubMed Central

Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed organizational (n = 106 of 112; 95% response rate) and treatment unit surveys (n = 348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in treatment philosophies. A diversity of treatment centers participate in the CTN; not for profit organizations with a primary mission of treating alcohol and drug disorders dominate. Compared to N-SSATS (National Survey of Substance Abuse Treatment Services), programs located in medical settings are over-represented and centers that are mental health clinics are under-represented. Outpatient, methadone, long-term residential and inpatient treatment units differed on patients served and services proved. Larger programs with higher counselor caseloads in residential settings reported more social model characteristics. Programs with higher social model scores were more likely to offer self-help meetings, vocational services and specialized services for women. Conversely, programs with accreditation had less social model influence. The CTN is an ambitious effort to engage community-based treatment organizations into research and more fully integrate research and practice.

McCarty, Dennis; Fuller, Bret; Kaskutas, Lee Ann; Wendt, William W.; Nunes, Edward V.; Miller, Michael; Forman, Robert; Magruder, Kathryn M.; Arfken, Cynthia; Copersino, Marc; Floyd, Anthony; Sindelar, Jody; Edmundson, Eldon

2008-01-01

328

Proposed quality control guidelines for National Committee for Clinical Laboratory Standards Susceptibility Tests using the veterinary antimicrobial agent tiamulin  

Microsoft Academic Search

Quality control guidelines for standardized antimicrobial susceptibility test methods are critical for the continuing accuracy of these clinical tests. In this report, quality control limits were proposed for the veterinary antimicrobial agent tiamulin with minimum inhibitory concentration (MIC) ranges of three or four log2 dilution steps in two different medium formulations. Disk diffusion zone diameter ranges were proposed for tiamulin

Michael A Pfaller; Ronald N Jones; Donald H Walter

2001-01-01

329

Poor effect of guideline based treatment of restless legs syndrome in clinical practice  

Microsoft Academic Search

BackgroundNumerous randomised controlled trials have proved the efficacy of dopaminergic and non-dopaminergic drugs in the treatment of restless legs syndrome (RLS). In contrast, epidemiological data demonstrate generally insufficient RLS treatment in clinical practice.ObjectiveTo prospectively assess the success of RLS treatment in the clinical setting and to evaluate potential demographic factors and comorbidities that may influence the response to therapy.Methods100 patients

Jana Godau; Nike Spinnler; Anne-Kathrin Wevers; Claudia Trenkwalder; Daniela Berg

2010-01-01

330

EAU Guidelines on Prostate Cancer  

Microsoft Academic Search

Objectives: To develop clinical guidelines for the management of patients with prostate cancer.Methods: Guidelines were compiled by a working panel based on current literature following a literature review using MEDLINE. Already published structured analysis from national and international guidelines was used, and panel consensus was employed when literature evidence was absent or of poor quality.Results: The full text of the

G. Aus; C. C. Abbou; D. Pacik; H. van Poppel; J. M. Wolff; F. Zattoni

2001-01-01

331

Use of a Clinical Decision Support Tool to improve guideline adherence for the treatment of methicillin-resistant Staphylococcus aureus: Skin and Soft Tissue Infections.  

PubMed

Skin and Soft Tissue Infections (SSTI's) with abscess are commonly seen in the Emergency Department (ED) setting. Given the increasing prevalence of methicillin-resistant Staphylococcus-aureus (MRSA)-related abscesses, appropriate evidence-based decisions are essential in assuring successful treatment. Provider adherence to clinical guidelines for the treatment of SSTI's with presumed MRSA remains inconsistent in terms of prescriptive practice related to antibiotic selection, culturing wounds, and patient discharge recommendations regarding the use of infection control techniques. Evidence indicates that the use of Clinical Decision Support (CDS) tools is valuable in improving provider awareness and adherence to clinical guidelines. This study was conducted to examine whether the development of a CDS tool to guide order entry for the treatment of MRSA-related SSTI's and embed it into the electronic medical record program would improve provider adherence to the North Carolina Consensus Guideline for Management of Suspected Commmunity-Acquired MRSA Skin and Soft Tissue. PMID:21836453

Carman, Margaret Jean; Phipps, Julie; Raley, Jennifer; Li, Suling; Thornlow, Deirdre

332

[The guideline 'Diagnosis and treatment of peripheral artery disease of the lower extremities' of The Netherlands Surgical Society].  

PubMed

The guideline 'Diagnosis and treatment of peripheral artery disease of the lower extremities' describes the diagnostic work-up and treatment of patients with peripheral artery disease of the legs. The text is the result of a cooperative effort of the Dutch Society of Vascular Surgery and the Section of nterventional Radiology of the Dutch Society of Radiology. A diagnosis of 'peripheral artery disease' can be made by measuring the ankle/brachial index. Additional investigations are only necessary ifa plan for invasive treatment must be drawn up. The first line of treatment in patients with intermittent claudication is walking exercise. If the results are unsatisfactory, percutaneus transluminal angioplasty (PTA) or surgery can be performed. In case of critical ischaemia, revascularisation is mandatory to prevent an amputation. In selected cases, percutaneous intentional endovascular revascularisation is a good alternative to bypass surgery. In patients with acute ischaemia in whom the vitality of the leg is not threatened, intra-arterial thrombolysis can be carried out as an alternative to surgery. An inhibitor of platelet aggregation such as acetylsalicylic acid and a statin should be prescribed to patients with peripheral artery disease. Only in case of venous bypass surgery should a coumarin derivative and a statin be prescribed for 2 years, while the bypass is controlled periodically for 6 months by duplex examination. PMID:16104112

Vahl, A C; Reekers, J A

2005-07-23

333

Implementing the National Institute of Clinical Excellence improving outcome guidelines for head and neck cancer: developing a business plan with reorganisation of head and neck cancer services.  

PubMed

The implementation of the National Institute of Clinical Excellence improving outcome guidelines (NICE-IOG) manual for head and neck cancer may have a huge potential cost implication. Head and neck cancer is a rare disease which utilises large quantities of resources which can only be provided in a tertiary centre. Head and neck cancer services should be centralised into a single site for each cancer network. A new higher tariff rate for complex head and neck cancer cases is needed which recognises the true cost of this work. Each network should set its own tariff to make head and neck cancer care financially viable. PMID:18429872

Jeannon, J-P; Abbs, I; Calman, F; Gleeson, M; Lyons, A; Hussain, K; McGurk, M; O'Connell, M; Probert, D; Ng, R; Simo, R

2008-04-01

334

Directly observed therapy for the treatment of tuberculosis—evidence based dosage guidelines  

Microsoft Academic Search

Tuberculosis is a communicable disease with public health implications and effective treatment is essential for control of the disease and prevention of the emergence of drug resistant strains. Drug therapy for this disease is well established and discussion now surrounds frequency of administration, duration of treatment and methods of improving compliance. Directly observed intermittent therapy of tuberculosis is supported by

R. Bednall; G. Dean; N. Bateman

1999-01-01

335

Impact of National Clinical Guideline Recommendations for Revascularization of Persistently Occluded Infarct-Related Arteries on Clinical Practice in the United States  

PubMed Central

Background The Occluded Artery Trial (OAT) was a large, randomized controlled trial published in 2006 that demonstrated no benefit to routine percutaneous coronary intervention (PCI) of persistently totally occluded infarct-related arteries (IRA) identified a minimum of 24 hours (on calendar days 3–28) after myocardial infarction (MI). The purpose of this study was to determine the impact of OAT results and consequent change in guideline recommendations for PCI for treatment of persistently occluded IRAs. Methods We identified all patients enrolled in the CathPCI Registry, from 2005 to 2008, undergoing catheterization more than 24 hours after MI with a totally occluded native coronary artery and no major OAT exclusion criteria. We examined trends in monthly rates of PCI for occlusions after OAT publication and after guideline revisions. Because reporting of diagnostic catheterizations was not mandatory, we examined trends among hospitals in the highest quartile for reporting of diagnostic procedures. Results A total of 28 780 patient visits from 896 hospitals were included. Overall, we found no significant decline in the adjusted monthly rate of PCI of occlusions after publication of OAT (odds ratio [OR], 0.997; 95% confidence interval [CI], 0.989–1.006) or after guideline revisions (OR, 1.007; 95% CI, 0.992–1.022). Among hospitals consistently reporting diagnostic catheterizations, there was no significant decline after OAT publication (OR, 1.018; 95% CI, 0.995–1.042), and there was a trend toward decline after guideline revisions (OR, 0.963; 95% CI, 0.920–1.000). Conclusion These findings suggest that the results of OAT and consequent guideline revisions have not, to date, been fully incorporated into clinical practice in a large cross-section of hospitals in the United States.

Deyell, Marc W.; Buller, Christopher E.; Miller, Louis H.; Wang, Tracy Y.; Dai, David; Lamas, Gervasio A.; Srinivas, Vankeepuram S.; Hochman, Judith S.

2013-01-01

336

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

USGS Publications Warehouse

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

Knapton, J. R.

1985-01-01

337

Spanish evidence-based guidelines on the treatment of psoriasis with biologic agents, 2013. Part 1: on efficacy and choice of treatment.  

PubMed

Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical experience with biologics, and the abundance of literature now available on these agents have made evidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasis treatment is to achieve complete or nearly complete clearing of lesions and to maintain it over time. Failing that ideal, the goal would be to reduce involvement to localized lesions that can be controlled with topical therapy. Although current evidence allows us to directly or indirectly compare the efficacy or risk of primary or secondary failure of available biologics based on objective outcomes, clinical trial findings cannot be directly translated to routine practice. As a result, the prescribing physician must tailor the treatment regimen to the individual patient. This update of the clinical practice guidelines issued by the Spanish Academy of Dermatology and Venereology (AEDV) on biologic therapy for psoriasis incorporates information from the most recent publications on this topic. PMID:24018211

Puig, L; Carrascosa, J M; Carretero, G; de la Cueva, P; Lafuente-Urrez, R F; Belinchón, I; Sánchez-Regaña, M; García-Bustínduy, M; Ribera, M; Alsina, M; Ferrándiz, C; Fonseca, E; García-Patos, V; Herrera, E; López-Estebaranz, J L; Marrón, S E; Moreno, J C; Notario, J; Rivera, R; Rodriguez-Cerdeira, C; Romero, A; Ruiz-Villaverde, R; Taberner, R; Vidal, D

2013-09-07

338

Guidelines for Aesthetic Design in Highway Corridors: Tools and Treatments for Texas Highway.  

National Technical Information Service (NTIS)

This study evaluated the nature of aesthetic treatments and elements, which have been used or may have application within the highway roadway. It also studied the literature concerning aesthetics and current practice within the Texas Department of Transpo...

J. R. Schutt K. L. Phillips H. C. Landphair

2001-01-01

339

Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: Diagnosis and treatment  

Microsoft Academic Search

BackgroundVentilator-associated pneumonia (VAP) is an important cause of morbidity and mortality in ventilated critically ill patients. Despite a large amount of research evidence, the optimal diagnostic and treatment strategies for VAP remain controversial.

John Muscedere; Peter Dodek; Sean Keenan; Rob Fowler; Deborah Cook; Daren Heyland

2008-01-01

340

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

National Technical Information Service (NTIS)

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 procedu...

D. P. Hoffman L. V. Gibson W. H. Hermes R. E. Bastian W. T. Davis

1994-01-01

341

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

SciTech Connect

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

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

2006-01-01

342

Stage and treatment variation with age in postmenopausal women with breast cancer: compliance with guidelines  

Microsoft Academic Search

Breast cancer-specific mortality is static in older women despite having fallen in younger age groups, possibly due to lack of screening and differences in treatment. This study compared stage and treatment between two cohorts of postmenopausal women (55–69 vs >70 years) in a single cancer network over 6 months. A total of 378 patients were studied (>70: N=167, 55–69 years:

L Wyld; D K Garg; I D Kumar; H Brown; M W R Reed

2004-01-01

343

Guidelines for glycemic control  

Microsoft Academic Search

Glycemic control in diabetes patients continues to evolve as new medications are introduced and clinicaltrial data become available. The American Diabetes Association (ADA) guidelines for 2004, for the first time, provide targets for both preprandial and postprandial glucose levels. The ADA, however, does not provide guidelines regarding specific medication therapy. This paper provides a detailed treatment algorithm that is easy

Stephen Clement

2004-01-01

344

[The BCTRIMS Expanded Consensus on treatment of multiple sclerosis: III. Evidence and recommendation-based guidelines].  

PubMed

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

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

345

Dental Trauma Guide: a source of evidence-based treatment guidelines for dental trauma.  

PubMed

Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment. PMID:22994505

Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander; Ahrensburg, Søren Steno

2012-10-01

346

Dental Trauma Guide: a source of evidence-based treatment guidelines for dental trauma.  

PubMed

Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTraumaGuide.org. It is the aspiration that the use of this Guide may lead the practitioner to offer an evidence-based diagnosis and treatment. PMID:22272918

Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander; Ahrensburg, Søren Steno

2012-01-25

347

Idiopathic pulmonary thromboembolism in the course of intensive psychiatric inpatient care: case report and treatment guidelines.  

PubMed

Idiopathic thromboembolism can occur in psychiatric patients who have been inactive during a period of inpatient hospital treatment. These patients are usually treated with antipsychotic medication which has also been reported to increase risk for thromboembolic disease. Here the authors describe a patient with neither prior history of thromboembolism nor any medical risk factors for thromboembolic disease, who was admitted with an acute relapse of psychotic illness. During the course of her intensive psychiatric treatment, she had chest pain and CT-pulmonary arteriogram revealed bilateral lower lobe pulmonary embolism. She was anticoagulated and made a full medical recovery. Treatment with high dosages of typical and atypical antipsychotic medication and a lack of mobility related to intensive nursing care and sedation were likely risk factors in her development of pulmonary emboli. PMID:22962386

McInerney, Shane J; McDonald, Colm

2012-09-07

348

Treatment guidelines and techniques in delivery of postmastectomy radiotherapy in management of operable breast cancer.  

PubMed

Radiation therapy has been shown to statistically significantly reduce the risk of locoregional recurrence in high-risk patients with operable breast cancer following mastectomy and systemic therapy. Recent trials have also demonstrated a significant survival benefit following radiotherapy in high-risk patients. Therefore, it is important to identify the patients who could potentially derive that survival benefit and to not offer treatment to those patients who are not at increased risk for failure. Established risk factors that predict for increased rates of locoregional recurrence include axillary lymph node involvement and T3 (or T4) disease. While treatment-related factors, such as the extent of the axillary dissection and extent of lymph nodal positivity, also undoubtedly affect locoregional recurrence, additional studies are needed to define the magnitude of their risk. Locoregional patterns of failure have identified the chest wall and supraclavicular/infraclavicular regions to be the most common sites of locoregional failure following mastectomy, which justifies treatment to these regions. While long-term complications are uncommon following locoregional radiotherapy, careful treatment planning is critical to minimize cardiac (and pulmonary) toxicity. PMID:11773304

Pierce, L J

2001-01-01

349

Evidence-based guidelines for non-prescription treatment of vulvovaginal candidiasis (VVC)  

Microsoft Academic Search

In the UK, there has been a rapid increase in the reclassification of prescription only medicines (POMs) to pharmacy only (P) and general sales list (GSL) status. This means that community pharmacy staff have a greater range of non-prescription medicines to recommend for the treatment of minor illness. Strategies are needed to promote good professional practice in the supply of

Margaret C. Watson; Christine M. Bond

2003-01-01

350

A Dutch guideline for the treatment of scoliosis in neuromuscular disorders  

Microsoft Academic Search

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,

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

2008-01-01

351

Polycystic ovary syndrome and combined oral contraceptive use: a comparison of clinical practice in the United States to treatment guidelines.  

PubMed

The October 2010 ESHRE/ASRM polycystic ovary syndrome (PCOS) workshop concluded: (1) all combined oral contraceptives (COC) appear to have equal efficacy for PCOS, (2) addition of antiandrogens (spironolactone) to COCs has little treatment benefit and (3) metformin does not improve the live-birth rate and should only be used with impaired glucose tolerance. We compared these guidelines to current practice in the United States IMS claims-database. Time-series analyses were conducted by calendar-year in women with PCOS to evaluate prescribing preferences for COCs, concomitant use of spironolactone, and utilization of metformin. Trends were analyzed with linear regression. Our cohort included 1.6 million women taking COCs, 46 780 with a PCOS claim. Drospirenone utilization increased by 1.52% (SE:0.48%, p = 0.007) per-year more in women with PCOS (4.16%, SE:0.45%, p < 0.001) than in women without PCOS (2.64%, SE:0.17%, p < 0.001)). Concomitant use of drospirenone and spironolactone was common (14.26%) and increased by 0.75% (SE:0.15%, p = 0.002) per-year. Although plasma glucose tests were unavailable, women with PCOS were more likely to take metformin than have a diabetes claim (45.8% versus 15.2%, p < 0.001), indicating some women likely receive metformin solely for PCOS. Our data suggests further attention is needed to medication management of PCOS to bridge the gap between guidelines and practice. PMID:23311996

Bird, Steven T; Hartzema, Abraham G; Etminan, Mahyar; Brophy, James M; Delaney, Joseph A C

2013-01-11

352

Management of encapsulating peritoneal sclerosis: a guideline on optimal and uniform treatment.  

PubMed

Encapsulating peritoneal sclerosis (EPS) represents a rare complication of long-term peritoneal dialysis (PD). It is characterised by diffuse peritoneal membrane fibrosis, progressive intestinal encapsulation and the clinical spectrum of intestinal obstruction. The pathogenesis is as yet not well understood but includes inflammation, angiogenesis and fibrosis. The current diagnosis of EPS lacks specificity and relies on clinical, radiographic or macroscopic evaluation. There is no general agreement on managing EPS although accumulating clinical data suggest drug treatment (steroids, tamoxifen), surgery (enterolysis) or a combination of both. Here, we provide a short overview on the current knowledge of EPS, with a focus on treatment. Moreover, we present a diagnostic and a therapeutic algorithm for EPS based on the best available published data and our combined experience. PMID:22173363

Habib, S M; Betjes, M G H; Fieren, M W J A; Boeschoten, E W; Abrahams, A C; Boer, W H; Struijk, D G; Ruger, W; Krikke, C; Westerhuis, R; de Sévaux, R G L; van der Sande, F M; Gaasbeek, A; Korte, M R

353

SEOM clinical guidelines for the treatment of Hodgkin’s lymphoma  

Microsoft Academic Search

Hodgkin’s lymphoma is a malignant disease with an incidence of 2.2 cases\\/100,000. The main goals of staging are to measure\\u000a the extent of disease and associated prognostic factors. Distinct recommendations were produced for initial work-up, first-line\\u000a therapy of early and advanced stage disease and treatment of relapsed or resistant patients.

Cristina Quero Blanco; Ramón García Arroyo; Mariano Provencio Pulla; Antonio Rueda Domínguez

2010-01-01

354

Evidence-Based Guidelines for Treatment of Hepatocellular Carcinoma in Japan  

Microsoft Academic Search

\\u000a Hepatocellular carcinoma (HCC) has five characteristics that are strikingly different from those of other malignant tumors\\u000a of the digestive system: (1) a strong causal relationship with hepatitis viruses (especially type B and type C), (2) a major\\u000a impact of the status of hepatic functional reserve and liver damage on the choice of treatment and the prognosis, (3) a high\\u000a recurrence

Kiyoshi Hasegawa; Norihiro Kokudo

355

Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines  

Microsoft Academic Search

Diagnostic and therapeutic strategies for acute biliary inflammation\\/infection (acute cholangitis and acute cholecystitis),\\u000a according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management\\u000a of acute biliary inflammation\\/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment\\u000a may be sufficient\\/appropriate. For moderate (grade II) acute cholangitis, early biliary

Fumihiko Miura; Tadahiro Takada; Yoshifumi Kawarada; Yuji Nimura; Keita Wada; Masahiko Hirota; Masato Nagino; Toshio Tsuyuguchi; Toshihiko Mayumi; Masahiro Yoshida; Steven M. Strasberg; Henry A. Pitt; Jacques Belghiti; Eduardo de Santibanes; Thomas R. Gadacz; Dirk J. Gouma; Sheung-Tat Fan; Miin-Fu Chen; Robert T. Padbury; Philippus C. Bornman; Sun-Whe Kim; Kui-Hin Liau; Giulio Belli; Christos Dervenis

2007-01-01

356

Guidelines for the use of intravenous immunoglobulin in the treatment of neurologic diseases.  

PubMed

The use of intravenous immunoglobulin (IVIg) in the management of patients with neuroimmune disorders has shown a progressive trend over the last few years. Despite the wide use of IVIg, consensus on its optimal use is deficient. The European Federation of Neurological Societies (EFNS) guidance regulations offer consensus recommendations for optimal use of IVIg. The effectiveness of IVIg has been proven in Guillain-Barré syndrome (level A), chronic inflammatory demyelinating polyradiculoneuropathy (level A), multifocal mononeuropathy (level A), acute exacerbations of myasthenia gravis and short-term treatment of severe myasthenia gravis (level A). As a second-line treatment, the use of IVIg is recommended in dermatomyositis in combination with prednisone (level B) and is considered as a treatment option in polymyositis (level C). As a second- or even third-line therapy, the use of IVIg should be considered in patients with relapsing-remitting multiple sclerosis if conventional immunomodulatory therapies are not tolerated (level B) and in relapses during pregnancy or post-partum period (good clinical practice point). Finally, it appears that the use of IVIg has a beneficial effect also in stiff-person syndrome (level A), some paraneoplastic neuropathies (level B), and some acute-demyelinating diseases and childhood refractory epilepsy (good practice point). PMID:23540178

Basci?-Kes, Vanja; Kes, Petar; Zavoreo, Iris; Lisak, Marijana; Zadro, Lucija; Cori?, Lejla; Demarin, Vida

2012-12-01

357

Withholding/withdrawing treatment from neonates: legislation and official guidelines across Europe.  

PubMed Central

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.

McHaffie, H E; Cuttini, M; Brolz-Voit, G; Randag, L; Mousty, R; Duguet, A M; Wennergren, B; Benciolini, P

1999-01-01

358

Challenging Current Asthma Treatment Guidelines: Improved Control of Asthma Symptoms with Nebulised Budesonide in Patients with Severe Asthma Receiving Continuous Oral Steroids  

Microsoft Academic Search

Objective: British Thoracic Society guidelines advocate the use of oral steroid therapy as a means of controlling symptoms in patients with severe asthma. However, it is well established that there are a number of undesirable adverse effects associated with this form of treatment. The aim of this study was to determine whether the addition of nebulised budesonide reduced oral steroid

Kevin C. Connolly; Michael D. Peake; David M. G. Halpin; Lynda Golightly; Marlyn L. Turbitt

2000-01-01

359

Adherence to treatment guidelines for acute diarrhoea in children up to 12 years in Ujjain, India - a cross-sectional prescription analysis  

Microsoft Academic Search

BACKGROUND: Diarrhoea accounts for 20% of all paediatric deaths in India. Despite WHO recommendations and IAP (Indian Academy of Paediatrics) and Government of India treatment guidelines, few children suffering from acute diarrhoea in India receive low osmolarity oral rehydration solution (ORS) and zinc from health care providers. The aim of this study was to analyse practitioners' prescriptions for acute diarrhoea

Deepali Pathak; Ashish Pathak; Gaetano Marrone; Vishal Diwan; Cecilia Stålsby Lundborg

2011-01-01

360

Practice guidelines: a more rational approach to diagnosis and treatment and a more effective use of health care resources  

Microsoft Academic Search

Practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate\\u000a health care for specific clinical circumstances. The implementation of practice guidelines is justified by factors such as\\u000a variations in clinical practice, malpractice and its associated costs, and the need to contain health care expenditures. In\\u000a this context, practice guidelines promote a more rational approach to clinical

E. Beghi; A. Citterio; F. Cornelio; G. Filippini; R. Grilli; A. Liberati

1998-01-01

361

Phenotypic and genotypic properties of Neisseria gonorrhoeae isolates in Norway in 2009: antimicrobial resistance warrants an immediate change in national management guidelines.  

PubMed

Despite rapidly diminishing treatment options for Neisseria gonorrhoeae and high levels of ciprofloxacin resistance worldwide, Norwegian guidelines still recommend ciprofloxacin as empirical treatment for gonorrhea. The present study aimed to characterize phenotypical and genotypical properties of N. gonorrhoeae isolates in Norway in 2009. All viable N. gonorrhoeae isolates (n = 114) from six university hospitals in Norway (2009) were collected, representing 42% of all notified gonorrhea cases. Epidemiological data were collected from the Norwegian Surveillance System for Communicable Diseases and linked to phenotypical and genotypical characteristics for each N. gonorrhoeae isolate. Resistance levels to the antimicrobials examined were: ciprofloxacin 78%, azithromycin 11%, cefixime 3.5%, ceftriaxone 1.8%, and spectinomycin 0%. The minimum inhibitory concentrations of gentamicin varied from 1.5 to 8 mg/L. Forty-one (36%) of the isolates were ?-lactamase-producing, 17 displayed penA mosaic alleles, and 72 different N. gonorrhoeae multiantigen sequence types (ST; 37 novel) were identified. The most common ST was ST1407 (n = 11), containing penA mosaic allele. Four of these isolates displayed intermediate susceptibility/resistance to cefixime. The N. gonorrhoeae strains circulating in Norway were highly diverse. The level of ciprofloxacin resistance was high and the Norwegian management guidelines should promptly exclude ciprofloxacin as an empirical treatment option for gonorrhea. PMID:21960034

Hjelmevoll, S O; Golparian, D; Dedi, L; Skutlaberg, D H; Haarr, E; Christensen, A; Jørgensen, S; Nilsen, Ø J; Unemo, M; Skogen, V

2011-09-30

362

[Guideline of neuropathic pain treatment and dilemma from neurological point of view].  

PubMed

Neuropathic pain is a complicated symptomatic disease as migraine in recent years. Not because the pain character differed from the nociceptive inflammatory symptoms but because of its complexity of mechanisms. Though peripheral sensitization, ectopic discharge, central sensitization, central re-organization and loss of inhibition play part of roles in mechanisms, however, based on this mechanistic treatment, the outcome still disappointed physicians and patients, exampled as central post-stroke central pain (CPSP). The pain reduction is far less than the expectation from patients and physician's under-treatment frequently occur due to the fear of adverse effects or off-label use of these anti-neuropathic pain drugs. Therefore, a multidisciplinary procedure including non-pharmacological management, rehabilitation program, careful explanation, stepwise pain reduction, daily diary record, and tailored individual planning for medications are helpful in treating this kind of sufferers. Pharmacological treatment is the mainstream in post-herpetic neuralgia (PHN), diabetic peripheral neuropathic pain (DPNP), central post-stroke pain (CPSP), trigeminal neuralgia (TN), complex regional pain syndrome (CRPS), cancer pain, failed back syndrome etc, while polypharmacy is still the major prescriptions facing such kind of miserable patients. The tricyclic antidepressants (TCA), gamma- aminobutyric acid (GABA), voltage-dependent calcium channel blockers, selective non-epinephrine reuptake inhibitor (SNRI), opioid or morphine etc, are still evidence-based medicines (EBM) but with different outcome for individuals. Acupuncture is to some extend effective in Taiwanese people with perceived evidence or placebo. The Taiwan guidance for total pain management and review of EBM in treating neuropathic pain from neurological point of view will be introduced in this manuscript. PMID:23196735

Yang, Chun-Ming; Chen, Nan-Cheng; Shen, Hsiu-Chu; Chou, Chi-Ho; Yeh, Poh-Shiow; Lin, Huey-Juan; Chang, Chia-Yu; Cheng, Tain-Junn; Lin, Kao-Chang

2012-09-01

363

Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy.  

PubMed

This article seeks to provide the practising clinician with guidance on the pharmacological management of tic disorders in children and adults. We performed a systematic review of the literature on the treatment of tic disorders. A multi-institutional group of 14 experts in psychiatry, child psychiatry, neurology, pediatrics, and psychology engaged in a consensus meeting. The evidence was presented and discussed, and nominal group techniques were employed to arrive at consensus on recommendations. A strong recommendation is made when the benefits of treatment clearly outweigh the risks and burdens, and can apply to most patients in most circumstances without reservation. With a weak recommendation, the benefits, risks, and burdens are more closely balanced, and the best action may differ depending on the circumstances. Based on these principles, weak recommendations were made for the use of pimozide, haloperidol, fluphenazine, metoclopramide (children only), risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone, topiramate, baclofen (children only), botulinum toxin injections, tetrabenazine, and cannabinoids (adults only). Strong recommendations were made for the use of clonidine and guanfacine (children only). While the evidence supports the efficacy of many of the antipsychotics for the treatment of tics, the high rates of side effects associated with these medications resulted in only weak recommendations for these drugs. In situations where tics are not severe or disabling, the use of a medication with only a weak recommendation is not warranted. However, when tics are more distressing and interfering, the need for tic suppression to improve quality of life is stronger, and patients and clinicians may be more willing to accept the risks of pharmacotherapy. PMID:22397999

Pringsheim, Tamara; Doja, Asif; Gorman, Daniel; McKinlay, Duncan; Day, Lundy; Billinghurst, Lori; Carroll, Alan; Dion, Yves; Luscombe, Sandra; Steeves, Thomas; Sandor, Paul

2012-03-01

364

Individual, facility and policy level influences on national coverage estimates for intermittent preventive treatment of malaria in pregnancy in Tanzania  

PubMed Central

Background Delivery of two doses of intermittent preventive treatment of malaria during pregnancy (IPTp) is a key strategy to reduce the burden of malaria in pregnancy in sub-Saharan Africa. However, different settings have reported coverage levels well below the target 80%. Antenatal implementation guidelines in Tanzania recommend IPTp first dose to be given at the second antenatal visit, and second dose at the third visit. This investigation measured coverage of IPTp at national level in Tanzania and examined the role of individual, facility, and policy level influences on achieved coverage. Methods Three national household and linked reproductive and child health (RCH) facility surveys were conducted July-August 2005, 2006, and 2007 in 210 clusters sampled using two-stage cluster sampling from 21 randomly selected districts. Female residents who reported a livebirth in the previous year were asked questions about malaria prevention during that pregnancy and individual characteristics including education, pregnancy history, and marital status. The RCH facility serving each cluster was also surveyed, and information collected about drug stocks, health education delivery, and the timing of antenatal care delivery by clinic users. Results The national IPTp coverage had declined over the survey period being 71% for first dose in 2005 falling to 65% in 2007 (?2 2.9, p = 0.05), and 38% for second dose in 2005 but 30% in 2007 (?2 4.4, p = 0.01). There was no evidence of any individual factors being associated with second dose coverage beyond living in an urban area. Availability of sulphadoxine-pyrimethamine at RCH had decreased year on year from 85% of clinics in stock in 2005 to 60% in 2007 (?2 20.6, p < 0.001). This reduction was evident in rural but not urban clinics. If safety recommendations and national antenatal care guidelines for IPTp delivery were followed, in 2007 only 76% of pregnant women could have received IPTp first dose and only 46% could have received second dose. Conclusion There is scope to improve IPTp first and second dose coverage at national scale within existing systems by improving stock at RCH, and by revising the existing guidelines to recommend delivery of IPTp after quickening, rather than at a pre-defined antenatal visit.

Marchant, Tanya; Nathan, Rose; Jones, Caroline; Mponda, Hadji; Bruce, Jane; Sedekia, Yovitha; Schellenberg, Joanna; Mshinda, Hassan; Hanson, Kara

2008-01-01

365

[Diagnosis and treatment management of basal cell skin carcinoma - guidelines analysis].  

PubMed

Basal cell carcinoma (BCC) is the most frequent skin cancer in France. BCC has above all a local evolution with an important locoregional morbidity. BCC are found in 80% in the cervicofacial region. Surgery is currently recognized to be the most reliable treatment. The surgeon needs to achieve an in sano excision and must recover the defect with the less aesthetic consequences. The aim of this work is to combine and to get-at-able the recommandations of the "Haute Autorité de santé" of 2004, and also to supply some details for the clinical practice of the plastic surgeon. PMID:22475480

Pinatel, B; Mojallal, A

2012-04-03

366

Guidelines on the management of fibromyalgia syndrome - a systematic review.  

PubMed

We compared the methodology and the recommendations of evidence-based guidelines for the management of fibromyalgia syndrome (FMS) to give an orientation within the continuously growing number of reviews on the therapy of FMS. Systematic searches up to April 2008 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, the Association of the Scientific Medical Societies in Germany (AWMF) and Medline were conducted. Three evidence-based guidelines for the management of FMS published by professional organizations were identified: The American Pain Society (APS) (2005), the European League Against Rheumatism (EULAR) (2007), and the AWMF (2008). The steering committees and panels of APS and AWMF were comprised of multiple disciplines engaged in the management of FMS and included patients, whereas the task force of EULAR only consisted of physicians, predominantly rheumatologists. APS and AWMF ascribed the highest level of evidence to systematic reviews and meta-analyses, whereas EULAR credited the highest level of evidence to randomised controlled studies. Both APS and AWMF assigned the highest level of recommendation to aerobic exercise, cognitive-behavioral therapy, amitriptyline, and multicomponent treatment. In contrast, EULAR assigned the highest level of recommendation to a set of to pharmacological treatment. Although there was some consistency in the recommendations regarding pharmacological treatments among the three guidelines, the APS and AWMF guidelines assigned higher ratings to CBT and multicomponent treatments. The inconsistencies across guidelines are likely attributable to the criteria used for study inclusion, weighting systems, and composition of the panels. PMID:19264521

Häuser, Winfried; Thieme, Kati; Turk, Dennis C

2009-03-04

367

Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.  

PubMed

Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development. PMID:22762776

Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven

2012-07-04

368

Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest  

PubMed Central

Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

2012-01-01

369

EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds.  

PubMed

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

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

370

Guidelines International Network: toward international standards for clinical practice guidelines.  

PubMed

Guideline development processes vary substantially, and many guidelines do not meet basic quality criteria. Standards for guideline development can help organizations ensure that recommendations are evidence-based and can help users identify high-quality guidelines. Such organizations as the U.S. Institute of Medicine and the United Kingdom's National Institute for Health and Clinical Excellence have developed recommendations to define trustworthy guidelines within their locales. Many groups charged with guideline development find the lengthy list of standards developed by such organizations to be aspirational but infeasible to follow in entirety. Founded in 2002, the Guidelines International Network (G-I-N) is a network of guideline developers that includes 93 organizations and 89 individual members representing 46 countries. The G-I-N board of trustees recognized the importance of guideline development processes that are both rigorous and feasible even for modestly funded groups to implement and initiated an effort toward consensus about minimum standards for high-quality guidelines. In contrast to other existing standards for guideline development at national or local levels, the key components proposed by G-I-N will represent the consensus of an international, multidisciplinary group of active guideline developers. This article presents G-I-N's proposed set of key components for guideline development. These key components address panel composition, decision-making process, conflicts of interest, guideline objective, development methods, evidence review, basis of recommendations, ratings of evidence and recommendations, guideline review, updating processes, and funding. It is hoped that this article promotes discussion and eventual agreement on a set of international standards for guideline development. PMID:22473437

Qaseem, Amir; Forland, Frode; Macbeth, Fergus; Ollenschläger, Günter; Phillips, Sue; van der Wees, Philip

2012-04-01

371

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

PubMed Central

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

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

2009-01-01

372

Practice guidelines in the addictions  

Microsoft Academic Search

Consensually established principles of clinical conduct, known variously as practice guidelines, standards, protocols, or algorithms, have proliferated throughout medicine over the past decade. Institutional and disciplinary efforts to develop and promulgate guidelines for the treatment of addictive disorders have recently been initiated. We review guideline development activities of the American Psychiatric Association, American Psychological Association, American Society of Addiction Medicine,

R. Dale Walker; Matthew Owen Howard; Patricia Silk Walker; M. Dow Lambert; Richard Suchinsky

1995-01-01

373

Guidelines, evidence, and cultural factors  

Microsoft Academic Search

OBJECTIVE: To compare four recent guidelines on uncomplicated cystitis and to examine how cultural factors may have affected recommendations. DESIGN: Descriptive study with a qualitative analysis of authors' reasons for recommendations. MATERIAL: Guidelines for general practitioners published 1999-2000 from Germany, The Netherlands, Norway, and Belgium on diagnosis and treatment of uncomplicated cystitis. Opinions of the guideline authors on the influence

T. Christiaens; D. de Backer; J. S. Burgers; A. Baerheim

2004-01-01

374

[Practical guidelines for the treatment of cases of adder envenomation in dogs].  

PubMed

Every year, dogs are presented to veterinary clinics in the Netherlands after having been bitten by a viper. The viper is the only venomous snake native to the Netherlands. Clinical signs after an acquired viper bite can range from none (after a 'dry' bite) to very mild up to life threatening following a 'wet' bite. To prevent mortality it is important to monitor the animals for a period of time and provide adequate treatment. Clotting disorders and multiple organ failure can occur several days to a week after the viper bite, appropriate follow up is therefore important. In the Netherlands, a specific antiserum is available for veterinarians. The use of this antiserum is strongly recommended in severe cases of viper envenomation. PMID:23101331

van Rhijn, N C; Leenders, M E C; Willemse, G C H; Dijkman, M A

2012-10-01

375

Guidelines for glycemic control.  

PubMed

Glycemic control in diabetes patients continues to evolve as new medications are introduced and clinical trial data become available. The American Diabetes Association (ADA) guidelines for 2004, for the first time, provide targets for both preprandial and postprandial glucose levels. The ADA, however, does not provide guidelines regarding specific medication therapy. This paper provides a detailed treatment algorithm that is easy to follow for nurse practitioners as well as primary care providers. Progress in our understanding of diabetes and new therapeutic agents will dictate modifications of treatment targets and guidelines, with the goal of making euglycemia achievable for all patients with diabetes. PMID:15628691

Clement, Stephen

2004-01-01

376

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

PubMed

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

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

2013-09-25

377

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

PubMed Central

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

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

2013-01-01

378

Air Pollution-Related Lichen Monitoring in National Parks, Forests, Refuges: Guidelines for Studies Intended for Regulatory and Management Purposes.  

National Technical Information Service (NTIS)

This guidance document is intended to serve as a resource for national park, forest, and refuge staff when considering lichen studies to address air quality concerns. It provides background regarding the use of lichens as air pollution indicators, their s...

E. Porter L. Geiser T. Blett

2003-01-01

379

Assessing compliance of cardiologists with the national cholesterol education program (NCEP) III guidelines in an ambulatory care setting  

PubMed Central

Introduction The NCEP III -ATP guidelines provide clear clinical directives for lipid management especially statins therapy in appropriate patient groups. Compliance of primary care physicians with these guidelines especially in ambulatory care settings has been shown to be poor. The compliance of cardiologist to these guidelines is less documented. Methods A retrospective chart review of 386 patients managed in a large urban cardiology practice was undertaken. Patients with documented contraindications to use of statins were excluded from the study. Only patients with two or more years of follow-up in the practice were included. Demographic variables and medical history including CAD or its equivalent and its major risk factors were identified. The proportion of patients on statins and adequacy of statins therapy were recorded. The lipid profiles of all patients were also analyzed. Results Fifteen patients with documented contraindications to statins therapy including persistent/severe LFT abnormalities, allergies, and gastrointestinal intolerance were excluded. A total of 371 patients were included in the analysis. The mean age for patients in the study was 65 years (range: 42–84). 236 (64%) were males while 141 (36%) were females. 161 (43%) patients were on statins while 210 (57%) weren't. 88 (62%) of females were on stain compared to 116 (49%) of males (p = 0.001). 68% of patients below the age of 50 yrs were not on statins compared with 55% of those greater than 50 yrs (p = 0.01). 38% of patients on statins therapy had sub-optimal lipid profile despite greater than two years of therapy. No statistically significant differences in race and use of satins were noted. Conclusion This study demonstrates a higher than expected prevalence of sub-optimal management of dyslipidemia among patients with established coronary heart disease without contraindications to statins managed by cardiologists. Cardiology and primary care practices require similar comprehensive routine lipid management program that is assiduously maintained and evaluated at both in-patient and out patient settings to ensure most patients receive optimal therapy with statins and other lipid lowering agents.

Aliyu, Zakari Y; Yousif, Sohair B; Plantholt, Kate; Salihu, Hamisu M; Erinle, Ayodele; Plantholt, Steve

2004-01-01

380

7 CFR 611.10 - Standards, guidelines, and plans.  

Code of Federal Regulations, 2013 CFR

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

2013-01-01

381

Guidelines for the processing and quality assurance of benthic invertebrate samples collected as part of the National Water-Quality Assessment Program  

USGS Publications Warehouse

Benthic invertebrate samples are collected as part of the U.S. Geological Survey?s National Water-Quality Assessment Program. This is a perennial, multidisciplinary program that integrates biological, physical, and chemical indicators of water quality to evaluate status and trends and to develop an understanding of the factors controlling observed water quality. The Program examines water quality in 60 study units (coupled ground- and surface-water systems) that encompass most of the conterminous United States and parts of Alaska and Hawaii. Study-unit teams collect and process qualitative and semi-quantitative invertebrate samples according to standardized procedures. These samples are processed (elutriated and subsampled) in the field to produce as many as four sample components: large-rare, main-body, elutriate, and split. Each sample component is preserved in 10-percent formalin, and two components, large-rare and main-body, are sent to contract laboratories for further processing. The large-rare component is composed of large invertebrates that are removed from the sample matrix during field processing and placed in one or more containers. The main-body sample component consists of the remaining sample materials (sediment, detritus, and invertebrates) and is subsampled in the field to achieve a volume of 750 milliliters or less. The remaining two sample components, elutriate and split, are used for quality-assurance and quality-control purposes. Contract laboratories are used to identify and quantify invertebrates from the large-rare and main-body sample components according to the procedures and guidelines specified within this document. These guidelines allow the use of subsampling techniques to reduce the volume of sample material processed and to facilitate identifications. These processing procedures and techniques may be modified if the modifications provide equal or greater levels of accuracy and precision. The intent of sample processing is to determine the quantity of each taxon present in the semi-quantitative samples or to list the taxa present in qualitative samples. The processing guidelines provide standardized laboratory forms, sample labels, detailed sample processing flow charts, standardized format for electronic data, quality-assurance procedures and checks, sample tracking standards, and target levels for taxonomic determinations. The contract laboratory (1) is responsible for identifications and quantifications, (2) constructs reference collections, (3) provides data in hard copy and electronic forms, (4) follows specified quality-assurance and quality-control procedures, and (5) returns all processed and unprocessed portions of the samples. The U.S. Geological Survey?s Quality Management Group maintains a Biological Quality-Assurance Unit, located at the National Water-Quality Laboratory, Arvada, Colorado, to oversee the use of contract laboratories and ensure the quality of data obtained from these laboratories according to the guidelines established in this document. This unit establishes contract specifications, reviews contractor performance (timeliness, accuracy, and consistency), enters data into the National Water Information System-II data base, maintains in-house reference collections, deposits voucher specimens in outside museums, and interacts with taxonomic experts within and outside the U.S. Geological Survey. This unit also modifies the existing sample processing and quality-assurance guidelines, establishes criteria and testing procedures for qualifying potential contract laboratories, identifies qualified taxonomic experts, and establishes voucher collections.

Cuffney, T. F.; Gurtz, M. E.; Meador, M. R.

1993-01-01

382

Substance Abuse Counselors' Implementation of Tobacco Cessation Guidelines1  

PubMed Central

This study assessed the extent of implementation of the Public Health Service tobacco cessation guidelines among a national sample of counselors working in five different types of substance abuse treatment programs. Further, we identified implementation patterns among counselors using cluster analysis and considered differences in counselor characteristics based on their cluster membership. Data were obtained from the 2008 Managing Effective Relationships in Treatment Services (MERITS I) project. Counselors (N = 615) working in Clinical Trials Network (CTN) affiliated community treatment programs completed paper-and-pencil surveys. Implementation of the guidelines was inconsistent and selective. Counselors could be grouped into low versus high implementers. Some counselor characteristics differed based on their implementation cluster membership.

Rothrauff, Tanja C.; Eby, Lillian T.

2013-01-01

383

Treatment of Mercury Contaminated Oil from Sandia National Laboratory  

SciTech Connect

First Article Tests of a stabilization method for greater than 260 mg mercury/kg oil were performed under a treatability study. This alternative treatment technology will address treatment of U.S. Department of Energy (DOE) organics (mainly used pump oil) contaminated with mercury and other heavy metals. Some of the oil is also co-contaminated with tritium, other radionuclides, and hazardous materials. The technology is based on contacting the oil with a sorbent powder (Self-Assembled Mercaptan on Mesoporous Support, SAMMS), proven to adsorb heavy metals, followed by stabilization of the oil/powder mixture using a stabilization agent (Nochar N990). Two variations of the treatment technology were included in the treatability study. The SAMMS (Self-Assembled Mercaptan on Mesoporous Silica) technology was developed by the Pacific Northwest National Laboratory for removal and stabilization of RCRA metals (i.e., lead, mercury, cadmium, silver, etc.) and for removal of mercury from organic solvents [1]. The SAMMS material is based on self-assembly of functionalized monolayers on mesoporous oxide surfaces. The unique mesoporous oxide supports provide a high surface area, thereby enhancing the metal-loading capacity. SAMMS material has high flexibility in that it binds with different forms of mercury, including metallic, inorganic, organic, charged, and neutral compounds [1] The material removes mercury from both organic wastes, such as pump oils, and from aqueous wastes. Mercury-loaded SAMMS not only passes TCLP tests, but also has good long-term durability as a waste form because: (1) the covalent binding between mercury and SAMMS has good resistance in ion-exchange, oxidation, and hydrolysis over a wide pH range and (2) the uniform and small pore size of the mesoporous silica prevents bacteria from solubilizing the bound mercury. Nochar's N990 Petrobond (Nochar, Inc., Indianapolis, IN) is an oil stabilization agent, specifically formulated for stabilizing vacuum pump oil, which has fewer volatile organics than many other oils. This material is a non-uniform granular powder that resembles ground Styrofoam plastics. This material has previously been used by itself and in combination with SAMMS to stabilize oil containing low levels of mercury {approx}50 mg/kg in surrogate waste studies [2].

Klasson, KT

2002-05-28

384

History of guidelines for the diagnosis and management of asthma: from opinion to control.  

PubMed

The Global Initiative on Asthma (GINA) was launched in 1993 in collaboration with the National Heart, Lung, and Blood Institute, the National Institutes of Health (USA) and the WHO. Its first effort was the production of a consensus report on asthma treatment, which aimed to bridge the gap between the various treatment options and the incorporation and implementation of innovative treatment forms into daily clinical practice. The first report published in 1995, A Global Strategy for Asthma Management and Prevention, has been translated into several languages, widely adopted and provided the foundation for several asthma guidelines worldwide. The GINA and other guidelines were primarily based on consensus of expert opinion in order to employ a severity-based classification system as a guide to treatment. However, in the late 1990s, guidelines underwent a major paradigm shift from opinion- to evidence-based classification as the foundation for asthma management. A second major shift involved the classification of asthma according to the level of disease control as a guide to treatment, which was realized for the first time in the revised 2006 GINA guidelines. Since their first appearance, asthma guidelines have played a leading role in disseminating information about asthma. In addition, they have had a substantial impact on standardizing asthma care around the world, which is likely to continue in the future. This article addresses the history of guideline development and issues related to asthma guidelines, with particular emphasis on the GINA guidelines. PMID:19537836

Kroegel, Claus; Wirtz, Hubert

2009-06-18

385

Canadian consensus guidelines for the optimal use of maraviroc in the treatment of HIV-infected adults  

PubMed Central

BACKGROUND AND OBJECTIVES: A Canadian group, consisting of six physicians and an HIV researcher with significant experience and knowledge in HIV management, reviewed the available data and developed guidelines for Canadian health care providers (who treat HIV infection) on the appropriate use of maraviroc (UK-427,857) in HIV-infected adults. METHODS: Evidence from the published literature and conference presentations, as well as the expert opinions of the group members were considered and evaluated to develop the recommendations. Feedback on the draft recommendations was obtained from this core group, as well as from four other physicians across Canada with expertise in HIV treatment and experience with the use of maraviroc. The final recommendations represent the core group’s consensus agreement once all feedback was considered. RESULTS/CONCLUSIONS: Recommendations were developed to guide physicians and other health care providers in the optimal use of maraviroc. The recommendations were considered in light of the fact that the decision to include maraviroc in an antiretroviral regimen depends not only on issues that concern all antiretroviral agents, such as efficacy, safety, resistance and drug interactions, but also on the issue of viral tropism, which is unique to maraviroc and other CCR5 inhibitors.

Rachlis, Anita; Harris, Marianne; Lalonde, Richard; Shafran, Stephen D; Tremblay, Cecile; Wainberg, Mark A; Walmsley, Sharon

2010-01-01

386

Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II--clinical applications and guidelines.  

PubMed

Yogic breathing is a unique method for balancing the autonomic nervous system and influencing psychologic and stress-related disorders. Part I of this series presented a neurophysiologic theory of the effects of Sudarshan Kriya Yoga (SKY). Part II will review clinical studies, our own clinical observations, and guidelines for the safe and effective use of yoga breath techniques in a wide range of clinical conditions. Although more clinical studies are needed to document the benefits of programs that combine pranayama (yogic breathing) asanas (yoga postures), and meditation, there is sufficient evidence to consider Sudarshan Kriya Yoga to be a beneficial, low-risk, low-cost adjunct to the treatment of stress, anxiety, post-traumatic stress disorder (PTSD), depression, stress-related medical illnesses, substance abuse, and rehabilitation of criminal offenders. SKY has been used as a public health intervention to alleviate PTSD in survivors of mass disasters. Yoga techniques enhance well-being, mood, attention, mental focus, and stress tolerance. Proper training by a skilled teacher and a 30-minute practice every day will maximize the benefits. Health care providers play a crucial role in encouraging patients to maintain their yoga practices. PMID:16131297

Brown, Richard P; Gerbarg, Patricia L

2005-08-01

387

[The new S2k AWMF guideline for the treatment of Bell's palsy in commented short form].  

PubMed

A new S2k AWMF guideline for the treatment of idiopathic facial palsy has been published. An accurate differential diagnosis is indispensable as 25-40% of all facial palsy cases are of non-idiopathic origin. It is explicitly recommended to treat patients with idiopathic facial palsy with steroids. Steroids favour a complete recovery, decrease the risk of synkinesis, autonomic sequelae and contractures. Adjuvant antiviral therapy cannot be recommended. On current data there is not sufficient evidence that the combination of steroids with antiviral drugs has a benefit for the patients. Even when not supported by randomized trials, adjuvant symptomatic therapy to protect the cornea and to avoid complications is recommended. There is no scientific evidence that physical therapy has any benefit but it should be taken into account because of psychological reasons. A benefit of acupuncture has not been proven. If eye closure remains incomplete as result of defective healing, one therapeutic option is lid loading of the upper eye lid. Moreover, in case of severe persistent palsy, several well-established microsurgical nerve and muscle plasty procedures are available. PMID:22961063

Heckmann, J G; Lang, C; Glocker, F X; Urban, P; Bischoff, C; Weder, B; Reiter, G; Meier, U; Guntinas-Lichius, O

2012-09-07

388

Incontinence-associated dermatitis: consensus statements, evidence-based guidelines for prevention and treatment, and current challenges.  

PubMed

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

Doughty, Dorothy; Junkin, Joan; Kurz, Peter; Selekof, Joan; Gray, Mikel; Fader, Mandy; Bliss, Donna Z; Beeckman, Dimitri; Logan, Susan

389

Recent Update of Guidelines for Neurointerventional Procedures  

PubMed Central

Treatment guidelines of the neurointerventional procedures are continuously updated. However, these guidelines differ between countries and even medical societies within the same country because of the differing interests and patient groups. The differences between guidelines are confusing to many neurointerventionalists. Recently "Clinical Research Center for Stroke" in Korea updated "Clinical Practice Guidelines for Stroke" for the patients in Korea. So we introduce those guidelines and compare several recent guidelines of international medical societies for neurointerventionalists.

Shin, Shang Hun; Kwon, Soon Chan

2013-01-01

390

Operational research and HIV policy and guidelines: lessons from a study of patients lost to follow-up from a public antiretroviral treatment program in Cameroon.  

PubMed

Can operations and implementation research guide today's unprecedented efforts to scale-up HIV/AIDS prevention, treatment, care, and support in resource-limited settings? Our study of patients with HIV/AIDS who were first seen at the Central Hospital (Yaoundé, Cameroon) to begin antiretroviral therapy demonstrates the value of using operations research to explore programs, policies, and guidelines used in health care. We studied one group of patients, those lost to follow-up. Our findings confirmed the value of early treatment, systems to follow individuals, free treatment, and resources that enable operations research. We encourage health-care workers and program managers to perform operational research in their own context, and we emphasize the importance of allocating adequate human, financial, and logistic resources for this activity. Finally, we stress that the health-care workers, program managers, and researchers must work together to better inform policy and guidelines. PMID:22932024

Mben, Jean-Marc; Kouanfack, Charles; Essomba, Claudine Ntsama; Mbougua, Jules Brice Tchatchueng; Kenfack, Alain; Tonfack, Clément Auguste Djouatsa; Laborde-Balen, Gabrièle; Bourgeois, Anke; Biwolé-Sida, Magloire; Delaporte, Eric; Laurent, Christian

2012-08-30

391

Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline.  

PubMed

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

Mathus-Vliegen, Elisabeth M H

2012-06-30

392

How can information extraction ease formalizing treatment processes in clinical practice guidelines? A method and its evaluation?  

PubMed Central

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 is independent of the final guideline representation language. Results: We have developed and evaluated several heuristics without the need to apply natural language understanding and implemented them in a framework to apply them to several guidelines from the medical subject of otolaryngology. Findings in the evaluation indicate that using semi-automatic, step-wise information extraction methods are a valuable instrument to formalize CPGs. Conclusion: Our evaluation shows that a heuristic-based approach can achieve good results, especially for guidelines with a major portion of semi-structured text. It can be applied to guidelines irrespective to the final guideline representation format.

Kaiser, Katharina; Akkaya, Cem; Miksch, Silvia

2010-01-01

393

Guidelines for the detection of high-risk lipoprotein profiles and the treatment of dyslipoproteinemias. Canadian Lipoprotein Conference Ad Hoc Committee on Guidelines for Dyslipoproteinemias.  

PubMed Central

Elevated plasma levels of cholesterol and triglycerides, low levels of high-density lipoproteins, hypertension, diabetes mellitus, smoking and abdominal obesity are risk factors for coronary heart disease (CHD) and stroke. Because of the preventable threat to life, well-being and productivity from perturbations of plasma lipoproteins (which affect about 60% of adults), we recommend a population-based strategy with public education on diet, exercise and the hazards of smoking and legislation for better food labelling. This should be combined with the medical guidelines we describe to detect and treat those at highest risk for CHD (including about 15% of adults), who merit priority for the medical, dietetic and laboratory services required. Among people aged 40 years or more this includes those with plasma total cholesterol levels greater than 7 mmol/L, fasting triglyceride levels greater than 3 mmol/L or cholesterol level greater than 6 mmol/L when associated with CHD or other risk factors for CHD. For younger people the criteria for highest risk include cholesterol levels greater than 6.5 mmol/L for those aged 30 to 39 years, greater than 6 mmol/L for those aged 20 to 29 and greater than 5 mmol/L for those under age 20.

1990-01-01

394

Diabetes in older adults. Overview of AGS guidelines for the treatment of diabetes mellitus in geriatric populations.  

PubMed

The recently published guidelines from the California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes provide recommendations that should help improve care in that population. This paper will summarize the guidelines and indicate which recommendations are evidence-based and which are based on expert opinion, as some aspects of the guidelines have not been examined in controlled clinical trials. Practitioners need to apply approaches to care that consider level of function and the patient's and family's wishes and values. PMID:15086070

Olson, Darin E; Norris, Susan L

2004-04-01

395

The use of guidelines for dissemination of “best practice” in primary care of patients with eating disorders  

Microsoft Academic Search

Objective: A number of sets of clinical guidelines have been developed for the treatment of eating-disordered patients. This study aimed to measure adherence to such guidance among family physi- cians working in primary care settings. Method: In the wake of the publication of national guidelines for ''best practice,'' family physicians in a large but diverse geographical region of the UK

Laura Currin; Glenn Waller; Janet Treasure; Jane Nodder; Christine Stone; Maria Yeomans; Ulrike Schmidt

2007-01-01

396

Successful Waste Treatment Methods at Sandia National Laboratories  

SciTech Connect

During the remediation of the waste landfills at Sandia National Laboratory in Albuquerque, New Mexico nine drums of mock high explosives were generated. This mixed waste stream was proposed to several offsite vendors for treatment and prices ranged from $2.50 to $10 per gram a total cost estimated to be in excess of $2 million dollars. This cost represents more than 30 percent of the annual budget for the Sandia Waste Management Operations. Concentrated solutions of common oxidizers, such as nitrates, nitrites, and peroxides, will also act as oxidizers and will give positive results in the Hazard Categorization oxidizer test. These solutions carry an EPA Hazardous Waste Number D001, Ignitable Waste, and Oxidizer as defined in 49 CFR 173.151. Sandia decided that given budget and time constraints to meet a Federal Facilities Compliance Act milestone, a process for onsite treatment should be evaluated. Clean samples of mock high explosive materials were obtained from Pantex excess inventory and treatability studies initiated to develop a treatment formula and process. The following process was developed and implemented in the summer of 2006: - Size reduction to allow for dissolution of the barium nitrate in water; - Dissolution of the Mock HE in water; - Deactivation of the oxidizer; - Stabilization of the barium and the cadmium contamination present as an underlying hazardous constituent. This project was completed and the treatment milestone achieved for less than $300,000. The Disassembly Sanitization Operation (DSO) is a process that was implemented to support weapon disassembly and disposition using recycling and waste minimization while achieving the demilitarization mission. The Department of Energy is faced with disassembling and disposition of a huge inventory of retired weapons, components, training equipment, spare parts, and weapon maintenance equipment. Environmental regulations have caused a dramatic increase for information needed to support the disposal and handling of these parts and materials. Manufacturing information from past decades often does not meet the needs for regulatory decisions of today to assure proper management of weapons components. Huge inventories of classified weapon components were required to have long-term storage at Sandia and many other locations throughout the complex. These materials are stored because they are classified, they may also contain radiological and/or hazardous components and disposal options may not have existed for this material. Long-term storage is costly and somewhat problematic. It requires a secured storage area, monitoring, auditing and it also has the potential for loss or theft of this material. Overall recycling rates for materials sent through the DSO process have enabled 70 to 80% of these components to be recycled. These components are made to extreme standards and are made of high quality materials. Once the material has been sanitized, the demand for these metals is very high. The DSO process for the NGPF classified components established the credibility of this technique as a viable process for addressing the long-term storage requirements of classified weapons component inventory. The success of this operation has generated interest from other Sandia Organization other locations throughout the complex. Other organizations are soliciting the help of the DSO team and the DSO is responding to these solicitations by expanding its scope to include work for other projects. For example, Pantex has asked the DSO team to assist with the destruction of their classified components. The operation is full scale and continues to grow and serve SNL/NM and DoE by providing a solution to this evolving issue. On an ongoing basis, SNL has been incurring expenses for the management and storage of classified components. It is estimated that this project will save the DoE and Sandia several hundreds of thousands of dollars until the excess inventory is eliminated. This innovative approach eliminates the need for long-term storage of classified weapons components and the

Rast, D.M.; Thompson, J.J.; Cooper, T.W.; Stockham, D.J

2007-07-01

397

Assessment of current National Cholesterol Education Program guidelines for total cholesterol, triglyceride, HDL-cholesterol, and LDL-cholesterol measurements  

Microsoft Academic Search

We examine the effect of systematic bias and random error, quality control, and intraperson biological varia- tion on the National Cholesterol Education Program (NCEP) clinical classifications for reported lipid mea- surements. We consider misclassification to occur if a true lipid homeostatic set point is within a desirable range but the reported lipid value is in a high-risk range, or if

Samuel P. Caudill; Gerald R. Cooper; S. Jay Smith; Gary L. Myers

398

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

EPA Science Inventory

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

399

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

ERIC Educational Resources Information Center

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

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

400

Guidelines on Firewalls and Firewall Policy.  

National Technical Information Service (NTIS)

This document provides guidelines for Federal organizations acquisition and use of security-related Information Technology (IT) products. These guidelines provide advice to agencies for sensitive (i.e., non-national security) unclassified systems. NIST's ...

2002-01-01

401

Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis  

Microsoft Academic Search

Rochelle Walensky and colleagues use a model-based analysis to examine which of the 2010 WHO antiretroviral therapy guidelines should be implemented first in resource-limited settings by ranking them according to survival, cost-effectiveness, and equity.

Rochelle P. Walensky; Robin Wood; Andrea L. Ciaranello; A. David Paltiel; Sarah B. Lorenzana; Xavier Anglaret; Adam W. Stoler; Kenneth A. Freedberg

2010-01-01

402

A national study of the substance abuse treatment workforce  

Microsoft Academic Search

This study's purpose is to gain a current perspective on the substance abuse treatment field's workforce. The data are from the Retrospective Study of treatment professionals designed to document how the Treatment Improvement Protocols published by the Center for Substance Abuse Treatment have influenced the implementation of best practices. The Retrospective Study consisted of a two-wave cross-sectional survey with telephone

Kevin P Mulvey; Susan Hubbard; Susan Hayashi

2003-01-01

403

ONCODOC: a successful experiment of computer-supported guideline development and implementation in the treatment of breast cancer.  

PubMed

Originally published as textual documents, clinical practice guidelines have poorly penetrated medical practice because their editorial properties do not allow the reader to easily solve, at the point of care, a given medical problem. However, despite the proliferation of implemented clinical practice guidelines as decision support systems providing an easy access to patient-centered information, there is still little evidence of high physician compliance to guidelines recommendations. Apart from physicians' psychological reluctance, the incompleteness of guideline knowledge and the impreciseness of the terms used, another reason may be that, although suited to average patients, clinical practice guideline recommendations are not a substitute for the physician-controlled clinical judgement that should be applied to each actual individual patient. Therefore, computer-based approaches based on the automation of context-free operationalization of guideline knowledge, although providing uniform optimal strategies to problem-focused care delivery, may generate inappropriate inferences for a specific patient that the physician does not follow in practice. Rather than providing automated decision support, ONCODOC allows the clinician to control the operationalization of guideline knowledge through his hypertextual reading of a knowledge base encoded as a decision tree. In this way, he has the opportunity to interpret the information provided in the context of his patient, therefore, controlling his categorization to the closest matching formal patient. Experimented in life-size ONCODOC demonstrated good appropriation of the system by physicians with significantly high scores of compliance. We successfully tested the implemented strategy and the knowledge base in a second medical institution, giving then a noticeable example of reuse and sharing of encoded guideline knowledge across institutions. PMID:11259883

Séroussi, B; Bouaud, J; Antoine, E C

2001-04-01

404

The Effect of Implementation of Guidelines for the Management of Severe Head Injury on Patient Treatment and Outcome  

Microsoft Academic Search

Summary  ¶?The authors retrospectively analysed two groups of consecutive patients who were similarly matched for brain injury severity.\\u000a From a total of 39 severe head injury patients, 23 were treated according to the Guidelines for the Management of Severe Head Injury with intracranial pressure (ICP) monitoring (“Guidelines group”). Such an approach allowed the maintenance of ICP within normal values, especially in

M. Vuki?; L. Negoveti?; D. Kova?; J. Ghajar; Z. Glavi?; A. Gop?evi?

1999-01-01

405

Use of anti-asthmatic drugs in Italy: analysis of prescriptions in general practice in the light of guidelines for asthma treatment  

Microsoft Academic Search

Our aim was to analyse anti-asthmatic drug utilisation in primary health care in a Northern Italian region in the light of guidelines for asthma treatment. Methods: We collected all prescriptions for anti-asthmatic agents reimbursed in 1998 in six local health authorities (overall population: 1,909,192 inhabitants) of Emilia Romagna (Northern Italy). The asthmatic cohort was defined as the population of subjects

E. Poluzzi; D. Resi; P. Zuccheri; D. Motola; F. De Ponti; A. Vaccheri; N. Montanaro

2002-01-01

406

[Prostate cancer: interpretation of management guidelines].  

PubMed

The guidelines of the urological and oncological societies reflect the different possible interpretations of evidence-based medicine, as well as the medical and economical, or even medico-legal constraints in the various countries. Essentially, the guidelines of the American Urological Association seem to be focused on the medico-legal aspects, and offer urologists a wide range of treatment options through each stage of the disease. The recommendations of the British National Institute for Health and Clinical Excellence (NICE) focus heavily on the medical and economic aspects and the risk-benefit ratio, whereas in those of the American Society of Clinical Oncology (ASCO) overall survival is the main criteria. The French and European recommendations (Association française d'urologie [AFU] and European Association of Urology [EAU]) are almost equivalent, except for a few minor differences, and strongly reflect the recommendations of the National Comprehensive Cancer Network (NCCN). PMID:23682482

Ploussard, Guillaume; Desgrandchamps, François

2013-04-01

407

von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA).  

PubMed

von Willebrand disease (VWD) is a commonly encountered inherited bleeding disorder affecting both males and females, causing mucous membrane and skin bleeding symptoms, and bleeding with surgical or other haemostatic challenges. VWD may be disproportionately symptomatic in women of child-bearing age. It may also occur less frequently as an acquired disorder (acquired von Willebrand syndrome). VWD is caused by deficiency or dysfunction of von Willebrand factor (VWF), a plasma protein that mediates platelet haemostatic function and stabilizes blood coagulation factor VIII. The pathophysiology, classification, diagnosis and management of VWD are relatively complex, but understanding them is important for proper diagnosis and management of patients with VWD. These evidence-based guidelines for diagnosis and management of VWD from the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel (USA) review relevant publications, summarize current understanding of VWD pathophysiology and classification, and present consensus diagnostic and management recommendations based on analysis of the literature and expert opinion. They also suggest an approach for clinical and laboratory evaluation of individuals with bleeding symptoms, history of bleeding or conditions associated with increased bleeding risk. This document summarizes needs for further research in VWF, VWD and bleeding disorders, including clinical research to obtain more objective information about bleeding symptoms, advancements in diagnostic and therapeutic tools, and enhancement in the education and training of clinicians and scientists in bleeding and thrombotic disorders. The NHLBI Web site (http://www.nhlbi.nih.gov/guidelines/vwd) has a more detailed document, a synopsis of these recommendations, and patient education information. PMID:18315614

Nichols, W L; Hultin, M B; James, A H; Manco-Johnson, M J; Montgomery, R R; Ortel, T L; Rick, M E; Sadler, J E; Weinstein, M; Yawn, B P

2008-03-01

408

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

Federal Register 2010, 2011, 2012, 2013

The Forest Service will prepare an Environmental Impact Statement (EIS) for a proposal to manage non-native invasive plant (NNIP) species on National Forest System (NFS) lands within the boundaries of the Idaho Panhandle National Forests (IPNF). This area is approximately 2.5 million acres in size and includes portions of the following states and counties; Benewah, Bonner, Boundary, Clearwater,......

2011-11-16

409

Children's Advertising Guidelines.  

ERIC Educational Resources Information Center

|These guidelines have been developed for the use of advertisers and advertising agencies and for the self-regulatory mechanism which these groups have established, the National Advertising Division, to help ensure that advertising directed to children is truthful, accurate, and fair to children's perceptions. Preliminary sections set forth basic…

Council of Better Business Bureaus, Inc., New York, NY.

410

RISK ASSESSMENT GUIDELINES  

EPA Science Inventory

EPA's Risk Assessment Guidelines were developed, based on recommendations from the National Academy of Science, to help guide EPA scientists in assessing the risks from chemicals or other agents in the environment. They also inform EPA decision makers and the general public ab...

411