Science.gov

Sample records for national treatment guidelines

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

    PubMed

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

    2015-06-01

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

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

    PubMed Central

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

    2014-01-01

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

  3. Danish national guidelines for treatment of diverticular disease.

    PubMed

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

    2012-05-01

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

  4. The 2012 revised Dutch national guidelines for the treatment of chronic hepatitis B virus infection.

    PubMed

    Buster, E H C J; Baak, B C; Bakker, C M; Beuers, U H W; Brouwer, J T; Drenth, J P H; van Erpecum, K J; van Hoek, B; Honkoop, P; Kerbert-Dreteler, M J; Koek, G H; van Nieuwkerk, K M J; van Soest, H; van der Spek, B W; Tan, A C I T L; Vrolijk, J M; Janssen, H L A

    2012-10-01

    In 2008, the Netherlands Association of Gastroenterologists and Hepatologists (Nederlands Vereniging van Maag-Darm-Leverartsen) published the Dutch national guidelines for the treatment of chronic hepatitis B virus infection. New insights into the treatment of chronic hepatitis B with relevance for clinical practice have been adopted in these concise, revised guidelines. The most important changes include the choice of initial antiviral therapy, licensing of tenofovir for the treatment of chronic hepatitis B and the management of antiviral resistance. PMID:23065990

  5. National Bookmobile Guidelines, 1992.

    ERIC Educational Resources Information Center

    Ohio State Library, Columbus.

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

  6. National Bookmobile Guidelines, 1992.

    ERIC Educational Resources Information Center

    Ohio State Library, Columbus.

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

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

    PubMed Central

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

    2016-01-01

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

  8. Judge says prison must obey NIH treatment guidelines. National Institute of Health.

    PubMed

    1999-08-01

    A U.S. Magistrate Judge ordered the Mississippi Department of Corrections (DOC) to comply with the National Institutes of Health's (NIH) guidelines for the standard of care for HIV-positive individuals. Current treatment of HIV-positive inmates in Mississippi was characterized as "abysmal" by the American Civil Liberties Union (ACLU), but defended as undergoing improvements, by a state medical expert. Despite NIH recommendations for antiretroviral treatment comprised of a protease inhibitor and two other drugs, inmates were only given a two-drug regimen. A protease inhibitor was added only after prisoners proved adherence for at least 6 months. The prison also failed to provide routine viral load testing. The terms of the injunction require the DOC to complete viral load tests for prisoners who have not begun triple drug therapy, and to write a protocol establishing standards of HIV care. PMID:11366997

  9. Guideline 3: Psychosocial Treatment.

    ERIC Educational Resources Information Center

    American Journal on Mental Retardation, 2000

    2000-01-01

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

  10. Guideline 3: Psychosocial Treatment.

    ERIC Educational Resources Information Center

    American Journal on Mental Retardation, 2000

    2000-01-01

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

  11. Guidelines for National Libraries.

    ERIC Educational Resources Information Center

    Sylvestre, Guy

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

  12. Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre

    PubMed Central

    Barnes, Emily R.; Theeke, Laurie A.; Mallow, Jennifer

    2015-01-01

    Rationale, aims and objectives Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Methods Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Results Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Conclusions Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits. PMID:25558956

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

    PubMed

    Candelaria, Myrna; Cervera-Ceballos, Eduardo; Meneses-Garca, Abelardo; Avils-Salas, Alejandro; Lome-Maldonado, Carmen; Zrate-Osorno, Alejandra; Ortiz-Hidalgo, Carlos; Rodrguez-Moguel, Leticia; Quinez-Urrego, Enoe Enedina; Ramos-Salazar, Patricia; Romero-Guadarrama, Mnica Belinda; Lara-Torres, Csar; Ramrez-Aceves, Roco; Lpez-Navarro, Omar; Rivas-Vera, Silvia; Daz-Meneses, Ivn Eudaldo; Estrada-Lobato, Enrique; Cervera-Ceballos, Jos; Rojas-Marn, Carlos Enrique; Hernndez-Rodriguez, Jos Mario; Prez-Lpez, Berenice; Gmez-Almaguer, David; Altamirano-Ley, Javier; Baz, Patricia; Valero-Saldaa, Luis Manuel; Navarrete-Herrera, Jos Ren; Torres-Salgado, Francisco Gerardo; Solano-Murillo, Pedro; Nambo-Lucio, Mara de Jess; Rivas-Llamas, Ramn; Aquino-Salgado, Jorge Luis; Avila-Arregun, Elsa Vernica; Corts-Esteban, Patricia; Chongo-Alfaro, Martha Lilia; Prez-Ramrez, Oscar de Jess; Toledano-Cuevas, Diana Vanesa; Lobato-Mendizbal, Eduardo; Martnez-Ramrez, Mario Alberto; Morales-Maravilla, Adrin; Sosa-Camas, Rosa Elena; Agreda-Vsquez, Gladys P; Camacho-Hernndez, Alejandro; Aguayo-Gonzlez, Alvaro; Espinoza-Zamora, Jos Ramiro; Snchez-Guerrero, Sergio A; Lozano-Zavaleta, Valentn; Selva-Pallares, Julio Edgar; Herndez-Rodrguez, Juan Manuel; Cardiel-Silva, Mariela; Castillo-Rivera, Manuel Hctor; Villela, Luis; Loarca-Pia, Luis Martn; Zurita-Martnez, Hugo; Graham-Casassus, Juan; Azaola-Espinosa, Patricio; Silva-Lpez, Salvador; Armenta-San Sebastin, Jorge Antonio; Mijangos-Huesca, Francisco; Prez-Osorio, Jorge Eduardo; Aldaco-Sarvide, Fernando; Castellanos, Guillermo; Ramrez-Ibarguen, Ana Florencia; Zapata-Canto, Nidia; Labardini-Mndez, Juan Rafael

    2013-06-01

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

  14. Rheumatoid arthritis patients fulfilling Korean National Health Insurance reimbursement guidelines for anti-tumor necrosis factor-? treatment and comparison to other guidelines.

    PubMed

    Hur, Jin-Wuk; Choe, Jung-Yoon; Kim, Dong-Wook; Kim, Hyun Ah; Kim, Sang-Hyon; Kim, Wan-Uk; Kim, Yun Sung; Lee, Hye-Soon; Lee, Sang-Heon; Park, Sung-Hwan; Park, Won; Park, Yong-Beom; Suh, Chang-Hee; Shim, Seung-Cheol; Song, Yeong-Wook; Yoon, Bo Young; Yu, Dae Young; Yoo, Dae Hyun

    2015-11-01

    The aim of this study was to compare anti-tumor necrosis factor-? (TNF?) treatment status in rheumatoid arthritis (RA) patients with the Korean National Health Insurance (KNHI) reimbursement eligibility criteria and with American College of Rheumatology (ACR) recommendations, Japan College of Rheumatology (JCR) guidelines and British Society for Rheumatology (BSR) guidelines. Between December 2011 and August 2012, outpatients from 17 South Korean general hospitals diagnosed with RA according to the 1987 ACR criteria were enrolled into a noninterventional, cross-sectional, observational study. Of 1700 patients (1414 female (83.2 %), mean age of 56.6 12.0, mean disease duration 97.9 91.8 months), 306 (18.0 %) had used anti-TNF? agents, and 224 (13.2 %) were currently using an anti-TNF? agent. Of 1394 anti-TNF?-naive patients, 32 (2.3 %) met KNHI reimbursement guidelines, 148 (10.6 %) met ACR recommendations, and 127 (9.1 %) and 126 (9.0 %) were considered eligible for anti-TNF? agents according to JCR and BSR guidelines, respectively. The main discrepancy was the higher active joint count required by the KNHI eligibility criteria. In the opinion of treating rheumatologists, the KNHI reimbursement criteria ineligibility accounted for 15.3 % (n = 213) of the reasons for not initiating anti-TNF? agents in anti-TNF?-naive group. The anti-TNF? user group showed significantly higher disease activity than the anti-TNF?-naive group based on DAS28 score. In comparison with the ACR recommendations and JCR and BSR guidelines, fewer patients met KNHI reimbursement eligibility criteria for anti-TNF? agents. The current amendment of the KNHI criteria based on DAS28 score will improve an access to biologic agents including anti-TNF? treatment for South Korean patients with active RA. PMID:26342296

  15. NANETS Treatment Guidelines

    PubMed Central

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

    2011-01-01

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

  16. Lessons from French National Guidelines on the treatment of venous thrombosis and central venous catheter thrombosis in cancer patients.

    PubMed

    Farge, Dominique; Durant, Cecile; Villiers, Stphane; Long, Anne; Mahr, Alfred; Marty, Michel; Debourdeau, Philippe

    2010-04-01

    Increased prevalence of Venous thromboembolism (VTE), as defined by deep-vein thrombosis (DVT), central venous catheter (CVC) related thrombosis or pulmonary embolism (PE) in cancer patients has become a major therapeutic issue. Considering the epidemiology and each national recommendations on the treatment of VTE in cancer patients, we analysed guidelines implementation in clinical practice. Thrombosis is the second-leading cause of death in cancer patients and cancer is a major risk factor of VTE, due to activation of coagulation, use of long-term CVC, the thrombogenic effects of chemotherapy and anti-angiogenic drugs. Three pivotal trials (CANTHANOX, LITE and CLOT) and several meta-analysis led to recommend the long term (3 to 6 months) use of LMWH during for treating VTE in cancer patients with a high level of evidence. The Italian Association of Medical Oncology (AIOM), the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), the French "Institut National du Cancer" (INCa), the European Society of Medical Oncology (ESMO) and the American College of Chest Physicians (ACCCP) have published specific guidelines for health care providers regarding the prevention and treatment of cancer-associated VTE. Critical appraisal of these guidelines, difficulties in implementation of prophylaxis regimen, tolerance and cost effectiveness of long term use of LMWH may account for large heterogenity in daily clinical practice. Homogenization of these guidelines in international consensus using an adapted independent methodological approach followed by educational and active implementation strategies at each national level would be very valuable to improve the care of VTE in cancer patients. PMID:20433988

  17. 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.

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

    PubMed Central

    2014-01-01

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

  19. Utilisation of the National Antiretroviral Therapy Guidelines among health care professionals working in Abuja treatment centres, Nigeria

    PubMed Central

    Abu, Ugbede O.; Ogunbanjo, Gboyega A.; Setswe, Geoffrey K.

    2009-01-01

    ABSTRACT Background Access to and utilisations of the National Antiretroviral Treatment Guidelines (NATG) are valuable factors for effective programme implementation. The objective of this study was to investigate the accessibility of the NATG and their utilisation by health care professionals from five treatment centres in Abuja, Nigeria. Method A quantitative cross-sectional descriptive survey was conducted in 2007 using purposively sampled health care professionals. Questionnaires were self-administered to participants who consented in writing to participate in the survey. Results 97 health care professionals participated in this study with about equal numbers of men and women: 48 (49.5%) women and 49 (50.5%) men. Of these, 21.6% were unaware of the existence of the NATG in their treatment centres. More than half (51.5%) reported that they did not have access to the NATG as opposed to those (48.5%) who had access to the guidelines. Furthermore, 16.5% of the participants confirmed that they had access to an institutional copy of the NATG while 14.4% indicated that they had individual copies and only 3.1% stated that they had individual copies and access to the hospital copy as well. Regarding utilisation of the NATG, 41.2% rarely used them, 32.9% never used them and only 25.7% often used them. The most frequent use of the NATG was among pharmacists (38.1%) compared to the least frequent use among nurses (20.0%). Conclusion Poor accessibility of the NATG may have a negative impact on guidelines utilisation among health care professionals in Nigeria.

  20. Uveal Melanoma UK National Guidelines.

    PubMed

    Nathan, P; Cohen, V; Coupland, S; Curtis, K; Damato, B; Evans, J; Fenwick, S; Kirkpatrick, L; Li, O; Marshall, E; McGuirk, K; Ottensmeier, C; Pearce, N; Salvi, S; Stedman, B; Szlosarek, P; Turnbull, N

    2015-11-01

    The United Kingdom (UK) uveal melanoma guideline development group used an evidence based systematic approach (Scottish Intercollegiate Guidelines Network (SIGN)) to make recommendations in key areas of uncertainty in the field including: the use and effectiveness of new technologies for prognostication, the appropriate pathway for the surveillance of patients following treatment for primary uveal melanoma, the use and effectiveness of new technologies in the treatment of hepatic recurrence and the use of systemic treatments. The guidelines were sent for international peer review and have been accredited by NICE. A summary of key recommendations is presented. The full documents are available on the Melanoma Focus website. PMID:26278648

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

    PubMed Central

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

    2013-01-01

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

  2. Guidelines for makeup water treatment

    SciTech Connect

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

    1990-03-01

    The EPRI Fossil Plant Cycle Chemistry Program, RP 2712, was developed in recognition of the importance of controlling cycle water and steam purity in attainment of maximized unit availability, reliability and efficiency. This guideline characterizes the state-of-the-art technology for production of cycle makeup water. It is intended to complement other RP 2712 projects in the areas of cycle chemistry guidelines, instrumentation and control, guideline demonstration and verification, and related subject areas. This guideline reviews available technology for and preferred approaches to production of fossil plant cycle makeup from various raw water supplies. Subject areas covered include makeup water source and source characteristics, unit processes comprising makeup treatment systems, guidelines for process selection, resin and membrane selection guidelines, techniques for monitoring performance and cost effectiveness, and waste disposal considerations. The report also identifies additional research activity needed to advance the state-of-the-art for makeup water treatment, results of a utility industry survey and other related topics. 72 refs., 60 figs., 74 tabs.

  3. UK malaria treatment guidelines.

    PubMed

    Lalloo, David G; Shingadia, Delane; Pasvol, Geoffrey; Chiodini, Peter L; Whitty, Christopher J; Beeching, Nicholas J; Hill, David R; Warrell, David A; Bannister, Barbara A

    2007-02-01

    Malaria is the tropical disease most commonly imported into the UK, with 1500-2000 cases reported each year, and 10-20 deaths. Approximately three-quarters of reported malaria cases in the UK are caused by Plasmodium falciparum, which is capable of invading a high proportion of red blood cells and rapidly leading to severe or life-threatening multi-organ disease. Most non-falciparum malaria cases are caused by Plasmodium vivax; a few cases are caused by the other two species of Plasmodium: Plasmodium ovale or Plasmodium malariae. Mixed infections with more than 1 species of parasite can occur; they commonly involve P. falciparum with the attendant risks of severe malaria. Management of malaria depends on awareness of the diagnosis and on performing the correct diagnostic tests: the diagnosis cannot be excluded until 3 blood specimens have been examined by an experienced microscopist. There are no typical clinical features of malaria, even fever is not invariably present. The optimum diagnostic procedure is examination of thick and thin blood films by an expert to detect and speciate the malarial parasites; P. falciparum malaria can be diagnosed almost as accurately using rapid diagnostic tests (RDTs) which detect plasmodial antigens or enzymes, although RDTs for other Plasmodium species are not as reliable. The treatment of choice for non-falciparum malaria is a 3-day course of oral chloroquine, to which only a limited proportion of P. vivax strains have gained resistance. Dormant parasites (hypnozoites) persist in the liver after treatment of P. vivax or P. ovale infection: the only currently effective drug for eradication of hypnozoites is primaquine. This must be avoided or given with caution under expert supervision in patients with glucose-6-phosphate dehydrogenase deficiency (G6PD), in whom it may cause severe haemolysis. Uncomplicated P. falciparum malaria can be treated orally with quinine, atovaquone plus proguanil (Malarone) or co-artemether (Riamet); quinine is highly effective but poorly tolerated in prolonged dosage and is always supplemented by additional treatment, usually with oral doxycycline. ALL patients treated for P. falciparum malaria should be admitted to hospital for at least 24 h, since patients can deteriorate suddenly, especially early in the course of treatment. Severe falciparum malaria, or infections complicated by a relatively high parasite count (more than 2% of red blood cells parasitized), should be treated with intravenous therapy until the patient is well enough to continue with oral treatment. In the UK, the treatment of choice for severe or complicated malaria is currently an infusion of intravenous quinine. This may exacerbate hypoglycaemia that can occur in malaria; patients treated with intravenous quinine therefore require careful monitoring. Intravenous artesunate reduces high parasite loads more rapidly than quinine and is more effective in treating severe malaria in selected situations. It can also be used in patients with contra-indications to quinine. Intravenous artesunate is unlicensed in the EU. Assistance in obtaining artesunate may be sought from specialist tropical medicine centres, on consultation, for named patients. Patients with severe or complicated malaria should be managed in a high dependency or intensive care environment. They may require haemodynamic support and management of acute respiratory distress syndrome, disseminated intravascular coagulation, renal impairment/failure, seizures, and severe intercurrent infections including gram-negative bacteraemia/septicaemia. Falciparum malaria in pregnancy is more likely to be severe and complicated: the placenta contains high levels of parasites. Stillbirth or early delivery may occur and diagnosis can be difficult if parasites are concentrated in the placenta and scanty in the blood. The treatment of choice for falciparum malaria in pregnancy is quinine; doxycycline is contraindicated in pregnancy but clindamycin can be substituted for it, and is equally effective. Primaquine (for eradication of P. vivax or P. ov

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

    PubMed

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

    2016-11-01

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

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

    PubMed

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

    2014-01-01

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

  6. National Osteoporosis Society vitamin D guideline summary.

    PubMed

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

    2014-09-01

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

  7. Current Controversies With Recent Cholesterol Treatment Guidelines.

    PubMed

    Phillips, Elizabeth; Saseen, Joseph J

    2016-02-01

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

  8. Treatment for Panic Disorder: Practical Guidelines.

    ERIC Educational Resources Information Center

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

    2002-01-01

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

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

    PubMed

    Kampman, Kyle; Jarvis, Margaret

    2015-01-01

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

  10. Shoulder Conditions: Diagnosis and Treatment Guideline.

    PubMed

    Codsi, Michael; Howe, Chris R

    2015-08-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    Kampman, Kyle; Jarvis, Margaret

    2015-01-01

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

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

    PubMed

    Pasternak, Richard C

    2003-08-01

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

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

    PubMed

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

    2012-09-01

    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

  15. Standard Treatment Guidelines in Primary Healthcare Practice

    PubMed Central

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

    2014-01-01

    In India, healthcare delivery is implemented at primary, secondary and tertiary levels. Of these, primary health care is the essential health care and is the first point of care for the public across the country. The primary health care system caters to nearly 70% of the population by treating about 90% of the common and locally prevailing problems. One of the integral elements of primary health care is provision of essential medicines, which should be available at all times in adequate amounts in appropriate dosage forms and at an affordable cost. It has an important bearing on the medical, economical and social outcomes of the healthcare delivery system. This situation mandates the need for rational use of medicines by standardizing the treatment of commonly occurring illness at the primary health care level. Standard Treatment Guidelines (STGs) have been in vogue in India only since recent times and is gaining popularity among practitioners. STGs have many advantages for the patients, healthcare providers, drug manufacturers and marketing agencies, and above all, the policy makers and the legislative system of the country. The drawback in STGs lies in the difficulties in implementation on a large scale. With due efforts to prioritize the health needs, comprehensive coverage of national health programs involving all the stakeholders including professional organizations, undergraduate medical curriculum planners and medical practitioners, STGs can be implemented effectively and thereby we can ensure a quality health care at the primary care level at an affordable cost as part of the now redefined Universal Health Coverage. This article is intended as a guide to understand the concept of STGs, prepared with the aim of capacity building for medical professionals in rationally treating patients in their day-to-day clinical practice. PMID:25657957

  16. Standard treatment guidelines in primary healthcare practice.

    PubMed

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

    2014-01-01

    In India, healthcare delivery is implemented at primary, secondary and tertiary levels. Of these, primary health care is the essential health care and is the first point of care for the public across the country. The primary health care system caters to nearly 70% of the population by treating about 90% of the common and locally prevailing problems. One of the integral elements of primary health care is provision of essential medicines, which should be available at all times in adequate amounts in appropriate dosage forms and at an affordable cost. It has an important bearing on the medical, economical and social outcomes of the healthcare delivery system. This situation mandates the need for rational use of medicines by standardizing the treatment of commonly occurring illness at the primary health care level. Standard Treatment Guidelines (STGs) have been in vogue in India only since recent times and is gaining popularity among practitioners. STGs have many advantages for the patients, healthcare providers, drug manufacturers and marketing agencies, and above all, the policy makers and the legislative system of the country. The drawback in STGs lies in the difficulties in implementation on a large scale. With due efforts to prioritize the health needs, comprehensive coverage of national health programs involving all the stakeholders including professional organizations, undergraduate medical curriculum planners and medical practitioners, STGs can be implemented effectively and thereby we can ensure a quality health care at the primary care level at an affordable cost as part of the now redefined Universal Health Coverage. This article is intended as a guide to understand the concept of STGs, prepared with the aim of capacity building for medical professionals in rationally treating patients in their day-to-day clinical practice. PMID:25657957

  17. [Diagnostic guideline and treatment of dementia].

    PubMed

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

    2015-01-01

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

  18. Individualized Treatment Guidelines for Postpubertal Cryptorchidism

    PubMed Central

    Chung, Jae Min

    2015-01-01

    Cryptorchidism is a well-known congenital anomaly in children. However, its diagnosis is often delayed for reasons including patient unawareness or denial of abnormal findings in the testis. Moreover, it has been difficult to establish an optimal treatment strategy for postpubertal cryptorchidism, given the small number of patients. Unlike cryptorchidism in children, postpubertal cryptorchidism is associated with an increased probability of neoplasms, which has led orchiectomy to be the recommended treatment. However, routine orchiectomy should be avoided in some cases due to quality-of-life issues and the potential risk of perioperative mortality. Based on a literature review, this study proposes individualized treatment guidelines for postpubertal cryptorchidism. PMID:26770935

  19. Invisalign: current guidelines for effective treatment.

    PubMed

    Kuncio, Daniel A

    2014-03-01

    Invisalign is an increasingly popular technique for aligning teeth and correcting malocclusions orthodontically. This article analyzes the current professional literature published on Invisalign and the benefits and risks of using the technique for both patients and doctors. The steady increase in the number of cases treated with Invisalign and where the technique is going in the future is investigated. Ten guidelines for Invisalign treatment and patient selection are given, along with case examples. PMID:24851387

  20. Double Up on Acne Treatments, New Guidelines Say

    MedlinePLUS

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

  1. Fertility preservation during cancer treatment: clinical guidelines

    PubMed Central

    Rodriguez-Wallberg, Kenny A; Oktay, Kutluk

    2014-01-01

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

  2. Treatment Guidelines for Children and Adolescents with Bipolar Disorder

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  3. Guidelines for the treatment of head and neck venous malformations

    PubMed Central

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

    2013-01-01

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

  4. Challenges in developing national HIV guidelines: experience from the eastern Mediterranean

    PubMed Central

    De Weggheleire, Anja; Bortolotti, Veronique; Zolfo, Maria; Crowley, Siobhan; Colebunders, Robert; Riedner, Gabriele

    2011-01-01

    Abstract Objective To appraise the process of development and clinical content of national human immunodeficiency virus (HIV) clinical practice guidelines of countries in the eastern Mediterranean and to formulate recommendations for future guideline development and adaptation. Methods Twenty-three countries in the World Health Organization (WHO) Eastern Mediterranean and United Nations Childrens Fund Middle East and North Africa regions were invited to submit national HIV clinical practice guidelines for review. The guideline development methodology was assessed using an adaptation of the Appraisal of Guidelines Research and Evaluation (AGREE) instrument and guideline content, using a checklist to evaluate concordance with WHO 2006 generic guidelines. Findings Twelve countries submitted 20 guidelines developed between 2004 and 2009. Median scores were poor (i.e. guideline content, recommended first-line treatment and eligibility criteria for antiretroviral therapy (ART) in adults were in line with WHO recommendations in most guidelines. However, recommendations on antiretroviral prophylaxis for the prevention of vertical HIV transmission, diagnosis and treatment of HIV infection in infants, monitoring patients on ART, treatment failure and co-morbidities were often lacking. Conclusion The large majority of national HIV clinical practice guidelines had methodological weaknesses and content inaccuracies. Countries require assistance with the adaptation process to ensure that guidelines are valid and up to date and accurately reflect WHO global clinical care recommendations for patients with HIV. PMID:21673860

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

    PubMed

    Pauwels, R A

    2000-02-01

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

  6. Treatment of hepatocellular carcinoma: beyond international guidelines.

    PubMed

    Sangiovanni, Angelo; Colombo, Massimo

    2016-01-01

    Treatment of hepatocellular carcinoma (HCC) is guided by the tumour stage. The Barcelona clinical liver cancer (BCLC) score endorsed by the European Society of the Liver EASL divides patients into five prognostic categories, each with a distinct treatment indication. Hepatic resection, orthotopic liver transplantation and percutaneous local ablation are strongly indicated in accurately selected patients with very early (BCLC 0) and early stage (BCLC A) tumours providing a survival rate of between 50 and 75% at year five. In patients with a large tumour burden such as those with intermediate stage BCLC B, repeated treatments with transarterial chemoembolization (TACE) are advocated with clinical benefits (from 16 to 22months). Survival may also improve in patients who are in poor condition or who do not respond to TACE and those with an advanced HCC (BCLC C), following oral therapy with the multikinase inhibitor, sorafenib. However, most recommendations are based on uncontrolled studies and expert opinions rather than well-designed controlled trials, and up to one-third of patients do not fit recommendations because of advanced age, the presence of significant comorbidities or a strategic location of the nodule. For these patients, treatment of HCC beyond guidelines is often advocated. PMID:26725909

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

    PubMed

    Milner, Karen K; Valenstein, Marcia

    2002-07-01

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

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

    PubMed

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

    2016-02-01

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

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

    PubMed Central

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

    2016-01-01

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

  10. 76 FR 22342 - National Standard 10 Guidelines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-21

    ... public meeting. SUMMARY: NMFS issues this advance notice of proposed rulemaking (ANPR) to provide... Guidelines. DATES: Written comments regarding the issues in this ANPR must be received by 5 p.m., local time, on July 20, 2011. A public meeting to obtain additional comments on the items discussed in this...

  11. A guideline for simulation studies of wastewater treatment plants.

    PubMed

    Langergraber, G; Rieger, L; Winkler, S; Alex, J; Wiese, J; Owerdieck, C; Ahnert, M; Simon, J; Maurer, M

    2004-01-01

    A guideline for simulation studies of wastewater treatment plants is proposed. The aim of the HSG-guideline is to define a reference quality level that helps to make the results of simulation studies comprehensible and comparable and therefore increases the quality and reliability of mathematical modelling in wastewater treatment. The paper gives a summary of the HSG-guideline, written by a group of university members from Germany, Austria and Switzerland. PMID:15553468

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

    PubMed Central

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

    2010-01-01

    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. PMID:19937426

  13. Treatment Guidelines of Atrial Fibrillation (AFib or AF)

    MedlinePLUS

    ... for High Blood Pressure Symptoms, Diagnosis & Monitoring of High Blood Pressure Prevention & Treatment of High Blood Pressure High Blood Pressure Tools & Resources Stroke More Treatment Guidelines of Atrial Fibrillation (AFib or AF) Updated: ...

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

    PubMed

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

    2015-02-01

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

  15. Deriving cleanup guidelines for radionuclides at Brookhaven National Laboratory

    SciTech Connect

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

    1997-01-01

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

  16. Treatment guidelines for Hepatitis C in Spain.

    PubMed

    Crespo-Casal, M

    2015-10-01

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

  17. Treatment of hepatocellular carcinoma: beyond international guidelines.

    PubMed

    Colombo, Massimo; Sangiovanni, Angelo

    2015-01-01

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

  18. Developing Guidelines for Classification and Treatment Decisions.

    ERIC Educational Resources Information Center

    Hippchen, Leonard J.

    1978-01-01

    The author maintains that correctional workers are at a critical juncture in the use of classification strategies. Numerous guidelines are available for classification, but too often these are not applied. Several suggestions are made for effective classifications. (Author/HMV)

  19. National Emphysema Treatment Trial

    PubMed Central

    Criner, Gerard J.; Sternberg, Alice L.

    2008-01-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Hobbs, Alan; Shively, R. Jay

    2013-01-01

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

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

    PubMed Central

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

    2012-01-01

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

  4. Guidelines for diagnosis, prevention and treatment of hand eczema.

    PubMed

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

    2015-01-01

    The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful me-dical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in head-to-head RCTs are needed.The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wis-senschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medi-cal Societies in Germany).No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest. PMID:25763418

  5. Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective

    PubMed Central

    White-Chu, E Foy; Conner-Kerr, Teresa A

    2014-01-01

    Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder. PMID:24596466

  6. Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective.

    PubMed

    White-Chu, E Foy; Conner-Kerr, Teresa A

    2014-01-01

    Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder. PMID:24596466

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

    PubMed Central

    2012-01-01

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

  8. Self-Injurious Behavior: Motivating Conditions and Guidelines for Treatment.

    ERIC Educational Resources Information Center

    Durand, V. Mark; Carr, Edward G.

    1985-01-01

    Self-injurious behavior is a serious concern for individuals who must provide educational services to developmentally disabled children. This article discusses research related to the motivation of self-injury; provides guidelines for designing treatment programs for self-injurious behavior; and introduces a new nonaversive treatment, differential

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

    PubMed

    Dzieniszewski, J; Jarosz, M

    2006-09-01

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

  10. Management of Transient Loss of Consciousness: National Institute for Health and Clinical Excellence Guideline

    MedlinePLUS

    ... Loss of Consciousness: National Institute for Health and Clinical Excellence Guideline Summaries for Patients are a service ... Synopsis of the National Institute for Health and Clinical Excellence Guideline for Management of Transient Loss of ...

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

    PubMed

    Treuer, Tams; Liu, Chia-Yih; Salazar, Gerardo; Kongsakon, Ronnachai; Jia, Fujun; Habil, Hussain; Lee, Min-Soo; Lowry, Amanda; Dueas, Hctor

    2013-12-01

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

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

    PubMed Central

    Lutz, Stephen; Chow, Edward

    2012-01-01

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

  13. [Brazilian guidelines for the treatment of narcolepsy].

    PubMed

    Ale, Flvio; Alves, Rosana Cardoso; Arajo, John F; Azevedo, Alexandre; Bacelar, Andrea; Bezerra, Mrcio; Bittencourt, Lia Rita Azeredo; Bustamante, Guilherme; Cardoso, Tania Aparecida Marchiori de Oliveira; Eckeli, Alan L; Fernandes, Regina Maria Frana; Goulart, Leonardo; Pradella-Hallinan, Mrcia; Hasan, Rosa; Sander, Heidi Haueisen; Pinto Jr, Luciano Ribeiro; Ceclia Lopes, Maria; Minhoto, Gisele Richter; Moraes, Walter; Moreira, Gustavo Antnio; Pachito, Daniela; Pedrazolli, Mrio; Poyares, Dalva; Prado, Lucila; Rizzo, Geraldo; Nonato Rodrigues, R; Roitman, Israel; Ademir Baptista, Silva; Tavares, Stella Mrcia Azevedo

    2010-09-01

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

  14. [Guidelines for the treatment of functional constipation].

    PubMed

    Bautista Casasnovas, A; Argelles Martn, F; Pea Quintana, L; Polanco Allu, I; Snchez Ruiz, F; Varea Caldern, V

    2011-01-01

    Constipation is common in childhood. It can affect around 5-30% of the child population, depending on the criteria used for diagnosis. The currently recommended treatment is based on three main points: a) explanation, b) disimpaction and c) maintenance therapy consisting of diet changes, behavioural modification, and the use of laxatives. In the last decades treatment on disimpaction have changed radically from the rectal route to the oral route with polyethylene glycol 3350 (PEG), the most used and accepted regimen nowadays. Treatment and care should take into account the individual needs and preferences of the patient. Good communication is essential, to allow patients to reach informed decisions about their care. Maintenance therapy consists of dietary interventions, toilet training, and laxatives to obtain daily painless defaecation in order to prevent re-accumulation of stools. Maintenance therapy should be start as soon as the child's bowel is disimpacted. Early intervention with oral laxatives may improve complete resolution of functional constipation. Enemas using phosphate, mineral oil, or normal saline are effective in relieving rectal impaction, but carry the risk of mechanical trauma and are not recommended for maintenance therapy in the paediatric population. Among osmotic agents, polyethylene glycol 3350 plus electrolyte solutions appear to be the first-line drug treatment to use in children of any age, as it is safe, effective, and well-tolerated. Recommended doses ranges from 0.25 to 1.5g/kg. Advances in the understanding of the gastrointestinal enteric nervous system and epithelial function have led to the development of new substances that bind to serotonin receptors or are chloride channel activators. PMID:21123124

  15. Guidelines for treatment of liver cancer.

    PubMed

    Livraghi, T

    2001-06-01

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

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

    SciTech Connect

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

    2014-02-01

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

  17. The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines.

    PubMed

    Nishida, Toshirou; Blay, Jean-Yves; Hirota, Seiichi; Kitagawa, Yuko; Kang, Yoon-Koo

    2016-01-01

    Although gastrointestinal stromal tumors (GISTs) are a rare type of cancer, they are the commonest sarcoma in the gastrointestinal tract. Molecularly targeted therapy, such as imatinib therapy, has revolutionized the treatment of advanced GIST and facilitates scientific research on GIST. Nevertheless, surgery remains a mainstay of treatment to obtain a permanent cure for GIST even in the era of targeted therapy. Many GIST guidelines have been published to guide the diagnosis and treatment of the disease. We review current versions of GIST guidelines published by the National Comprehensive Cancer Network, by the European Society for Medical Oncology, and in Japan. All clinical practice guidelines for GIST include recommendations based on evidence as well as on expert consensus. Most of the content is very similar, as represented by the following examples: GIST is a heterogeneous disease that may have mutations in KIT, PDGFRA, HRAS, NRAS, BRAF, NF1, or the succinate dehydrogenase complex, and these subsets of tumors have several distinctive features. Although there are some minor differences among the guidelines-for example, in the dose of imatinib recommended for exon9-mutated GIST or the efficacy of antigen retrieval via immunohistochemistry-their common objectives regarding diagnosis and treatment are not only to improve the diagnosis of GIST and the prognosis of patients but also to control medical costs. This review describes the current standard diagnosis, treatment, and follow-up of GISTs based on the recommendations of several guidelines and expert consensus. PMID:26276366

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

    PubMed Central

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

    2015-01-01

    Background Low adherence to Global initiative for chronic Obstructive Lung Disease (GOLD) guideline recommendations has been reported worldwide. There has been no study on the adherence to GOLD guidelines for COPD treatment in Turkey. Objectives To investigate the rates of adherence to GOLD 2010 guidelines for COPD treatment among pulmonologists. Design A multi-center, cross-sectional, observational study was carried out in eleven pulmonary outpatient clinics across Turkey. Adherence to GOLD was evaluated through hospital records. Demographic and clinical data were recorded. Results Study included 719 patients (mean age: 62.99.7 years; males 85.4%) of whom 16 was classified as GOLD Stage I, 238 as II, 346 as III, and 119 as IV, and only 59.5% received appropriate treatment. Rates of guideline adherence varied across GOLD stages (I, 6.3%; II, 14.7%; III, 84.4%; and IV, 84%). Causes of inappropriate therapies were overtreatment (Stage I, 100% and Stage II, 91.1%), undertreatment (Stage III, 3.3% and Stage IV, 10.9%) and lack of treatment (Stage II, 3.8%; Stage III, 2.3%; and Stage IV, 5.9%). The most preferred regimen (43.4%) was long-acting ?2-agonist-inhaled corticosteroid-long-acting muscarinic antagonist. Overall, 614 patients (89%) received treatment containing inhaled corticosteroid. Conclusion Pulmonologists in Turkey have low rates of adherence to GOLD guidelines in COPD treatment. Inappropriateness of therapies was due to overtreatment in early stages and excessive use of inhaled corticosteroid (ICS) in all disease stages. PMID:26715844

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

    ERIC Educational Resources Information Center

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

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

  20. The recent national lipid association recommendations: how do they compare to other established dyslipidemia guidelines?

    PubMed

    Flink, Laura; Underberg, James A; Newman, Jonathan D; Gianos, Eugenia

    2015-04-01

    The National Lipid Association (NLA) recently released recommendations for the treatment of dyslipidemias. These recommendations have commonalities and differences with those of other major societies with respect to risk assessment, lifestyle therapy, targets of therapy, and the use of non-statin agents. In this review, we compare the basic elements of the guidelines from each major society to provide clinicians with a comprehensive document reviewing the key principles of each. PMID:25690588

  1. 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.

    TOXLINE Toxicology Bibliographic Information

    Mofenson LM; Brady MT; Danner SP; Dominguez KL; Hazra R; Handelsman E; Havens P; Nesheim S; Read JS; Serchuck L; Van Dyke R; Centers for Disease Control and Prevention; National Institutes of Health; HIV Medicine Association of the Infectious Diseases Society of America; Pediatric Infectious Diseases Society; American Academy of Pediatrics

    2009-09-04

    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

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

    PubMed

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

    2014-01-01

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

  3. Community Adherence to Schizophrenia Treatment and Safety Monitoring Guidelines

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    ERIC Educational Resources Information Center

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

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

  6. 2014 UK national guideline for the management of anogenital herpes.

    PubMed

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

    2015-10-01

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

  7. 2014 Korean Liver Cancer Study Group-National Cancer Center Korea Practice Guideline for the Management of Hepatocellular Carcinoma

    PubMed Central

    2015-01-01

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

  8. Practical guidelines for the treatment of inflammatory bowel disease

    PubMed Central

    Kuhbacher, T; Flsch, UR

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

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

  10. [Guideline 'Diagnosis and treatment of inflammatory bowel disease in children'].

    PubMed

    de Ridder, Lissy; Rings, Edmond H H M; Escher, Johanna C

    2010-01-01

    A multidisciplinary working group has outlined evidence-based practice guidelines for the diagnosis and treatment of inflammatory bowel disease in children (IBD). Both diagnosis and treatment of IBD in children differ significantly from practice in adults. The incidence of IBD in children is low (5.2 per 100,000 per year in the age group 0-17 years), but most of the presenting symptoms are non-specific; therefore it is difficult for the general practitioner to recognise the disease in children. For a correct diagnosis, ileocolonoscopy and upper gastrointestinal endoscopy are necessary, often combined with radiological imaging of the small bowel. In children and adolescents with Crohn's disease, nutritional therapy is the first choice of treatment for remission induction. As maintenance treatment, immunomodulators (azathioprine or mercaptopurine) should be started from the time of initial diagnosis. In children and adolescents with ulcerative colitis, the first treatment is with aminosalicylates. Prednisone and/or immunomodulators (azathioprine, cyclosporin) are indicated if there is insufficient response to aminosalicylates. A final treatment option is colectomy. The transition from paediatric to adult health care needs special attention as the patient and his or her parents may be reluctant to change trusted contacts which they have made. PMID:21029495

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

    PubMed Central

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

    2016-01-01

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

  12. Antiviral Treatment Guidelines for Middle East Respiratory Syndrome

    PubMed Central

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

    2015-01-01

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

  13. [Italian guidelines for the diagnosis and treatment of Paget's disease of bone].

    PubMed

    Adami, S; Bartolozzi, P; Brandi, M L; Falchetti, A; Filipponi, P; Gonnelli, S; Bianchi, G; Isaia, G C; Nuti, R

    2007-01-01

    Paget's disease of bone is a chronic focal abnormality of bone turnover that remains totally asymptomatic over a very long period of time but that eventually ensue in bone pain and skeletal deformities. Although, in the last decade new insights have been obtained on its etiology, this remains largely obscure. Effective medical treatment (based on the use of bisphosphonates) has become available and the diagnostic procedures are now well defined. However, there remains considerable controversy regarding the hierarchy of diagnostic procedures and the medical treatment threshold. In the last few years different institution have published national guidelines, reflecting local national health systems and the available medical treatment. In this review, a working group derived from members of the SIOMMMS has examined the information available regarding the diagnosis and treatment of Paget's disease in order to develop guidelines to assist in the management of this condition. The first draft was then extensively reviewed by experts derived from the most representative scientific societies of rheumatology, internal medicine, and orthopaedic surgery. The document provides the most updated recommendations based primarily on the "evidence-based- medicine" but also on the Italian regulation for the diagnostic procedures and on the available medical treatments. PMID:17603696

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

    PubMed

    Lee, Paul R; Kossoff, Eric H

    2011-06-01

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

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

    PubMed

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

    2014-03-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    2014-01-01

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

  18. Italian guidelines for the management and treatment of neonatal cholestasis.

    PubMed

    Dani, Carlo; Pratesi, Simone; Raimondi, Francesco; Romagnoli, Costantino

    2015-01-01

    Hyperbilirubinemia is a frequent condition affecting newborns during the first two weeks of life and when it lasts more than 14 days it is defined as prolonged jaundice. This condition requires differential diagnosis between the usually benign unconjugated hyperbilirubinemia and the pathological conjugated hyperbilirubinemia, that is mainly due to neonatal cholestasis. It is important that the diagnosis of neonatal cholestasis be well-timed to optimize its management, prevent worsening of the patient's outcome, and to avoid premature, painful, expensive, and useless tests. Unfortunately, this does not always occur and, therefore, the Task Force on Hyperbilirubinemia of the Italian Society of Neonatology presents these shared Italian guidelines for the management and treatment of neonatal cholestasis whose overall aim is to provide a useful tool for its assessment for neonatologists and family pediatricians. PMID:26428285

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

    PubMed

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

    2014-03-01

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

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

    PubMed

    Moreno-Prez, Oscar; Esteva De Antonio, Isabel

    2012-01-01

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

  1. Guideline for diagnosis and treatment of subacromial pain syndrome

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2010-01-01

    Summary This report updates and combines into one document earlier versions of guidelines for preventing and treating opportunistic infections (OIs) among HIV-exposed and HIV-infected children, last published in 2002 and 2004, respectively. These guidelines are intended for use by clinicians and other health-care workers providing medical care for HIV-exposed and HIV-infected children in the United States. The guidelines discuss opportunistic pathogens that occur in the United States and one that might be acquired during international travel (i.e., malaria). Topic areas covered for each OI include a brief description of the epidemiology, clinical presentation, and diagnosis of the OI in children; prevention of exposure; prevention of disease by chemoprophylaxis and/or vaccination; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; and discontinuation of secondary prophylaxis after immune reconstitution. A separate document about preventing and treating of OIs among HIV-infected adults and postpubertal adolescents (Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents) was prepared by a working group of adult HIV and infectious disease specialists. The guidelines were developed by a panel of specialists in pediatric HIV infection and infectious diseases (the Pediatric Opportunistic Infections Working Group) from the U.S. government and academic institutions. For each OI, a pediatric specialist with content-matter expertise reviewed the literature for new information since the last guidelines were published; they then proposed revised recommendations at a meeting at the National Institutes of Health (NIH) in June 2007. After these presentations and discussions, the guidelines underwent further revision, with review and approval by the Working Group, and final endorsement by NIH, CDC, the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Disease Society (PIDS), and the American Academy of Pediatrics (AAP). The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of the evidence supporting the recommendation so readers can ascertain how best to apply the recommendations in their practice environments. An important mode of acquisition of OIs, as well as HIV infection among children, is from their infected mother; HIV-infected women coinfected with opportunistic pathogens might be more likely than women without HIV infection to transmit these infections to their infants. In addition, HIV-infected women or HIV-infected family members coinfected with certain opportunistic pathogens might be more likely to transmit these infections horizontally to their children, resulting in increased likelihood of primary acquisition of such infections in the young child. Therefore, infections with opportunistic pathogens might affect not just HIV-infected infants but also HIV-exposed but uninfected infants who become infected by the pathogen because of transmission from HIV-infected mothers or family members with coinfections. These guidelines for treating OIs in children therefore consider treatment of infections among all children, both HIV-infected and uninfected, born to HIV-infected women. Additionally, HIV infection is increasingly seen among adolescents with perinatal infection now surviving into their teens and among youth with behaviorally acquired HIV infection. Although guidelines for postpubertal adolescents can be found in the adult OI guidelines, drug pharmacokinetics and response to treatment may differ for younger prepubertal or pubertal adolescents. Therefore, these guidelines also apply to treatment of HIV-infected youth who have not yet completed pubertal development. Major changes in the guidelines include 1) greater emphasis on the importance of antiretroviral therapy for preventing and treating OIs, especially those OIs for which no specific therapy exists; 2) information about the diagnosis and management of immune reconstitution inflammatory syndromes; 3) information about managing antiretroviral therapy in children with OIs, including potential drug--drug interactions; 4) new guidance on diagnosing of HIV infection and presumptively excluding HIV infection in infants that affect the need for initiation of prophylaxis to prevent Pneumocystis jirovecii pneumonia (PCP) in neonates; 5) updated immunization recommendations for HIV-exposed and HIV-infected children, including hepatitis A, human papillomavirus, meningococcal, and rotavirus vaccines; 6) addition of sections on aspergillosis; bartonella; human herpes virus-6, −7, and −8; malaria; and progressive multifocal leukodystrophy (PML); and 7) new recommendations on discontinuation of OI prophylaxis after immune reconstitution in children. The report includes six tables pertinent to preventing and treating OIs in children and two figures describing immunization recommendations for children aged 0--6 years and 7--18 years. Because treatment of OIs is an evolving science, and availability of new agents or clinical data on existing agents might change therapeutic options and preferences, these recommendations will be periodically updated and will be available at http://AIDSInfo.nih.gov. PMID:19730409

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

    PubMed Central

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

    2012-01-01

    Objective: The aim was to develop clinical practice guidelines on hypertriglyceridemia. Participants: The Task Force included a chair selected by The Endocrine Society Clinical Guidelines Subcommittee (CGS), five additional experts in the field, and a methodologist. The authors received no corporate funding or remuneration. Consensus Process: Consensus was guided by systematic reviews of evidence, e-mail discussion, conference calls, and one in-person meeting. The guidelines were reviewed and approved sequentially by The Endocrine Society's CGS and Clinical Affairs Core Committee, members responding to a web posting, and The Endocrine Society Council. At each stage, the Task Force incorporated changes in response to written comments. Conclusions: The Task Force recommends that the diagnosis of hypertriglyceridemia be based on fasting levels, that mild and moderate hypertriglyceridemia (triglycerides of 150999 mg/dl) be diagnosed to aid in the evaluation of cardiovascular risk, and that severe and very severe hypertriglyceridemia (triglycerides of > 1000 mg/dl) be considered a risk for pancreatitis. The Task Force also recommends that patients with hypertriglyceridemia be evaluated for secondary causes of hyperlipidemia and that subjects with primary hypertriglyceridemia be evaluated for family history of dyslipidemia and cardiovascular disease. The Task Force recommends that the treatment goal in patients with moderate hypertriglyceridemia be a non-high-density lipoprotein cholesterol level in agreement with National Cholesterol Education Program Adult Treatment Panel guidelines. The initial treatment should be lifestyle therapy; a combination of diet modification and drug therapy may also be considered. In patients with severe or very severe hypertriglyceridemia, a fibrate should be used as a first-line agent. PMID:22962670

  5. A national model for developing, implementing, and evaluating evidence-based guidelines for prehospital care.

    PubMed

    Lang, Eddy S; Spaite, Daniel W; Oliver, Zoe J; Gotschall, Catherine S; Swor, Robert A; Dawson, Drew E; Hunt, Richard C

    2012-02-01

    In 2007, the Institute of Medicine's (IOM's) Committee on the Future of Emergency Care recommended that a multidisciplinary panel establish a model for developing evidence-based protocols for the treatment of emergency medical systems (EMS) patients. In response, the National EMS Advisory Council (NEMSAC) and the Federal Interagency Committee on EMS (FICEMS) convened a panel of multidisciplinary experts to review current strategies for developing evidence-based guidelines (EBGs) and to propose a model for developing such guidelines for the prehospital milieu. This paper describes the eight-step model endorsed by FICEMS, NEMSAC, and a panel of EMS and evidence-based medicine experts. According to the model, prehospital EBG development would begin with the input of evidence from various external sources. Potential EBG topics would be suggested following a preliminary evidentiary review; those topics with sufficient extant foundational evidence would be selected for development. Next, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology would be used to determine a quality-of-evidence rating and a strength of recommendation related to the patient care guidelines. More specific, contextualized patient care protocols would then be generated and disseminated to the EMS community. After educating EMS professionals using targeted teaching materials, the protocols would be implemented in local EMS systems. Finally, effectiveness and uptake would be measured with integrated quality improvement and outcomes monitoring systems. The constituencies and experts involved in the model development process concluded that the use of such transparent, objective, and scientifically rigorous guidelines could significantly increase the quality of EMS care in the future. PMID:22320372

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

    PubMed Central

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

    2005-01-01

    OBJECTIVE To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. OPTIONS Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. OUTCOMES The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. EVIDENCE An “extraction” team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. VALUES To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of “conservative” care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to, or better than the published evidence. REPORTED BENEFITS, HARMS AND COSTS The expected benefits from the recommendations include more rapid recovery from pain, impairment and disability (improved pain and ROM). The GDC identified evidence-based pain benefits from 10 unimodal treatments and more than 7 multimodal treatments. There were no pain benefits from magnets in necklaces, education or relaxation alone, occipital release alone, or head retraction-extension exercise combinations alone. The specificity of the studied treatments meant few studies could be generalized to more than a minority of patients. Adverse events were not addressed in most studies, but where they were, there were none or they were minor. The theoretic harm of vertebral artery dissection (VAD) was not reported, but an analysis suggested that 1 VAD may occur subsequent to 1 million cervical manipulations. Costs were not analyzed in this guideline, but it is the understanding of the GDC that recommendations limiting ineffective care and promoting a more rapid return of patients to full functional capacity will reduce patient costs, as well as increase patient safety and satisfaction. For simplicity, this version of the guideline includes primarily data synthesized across studies (evidence syntheses), whereas the technical and the interactive versions of this guideline (http://ccachiro.org/cpg) also include relevant data from individual studies (evidence extractions). RECOMMENDATIONS The GDC developed treatment, risk-management and research recommendations using the available evidence. Treatment recommendations addressing 13 treatment modalities revolved around a decision algorithm comprising diagnosis (or assessment leading to diagnosis), treatment and reassessment. Several specific variations of modalities of treatment were not recommended. For adverse events not associated with a treatment modality, but that occur in the clinical setting, there was evidence to recommend reconsideration of treatment options or referral to the appropriate health services. For adverse events associated with a treatment modality, but not a known or observable risk factor, there was evidence to recommend heightened vigilance when a relevant treatment is planned or administered. For adverse events associated with a treatment modality and predicted by an observable risk factor, there was evidence to recommend absolute contraindications, and requirements for treatment modality modification or caution to minimize harm and maximize benefit. For managing the theoretic risk of dissection, there was evidence to recommend a systematic risk-management approach. For managing the theoretic risk of stroke, there was support to recommend minimal rotation in administering any modality of upper-cervical spine treatment, and to recommend caution in treating a patient with hyperhomocysteinemia, although the evidence was especially ambiguous in both of these areas. Research recommendations addressed the poor caliber of many of the studies; the GDC concluded that the scientific base for chiropractic cervical treatment of neck pain was not of sufficient quality or scope to “cover” current chiropractic practice comprehensively, although this should not suggest other disciplines are more evidence-based. VALIDATION This guideline was authored by the 10 members of the GDC (Elizabeth Anderson-Peacock, Jean-Sébastien Blouin, Roland Bryans, Normand Danis, Andrea Furlan, Henri Marcoux, Brock Potter, Rick Ruegg, Janice Gross Stein, Eleanor White) based on the work of 3 literature search teams and an evidence extraction team, and in light of feedback from a commentator (Donald R Murphy), a 5-person review panel (Robert R Burton, Andrea Furlan, Richard Roy, Steven Silk, Roy Till), a 6-person Task Force (Grayden Bridge, H James Duncan, Wanda Lee MacPhee, Bruce Squires, Greg Stewart, Dean Wright), and 2 national profession-wide critiques of complete drafts. Two professional editors with extensive guidelines experience were contracted (Thor Eglington, Bruce P Squires). Key contributors to the guideline included individuals with specialties or expert knowledge in chiropractic, medicine, research processes, literature analysis processes, clinical practice guideline processes, protective association affairs, regulatory affairs, and the public interest. This guideline has been formally peer reviewed. PMID:17549134

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2014-04-01

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

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

    PubMed Central

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

    2014-01-01

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

  10. 75 FR 13137 - National Institutes of Health Guidelines for Human Stem Cell Research

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-18

    ...The National Institutes of Health (NIH) is extending the public comment period on a revision to the definition of human embryonic stem cells (hESCs) in the ``National Institutes of Health Guidelines for Human Stem Cell Research'' (Guidelines). Due to a technical problem, comments entered in the Web site between 11:59 p.m. EST on February 28, 2010, through 8 a.m. EST on March 2, 2010, were not......

  11. National Symposium for Business and Office Education Curriculum Guidelines.

    ERIC Educational Resources Information Center

    Kingston, Carmela C.; Thomas, Ellis R.

    Symposium participants met to develop guidelines for developing curriculum for the area of business and office education, K through adult. The session reports are presented in outline form according to topic definition, problem areas, and recommendations. Topics discussed include: organizational patterns in the business and office education

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

    PubMed

    Shibata, Hiroyuki

    2015-11-01

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

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

    PubMed

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

    2012-07-01

    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

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

    PubMed

    Zhong, Fangying; Liu, Chenxi; Zhang, Xinping

    2014-12-01

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

  15. Federal Guidelines - Operation and Maintenance of Wastewater Treatment Facilities.

    ERIC Educational Resources Information Center

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

    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

  16. A national survey of implementation of guidelines for gestational diabetes mellitus.

    PubMed

    O'Higgins, A; Dunne, F; Lee, B; Smith, D; Turner, M J

    2014-09-01

    In 2010, national guidelines for the management of gestational diabetes mellitus (GDM) were published by the Health Service Executive (HSE). In 2012, a questionnaire was distributed to all maternity units to survey implementation of the guidelines. All units screened women for GDM, but used different screening tests with fifteen units (79%) using the recommended 75g OGTT, three units (16%) using a 100g OGTT and one unit (5%) using a 50g glucose challenge test. Optimal outcomes are best achieved through multidisciplinary diabetes-obstetric care and this was available in nine of the units (47%). The prevalence of GDM varied from 2.2 - 7.4%. Insulin usage varied from 15-56%. Six centres (31%) had not implemented the national guidelines in full because of lack of resources. Despite national endorsement of the guideline, significant variations remain in implementation. This may lead to differences in clinical outcomes depending on where a woman attends for obstetric care. PMID:25282959

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

    PubMed

    Emmi, V

    2005-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

  19. [Clinical practice guideline. Diagnosis and treatment of dyslipidemia.

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  2. Preventive treatment in migraine and the new US guidelines

    PubMed Central

    Estemalik, E; Tepper, S

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  5. 76 FR 30308 - National Standard 10 Guidelines; Public Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-25

    ... (76 FR 22342). More background on this action is contained in the ANPR published on April 21, 2011 (76... Proposed Rulemaking (ANPR) to request public comment on potential revisions to the National Standard 10... National Standard 10 ANPR. The public will be allowed to comment at the meetings. DATES: Meetings...

  6. An audit highlighting a lack of awareness of the UK national guidelines for HIV testing, 2008.

    PubMed

    Mitchell, L; Bushby, S A; Chauhan, M

    2011-12-01

    Following the publication of the UK national guidelines for HIV testing 2008, we carried out a local audit to determine the level of awareness of these guidelines among doctors working in Sunderland Royal Hospital, Sunderland, UK. An email questionnaire was distributed. Over two-thirds of respondents were unaware of the publication of the guidelines. Only 36% of respondents felt comfortable in offering a patient testing for HIV. The majority of doctors who responded lacked knowledge and confidence in issues surrounding HIV management and diagnosis, suggesting that better dissemination of information and training is still needed. PMID:22174061

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

    SciTech Connect

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

    2011-08-12

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

  8. New Cholesterol Guidelines for the Management of Atherosclerotic Cardiovascular Disease Risk: A Comparison of the 2013 American College of Cardiology/American Heart Association Cholesterol Guidelines with the 2014 National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia.

    PubMed

    Adhyaru, Bhavin B; Jacobson, Terry A

    2016-03-01

    This review discusses the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and compares it with the 2014 National Lipid Association (NLA) Recommendations for Patient-Centered Management of Dyslipidemia. The review discusses some of the distinctions between the guidelines, including how to determine a patient's atherosclerotic cardiovascular disease risk, the role of lipoprotein treatment targets, the importance of moderate- and high-intensity statin therapy, and the use of nonstatin therapy in light of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial. PMID:26892995

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

    PubMed

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

    2014-12-01

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

  10. Guideline of guidelines: urinary incontinence.

    PubMed

    Syan, Raveen; Brucker, Benjamin M

    2016-01-01

    The objective of the article is to review key guidelines on the management of urinary incontinence (UI) to guide clinical management in a practical way. Guidelines produced by theEuropean Association of Urology (updated in 2014), the Canadian Urological Association (updated in 2012), the International Consultation on Incontinence (updated in 2012), and the National Collaborating Centre for Women's and Children's Health (updated in 2013) were examined and their recommendations compared. In addition, specialised guidelines produced by the collaboration between the American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction on overactive bladder and the use of urodynamics were reviewed. The Appraisal of Guidelines for Research and Evaluation II (AGREE) instrument was used to evaluate the quality of these guidelines. There is general agreement between the groups on the recommended initial evaluation and the use of conservative therapies for first-line treatment, with a limited role for imaging or invasive testing in the uncomplicated patient. These groups have greater variability in their recommendations for invasive procedures; however, generally the mid-urethral sling is recommended for uncomplicated stress UI, with different recommendations on the approach, as well as the comparability to other treatments, such as the autologous fascial sling. This 'Guideline of Guidelines' provides a summary of the salient similarities and differences between prominent groups on the management of UI. PMID:26033093

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

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

    SciTech Connect

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

    1994-11-01

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

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

    PubMed

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

    2016-01-01

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

  14. Treatment of venous thromboembolism: guidelines translated for the clinician.

    PubMed

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

    2009-10-01

    Venous thromboembolism is a major cause of morbidity and mortality affecting over 2 million people in the United States each year. The American College of Chest Physicians (ACCP) published their first consensus statement on antithrombotic therapy in 1986, and the most recent guidelines from the ACCP on this topic were released in 2008. We aim to summarize the most recent ACCP guidelines on therapy for venous thromboembolism with practical application and interpretation for the practicing physician. We will briefly review the rating system used in the guidelines for the level of evidence and the strength of the recommendation. We will then discuss the recommendations for initial anticoagulant therapies including low molecular weight heparin, unfractionated heparin, and fondaparinux for patients with both deep vein thrombosis (DVT) and pulmonary embolism (PE). A discussion of the guidelines on duration of anticoagulant therapy with a vitamin K antagonist is also included. In addition, we will address the use of thrombolytic therapy and inferior vena cava filter placement for DVT and PE. Prevention of postphlebitic syndrome is discussed as well. We will conclude with a brief discussion of future directions including several novel therapeutic anticoagulants. PMID:19579012

  15. Comparing Guidelines for Statin Treatment in Canada and the United States

    PubMed Central

    Hennessy, Deirdre A; Bushnik, Tracey; Manuel, Douglas G; Anderson, Todd J

    2015-01-01

    Background New guidelines for cardiovascular disease risk assessment and statin eligibility have recently been published in the United States by the American College of Cardiology and the American Heart Association (ACC-AHA). It is unknown how these guidelines compare with the Canadian Cardiovascular Society (CCS) recommendations. Methods and Results Using data from the Canadian Health Measures Survey 20072011, we estimated the cardiovascular disease risk and proportion of the Canadian population, aged 40 to 75years without cardiovascular disease, who would theoretically be eligible for statin treatment under both the CCS and ACC-AHA guidelines. The survey sample used (n=1975) represented 13.1 million community dwelling Canadians between the ages of 40 and 75years. In comparing the CVD risk assessment methods, we found that calculated CVD risk was higher based on the CCS guidelines compared with the ACC-AHA guidelines. Despite this, a similar proportion and number of Canadians would be eligible for statin treatment under the 2 sets of recommendations. Some discordance in recommendations was found within subgroups of the population, with the CCS guidelines recommending more treatment for individuals who are younger, with a family history of CVD, or with chronic kidney disease. The ACC-AHA recommend more treatment for people who are older (age 60+ years). These results likely overestimate the treatment rate under both guidelines because, in primary prevention, a clinicianpatient discussion must occur before treatment and determines uptake. Conclusions Implementing the ACC-AHA lipid treatment guidelines in Canada would not result in an increase in individuals eligible for statin treatment. In fact, the proportion of the population recommended for statin treatment would decrease slightly and be targeted at different subgroups of the population. PMID:26175357

  16. From Physical Activity Guidelines to a National Activity Plan

    ERIC Educational Resources Information Center

    Bornstein, Daniel B.; Pate, Russell R.

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Xiaobing, Sun

    2012-01-01

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

  20. Guidelines for the treatment of mild hypertension: Memorandum from a WHO/ISH meeting*

    PubMed Central

    1983-01-01

    The present guidelines were endorsed by the participants at the Third Mild Hypertension Conference, held at Brgenstock, Switzerland, 27-29 September 1982. They include the definition of mild hypertension, and describe blood pressure measurement, factors influencing the decision to begin treatment, methods of treatment, and follow-up. The guidelines are based on the best available scientific evidence, and will be updated in the future to keep abreast of future developments in this field. PMID:6601543

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

    PubMed

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Hildesheimer, Francoise

    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

  3. 75 FR 8085 - National Institutes of Health Guidelines for Human Stem Cell Research

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-23

    ... revision to the definition of human embryonic stem cells (hESCs) in the ``National Institutes of Health... defined as: ``For the purpose of these Guidelines, `human embryonic stem cells (hESCs)' are cells that are... stem cells (hESCs)' are pluripotent cells that are derived from ] early stage human embryos, up to...

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

    ERIC Educational Resources Information Center

    Holthe, Asle; Larsen, Torill; Samdal, Oddrun

    2011-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    Das, Parthajit; Samanta, Ash; Dasgupta, Bhaskar

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2015-01-01

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

  9. Review of national research ethics regulations and guidelines in Middle Eastern Arab countries

    PubMed Central

    2012-01-01

    Background Research ethics guidelines are essential for conducting medical research. Recently, numerous attempts have been made to establish national clinical research documents in the countries of the Middle East. This article analyzes these documents. Methods Thirteen Arab countries in the Middle East were explored for available national codes, regulations, and guidelines concerning research ethics, and 10 documents from eight countries were found. We studied these documents, considering the ethical principles stated in the Declaration of Helsinki, the Council for International Organizations of Medical Sciences (CIOMS) guidelines, and the International Conference of Harmonization - Guidelines for Good Clinical Practice (ICH-GCP). Our paper comprises a complete list of protections, such as confidentiality, informed consent, ethics committees, and others. Results This study found different levels and kinds of research ethics regulations and guidelines in the countries examined. Two groups can be distinguished: the countries in the first group have one or more research ethics regulations or guidelines, while the countries in the second group have not yet established any. Most of the documents showed various degrees of deficiencies in regard to ethical protection. The majority of the documents that were examined refer to one or more international documents on biomedical research ethics. Conclusions Recently, a lot of efforts have been made in many countries in the Middle East. However, compared with international documents, most of the research ethics documents in use in this region demonstrate numerous deficiencies. As it relates to these documents, extensive differences could be observed in regard to development, structure, content, and reference to international guidelines. PMID:23234422

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

    SciTech Connect

    1995-08-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-12-01

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

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

    PubMed Central

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

    2015-01-01

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

  14. Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments: 2014 update.

    PubMed

    Russell, Katie W; Scaife, Courtney L; Weber, David C; Windsor, Jeremy S; Wheeler, Albert R; Smith, William R; Wedmore, Ian; McIntosh, Scott E; Lieberman, James R

    2014-12-01

    The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded on the basis of the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments published in Wilderness & Environmental Medicine 2014;25(1):41-49. PMID:25498266

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

    PubMed Central

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    World Health Organization, Geneva (Switzerland).

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

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

    ERIC Educational Resources Information Center

    World Health Organization, Geneva (Switzerland).

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

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

    PubMed

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Choate, Laura H.; Gintner, Gary G.

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Choate, Laura H.; Gintner, Gary G.

    2011-01-01

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

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

    PubMed

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

    2014-04-01

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

  2. Evidence-based guideline update: Medical treatment of infantile spasms

    PubMed Central

    Go, C.Y.; Mackay, M.T.; Weiss, S.K.; Stephens, D.; Adams-Webber, T.; Ashwal, S.; Snead, O.C.

    2012-01-01

    Objective: To update the 2004 American Academy of Neurology/Child Neurology Society practice parameter on treatment of infantile spasms in children. Methods: MEDLINE and EMBASE were searched from 2002 to 2011 and searches of reference lists of retrieved articles were performed. Sixty-eight articles were selected for detailed review; 26 were included in the analysis. Recommendations were based on a 4-tiered classification scheme combining pre-2002 evidence and more recent evidence. Results: There is insufficient evidence to determine whether other forms of corticosteroids are as effective as adrenocorticotropic hormone (ACTH) for short-term treatment of infantile spasms. However, low-dose ACTH is probably as effective as high-dose ACTH. ACTH is more effective than vigabatrin (VGB) for short-term treatment of children with infantile spasms (excluding those with tuberous sclerosis complex). There is insufficient evidence to show that other agents and combination therapy are effective for short-term treatment of infantile spasms. Short lag time to treatment leads to better long-term developmental outcome. Successful short-term treatment of cryptogenic infantile spasms with ACTH or prednisolone leads to better long-term developmental outcome than treatment with VGB. Recommendations: Low-dose ACTH should be considered for treatment of infantile spasms. ACTH or VGB may be useful for short-term treatment of infantile spasms, with ACTH considered preferentially over VGB. Hormonal therapy (ACTH or prednisolone) may be considered for use in preference to VGB in infants with cryptogenic infantile spasms, to possibly improve developmental outcome. A shorter lag time to treatment of infantile spasms with either hormonal therapy or VGB possibly improves long-term developmental outcomes. PMID:22689735

  3. 2015 UK national guideline for the management of infection with Chlamydia trachomatis.

    PubMed

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

    2016-03-01

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

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

    PubMed

    Cooper, Marcia Janet; Zlotkin, Stanley Howard

    2003-12-01

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

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

    PubMed Central

    Stanley, J M

    1989-01-01

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

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

    ERIC Educational Resources Information Center

    McClellan, Jon

    2005-01-01

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

  7. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases.

    PubMed

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

    2015-01-01

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

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

    SciTech Connect

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

    1998-12-31

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

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

    PubMed

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

    2014-12-01

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

  10. Guidelines for ozone case histories in cooling water treatment and other applications

    SciTech Connect

    Burda, P.A.

    1994-12-31

    Too many claims and reports on non-conventional water treatment technologies are still viewed as biased and thereby retarding larger scale acceptance specifically of ozone technology. The reasoning of the ozone treatment successes or its discontinuing due to the failures is not being properly documented. Therefore, this work was accomplished for proposed NACE International Standard ``Guidelines for Case Histories in Ozone Treated Cooling Water,`` to guide in data collecting case histories to be utilized for comparison of cooling tower treatment alternatives.

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

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

    PubMed

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

    2008-01-01

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

  14. Guidelines for the diagnosis and treatment of schistosomal myeloradiculopathy.

    PubMed

    Lambertucci, Jos Roberto; Silva, Luciana Cristina dos Santos; do Amaral, Ronaldo Santos

    2007-01-01

    Schistosomal myeloradiculopathy is the most severe and disabling ectopic form of Schistosoma mansoni infection. The prevalence of SMR in centres in Brazil and Africa that specialise in attending patients with non traumatic myelopathy is around 5%. The initial signs and symptoms of the disease include lumbar and/or lower limb pain, paraparesis, urinary and intestinal dysfunctions, and impotence in men. The cerebrospinal fluid of SMR patients shows an increase in protein concentration and in the number of mononuclear cells in 90% of cases; eosinophils have been reported in 40%. The use of magnetic resonance imaging is particularly valuable in the diagnosis of Schistosomal myeloradiculopathy. The exclusion of other myelopathies and systemic diseases remains mandatory. Early diagnosis and treatment with steroids and schistosomicides provide a cure for most patients, whilst delayed treatment can result in irreversible physical disabilities or death. To improve awareness concerning Schistosomal myeloradiculopathy amongst public health professionals, and to facilitate the control of the disease, the Brazilian Ministry of Health has launched a program of education and control of this ectopic form of schistosomiasis. The present paper reviews current methods for the diagnosis of SMR and outlines protocols for treatment of the disease. PMID:17992416

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

    PubMed

    Barrera-Cruz, Antonio; Daz-Ramos, Rita Delia; Viniegra-Osorio, Arturo; Grajales-Muiz, Concepcin; Dvila-Torres, Javier

    2015-01-01

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

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

    PubMed

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

    2011-08-01

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

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

    PubMed Central

    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

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

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

    PubMed

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

    2015-12-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

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

    ERIC Educational Resources Information Center

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

    2003-01-01

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

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

    ERIC Educational Resources Information Center

    Liansheng, Yuan

    2012-01-01

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

  3. Dental treatment of the pregnant patient: literature review and guidelines for the practicing clinician.

    PubMed

    Shessel, Bradley A; Portnof, Jason E; Kaltman, Steven I; Nitsch, Romy

    2013-01-01

    The purpose of this review article is to assist the practicing clinician by categorizing and packaging useful clinical information into a format that will assist with the treatment of pregnant patients. Our goal is to offer the scientific foundations that lead to current practice guidelines, specifically those that are of particular relevance to today's dental professional. PMID:25055399

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

    PubMed Central

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

    2008-01-01

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

  5. Management of anaemia and blood transfusion in critical care - implementing national guidelines in ICU

    PubMed Central

    Watson, Sethina; Kendrick, Kate

    2014-01-01

    Anaemia in intensive care is common, with approximately 50% of patients receiving a red cell transfusion. Recognised complications from transfusion include transfusion associated lung injury, infection, and organ failure progression. Most cohort studies show a positive relationship between red cell transfusion and adverse outcomes. In 2012, the British Committee for Standards in Haematology issued guidelines for red cell (RBC) transfusion in critical care. They recommend a haemoglobin transfusion trigger of below 70 g/dL unless the patient is bleeding, has acute sepsis, neurological injury, or an acute coronary syndrome. RBC transfusions in a single intensive care unit (ICU) were prospectively assessed for compliance with national guidance. Each transfusion was categorised with a traffic light system: red for inappropriate, green for appropriate, and amber for those that were not clearly appropriate or inappropriate. The quality improvement project began with a clinical effectiveness audit of doctors' knowledge of critical care transfusion thresholds. Two quality improvement interventions were used: 1) a local blood transfusion guideline was produced and posters were placed in the ICU 2) this guidance was attached to the transfusion prescriptions. Data was collected after each intervention. A total of 30 random adult RBC transfusions were analysed between August 2013 and February 2014. Despite good results from the effectiveness audit an assessment of RBC transfusions demonstrated room for improvement. Prior to introduction of the guideline intervention, a total of two transfusions were green, one red and seven amber. Following both interventions there were seven green transfusions and three amber. No transfusions were classed as inappropriate. According to additional trust based ICU transfusion records, there was approximately a 50% reduction (41 to 18 RBC transfusions) in overall blood transfusions following the first intervention in October 2013. Simple interventions to raise awareness such as surveys, posters, and reminders can dramatically improve RBC prescribing in accordance to evidence based guidelines. Making prescribers aware of guidelines can dramatically reduce the total number of overall transfusions and increase transfusion appropriateness. PMID:26734254

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

    SciTech Connect

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

    2013-02-15

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

  7. Current Guidelines for Postoperative Treatment and Follow-Up of Well-Differentiated Thyroid Cancer.

    PubMed

    Yoo, Jenny Y; Stang, Michael T

    2016-01-01

    Well-differentiated thyroid cancer is increasing in incidence but the disease-specific mortality remains very low. The only effective adjuvant treatment is radioactive iodine ablation. Guidelines regarding the use and dosage of radioactive iodine depend on pathologic features of the primary and metastatic tumor that define risk. Long-term treatment includes thyroid-stimulating hormone suppression and surveillance with serum thyroglobulin and radiologic assessment for nodal recurrence. PMID:26610773

  8. Italian guidelines for management and treatment of hyperbilirubinaemia of newborn infants???35weeks gestational age

    PubMed Central

    2014-01-01

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

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

    PubMed Central

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

    2009-01-01

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

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

    PubMed Central

    2014-01-01

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

  11. Development of a guideline for treatment of deep and superficial venous thrombosis in the emergency department.

    PubMed

    Tosone, Nancy C; Costanzo, Cindy

    2012-01-01

    Patients with DVT, aged 45.64 years, often present to the ED, with an annual cost of $1.5-$3.2 billion per year. This paper describes the process used to implement an evidence-based guideline on deep venous thrombosis (DVT) for the emergency department (ED). Specific aims were to (a) conduct an organizational assessment of DVT treatment practices; (b) compare organizational results with evidence-based treatment guidelines; (c) develop recommendations for the treatment of DVT for ED discharge; and (d) conduct an interdisciplinary evaluation of the evidence-based guideline. A retrospective review of 149 records of adults in an urban Midwestern ED in 2010 was undertaken. Differences in provider practices were identified. A guideline was developed that included clinical management, social/financial concerns, patient education, anticoagulation monitoring, and outpatient follow-up. Implementation and evaluation were accomplished through electronic and paper communication, medical record monitoring, and patient call back. Evaluation also included simulation exercises with an interdisciplinary team. PMID:22561224

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

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

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

    1996-04-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    SciTech Connect

    Wheeler, W.

    1998-12-01

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

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

    PubMed

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

    2014-03-17

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

  17. [Which antipsychotic as first choice in schizophrenia? The Dutch Multidisciplinary Guideline for Schizophrenia 2005 versus the Pharmacotherapy Compass 2005, the Dutch National Health Insurance System Formulary].

    PubMed

    Harms, H H

    2006-01-01

    The pharmacotherapy advice contained in the 'Multidisciplinaire Richtlijn Schizofrenie 2005' (abbreviated to MDRS 2005 and translated as the Dutch Multidisciplinary Schizophrenia Guideline) is compared with the advice given in the 'Farmacotherapeutisch Kompas 2005' (abbreviated to FTK 2005 and translated as the Pharmacotherapy Compass 2005) and with international guidelines. FTK 2005, which is the Dutch National Health Insurance Formularium, recommends that treatment should start with a conventional (first-generation) antipsychotic, namely haloperidol. International guidelines, however, advise starting with an atypical (second-generation) antipsychotic. MDRS 2005 suggests that the pros and cons of the medication should be discussed with the patient and that the choice of drug should be based on the outcome of this discussion. Ifthat discussion becomes problematical then, according to MD RS 2005, it is advisable PMID:16955985

  18. Risk assessment and prophylaxis of venous thromboembolism in surgical inpatients: improving adherence to national guidelines

    PubMed Central

    Johnson, Oscar; Kumar, Shankar

    2015-01-01

    In Europe, venous thromboembolism (VTE) is the third most common cause of vascular death after myocardial infarction and stroke. It is especially common during and after hospitalisation for surgery and acute medical illness though many other risk factors have now been identified. VTE is often preventable with judicious use of preventative measures in the form of thromboprophylaxis and mechanical antiembolism stockings. In 2014, a study was undertaken across all surgical wards at a teaching hospital in London to assess compliance to national guidelines for VTE risk assessment and subsequent institution of protective measures. The initial results demonstrated that performance could be improved in terms of meeting the national target of assessing 95% of surgical inpatients for risk of VTE at admission, prescribing anti-embolism stockings, ensuring that they are correctly worn, and reassessing patients 24 hours later. Utilising a multidisciplinary team approach, simple interventions were put in place such as e-mail reminders, posters, and senior input during ward rounds. Three subsequent measurements demonstrated that sustained improvement was achieved with the national guideline of 95% VTE risk assessment met. Improved performance was noted across all parameters considered, highlighting that simple intervention with all team members involved can improve patient safety and care.

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    SciTech Connect

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

    1996-11-01

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

  2. 199?Development of a National Guideline on Skin Testing and Immunotherapy

    PubMed Central

    Linnemann, Dsire Larenas; Ortega Martell, Jos Antonio; del Rio, Blanca; Rodriguez-Perez, Noel; Arias-Cruz, Alfredo; Estrada, Alan

    2012-01-01

    Background Several international guidelines exist on allergen immunotherapy (AIT) eg American, European, British, Spanish, Italian- but local conditions that reign in each country limit their applicability. We present the steps we followed to develop a National Guideline on AIT, taking into account local legislation, extracts available, costs and patient preference. Methods Firstly a Nation-wide survey on the practice of skin testing and AIT was undertaken among all members of Mexican Allergist Societies. Secondly, based on the replies obtained with the survey clinical questions were formulated on critical points and issues susceptible for improvement, as diagnosed by the survey. Thirdly, all 6 Regional Allergist Societies were visited to obtain the opinion of their members on the clinical questions concerning how immunotherapy could best be practiced under local Mexican conditions. This led to the Consensed experience. Fourthly, 6 experts looked for the replies to the clinical questions reviewing the literature and assigning quality of evidence to the articles on the specific issues treated by each clinical question. Results To develop the final document the GRADE approach was used. For each clinical question both, knowledge from the local consensed experience and the evidence-based replies were taken into account, as well as cost, patient preference and safety to make a set of recommendations and suggestions on the most crucial aspects of skin testing and AIT. Forming centers of allergists in Mexico corrected the final draft. The final document came out as the January issue of Revista Mexicana Alergia and was presented by the authors in a National Course on Immunotherapy (May 2011), withapart from the lecturesa more workshop-like part to allow for practical exercising and discussion. The updated questions on allergen immunotherapy for the final board exam are based on the Guideline. Allergy-residents developed a slide-show. In 2012 Regional Allergist Societies shall be visited again. Conclusions We present a democratic way of how a National Guideline can be developed, supported by evidence-based medicine and local experience in a country where little is legislated on this respect and quality improvement has to be stimulated by the professional community. We show how implementation can be enhanced.

  3. Tobacco Use Screening and Treatment by Outpatient Psychiatrists Before and After Release of the American Psychiatric Association Treatment Guidelines for Nicotine Dependence

    PubMed Central

    Sherman, Scott

    2014-01-01

    Objectives. We examined tobacco use screening and treatment by US psychiatrists before and after release of the 1996 American Psychiatric Association (APA) nicotine dependence treatment guidelines. Methods. We used data from the National Ambulatory Medical Care Survey to identify rates of tobacco screening and treatment by psychiatrists before the release of the guidelines (19931996) and during 2 postguidelines periods: 20012005 and 20062010. Multiple logistic regression was used to compare preguidelines and postguidelines rates. Results. Psychiatrists screened for tobacco use during 77% of visits from 1993 to 1996, 69% of visits from 2001 to 2005 (odds ratio [OR]?=?0.69; 95% confidence interval [CI]?=?0.64, 0.75), and 60% of visits from 2006 to 2010 (OR?=?0.46; 95% CI =?0.43, 0.50). Psychiatrists provided cessation counseling to 12% of smokers from 1993 to 1996, 11% from 2001 to 2005 (OR?=?0.97; 95% CI?=?0.74, 1.26), and 23% from 2006 to 2010 (OR?=?2.23; 95% CI?=?1.74, 2.86). Psychiatrists prescribed nicotine replacement therapy to fewer than 1% of smokers during all 3 time periods. Conclusions. Psychiatrists are screening for tobacco use at declining rates, and the proportion of smokers provided with treatment remains low. PMID:24228666

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

    PubMed

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

    2012-02-01

    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 web approach. The FCM technique is capable of dealing with situations including uncertain descriptions using similar procedure such as human reasoning does. Thus, it was selected for the case of modeling and knowledge integration of clinical practice guidelines. The semantic web tools were established to implement the FCM approach. The knowledge base was constructed from the clinical guidelines as the form of if-then fuzzy rules. These fuzzy rules were transferred to FCM modeling technique and, through the semantic web tools, the whole formalization was accomplished. The problem of urinary tract infection (UTI) in adult community was examined for the proposed approach. Forty-seven clinical concepts and eight therapy concepts were identified for the antibiotic treatment therapy problem of UTIs. A preliminary pilot-evaluation study with 55 patient cases showed interesting findings; 91% of the antibiotic treatments proposed by the implemented approach were in fully agreement with the guidelines and physicians' opinions. The results have shown that the suggested approach formalizes medical knowledge efficiently and gives a front-end decision on antibiotics' suggestion for cystitis. Concluding, modeling medical knowledge/therapeutic guidelines using cognitive methods and web semantic tools is both reliable and useful. PMID:21911082

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

    PubMed

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

    2015-11-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2015-12-01

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

  8. [Diagnosis and treatment of diving accidents. New German guidelines for diving accidents 2014-2017].

    PubMed

    Jttner, B; Wlfel, C; Liedtke, H; Meyne, K; Werr, H; Bruer, T; Kemmerer, M; Schmeier, G; Piepho, T; Mller, O; Schppenthau, H

    2015-06-01

    In 2015 the German Society for Diving and Hyperbaric Medicine (GTM) and the Swiss Underwater and Hyperbaric Medical Society (SUHMS) published the updated guidelines on diving accidents 2014-2017. These multidisciplinary guidelines were developed within a structured consensus process by members of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), the Sports Divers Association (VDST), the Naval Medical Institute (SchiffMedInst), the Social Accident Insurance Institution for the Building Trade (BG BAU), the Association of Hyperbaric Treatment Centers (VDD) and the Society of Occupational and Environmental Medicine (DGAUM). This consensus-based guidelines project (development grade S2k) with a representative group of developers was conducted by the Association of Scientific Medical Societies in Germany. It provides information and instructions according to up to date evidence to all divers and other lay persons for first aid recommendations to physician first responders and emergency physicians as well as paramedics and all physicians at therapeutic hyperbaric chambers for the diagnostics and treatment of diving accidents. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose and the following key action statements: on-site 100% oxygen first aid treatment, still patient positioning and fluid administration are recommended. Hyperbaric oxygen (HBO) recompression remains unchanged the established treatment in severe cases with no therapeutic alternatives. The basic treatment scheme recommended for diving accidents is hyperbaric oxygenation at 280 kPa. For quality management purposes there is a need in the future for a nationwide register of hyperbaric therapy. PMID:26025255

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

    PubMed

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

    2016-01-01

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

  10. Pharmacological management of acute mania: does current prescribing practice reflect treatment guidelines?

    PubMed

    Streeruwitz, A; Barnes, T R E; Fehler, J; Ohlsen, R; Curtis, V A

    2007-03-01

    The records of 70 inpatients with an acute manic episode were audited, to examine the relationship between current prescribing practice, the recommendations of recent clinical guidance and short-term clinical outcomes. Overall, 38 combinations of medication were prescribed. Within the first 24 hours of treatment, monotherapy with a second generation antipsychotic was favoured. At discharge, combination treatment (a mood stabilizer and a second generation antipsychotic) predominated. Early initiation of medication was significantly associated with an earlier clinical decision to discharge. Prescribing was generally in accord with published guidelines. The findings reinforce the value of prescribing surveys in mental health and the need to share understanding of the constraints that may lead to deviation from prescribing guidelines. PMID:17329301

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

    PubMed Central

    Balmaceda, Casilda M

    2014-01-01

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

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

    PubMed

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

    2015-10-01

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

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

    PubMed

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

    2016-02-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Reddel, Helen K

    2015-09-01

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

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

    PubMed Central

    Yoon, Jeong Hee; Park, Joong-Won

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. Updated clinical practice guidelines for the prevention and treatment of mucositis.

    PubMed

    Keefe, Dorothy M; Schubert, Mark M; Elting, Linda S; Sonis, Stephen T; Epstein, Joel B; Raber-Durlacher, Judith E; Migliorati, Cesar A; McGuire, Deborah B; Hutchins, Ronald D; Peterson, Douglas E

    2007-03-01

    Considerable progress in research and clinical application has been made since the original guidelines for managing mucositis in cancer patients were published in 2004, and the first active drug for the prevention and treatment of this condition has been approved by the United States Food and Drug Administration and other regulatory agencies in Europe and Australia. These changes necessitate an updated review of the literature and guidelines. Panel members reviewed the biomedical literature on mucositis published in English between January 2002 and May 2005 and reached a consensus based on the criteria of the American Society of Clinical Oncology. Changes in the guidelines included recommendations for the use of palifermin for oral mucositis associated with stem cell transplantation, amifostine for radiation proctitis, and cryotherapy for mucositis associated with high-dose melphalan. Recommendations against specific practices were introduced: Systemic glutamine was not recommended for the prevention of gastrointestinal mucositis, and sucralfate and antimicrobial lozenges were not recommended for radiation-induced oral mucositis. Furthermore, new guidelines suggested that granulocyte-macrophage-colony stimulating factor mouthwashes not be used for oral mucositis prevention in the transplantation population. Advances in mucositis treatment and research have been complemented by an increased rate of publication on mucosal injury in cancer. However, additional and sustained efforts will be required to gain a fuller understanding of the pathobiology, impact on overall patient status, optimal therapeutic strategies, and improved educational programs for health professionals, patients, and caregivers. These efforts are likely to have significant clinical and economic impact on the treatment of cancer patients. Cancer 2007;109:820-31. (c) 2007 American Cancer Society. PMID:17236223

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

    PubMed

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

    2015-08-01

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

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

    PubMed Central

    2015-01-01

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

  1. 45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note... 45 Public Welfare 4 2014-10-01 2014-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15... opinions about the future “quality of life” of a retarded or disabled person. The fifth main feature of...

  2. 45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note... 45 Public Welfare 4 2013-10-01 2013-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15... opinions about the future “quality of life” of a retarded or disabled person. The fifth main feature of...

  3. 45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note... 45 Public Welfare 4 2010-10-01 2010-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15... opinions about the future “quality of life” of a retarded or disabled person. The fifth main feature of...

  4. 45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note... 45 Public Welfare 4 2012-10-01 2012-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15... opinions about the future “quality of life” of a retarded or disabled person. The fifth main feature of...

  5. 45 CFR Appendix to Part 1340 - Interpretative Guidelines Regarding 45 CFR 1340.15-Services and Treatment for Disabled Infants

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...—Interpretative Guidelines Regarding 45 CFR 1340.15—Services and Treatment for Disabled Infants Explanatory Note... 45 Public Welfare 4 2011-10-01 2011-10-01 false Interpretative Guidelines Regarding 45 CFR 1340.15... opinions about the future “quality of life” of a retarded or disabled person. The fifth main feature of...

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

    PubMed Central

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

    2009-01-01

    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. PMID:19173739

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

    PubMed Central

    Kuderer, Nicole M.; Lyman, Gary H.

    2014-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2014-01-01

    With the recent attention to the importance of evidence-based medicine in psychiatry, a number of treatment guidelines have been published. This survey investigated prescribing pattern and predictors for guideline disconcordance in the acute treatment of bipolar depression across mainland China. Pharmacological treatments of 1078 patients with bipolar depression were examined. Guidelines disconcordance was determined by comparing the medication(s) patients were prescribed with the recommendation(s) in the guidelines of the Canadian Network for Mood and Anxiety Treatments. Predictors for guidelines discordance were analyzed with logistic regression. Of the 1078 patients, 50.2% patients were treated against treatment guidelines recommendations. The patients who were treated in general hospitals (OR?=?1.53, 95% CI 1.181.97), with a depressive episode (OR?=?1.67, 95% CI 1.272.19) and an older age at first onset (OR?=?1.62, 95% CI 1.152.28) were more likely to receive guideline-disconcordant treatment than their counterparts. In contrast, the patients with current mental comorbidity, an older age at study entry, a longer duration of disease, and more frequent episodes in past year were less likely to receive guideline-disconcordant treatments than their counterparts with an OR of 0.43 (95% CI 0.240.77), 0.52 (95CI% 0.360.75), 0.48 (95% CI 0.360.65), and 0.50 (95% CI 0.380.64), respectively. Our finding suggested the disconcordance with treatment guidelines in patients with an acute bipolar depression is common under naturalistic conditions in mainland China, and the predicting factors correlated with guidelines disconcordance include both psychiatrist-specific (clinicians from general hospitals) and patient-specific features (a depressive episode at first onset, no current co-morbidity with mental disorders, a younger age at study entry, an older age at first onset, shorter duration of disease, and non-frequent episodes in past year). PMID:24763748

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  15. [Worker participation as a treatment goal: new guideline "Rheumatoid Arthritis and Participation in Work"].

    PubMed

    Boonen, A; Lems, W F

    2015-01-01

    Participation in work is important for every individual and for society as a whole. Despite large improvements in the outcomes of rheumatoid arthritis as a consequence of earlier diagnosis and more effective drug strategies, the disease continues to lead to restrictions in work participation in a substantial proportion of patients. The Dutch Rheumatology Association (NVR) has therefore developed a multidisciplinary guideline, "Rheumatoid Arthritis and Participation in Work". The main aim of this guideline is to improve early recognition by healthcare providers of disease related problems in work participation and to guide the development of a work-directed individual treatment plan. The ultimate goal is to prevent long-term sickness absences and work disability in patients with rheumatoid arthritis. PMID:26732216

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

    PubMed

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

    2016-01-01

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

  17. [Withholding or withdrawing life saving treatment in pediatric intensive care unit: GFRUP guidelines].

    PubMed

    Hubert, P; Canoui, P; Cremer, R; Leclerc, F

    2005-10-01

    Several recent French studies have revealed that 40% of death in pediatric intensive care units are associated with withdrawal or limitation of life saving treatments. Because such decisions are common, the Groupe francophone de ranimation et urgences pdiatriques (GFRUP) has decided to publish recommendations in order to help paediatricians dealing with those difficult issues and to improve their decisions. In a first part of the document the ethical principles that imply those guidelines are recalled, followed by definitions of the terms currently employed. The second part contains guidelines regarding decision making process, the way it is applied and organisation of relatives as well as paramedical and medical staff support when the death of a child occurs. PMID:15935627

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

    PubMed

    Stuenkel, Cynthia A; Santen, Richard J

    2016-03-01

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

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

    PubMed

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

    2015-03-01

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

  20. Low Stroke Rate of Carotid Stenosis Under the Guideline-Oriented Medical Treatment Compared With Surgical Treatment.

    PubMed

    Sato, Kimitoshi; Fujiyoshi, Kazuhiro; Hoshi, Keika; Noda, Chiharu; Yamaoka-Tojo, Minako; Ako, Junya; Kumabe, Toshihiro

    2016-01-19

    Medical treatment for asymptomatic carotid artery stenosis (ACAS) has advanced recently. The outcomes of medical treatment and surgical treatment were evaluated to clarify the optimal treatment for ACAS.Patients with ACAS of ? 50% luminal narrowing underwent serial follow-up carotid artery ultrasonography for one year or more at the Center for Cardiovascular Disease Prevention between November 2006 and October 2013. The incidence of cardiovascular events (stroke, myocardial infarction, cardiovascular death) was examined in 64 patients (medical treatment group), and in 47 patients (surgical group) who underwent surgical treatment (carotid endarterectomy or carotid artery stenting) during this same period at the Department of Neurosurgery.Annual cardiovascular event rate was 0.91% (2/219 person-year) in the group of guideline-oriented medical treatment with an annual check-up for disease management and 5.6% (6/107 person-year) in the surgical group (log-rank P = 0.027; HR in the medical treatment group, 0.19 [medical treatment/surgical]; 95% confidence interval [CI], 0.028 to 0.87). Annual stroke event rate was 0.46% (1/219 person-year) in the medical treatment group and 4.7% (5/107 personyear) in the surgical group (log-rank P = 0.016; HR in the medical treatment group, 0.11 [medical treatment/surgical]; 95% CI, 0.0057 to 0.70). Multivariate logistic analysis showed that the surgical group was an independent variable associated with cardiovascular events (P = 0.049).Annual cardiovascular and stroke event rates were low in patients receiving medical treatment for ACAS and better than surgical treatment. The present study shows that medical treatment is an important option for ACAS. PMID:26673440

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

    PubMed Central

    Heatley, M K

    1999-01-01

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

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

    PubMed

    Bödör, Anikó; Kiss, István

    2016-02-01

    The aim of this review is to present recommendations of the currently valid Hungarian practice guidelines regarding antihypertensive therapy of the elderly and very elderly with different cardiovascular risk profiles, compare and contrast these with international guidelines, describe changes brought about by the past 15 years, and review the evidence behind. Hypertension treatment guidelines and relevant statements of the Hungarian and European Societies of Hypertension, of the Joint National Committee and American Heart Association were processed. The use of age-independent treatment threshold, goal blood pressure values, and the tendency towards more intensive control in co-morbidities conferring high cardiovascular risk were overcome by the upsurge of new evidence and the re-evaluation of previous clinical trial data. These lead to the introduction of age-specific and generally less stringent blood pressure targets in all regions compared. However, the guidelines currently in force still differ in terms of the attainable values in concomitant diabetes, chronic kidney disease or albuminuria, use of beta-blockers and the definition of elderly. Nevertheless, there is unanimous agreement that benefit from lowering of blood pressure under systolic 140 mmHg is not supported by evidence and further investigation is warranted to determine optimal treatment targets in the elderly, in the aged over 80 and specific elderly risk groups. Orv. Hetil., 2016, 157(7), 247-259. PMID:26853726

  3. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia. Part 3: Update 2015 Management of special circumstances: Depression, Suicidality, substance use disorders and pregnancy and lactation.

    PubMed

    Hasan, Alkomiet; Falkai, Peter; Wobrock, Thomas; Lieberman, Jeffrey; Glenthj, Birte; Gattaz, Wagner F; Thibaut, Florence; Mller, Hans-Jrgen

    2015-04-01

    These updated guidelines are based on the first edition of the World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia published in the years 2005 and 2006. For this 2015 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 which are clinically and scientifically relevant. They are intended to be used by all physicians diagnosing and treating patients with schizophrenia. Based on the first version of these guidelines a systematic review, as well as a data extraction from national guidelines have been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and subsequently categorised into six levels of evidence (A-F) and five levels of recommendation (1-5). This third part of the updated guidelines covers the management of the following specific treatment circumstances: comorbid depression, suicidality, various comorbid substance use disorders (legal and illegal drugs), and pregnancy and lactation. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication and other pharmacological treatment options) of patients with schizophrenia. PMID:25822804

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

    PubMed

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

    2014-12-01

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

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

    SciTech Connect

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

    2008-12-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-12-01

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

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

    PubMed

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

    2007-10-01

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

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

    PubMed

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

    2001-05-01

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

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

    PubMed

    Meyenburg, Bernd; Kröger, Anne; Neugebauer, Rebecca

    2015-01-01

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

  11. 2015 UK National Guideline on the management of non-gonococcal urethritis.

    PubMed

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

    2016-02-01

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

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

    PubMed

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

    2014-04-01

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

  13. Comparing the estimation of postpartum hemorrhage using the weighting method and National Guideline with the postpartum hemorrhage estimation by midwives

    PubMed Central

    Golmakani, Nahid; Khaleghinezhad, Khosheh; Dadgar, Selmeh; Hashempor, Majid; Baharian, Nosrat

    2015-01-01

    Introduction: In developing countries, hemorrhage accounts for 30% of the maternal deaths. Postpartum hemorrhage has been defined as blood loss of around 500 ml or more, after completing the third phase of labor. Most cases of postpartum hemorrhage occur during the first hour after birth. The most common reason for bleeding in the early hours after childbirth is uterine atony. Bleeding during delivery is usually a visual estimate that is measured by the midwife. It has a high error rate. However, studies have shown that the use of a standard can improve the estimation. The aim of the research is to compare the estimation of postpartum hemorrhage using the weighting method and the National Guideline for postpartum hemorrhage estimation. Materials and Methods: This descriptive study was conducted on 112 females in the Omolbanin Maternity Department of Mashhad, for a six-month period, from November 2012 to May 2013. The accessible method was used for sampling. The data collection tools were case selection, observation and interview forms. For postpartum hemorrhage estimation, after the third section of labor was complete, the quantity of bleeding was estimated in the first and second hours after delivery, by the midwife in charge, using the National Guideline for vaginal delivery, provided by the Maternal Health Office. Also, after visual estimation by using the National Guideline, the sheets under parturient in first and second hours after delivery were exchanged and weighted. The data were analyzed using descriptive statistics and the t-test. Results: According to the results, a significant difference was found between the estimated blood loss based on the weighting methods and that using the National Guideline (weighting method 62.68 16.858 cc vs. National Guideline 45.31 13.484 cc in the first hour after delivery) (P = 0.000) and (weighting method 41.26 10.518 vs. National Guideline 30.24 8.439 in second hour after delivery) (P = 0.000). Conclusions: Natural child birth education by using the National Guideline can increase the accuracy of estimated blood loss. Therefore, training the personnel to use this guideline is recommended. However, It has less accuracy than 'sheet weighing. Consequently, usage of symptoms and the weighing method is recommended in cases of postpartum bleeding. PMID:26257803

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

    PubMed

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

    2015-05-01

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

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

    PubMed Central

    Graham, Tanya; Alderson, Phil; Stokes, Tim

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  17. [Dental caries in the elderly. 2. Root caries. Symptoms and treatment guidelines].

    PubMed

    Arneberg, P

    1989-10-01

    Guidelines for treatment of root surface caries in the elderly are presented. Caries susceptibility of these surfaces may be reduced by the absorbtion of fluoride and other minerals from the oral fluids. Early signs of root caries are a matte appearance and a softening of the root surface. Discoloration and cavity formation appear later. Insufficient filling margins on the root and the cemento-enamel junction are typical sites for root caries development. Early diagnosis through thorough clinical examination is important, since preventive treatment of primary root caries lesions has a better long term prognosis than restorative treatment. Glass-ionomers are a natural choice for the restoration of root caries lesions. Fluorides are efficient for root caries prevention in the elderly dental patient. An annual caries increment exceeding 2 lesions is considered indicative of a reinforced prophylactic program; when exceeding 5 lesions, the patient should be examined after a few months, to ascertain stop in caries progression. PMID:2639309

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

    PubMed Central

    2013-01-01

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

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

    PubMed

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

    2013-03-01

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

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

    PubMed

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

    2015-01-01

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

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

    SciTech Connect

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

    2010-10-15

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

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

    PubMed

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

    2016-02-01

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

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

    PubMed

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

    2014-12-01

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

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

    PubMed

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

    2013-12-01

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

  5. Eighth Joint National Committee (JNC-8) Guidelines and the Outpatient Management of Hypertension in the African-American Population

    PubMed Central

    Abel, Nicole; Contino, Krysta; Jain, Navjot; Grewal, Navjot; Grand, Elizabeth; Hagans, Iris; Hunter, Krystal; Roy, Satyajeet

    2015-01-01

    Background: Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8) guidelines, there have been major changes in blood pressure management in the various subgroups. Aim: Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens. Materials and Methods: African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI), age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB) only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed. Results: In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6%) were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage. Conclusion: Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents. PMID:26713289

  6. [Identification, diagnostics and guideline conform therapy of osteoporosis (DVO) in trauma patients : a treatment algorithm].

    PubMed

    Neuerburg, C; Schmidmaier, R; Schilling, S; Kammerlander, C; Bcker, W; Mutschler, W; Stumpf, U

    2015-11-01

    Osteoporosis-associated fractures are of increasing importance in trauma surgery. The implementation of systematic diagnostics and treatment of osteoporosis during hospitalization, however, remains insufficient; therefore, a specific algorithm for the diagnosis and treatment of osteoporosis in trauma surgery patients was developed based on the German Osteology Society (Dachverband Osteologie, DVO) guidelines for osteoporosis from 2014. In a first step, the individual patient age and risk profile for osteoporosis are identified considering specific fractures indicative of osteoporosis. For these patients a questionnaire is completed which detects specific risk factors. In addition, the physical activity, risk of falls, dietary habits and the individual medication are collated as these can have a decisive influence on the subsequent therapy decisions. Prior to a specific treatment, laboratory osteoporosis tests, bone densitometry by dual energy X-ray absorptiometry (DXA) and if needed X-rays of the spine are carried out. For proximal femoral fractures the treatment of osteoporosis could already be indicated. With pre-existing glucocorticoid therapy, a history of previous fractures or other risk factors according to the risk questionnaire, the threshold of treatment has to be adjusted according to the table of T-scores detected by DXA. The treatment algorithm for diagnostics and treatment of osteoporosis in hospitalized trauma surgery patients can systematically and efficiently improve the identification of patients at risk. Thus, further fractures associated with osteoporosis or failure of internal fixation could be reduced in future. A prospective validation of the algorithm has already be initiated. PMID:26486129

  7. Venous thromboembolism (VTE) risk assessment and prophylaxis in acute orthopaedic admissions: improving compliance with national guidelines

    PubMed Central

    Watts, Laura; Grant, David

    2014-01-01

    Each year over 25,000 people die from Venous Thromboembolism (VTE) contracted in hospital. This is more than the combined total of deaths from breast cancer, AIDS and traffic accidents. (1) Orthopaedic patients are at particular risk of VTE. In 2011, the project team carried out an audit into compliance with national VTE assessment guidelines on all acute trauma and orthopaedic admissions during a two week period at a District General Hospital. The study demonstrated that compliance was initially low, but showed a large improvement following the implementation of simple measures. The measures included: asking consultants to remind junior doctors, putting posters up in the trauma doctors office, asking nursing staff to check for a VTE assessment on admission to the ward, and putting reminders on the patient name board. The project team subsequently recommended an alteration to the hospital's computer system to incorporate a check of VTE assessment and prophylaxis. A second assessment using the same methodology sought to assess whether the previous improvements were sustained and the impact of this computer system alteration. Overall, compliance with national VTE guidance improved further.

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

    PubMed Central

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

    2006-01-01

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

  9. The Saudi Clinical Practice Guideline for the treatment of venous thromboembolism

    PubMed Central

    Al-Hameed, Fahad M.; Al-Dorzi, Hasan M.; Al-Momen, Abdulkarim M.; Algahtani, Farjah H.; Al-Zahrani, Hazzaa A.; Al-Saleh, Khalid A.; Al-Sheef, Mohammed A.; Owaidah, Tarek M.; Alhazzani, Waleed; Neumann, Ignacio; Wiercioch, Wojtek; Brozek, Jan; Schnemann, Holger; Akl, Elie A.

    2015-01-01

    Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is commonly encountered in daily clinical practice. After diagnosis, its management frequently carries significant challenges to the clinical practitioner. Treatment of VTE with the inappropriate modality and/or in the inappropriate setting may lead to serious complications and have life-threatening consequences. As a result of an initiative of the Ministry of Health of the Kingdom of Saudi Arabia, an expert panel led by the Saudi Association for Venous Thrombo-Embolism (a subsidiary of the Saudi Thoracic Society) and the Saudi Scientific Hematology Society with the methodological support of the McMaster University Guideline working group, this clinical practice guideline was produced to assist health care providers in VTE management. Two questions were identified and were related to the inpatient versus outpatient treatment of acute DVT, and the early versus standard discharge from hospital for patients with acute PE. The corresponding recommendations were made following the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. PMID:26219456

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

    PubMed Central

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

    2008-01-01

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

  11. Clinical practice guidelines for the treatment of invasive Aspergillus infections in adults in the Middle East region: Expert panel recommendations.

    PubMed

    Al-Abdely, Hail M; Alothman, Adel F; Salman, Jameela Al; Al-Musawi, Tariq; Almaslamani, Muna; Butt, Adeel A; Al Thaqafi, Abdulhakeem O; Raghubir, Nirvana; Morsi, Waleed El; Yared, Nadine A

    2014-02-01

    The incidence of invasive Aspergillus infections in the Middle East continues to rise with the increase in the number of immunocompromised patients, and carries significant morbidity and mortality. A panel of experts analysed the evidence from the most recent international guidelines and relevant published literature to reach consensus and develop clear clinical practice guidelines to aid diagnosis and treatment of invasive Aspergillus infections in the Middle East. Disease-specific recommendations were provided for the management of invasive aspergillosis. The expert panel acknowledged that these guidelines should be followed as closely as possible but used alongside clinical judgement. PMID:24029495

  12. The National Emphysema Treatment Trial (NETT)

    PubMed Central

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

    2011-01-01

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

  13. 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

    PubMed Central

    2012-01-01

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

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

    PubMed

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

    2015-02-01

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

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

    PubMed

    Giordana, P; Miserey, G

    2014-12-01

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

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

    PubMed

    Takahashi, Shunji

    2015-09-01

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

  17. [National guidelines for the management of patients with chronic lymphocytic leukemia. Sociedad Espanola de Hematolog?a y Hemoterapia and Grupo Espanol de Leucemia Linfoc?tica Cro nica].

    PubMed

    Garca Marco, Jos A; Giraldo Castellano, Pilar; Lpez Jimnez, Javier; Ros Herranz, Eduardo; Sastre Moral, Jos Luis; Terol Caster, M Jos; Bosch Albareda, Francesc

    2013-08-17

    Chronic lymphocytic leukemia is the most common chronic lymphoproliferative disorder in Spain. The clinical management of this entity varies widely. Currently, in Spain, there are no national consensus guidelines, such as those published in other countries, to guide the diagnosis and treatment of this malignancy and the use of prognostic scores. This article reviews the current scientific literature and addresses issues on the diagnosis of chronic lymphocytic leukemia, the spread of the disease, the presence of comorbidities, the classification of prognostic scores, the common treatment regimens stratified by risk factors, and the management of complications associated with both the disease and its treatment, as well as the various controversies related to this entity. This document was drafted with the collaboration of national experts and aims to establish practical guidelines with their corresponding levels of evidence and grades of recommendation to guide the diagnosis, treatment and follow-up of patients with chronic lymphocytic leukemia. PMID:23830547

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Dandapat, Sudeepta; Robinson, Jennifer G

    2016-03-01

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

  20. [National consensus of diagnosis and treatment of non-small cell lung cancer].

    PubMed

    Arrieta, Oscar; Guzmn-de Alba, Enrique; Alba-Lpez, Luis Felipe; Acosta-Espinoza, Alicia; Alatorre-Alexander, Jorge; Alexander-Meza, Jos Francisco; Allende-Prez, Silvia Rosa; Alvarado-Aguilar, Salvador; Araujo-Navarrete, Margarita E; Argote-Greene, Luis Marcelo; Aquino-Mendoza, Cinthia Alejandra; Astorga-Ramos, Alma Magdalena; Austudillo-de la Vega, Horacio; Avils-Salas, Alejandro; Barajas-Figueroa, Luis Javier; Barroso-Quiroga, Nimbe; Blake-Cerda, Mnica; Cabrera-Galeana, Paula Anel; Calderillo-Ruz, Germn; Campos-Parra, Alma Delia; Cano-Valdez, Ana Mara; Capdeville-Garca, Daniel; Castillo-Ortega, Graciano; Casillas-Surez, Catalina; Castillo-Gonzlez, Patricia; Corona-Cruz, Jos Francisco; Correa-Acevedo, Mara Elma; Cortez-Ramrez, Sfora Sonciry; de la Cruz-Vargas, Jhony Alberto; de la Garza-Salazar, Jaime G; de la Mata-Moya, Mara Dolores; Domnguez-Flores, Mara Eugenia; Domnguez-Malagn, Hugo Ricardo; Domnguez-Parra, Luis Manuel; Domnguez-Peregrina, Alfredo; Durn-Alcocer, Jaime; Enrquez-Aceves, Mara Isabel; Elizondo-Ros, Abelardo; Escobedo-Snchez, Moiss Dante; de Villafranca, Pablo Espinosa-Mireles; Flores-Cantisani, Alberto; Flores-Gutirrez, Juan Pablo; Franco-Marina, Francisco; Franco-Gonzlez, Edwin Efran; Franco-Topete, Ramn Antonio; Fuentes-de la Pea, Homero; Galicia-Amor, Susana; Gallardo-Rincn, Dolores; Gamboa-Domnguez, Armando; Garca-Andreu, Jorge; Garca-Cullar, Claudia Mara; Garca-Sancho-Figueroa, Mara Cecilia; Garca-Torrentera, Rogelio; Gerson-Cwilich, Raquel; Gmez-Gonzlez, Arturo; Green-Schneeweiss, Len; Guilln-Nez, Mara del Roco; Gutirrez-Velzquez, Hilda; Ibarra-Prez, Carlos; Jimnez-Fuentes, Edgardo; Jurez-Snchez, Paula; Jurez-Ramiro, Alejandro; Kelly-Garca, Javier; Kuri-Exsome, Roberto; Lzaro-Len, Jess Miguel; Len-Rodrguez, Eucario; Llanos-Osuna, Sara; Llanos-Osuna, Sara; Loyola-Garca, Ulises; Lpez-Gonzlez, Jos Sullivan; Lpez y de Antuano, Francisco Javier; Loustaunau-Andrade, Marco Antonio; Macedo-Prez, Eleazar Omar; Machado-Villarroel, Limberth; Magallanes-Maciel, Manuel; Martnez-Barrera, Luis; Martnez-Cedillo, Jorge; Martnez-Martnez, Gloria; Medina-Esparza, Alfredo; Meneses-Garca, Abelardo; Mohar-Betancourt, Alejandro; Morales Blanhir, Jaime; Morales-Gmez, Jos; Motola-Kuba, Daniel; Njera-Cruz, Marcela Patricia; Nez-Valencia, Carolina del Carmen; Ocampo-Ocampo, Mara Anglica; Ochoa-Vzquez, Mara Dolores; Olivares-Torres, Carlos A; Palomar-Lever, Andrs; Patio-Zarco, Mario; Prez-Padilla, Rogelio; Pea-Alonso, Yolanda Roco; Prez-Romo, Alfredo Rafael; Aquilino Prez, Mario; Pinaya-Ruz, Paulo Martn; Pointevin-Chacn, Mara Adela; Poot-Braga, Juan Jos; Posadas-Valay, Rodolfo; Ramirez-Mrquez, Marcelino; Reyes-Martnez, Ivonne; Robledo-Pascual, Julio; Rodrguez-Cid, Jernimo; Rojas-Marn, Carlos Enrique; Romero-Bielma, Elizabeth; Rubio-Gutirrez, Jaime Ernesto; Senz-Fras, Julia Angelina; Salazar-Lezama, Miguel Angel; Snchez-Lara, Karla; Sansores Martnez, Ral; Santilln-Doherty, Patricio; Alejandro-Silva, Juan; Tllez-Becerra, Jos Luis; Toledo-Buenrostro, Vinicio; Torre-Bouscoulet, Luis; Torecillas-Torres, Laura; Torres, Marine; Tovar-Guzmn, Vctor; Turcott-Chaparro, Jenny Georgina; Vzquez-Corts, Jess Javier; Vzquez-Manrquez, Mara Eugenia; Vilches-Cisneros, Natalia; Villegas-Elizondo, Jos Felipe; Zamboni, Mauro M; Zamora-Moreno, Jess; Zinser-Sierra, Juan W

    2013-03-01

    Mexican specialists in oncology, oncologic surgery, thoracic surgery, pneumology, pathology, molecular biology, anesthesiology, algology, psychology, nutrition, and rehabilitation (all of them experts in lung cancer treatment) in order to develop the National Consensus on Lung Cancer. The consensus has been developed as an answer to the need of updated Mexican guidelines for the optimal treatment of the disease, as well as to the requirements that such guidelines be established by multidisciplinary panel, depicting the current attention given to cancer lung cases in Mexico. Thus, this paper analyses the epidemiological review, screening, diagnosis, staging, pathology, translational medicine, and the suitable therapies for early, locally advanced, and metastatic disease in the first, second, and third lines of management, as well as rehabilitation and palliative measures. PMID:24459776

  1. Correlation between Intake of Dietary Fiber and Adherence to the Korean National Dietary Guidelines in Adolescents from Jeonju.

    PubMed

    Park, Sunmi; Na, Woori; Kim, Misung; Kim, Eunsoo; Sohn, Cheongmin

    2012-12-01

    This study surveyed dietary intake and adherence to the Korean national dietary guidelines in Korean adolescents. To elucidate basic data for use in nutrition education, which aims to improve adolescent compliance with the national dietary guidelines and to increase the intake of dietary fiber, we evaluated the sources of fiber in adolescent diets. This study included 182 male and 212 female students from 2 middle schools in the Jeonju province. From November 15~20, 2011, we surveyed the students for general characteristics, adherence to the Korean national dietary guidelines, and dietary intake. Dietary fiber intake was 16.57 6.95 g/day for male students and 16.14 7.11 g/day for female students. The food groups that contributed most to dietary fiber intake were (in descending order) cereals, vegetables, seasoning, and fruits. The fiber-containing food items consumed most were cabbage- kimchi, cooked rice, instant noodles, and cabbage. Based on adherence to the Korean national dietary guidelines, the vegetable-based intake of dietary fiber in groups 1 (score 15~45), 2 (score 46~52), and 3 (score 53~75) were 4.41 2.595 g/day, 4.12 2.692 g/day, and 5.49 3.157 g/day, respectively (p<0.001). In addition, the total intake of dietary fiber varied significantly among the three groups (p<0.001) as follows: Group 1, 14.99 6.374 g/day; Group 2, 15.32 6.772 g/day; and Group 3, 18.79 7.361 g/day. In this study, we discovered that adherence to the Korean national dietary guidelines correlates with improved intake of dietary fiber. Therefore, marketing and educational development is needed to promote adherence to the Korean national dietary guidelines. In addition, nutritional education is needed to improve dietary fiber consumption through the intake of vegetables and fruits other than kimchi. PMID:24471093

  2. Treatment of Anemia in Patients with Heart Disease: A Clinical Practice Guideline

    MedlinePLUS

    ... of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians ... of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians.” ...

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-10-01

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

  5. [Guidelines for the treatment on infections caused by methicillin-resistant Staphylococcus aureus].

    PubMed

    Mensa, J; Barbern, J; Llinares, P; Picazo, Jj; Bouza, E; Alvarez-Lerma, F; Borges, M; Serrano, R; Len, C; Guirao, X; Arias, J; Carreras, E; Sanz, Ma; Garca-Rodrguez, Ja

    2008-12-01

    Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have undergone important changes in the last five years that have influenced the choice of therapy: i) increase of their frequency in hospital-associated settings and, more recently, in community settings; ii) better knowledge of clinical implications of the pharmacokinetic and pharmacodynamic properties of vancomycin; iii) improvement of current standard methods for rapid detection of MRSA in clinical samples; iv) clear evidence that vancomycin is losing efficacy against MRSA with MIC > 1 microg/mL; and v) appearance of new antibiotics suitable for use in these infections (linezolid, daptomycin, tigecyclin). Under this situation guidelines for the treatment of common infections caused by MRSA appear to be necessary to improve the efficacy and reduce the mortality. PMID:19031124

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

    PubMed Central

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

    2013-01-01

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

  7. A comparison of Canadian and American guidelines for lipid management using data from the National Cholesterol Education Program Evaluation ProjecT Utilizing Novel E-technology (NEPTUNE) II survey

    PubMed Central

    Maki, Kevin C; Davidson, Michael H; Dicklin, Mary R

    2006-01-01

    BACKGROUND The United States National Cholesterol Education Program (NCEP) Adult Treatment Panel III and the Canadian Working Group on Hypercholesterolemia and Other Dyslipidemias (CWG) have each issued guidelines for the treatment of dyslipidemia. OBJECTIVE The present analysis compared the percentage of patients reaching target lipid levels according to NCEP and CWG guidelines among participants of the NCEP Evaluation ProjecT Utilizing Novel E-technology (NEPTUNE) II, a survey performed in the United States. METHODS American physicians who were high prescribers of lipid-modifying medications (n=376) each enrolled 10 to 20 consecutive patients from February to September 2003. Medical information, laboratory measurements and treatment plans associated with a single office visit were entered into a personal digital assistant and uploaded to a central database via the Internet. RESULTS Under both sets of guidelines, treatment success was strongly related to risk category (P<0.001). Treatment goal achievement in the low-risk (zero or one risk factor) and moderate-risk (two or more risk factors) categories was not substantially different between NCEP and CWG guidelines; however, in the high-risk category (coronary artery disease [CAD] and risk equivalents [RE]), CWG treatment goals were met less frequently than NCEP goals. NCEP combined low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol treatment goals were met by 39% of hypertriglyceridemic patients (27% in the CAD + CAD RE category). CWG combined low-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol ratio treatment goals were met by 38% of hypertriglyceridemic patients (19% in the CAD + CAD RE category). CONCLUSIONS These data indicate substantial underachievement of treatment goals by patients at high risk under both the CWG and NCEP guidelines. The lower frequency of treatment success in high-risk patients according to the CWG definition indicates that more aggressive treatment is needed to reach CWG goals. PMID:16568156

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

    PubMed Central

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

    2015-01-01

    Introduction: Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. Methods: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations. Recommendations: We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) We suggest that qualified dentists provide oversight rather than no follow-upof oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE) We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits as opposed to no follow-upwith a qualified dentist and a sleep physician. (GUIDELINE) Conclusions: The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations. Citation: Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 2015;11(7):773827. PMID:26094920

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

    PubMed

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

    2013-10-01

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

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

    PubMed

    Fernandes, Josicelia Dumt; Sadigursky, Dora; Silva, Rosana Maria de Oliveira; Amorim, Aclair Bastos; Teixeira, Giselle Alves da Silva; de Arajo, Maria da Conceio Filgueiras

    2009-12-01

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

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

    PubMed

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

    2016-03-01

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

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

    PubMed

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

    2014-10-01

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

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

    PubMed

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

    2014-06-01

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

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

    PubMed

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

    2015-09-01

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

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

    PubMed Central

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

    2015-01-01

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

  16. Diagnosis and treatment of Merkel Cell Carcinoma. European consensus-based interdisciplinary guideline.

    PubMed

    Lebbe, Celeste; Becker, Jrgen C; Grob, Jean-Jacques; Malvehy, Josep; Del Marmol, Veronique; Pehamberger, Hubert; Peris, Ketty; Saiag, Philippe; Middleton, Mark R; Bastholt, Lars; Testori, Alessandro; Stratigos, Alexander; Garbe, Claus

    2015-11-01

    Merkel cell carcinoma (MCC) is a rare tumour of the skin of neuro-endocrine origin probably developing from neuronal mechanoreceptors. A collaborative group of multidisciplinary experts form the European Dermatology Forum (EDF), The European Association of Dermato-Oncology (EADO) and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on MCC diagnosis and management, based on a critical review of the literature, existing guidelines and expert's experience. Clinical features of the cutaneous/subcutaneous nodules hardly contribute to the diagnosis of MCC. The diagnosis is made by histopathology, and an incisional or excisional biopsy is mandatory. Immunohistochemical staining contributes to clarification of the diagnosis. Initial work-up comprises ultrasound of the loco-regional lymph nodes and total body scanning examinations. The primary tumour should be excised with 1-2cm margins. In patients without clinical evidence of regional lymph node involvement, sentinel node biopsy is recommended, if possible, and will be taken into account in a new version of the AJCC classification. In patients with regional lymph node involvement radical lymphadenectomy is recommended. Adjuvant radiotherapy might be considered in patients with multiple affected lymph nodes of extracapsular extension. In unresectable metastatic MCC mono- or poly-chemotherapy achieve high remission rates. However, responses are usually short lived. Treatment within clinical trials is regarded as a standard of care in disseminated MCC. PMID:26257075

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Mingming, Ji

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Mingming, Ji

    2012-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  2. [Anti-osteoporosis drugs based on the guidelines for the Prevention and Treatment of Osteoporosis (2011 edition) ].

    PubMed

    Ono, Kumiko; Ohashi, Satoru; Tanaka, Sakae

    2014-03-01

    The aim of osteoporosis treatment is to reduce fracture risk. Many kinds of anti-osteoporosis drugs are available in these days, and most of them increase bone mineral density and reduce the risk of fractures. Japanese 2011 guidelines for prevention and treatment of osteoporosis documents the recommendation level of each osteoporosis drugs. It is important to select drugs appropriate for each osteoporosis patient considering the mechanisms of drug action and their clinical efficiency. PMID:24576937

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

    PubMed Central

    Fagan, Mark; Mhlen, Marthe; Lindbk, Morten; Berild, Dag

    2012-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2014-10-01

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

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

    PubMed

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

    2016-02-01

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

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

    PubMed

    Reynolds, T M

    2006-01-01

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2015-08-01

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

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

    SciTech Connect

    Rossi, Michele; Iezzi, Roberto

    2013-11-06

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

  11. Diagnosis and treatment of primary CNS lymphoma in immunocompetent patients: guidelines from the European Association for Neuro-Oncology.

    PubMed

    Hoang-Xuan, Kh; Bessell, Eric; Bromberg, Jacoline; Hottinger, Andreas F; Preusser, Matthias; Rud, Roberta; Schlegel, Uwe; Siegal, Tali; Soussain, Carole; Abacioglu, Ufuk; Cassoux, Nathalie; Deckert, Martina; Dirven, Clemens M F; Ferreri, Andrs J M; Graus, Francesc; Henriksson, Roger; Herrlinger, Ulrich; Taphoorn, Martin; Soffietti, Riccardo; Weller, Michael

    2015-07-01

    The management of primary CNS lymphoma is one of the most controversial topics in neuro-oncology because of the complexity of the disease and the very few controlled studies available. In 2013, the European Association of Neuro-Oncology created a multidisciplinary task force to establish evidence-based guidelines for immunocompetent adults with primary CNS lymphoma. In this Review, we present these guidelines, which provide consensus considerations and recommendations for diagnosis, assessment, staging, and treatment of primary CNS lymphoma. Specifically, we address aspects of care related to surgery, systemic and intrathecal chemotherapy, intensive chemotherapy with autologous stem-cell transplantation, radiotherapy, intraocular manifestations, and management of elderly patients. The guidelines should aid clinicians in their daily practice and decision making, and serve as a basis for future investigations in neuro-oncology. PMID:26149884

  12. Leading the Way to Environmental Literacy and Quality: National Guidelines for Environmental Education

    ERIC Educational Resources Information Center

    McCrea, Edward J.

    2006-01-01

    Ed McCrea, former executive director of North American Association for Environmental Education (NAEE), calls the development of the environmental education guidelines the single most important event that has occurred in the field of environmental education in the last decade. For the first time in its history, environmental education has a set of

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

    SciTech Connect

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

    1980-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    PubMed

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

    2015-12-01

    This study determined the impact of preexisting mental illnesses on guideline-consistent breast cancer treatment and breast cancer-related health care utilization. This was a retrospective, longitudinal, cohort study conducted using data from the 2006-2008 Medicaid Analytic Extract files. The target population for the study consisted of female Medicaid enrollees who were aged 18-64 years and were newly diagnosed with breast cancer in 2007. Guideline-consistent breast cancer treatment was defined according to established guidelines. Breast cancer-related health care use was reported in the form of inpatient, outpatient, and emergency room visits. Statistical analyses consisted of multivariable hierarchical regression models. A total of 2142 newly diagnosed cases of breast cancer were identified. Approximately 38% of these had a preexisting mental illness. Individuals with any preexisting mental illness were less likely to receive guideline-consistent breast cancer treatment compared to those without any preexisting mental illness (adjusted odds ratio: 0.793, 95% confidence interval [CI]: 0.646-0.973). A negative association was observed between preexisting mental illness and breast cancer-related outpatient (adjusted incident rate ratio (AIRR): 0.917, 95% CI: 0.892-0.942) and emergency room utilization (AIRR: 0.842, 95% CI: 0.709-0.999). The association between preexisting mental illnesses and breast cancer-related inpatient utilization was statistically insignificant (AIRR: 0.993, 95% CI: 0.851-1.159). The findings of this study indicate that breast cancer patients with preexisting mental illnesses experience disparities in terms of receipt of guideline-consistent breast cancer treatment and health care utilization. The results of this study highlight the need for more focused care for patients with preexisting mental illness. (Population Health Management 2015;18:449-458). PMID:26106925

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

    PubMed

    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

    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

  17. Patient Outcomes According to Adherence to Treatment Guidelines for Rhythm Control of Atrial Fibrillation

    PubMed Central

    Qin, Dingxin; Leef, George; Alam, Mian Bilal; Rattan, Rohit; Munir, Mohamad Bilal; Patel, Divyang; Khattak, Furqan; Vaghasia, Nishit; Adelstein, Evan; Jain, Sandeep K.; Saba, Samir

    2015-01-01

    Background Although guidelines for antiarrhythmic drug therapy in atrial fibrillation (AF) were published in 2006, it remains uncertain whether adherence to these guidelines affects patient outcomes. Methods and Results We retrospectively evaluated the records of 5976 consecutive AF patients who were prescribed at least 1 antiarrhythmic drug between 2006 and 2013. Patients with 1 or more prescribed antiarrhythmic drugs that did not comply with guideline recommendations comprised the nonguideline?directed group (=2920); the remainder constituted the guideline?directed group (=3056). Time to events was assessed using the survival analysis method and adjusted for covariates using Cox regression. Rates of adherence to the guidelines increased significantly with a higher degree of prescriber specialization in arrhythmias (49%, 55%, and 60% for primary care physicians, general cardiologists, and cardiac electrophysiologists, respectively, P=0.001) for the first prescribed antiarrhythmic drug. Compared to the nonguideline?directed group, the guideline?directed group had higher rates of heart failure, but lower baseline CHADS2?VASc scores (P<0.001) and lower rates of coronary artery disease, valvular disease, hypertension, hyperlipidemia, pulmonary disease, and renal insufficiency (P<0.05 for all). During 4526 months follow?up, the guideline?directed group had a lower risk of AF recurrence (hazard ratio=0.86, 95% CI=0.80 to 0.93), fewer hospital admissions for AF (hazard ratio=0.87, 95% CI=0.79 to 0.97), and fewer procedures for recurrent AF, including electrical cardioversion, pacemaker implantation, and atrioventricular nodal ablation (P<0.01 for all). The mortality and stroke risks were similar between the groups. Conclusions Adherence to published guidelines in the antiarrhythmic management of AF is associated with improved patient outcomes. PMID:25845930

  18. [Czech Atherosclerosis Society Guidelines for the diagnosis and treatment of dyslipidemias in adults].

    PubMed

    Vaverkov, H; Soska, V; Rosolov, H; Ceska, R; Cfkov, R; Freiberger, T; Pit'ha, J; Poledne, R; Stulc, T; Urbanov, Z; Vrblk, M

    2007-02-01

    The present guidelines are based on the recommendations published in 2005 entitled "Prevention of Cardiovascular Diseases in Adulthood" summarizing the conclusions of nine Czech medical societies and agree with them in the assessment of individual risks of mortality from cardiovascular disease (CVD) according to SCORE tables. They reflect new research data in pathophysiology of dyslipidemias (DLP) and particularly the results of recent clinical trials of lipid-lowering therapy and their meta-analyses. They establish priorities for the screening and management of DLP, present suitable diagnostic methods, additional investigations of potential use in risk assessment, including some emerging risk factors and detection of sub-clinical atherosclerosis in persons in a moderate-risk category. Major changes include a lower LDL-cholesterol treatment target (< 2.0 mmol/L for all CVD individuals) and a possible use of apolipoprotein B as a secondary target in selected persons (< 0.9 g/L in high risk without CVD, < 0.8 g/L for CVD patients) and nonHDL-cholesterol (< 3.3 mmol/L in high risk without CVD, < 2.8 mmol/L for CVD patients). Therapy of individual DLP phenotypes (monotherapy and combination therapy) as well as basic principles for control examination at lipid-lowering medication are described. Recommended therapeutic lifestyle changes are shown. Enclosed are five annexes: DLP diagnosis; causes of secondary DLP; additional investigations of potential use in risk stratification; familial hypercholesterolemia; list of recommended foods; two variants of SCORE tables for risk assessment for the Czech Republic; the scheme of recommended procedures and treatment algorithm in DLP asymptomatic individuals. PMID:17419181

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

    ERIC Educational Resources Information Center

    Orwin, Rob; Williams, Valerie

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

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

    PubMed Central

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

    2001-01-01

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

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

    PubMed Central

    Mailis, Angela; Taenzer, Paul

    2012-01-01

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

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

    PubMed Central

    Brysiewicz, Petra

    2015-01-01

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

  3. LANDFILLS EFFLUENT LIMITATIONS GUIDELINES DATABASE

    EPA Science Inventory

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

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

    PubMed Central

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

    1999-01-01

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

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

    PubMed

    Birkner, B

    2000-09-01

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

  6. SIOP-PODC adapted risk stratification and treatment guidelines: Recommendations for neuroblastoma in low- and middle-income settings.

    PubMed

    Parikh, Nehal S; Howard, Scott C; Chantada, Guillermo; Israels, Trijn; Khattab, Mohammed; Alcasabas, Patricia; Lam, Catherine G; Faulkner, Lawrence; Park, Julie R; London, Wendy B; Matthay, Katherine K

    2015-08-01

    Neuroblastoma is the most common extracranial solid tumor in childhood in high-income countries (HIC), where consistent treatment approaches based on clinical and tumor biological risk stratification have steadily improved outcomes. However, in low- and middle- income countries (LMIC), suboptimal diagnosis, risk stratification, and treatment may occur due to limited resources and unavailable infrastructure. The clinical practice guidelines outlined in this manuscript are based on current published evidence and expert opinions. Standard risk stratification and treatment explicitly adapted to graduated resource settings can improve outcomes for children with neuroblastoma by reducing preventable toxic death and relapse. PMID:25810263

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

    PubMed Central

    2013-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  10. Technology for Water Treatment (National Water Management)

    NASA Technical Reports Server (NTRS)

    1992-01-01

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

  11. Planning and Establishment of a National Teledocumentation Network--Guidelines Based on the Spanish Experience.

    ERIC Educational Resources Information Center

    Mahon, F. V., Ed.

    Finding that the promotion of a national information industry can best be pursued through the planning and establishment of a national teledocumentation network, this study (based on the experiences of Spain) offers a model that may be of interest to UNESCO (United Nations Educational, Scientific and Cultural Organization) member states wishing to

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2013-01-01

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

  15. [On "2015 Guidelines for Prevention and Treatment of Osteoporosis". Drug-induced osteoporosis: glucocorticoid-induced osteoporosis].

    PubMed

    Suzuki, Yasuo

    2015-09-01

    Osteoporosis is the most common and important adverse effect of glucocorticoid (GC) therapy. Since GC-induced bone loss is most rapid during the initial 3 - 6 months and primary prevention of bone loss is especially important, guidelines for management of GC-induced osteoporosis have been published overseas and in Japan. The Japanese Society for Bone and Mineral Research (JSBMR) has updated the Guidelines on the Management and Treatment of Glucocorticoid-induced Osteoporosis (GIO) and has incorporated a new scoring method. By analyzing five Japanese GIO cohorts from primary and secondary prevention studies, age, GC dose, lumbar BMD, and prior fragility fractures were identified as factors predicting future fracture and the fracture risk for an individual can be calculated as the sum of the scores for each risk factor. The guidelines were updated on the basis of a score of 3 as the optimal cut-off score for pharmacological intervention. Among the agents approved for the treatment of osteoporosis in Japan, the committee comprehensively reviewed validity for both primary and secondary prevention and assessed the benefit for both BMD and fracture prevention based on the results of clinical studies. Both alendronate and risedronate are recommended as first-line treatment. Ibandronate, teriparatide, and active vitamin D3 derivatives are recommended as alternative option. PMID:26320535

  16. Organizational interventions to encourage guideline implementation.

    PubMed

    Curry, S J

    2000-08-01

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

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

    SciTech Connect

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

    2009-04-15

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

  18. National treatment systems in global perspective.

    PubMed

    Klingemann, H

    1999-09-01

    Drug policy development is mostly viewed as emerging within the nation state. Processes of diffusion of innovative policies have been neglected to a large extent. The comparative study of public policy has demonstrated, however, that diffusion is an important predictor of early policy adaptation. Thus, the analysis asks the general question of the relative importance of endogenous and exogenous effects on the development of drug policies in various countries. Specifically it describes the Swiss debate leading to the popular initiative on 'Youth Without Drugs' as well as the international reactions regarding its liberal outcome. Results of an expert survey show two broad types of reactions. There is one set of countries where chances for the introduction of limited heroin-prescription trials during the next 5 years are considered probable and a second set of countries which seems to be strictly status quo oriented. In the concluding section a model is suggested which systematically considers endogenous as well as exogenous predictors of 'soft' or 'hard' drug policy adoption. Results of a first tentative test of the model are encouraging for future empirical research on diffusion processes of drug policies. PMID:10460974

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

    PubMed Central

    2015-01-01

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

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

    PubMed

    Jo, Heui-Sug; Kim, Dong Ik; Oh, Moo-Kyung

    2015-12-01

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

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

    PubMed

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

    2014-10-01

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

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

    PubMed

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

    2014-08-01

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

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

    PubMed

    Garrett, Mario D; Valle, Ramn

    2016-03-01

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

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

    ERIC Educational Resources Information Center

    Slenker, Suzanne E.; And Others

    1985-01-01

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

  5. Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments.

    PubMed

    Russell, Katie W; Scaife, Courtney L; Weber, David C; Windsor, Jeremy S; Wheeler, Albert R; Smith, William; Wedmore, Ian; McIntosh, Scott E; Lieberman, James R

    2014-03-01

    The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. PMID:24462332

  6. A Model Policy Statement and Guidelines for Implementation: Equal Treatment of Students.

    ERIC Educational Resources Information Center

    Education Commission of the States, Denver, CO.

    This booklet offers a model policy statement that schools shall provide equal educational opportunities to all students regardless of sex. It includes stipulations and guidelines to achieve equal access in all areas of education. The following areas are considered: (1) Course offerings: every course shall be open to all students and schools should

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

    ERIC Educational Resources Information Center

    Barker, Lauren N.; Ziino, Carlo

    2010-01-01

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

  8. The 2013 ACC/AHA Cholesterol Treatment Guidelines: Applicability to Patients with Diabetes.

    PubMed

    Ziaeian, Boback; Dinkler, John; Guo, Yuanlin; Watson, Karol

    2016-02-01

    Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide and the management of blood cholesterol is a cornerstone of medical therapy for the primary and secondary prevention of cardiovascular disease. Patients with diabetes represent an important high-risk group in whom clinicians should advocate the use of statins and lifestyle modification for the reduction of ASCVD. The recent 2013 ACC/AHA guidelines on managing blood cholesterol provide an important framework for the effective implementation of this important risk reduction strategy. The guidelines identify four groups of individuals who have been shown to benefit from statin therapy and update the dosing and monitoring recommendations based on evidence from published, large-scale randomized controlled trials (RCTs) with clinical hard endpoints. Primary care physicians and specialists play key roles in identifying populations at elevated ASCVD risk and providing effective care for patients, especially those with diabetes. This article will summarize the 2013 ACC/AHA guidelines on managing blood cholesterol and provide a practical management overview in order to facilitate implementation of these guidelines for patients with diabetes. PMID:26803649

  9. The Impact of the New WHO Antiretroviral Treatment Guidelines on HIV Epidemic Dynamics and Cost in South Africa

    PubMed Central

    Hontelez, Jan A. C.; de Vlas, Sake J.; Tanser, Frank; Bakker, Roel; Brnighausen, Till; Newell, Marie-Louise; Baltussen, Rob; Lurie, Mark N.

    2011-01-01

    Background Since November 2009, WHO recommends that adults infected with HIV should initiate antiretroviral therapy (ART) at CD4+ cell counts of ?350 cells/l rather than ?200 cells/l. South Africa decided to adopt this strategy for pregnant and TB co-infected patients only. We estimated the impact of fully adopting the new WHO guidelines on HIV epidemic dynamics and associated costs. Methods and Finding We used an established model of the transmission and control of HIV in specified sexual networks and healthcare settings. We quantified the model to represent Hlabisa subdistrict, KwaZulu-Natal, South Africa. We predicted the HIV epidemic dynamics, number on ART and program costs under the new guidelines relative to treating patients at ?200 cells/l for the next 30 years. During the first five years, the new WHO treatment guidelines require about 7% extra annual investments, whereas 28% more patients receive treatment. Furthermore, there will be a more profound impact on HIV incidence, leading to relatively less annual costs after seven years. The resulting cumulative net costs reach a break-even point after on average 16 years. Conclusions Our study strengthens the WHO recommendation of starting ART at ?350 cells/l for all HIV-infected patients. Apart from the benefits associated with many life-years saved, a modest frontloading appears to lead to net savings within a limited time-horizon. This finding is robust to alternative assumptions and foreseeable changes in ART prices and effectiveness. Therefore, South Africa should aim at rapidly expanding its healthcare infrastructure to fully embrace the new WHO guidelines. PMID:21799755

  10. Understanding barriers to implementing the Norwegian national guidelines for healthy school meals: a case study involving three secondary schools.

    PubMed

    Holthe, Asle; Larsen, Torill; Samdal, Oddrun

    2011-07-01

    The main goal of the present study was to investigate the barriers to implementing the Norwegian national guidelines for healthy school meals as perceived by principals, project leaders, teachers and students. This study employed a multiple-case design using an explorative approach. Data were collected at three secondary schools in Norway participating in the intervention project Physical activity and healthy school meals. Individual interviews were conducted with school principals and project leaders, and focus group interviews were conducted separately with teachers and students. Four categories of barriers were identified: (1) lack of adaptation of the guidelines to the target group; (2) lack of resources and funding; (3) conflicting values and goals; and (4) access to unhealthy food outside school. The research identified differences in perceived barriers between the staff responsible for implementation and the students as the target group of the measures. All staff groups perceived barriers relating to both resources, and conflicting values and goals. The teachers were more concerned about issues of relevance for adaptation to the target groups than were the principals and project leaders. The students were concerned mostly with issues directly affecting their experience with items offered in the canteen. PMID:21689274

  11. [Summary of the practice guideline for the diagnosis and treatment of ADHD in adolescents and adults with addictions].

    PubMed

    Matthys, Frieda; Joostens, Peter; van den Brink, Wim; Sabbe, Bernard

    2013-01-01

    Various guidelines are available for the diagnosis and treatment of ADHD in adults, but not for patients with ADHD and a comorbid substance use disorder (SUD). In 2010, the Addiction Medicine Working Party, a division of the VAD (Verenigingvoor Alcohol- en andere Drugproblemen/Association for Alcohol and other Drug Problems) developed a practice guideline on how, when and by whom ADHD can be diagnosed in patients with an addiction, and how these patients should be treated. Given the high prevalence of ADHD in treatment-seeking SUD patients and the availability of valid screening instruments, all SUD patients should be screened for ADHD as soon as their drug use has stabilized. Acquiring information from external sources as well as clinical observation and questionnaires are important tools for the establishment of the diagnosis of ADHD. Integrated treatment primarily includes psycho-education, coaching and cognitive behavioural therapy in addition to pharmacotherapy. Evidence-based treatments for addiction may also be effective in patients with concomitant ADHD, provided the methods are adapted to the limitations that are associated with this condition. PMID:23759179

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  14. 77 FR 26238 - Fisheries of the United States; National Standard 1 Guidelines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-03

    ... fishery conservation and management contained in Section 301 of the Magnuson Stevens Fishery Conservation... this ANPR, as well as any additional ideas and solutions that could improve provisions of the National... INFORMATION: Background Section 301(a) of the Magnuson-Stevens Fishery Conservation and Management Act...

  15. Research and Educational Leadership: Navigating the New National Research Council Guidelines

    ERIC Educational Resources Information Center

    English, Fenwick W., Ed.; Furman, Gail C., Ed.

    2006-01-01

    "Research and Educational Leadership" is the first book to directly address the implications of the National Research Council's (NRC's) "Scientific Research in Education" (2002) in the fields of educational leadership and school administration. This text points out the strengths and weaknesses of the NRC's recommendations and specifically

  16. 32 CFR 147.9 - Guideline G-Alcohol consumption.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 1 2014-07-01 2014-07-01 false Guideline G-Alcohol consumption. 147.9 Section... Adjudication 147.9 Guideline GAlcohol consumption. (a) The concern. Excessive alcohol consumption often... worker who is a staff member of a recognized alcohol treatment program; (5) Habitual or binge...

  17. 32 CFR 147.9 - Guideline G-Alcohol consumption.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 1 2012-07-01 2012-07-01 false Guideline G-Alcohol consumption. 147.9 Section... Adjudication 147.9 Guideline GAlcohol consumption. (a) The concern. Excessive alcohol consumption often... worker who is a staff member of a recognized alcohol treatment program; (5) Habitual or binge...

  18. 32 CFR 147.9 - Guideline G-Alcohol consumption.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 1 2013-07-01 2013-07-01 false Guideline G-Alcohol consumption. 147.9 Section... Adjudication 147.9 Guideline GAlcohol consumption. (a) The concern. Excessive alcohol consumption often... worker who is a staff member of a recognized alcohol treatment program; (5) Habitual or binge...

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

    SciTech Connect

    Kielusiak, C.

    1993-02-01

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

  20. National General Aviation Design Competition Guidelines 1999-2000 Academic Year

    NASA Technical Reports Server (NTRS)

    1999-01-01

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

  1. Problem Gambling Treatment within the British National Health Service

    ERIC Educational Resources Information Center

    Rigbye, Jane; Griffiths, Mark D.

    2011-01-01

    According to the latest British Gambling Prevalence Survey, there are approximately 300,000 adult problem gamblers in Great Britain. In January 2007, the "British Medical Association" published a report recommending that those experiencing gambling problems should receive treatment via the National Health Service (NHS). This study examines the…

  2. NATIONAL CONFERENCE ON MANAGEMENT AND TREATMENT OF CONTAMINATED SEDIMENTS: PROCEEDINGS

    EPA Science Inventory

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

  3. Problem Gambling Treatment within the British National Health Service

    ERIC Educational Resources Information Center

    Rigbye, Jane; Griffiths, Mark D.

    2011-01-01

    According to the latest British Gambling Prevalence Survey, there are approximately 300,000 adult problem gamblers in Great Britain. In January 2007, the "British Medical Association" published a report recommending that those experiencing gambling problems should receive treatment via the National Health Service (NHS). This study examines the

  4. A National Survey of Substance Abuse Treatment for Juvenile Offenders

    PubMed Central

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

    2008-01-01

    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. PMID:17383550

  5. Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia.

    PubMed

    Pimazoni-Netto, Augusto; Zanella, Maria Teresa

    2014-11-01

    Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. The same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. The main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases. PMID:24892463

  6. Guidelines of the Brazilian Dermatology Society for diagnosis, treatment and follow up of primary cutaneous melanoma - Part I.

    PubMed

    Castro, Luiz Guilherme Martins; Messina, Maria Cristina; Loureiro, Walter; Macarenco, Ricardo Silvestre; Duprat Neto, Joo Pedreira; Giacomo, Thais Helena Bello Di; Bittencourt, Flvia Vasques; Bakos, Renato Marchiori; Serpa, Srgio Schrader; Stolf, Hamilton Ometto; Gontijo, Gabriel

    2015-12-01

    The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In the first part, the following clinical questions were answered: 1) The use of dermoscopy for diagnosis of primary cutaneous melanoma brings benefits for patients when compared with clinical examination? 2) Does dermoscopy favor diagnosis of nail apparatus melanoma? 3) Is there a prognostic difference when incisional or excisional biopsies are used? 4) Does revision by a pathologist trained in melanoma contribute to diagnosis and treatment of primary cutaneous melanoma? What margins should be used to treat lentigo maligna melanoma and melanoma in situ? PMID:26734867

  7. Guidelines of the Brazilian Dermatology Society for diagnosis, treatment and follow up of primary cutaneous melanoma - Part I*

    PubMed Central

    Castro, Luiz Guilherme Martins; Messina, Maria Cristina; Loureiro, Walter; Macarenco, Ricardo Silvestre; Duprat Neto, Joo Pedreira; Giacomo, Thais Helena Bello Di; Bittencourt, Flvia Vasques; Bakos, Renato Marchiori; Serpa, Srgio Schrader; Stolf, Hamilton Ometto; Gontijo, Gabriel

    2015-01-01

    The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In the first part, the following clinical questions were answered: 1) The use of dermoscopy for diagnosis of primary cutaneous melanoma brings benefits for patients when compared with clinical examination? 2) Does dermoscopy favor diagnosis of nail apparatus melanoma? 3) Is there a prognostic difference when incisional or excisional biopsies are used? 4) Does revision by a pathologist trained in melanoma contribute to diagnosis and treatment of primary cutaneous melanoma? What margins should be used to treat lentigo maligna melanoma and melanoma in situ? PMID:26734867

  8. Sharing Collegiate Resources: The New Challenge: Guidelines to Facilitate Interinstitutional Resource Sharing Based on a National Invitational Conference at Wingspread (Racine, Wisconsin, March 23-25, 1981).

    ERIC Educational Resources Information Center

    Konkel, Richard H.; Patterson, Lewis D.

    Guidelines that are designed to facilitate interinstitutional resource sharing are presented for trustees, legislators, business and lay leaders and educators based on a 1981 national conference. Attention is directed to the range of potential benefits of resource sharing, the structures and processes for achieving resource sharing, and the action

  9. 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

    Nayak, Nina P.

    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

  10. Connecting Marketing and Implementation Research and Library Program Development: A Case Study of the Implementation of [U.S.] National Guidelines and Standards.

    ERIC Educational Resources Information Center

    Haycock, Ken; Cavill, Pat

    This case study examined: (1) what market research is required for planning for the implementation of "Information Power: Building Partnerships for Learning," the 1998 national guidelines for effective school library media programs; (2) what issues need to be addressed and what target audiences are required to effect change, as well as how these

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

    ERIC Educational Resources Information Center

    Menda Behrens, Eduardo

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

  12. [Adherence to the international guidelines on the treatment of diabetic leg syndrome--options available in the Czech Republic].

    PubMed

    Jirkovská, A

    2011-11-01

    Possibilities of fulfilling of the practical guidelines on the management of the diabetic foot in the Czech Republic are limited by lack of experts and specialized place of work in podiatry, inconsiderable are economic problems, too. Foot care is of highest quality when is directed by a multidisciplinary foot team. In the Czech Republic, there is an urgent need for podiatry training programme and foot clinic support. Investing in diabetic foot programme can be one of the most cost-effective forms of healthcare expenditure, provided the programme is goal-focused and properly implemented. Paper deal with key points of the podiatry programme--organization, health care education and effective prevention and risk patients follow-up, rational surgical treatment and foot infection management, extension of up-to-date methods of PAD treatment, and effective economic approach to foot care especially considering DRG system during hospitalization. PMID:22165694

  13. Guidelines for submitting data to the National Space Science Data Center

    NASA Technical Reports Server (NTRS)

    1984-01-01

    The mission of the National Space Science Data Center (NSSDC) is to disseminate space science data for further analysis beyond that provided by the principal investigators (PIs) or team leaders (TLs) and their coworkers. Consequently, the NSSDC is responsible for the acquisition, organization, storage, retrieval, announcement, and distribution of scientific data obtained mainly from satellites and spacecraft. Any scientist may acquired data from the NSSDC and use them in further studies, either alone or in conjunction with data from ground-based or spacecraft experiments. With the responsibility for archiving data is the concomitant responsibility for distributing the documentation necessary to make those data usable. Since the group most knowledgeable about a particular experiment and its data is the PI or TL and his coworkers, and since the NSSDC cannot possibly supply the qualified personnel needed to write this documentation comprehensively, it is the responsibility of the PI or TL to provide the essential documentation. The NSSDC will support this effort by defining what is needed, by reviewing what is provided, and by reproducing and distributing the resulting documentation with the data. For a high-use data set, the NSSDC may publish the documentation as a Data Users Note; for a low-use data set, the NSSDC may distribute a Xerox, microfilm, or microfiche copy of the documentation.

  14. Guidelines for Hanford Site implementation of the National Environmental Policy Act

    SciTech Connect

    King, S.E.

    1989-03-01

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

  15. Guidelines for the diagnosis and treatment of peri-implant diseases.

    PubMed

    Padial-Molina, Miguel; Suarez, Fernando; Rios, Hector F; Galindo-Moreno, Pablo; Wang, Hom-Lay

    2014-01-01

    Although some risk factors of peri-implant disease are well defined, the lack of efficient and predictable approaches to treat peri-implantitis has created difficulty in the management of those complications. The aim of this review was to evaluate the reliability of the diagnosis methods and to provide a set of guidelines to treat peri-implant diseases. A search of PubMed and a hand search of articles related to peri-implant diseases were conducted up to August 2013. A summary of the current methods for the diagnosis of peri-implantitis, its potential risk factors, and a flow chart to guide the clinical management of these conditions are presented. PMID:25411744

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

    PubMed

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

    2014-04-01

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

  17. Breaking new ground: challenging existing asthma guidelines

    PubMed Central

    2006-01-01

    Background While we have international guidelines and various national guidelines for asthma diagnosis and management, asthma remains poorly controlled in many children and adults. In this paper we review the limitations of current asthma guidelines and describe important issues and remaining questions regarding asthma guidelines for use, particularly in primary care. Discussion Clinical practice guidelines based on evidence from randomized controlled trials are considered the most rigorous and accurate. Current evidence-based guidelines are written predominantly from the perspective of the patient with a clear-cut asthma diagnosis, however, and tend not to consider the heterogeneity of asthma or to accommodate individual patient variations in response to treatment or their needs, differences in practice settings, or local differences in availability and cost of therapies. The results of randomized controlled trials, which are designed to establish efficacy of treatment under ideal conditions, may not apply to 'real-world' clinical practice, where patients are unselected, monitoring is less frequent, and effectiveness the benefit of treatment in routine clinical practice is the most relevant outcome. Moreover, most guidelines see asthma in isolation rather than considering other factors that may impact on asthma and response to asthma therapy, particularly age, allergic rhinitis, cigarette smoking, adherence, and genetic factors. When these links are recognized, guidelines rarely provide practical recommendations for treatment in these scenarios. Finally, there is some evidence that general practitioners are not convinced of the applicability of asthma guidelines to their practice settings, especially when those writing the guidelines principally work in specialist practice. Conclusion Developing country-specific guidelines or, ideally, local guidelines could provide more practical solutions for asthma care and could account for regional factors that influence patient choice and adherence to therapy. Pragmatic clinical trials and well-designed observational trials are needed in addition to randomized controlled trials to assess real-world effectiveness of therapies, and such evidence needs also to be considered by guideline writers. Finally, practical tools to facilitate the diagnosis and assessment of asthma and factors responsible for poor control, such as associated allergic rhinitis, limited adherence, and smoking behavior, are needed to supplement treatment information provided in clinical practice guidelines for asthma. PMID:17140424

  18. Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records

    PubMed Central

    Tell, David; Engstrm, Sven; Mlstad, Sigvard

    2015-01-01

    Objective To study how prescription patterns concerning respiratory tract infections differ between interns, residents, younger general practitioners (GPs), older GPs and locums. Design Retrospective study of structured data from electronic patient records. Setting Data were obtained from 53 health centres and 3 out-of-hours units in Jnkping County, Sweden, through their common electronic medical record database. Participants All physicians working in primary care during the 2-year study period (1 November 2010 to 31 October 2012). Outcome measures Physicians adherence to current guidelines for respiratory tract infections regarding the use of antibiotics. Results We found considerable differences in prescribing patterns between physician categories. The recommended antibiotic, phenoxymethylpenicillin, was more often prescribed by interns, residents and younger GPs, while older GPs and locums to a higher degree prescribed broad-spectrum antibiotics. The greatest differences were seen when the recommendation in guidelines was to refrain from antibiotics, as for acute bronchitis. Interns and residents most often followed guidelines, while compliance in descending order was: young GPs, older GPs and locums. We also noticed that male doctors were somewhat overall more restrictive with antibiotics than female doctors. Conclusions In general, primary care doctors followed national guidelines on choice of antibiotics when treating respiratory tract infections in children but to a lesser degree when treating adults. Refraining from antibiotics seems harder. Adherence to national guidelines could be improved, especially for acute bronchitis and pneumonia. This was especially true for older GPs and locums whose prescription patterns were distant from the prevailing guidelines. PMID:26179648

  19. Treatment in Kenyan rural health facilities: projected drug costs using the WHO-UNICEF integrated management of childhood illness (IMCI) guidelines.

    PubMed Central

    Boulanger, L. L.; Lee, L. A.; Odhacha, A.

    1999-01-01

    Guidelines for the integrated management of childhood illness (IMCI) in peripheral health facilities have been developed by WHO and UNICEF to improve the recognition and treatment of common causes of childhood death. To evaluate the impact of the guidelines on treatment costs, we compared the cost of drugs actually prescribed to a sample of 747 sick children aged 2-59 months in rural health facilities in western Kenya with the cost of drugs had the children been managed using the IMCI guidelines. The average cost of drugs actually prescribed per child was US$ 0.44 (1996 US$). Antibiotics were the most costly component, with phenoxymethylpenicillin syrup accounting for 59% of the cost of all the drugs prescribed. Of the 295 prescriptions for phenoxymethylpenicillin syrup, 223 (76%) were for treatment of colds or cough. The cost of drugs that would have been prescribed had the same children been managed with the IMCI guidelines ranged from US$ 0.16 per patient (based on a formulary of larger-dose tablets and a home remedy for cough) to US$ 0.39 per patient (based on a formulary of syrups or paediatric-dose tablets and a commercial cough preparation). Treatment of coughs and colds with antibiotics is not recommended in the Kenyan or in the IMCI guidelines. Compliance with existing treatment guidelines for the management of acute respiratory infections would have halved the cost of the drugs prescribed. The estimated cost of the drugs needed to treat children using the IMCI guidelines was less than the cost of the drugs actually prescribed, but varied considerably depending on the dosage forms and whether a commercial cough preparation was used. PMID:10593034

  20. Epidemiology and Treatment Guidelines of Negative Symptoms in Schizo-phrenia in Central and Eastern Europe: A Literature Review

    PubMed Central

    Szkultecka-Dębek, Monika; Walczak, Jacek; Augustyńska, Joanna; Miernik, Katarzyna; Stelmachowski, Jarosław; Pieniążek, Izabela; Obrzut, Grzegorz; Pogroszewska, Angelika; Paulić, Gabrijela; Damir, Marić; Antolić, Siniša; Tavčar, Rok; Indrikson, Andra; Aadamsoo, Kaire; Jankovic, Slobodan; Pulay, Attila J; Rimay, József; Varga, Márton; Sulkova, Ivana; Veržun, Petra

    2015-01-01

    Aim : To gather and review data describing the epidemiology of schizophrenia and clinical guidelines for schizophrenia therapy in seven Central and Eastern European countries, with a focus on negative symptoms. Methods : A literature search was conducted which included publications from 1995 to 2012 that were indexed in key databases. Results : Reports of mean annual incidence of schizophrenia varied greatly, from 0.04 to 0.58 per 1,000 population. Lifetime prevalence varied from 0.4% to 1.4%. One study reported that at least one negative symptom was present in 57.6% of patients with schizophrenia and in 50–90% of individuals experiencing their first episode of schizophrenia. Primary negative symptoms were observed in 10–30% of patients. Mortality in patients with schizophrenia was greater than in the general population, with a standardized mortality ratio of 2.58–4.30. Reasons for higher risk of mortality in the schizophrenia population included increased suicide risk, effect of schizophrenia on lifestyle and environment, and presence of comorbidities. Clinical guidelines overall supported the use of second-generation antipsychotics in managing negative symptoms of schizophrenia, although improved therapeutic approaches are needed. Conclusion : Schizophrenia is one of the most common mental illnesses and poses a considerable burden on patients and healthcare resources alike. Negative symptoms are present in many patients and there is an unmet need to improve treatment offerings for negative symptoms beyond the use of second-generation antipsychotics and overall patient outcomes. PMID:26535049

  1. Current recommendations for the diagnosis and treatment of concussion in sport: a comparison of three new guidelines.

    PubMed

    West, Therese A; Marion, Donald W

    2014-01-15

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

  2. Peroxisome biogenesis disorders in the Zellweger spectrum: An overview of current diagnosis, clinical manifestations, and treatment guidelines.

    PubMed

    Braverman, Nancy E; Raymond, Gerald V; Rizzo, William B; Moser, Ann B; Wilkinson, Mark E; Stone, Edwin M; Steinberg, Steven J; Wangler, Michael F; Rush, Eric T; Hacia, Joseph G; Bose, Mousumi

    2016-03-01

    Peroxisome biogenesis disorders in the Zellweger spectrum (PBD-ZSD) are a heterogeneous group of genetic disorders caused by mutations in PEX genes responsible for normal peroxisome assembly and functions. As a result of impaired peroxisomal activities, individuals with PBD-ZSD can manifest a complex spectrum of clinical phenotypes that typically result in shortened life spans. The extreme variability in disease manifestation ranging from onset of profound neurologic symptoms in newborns to progressive degenerative disease in adults presents practical challenges in disease diagnosis and medical management. Recent advances in biochemical methods for newborn screening and genetic testing have provided unprecedented opportunities for identifying patients at the earliest possible time and defining the molecular bases for their diseases. Here, we provide an overview of current clinical approaches for the diagnosis of PBD-ZSD and provide broad guidelines for the treatment of disease in its wide variety of forms. Although we anticipate future progress in the development of more effective targeted interventions, the current guidelines are meant to provide a starting point for the management of these complex conditions in the context of personalized health care. PMID:26750748

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

    PubMed Central

    Marion, Donald W.

    2014-01-01

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

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

    PubMed Central

    Espie, Jonathan; Eisler, Ivan

    2015-01-01

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

  5. Impact of a Standardized Treatment Guideline for Pediatric Iatrogenic Opioid Dependence: A Quality Improvement Initiative

    PubMed Central

    Reyburn-Orne, Teri; Youssef, Tarek H.; Haddad, Imad Y.; Gerkin, Richard D.

    2016-01-01

    OBJECTIVES: To determine whether utilization of a hospital-based clinical practice guideline for the care of pediatric iatrogenic opioid dependence (IOD) would promote a decrease in opioid exposure and improve management of opioid abstinence syndrome (AS). METHODS: This study is a retrospective chart review of critically ill patients from a tertiary care children's hospital. Inclusion criteria included mechanically ventilated patients up to 18 years of age who received continuous opioid infusions for at least 7 days and any length of methadone administration. Data on IOD patients from January 2005 to June 2010 was divided into 3 periods: baseline, phase 1, and phase 2. Primary outcome was decrease in opioid exposure, measured by methadone duration of use and any additional opioid bolus doses used in AS management. Documentation of additional opioid bolus doses was regarded as a surrogate measure of AS. Secondary outcomes included total cumulative fentanyl dose, continuous fentanyl infusion duration of use, and hospital and pediatric intensive care unit length of stay. RESULTS: There was a significant decrease in methadone duration of use in IOD patients from 15.3 ± 8.7 days at baseline to 9.5 ± 3.7 days during phase 1 (p = 0.002), to 8.1 ± 3.7 days on phase 2 (reduction not significant, p = 0.106) of this evaluation. Additional opioid bolus doses were significantly lower from baseline to phase 1 (5.5 ± 5.1 vs. 1.8 ± 2.3, p = 0.001) and from phase 1 to phase 2 (1.8 ± 2.3 vs. 0.2 ± 1.5, p = 0.003). For the remaining outcomes, differences were not observed among the evaluation periods, except for the total cumulative fentanyl dose, which was reduced from 2.8 ± 3.7 mg/kg at baseline to 1 ± 1 mg/kg only during phase 1 (p = 0.017). CONCLUSIONS: Introduction of a standardized, hospital-based clinical practice guideline for children with IOD reduced the length of exposure to opioids and improved opioid AS management.

  6. Polish consensus guidelines on the use of acyclovir in the treatment and prevention of VZV and HSV infections.

    PubMed

    Szenborn, Leszek; Kraszewska-Głomba, Barbara; Jackowska, Teresa; Duszczyk, Ewa; Majda-Stanisławska, Ewa; Marczyńska, Magdalena; Ołdak, Elżbieta; Pawłowska, Małgorzata; Służewski, Wojciech; Wysocki, Jacek; Stryczyńska-Kazubska, Joanna; Kuchar, Ernest

    2016-02-01

    A physician has to perform a benefit-risk assessment each time acyclovir is prescribed "off label" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological. PMID:26643900

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

    SciTech Connect

    Cheng, S.-J.; Lee, J.-J.; Ting, L.-L.; Tseng, I.-Y.; Chang, H.-H.; Chen, H.-M.; Kuo, Y.-S.; Hahn, L.-J.; Kok, S.-H. . E-mail: kok@ha.mc.ntu.edu.tw

    2006-01-01

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

  8. Guidelines for the evaluation and treatment of muscle dysfunction in patients with chronic obstructive pulmonary disease.

    PubMed

    Barreiro, Esther; Bustamante, Víctor; Cejudo, Pilar; Gáldiz, Juan B; Gea, Joaquim; de Lucas, Pilar; Martínez-Llorens, Juana; Ortega, Francisco; Puente-Maestu, Luis; Roca, Josep; Rodríguez-González Moro, José Miguel

    2015-08-01

    In patients with chronic obstructive pulmonary disease (COPD), skeletal muscle dysfunction is a major comorbidity that negatively impacts their exercise capacity and quality of life. In the current guidelines, the most recent literature on the various aspects of COPD muscle dysfunction has been included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) scale has been used to make evidence-based recommendations on the different features. Compared to a control population, one third of COPD patients exhibited a 25% decline in quadriceps muscle strength, even at early stages of their disease. Although both respiratory and limb muscles are altered, the latter are usually more severely affected. Numerous factors and biological mechanisms are involved in the etiology of COPD muscle dysfunction. Several tests are proposed in order to diagnose and evaluate the degree of muscle dysfunction of both respiratory and limb muscles (peripheral), as well as to identify the patients' exercise capacity (six-minute walking test and cycloergometry). Currently available therapeutic strategies including the different training modalities and pharmacological and nutritional support are also described. PMID:26072153

  9. [Nutritional management of severely injured patients : Treatment between guidelines and reality].

    PubMed

    Ney, L; Annecke, T

    2011-11-01

    Severe trauma triggers endocrine and inflammatory responses, leading to hyperglycaemia, insulin resistance and protein catabolism. Pharmacological and nutritional interventions cannot counteract these metabolic disturbances. However, adequate supply of energy and proteins may reduce excessive catabolism.Available guidelines recommend early use of enteral nutrition with energetic supply of about 25 kcal/kg and additional protein supply of 1.5 g/kg/day. These aims will be missed frequently by solely providing enteral nutrition in severely injured patients. Early supplemental parenteral nutrition should be used in these cases. Concomitantly, gastric paresis and paralytic ileus hampering enteral nutrition should be treated by propulsive and prokinetic drugs and by use of duodenal or jejunal site of application in selected cases.Euphoric hopes linked with intensified insulin therapy (IIT), targeting blood glucose levels <110 mg/dl in intensive care patients, had to be widely abandoned in recent years. The goal for blood glucose levels should be set at 180 mg/dl as the upper limit according to current knowledge, which promises to optimize the balance between efficacy and safety. PMID:22048451

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

    USGS Publications Warehouse

    Knapton, J.R.

    1985-01-01

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

  11. SEOM clinical guidelines for the treatment of follicular non-Hodgkin's lymphoma.

    PubMed

    Provencio Pulla, M; Alfaro Lizaso, J; de la Cruz Merino, L; Gum I Padr, J; Quero Blanco, C; Gmez Codina, J; Llanos Muoz, M; Martinez Banaclocha, N; Rodriguez Abreu, D; Rueda Domnguez, A

    2015-12-01

    Follicular non-Hodgkin's lymphoma (FL) is a nodal B lymphoid malignancy that originates from the germinal center of a lymph node. FL is the second most frequent lymphoma subtype. The course of the disease is usually characterised by a typically indolent clinical course, with a median survival rate of 8-10years, although most patients relapse after treatment. Diagnosis should always be based on a surgical specimen like an excisional node lymph biopsy. The first-line treatment of FL will depend of extension disease, tumour burden, patient symptoms, performance status and also patient decision. The addition of rituximab to conventional chemotherapy has improved ORR, PFS and OS. As first line in patients that need treatment, a combination of chemotherapy with rituximab induction followed by 2years of rituximab maintenance is the best option. High-dose chemotherapy with autologous stem-cell transplantation in first line has not shown improvement and is not recommended as first-line therapy. Before any treatment decision in relapsed patients, a repeat biopsy is mandatory to rule out a transformation into large cell aggressive lymphoma. Standard treatment is controversial, depends on the efficacy of prior treatment, duration of the time-to-relapse, patient's age and histological findings at relapse. PMID:26586117

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

    SciTech Connect

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

    1994-01-01

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

  13. The National Institute for Health and Clinical Excellence (NICE) to Hospital Elder Life Program (HELP): Operationalizing Nice Guidelines to Improve Clinical Practice

    PubMed Central

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

    2014-01-01

    The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom developed guidelines for the diagnosis, prevention, and management of delirium in July, 2010, which included 10 recommendations for delirium prevention. The Hospital Elder Life Program (HELP) is a targeted multicomponent strategy which has proven effective and cost-effective to prevent functional and cognitive decline in hospitalized older persons. HELP provided much of the basis for 7/10 (70%) of the NICE recommendations. Given interest by new HELP sites to meet NICE guidelines, we developed 3 new protocols which were not previously included in the HELP program, addressing hypoxia, infection, and pain. Additionally, the NICE dehydration guideline included constipation, which was not specifically addressed in the HELP protocols. This project describes the systematic development of 3 new protocols (hypoxia, infection, and pain) and the expansion of an existing HELP protocol (constipation/dehydration) to achieve alignment between the HELP protocols and NICE guidelines. Following the Institute of Medicine recommendations for developing trustworthy guidelines, we undertook a systematic review of current literature by an interdisciplinary group of experts, rated the quality of the evidence, developed intervention protocols based on the highest quality evidence, and submitted the protocols first to internal review, then external review by an interdisciplinary panel of experts. The protocols were revised based on the review process, and were incorporated into the HELP materials. Inclusion of these protocols enhances the scope of the HELP program, and allows fulfillment of NICE guideline recommendations for delirium prevention. The rigorous process we applied may provide a useful example for updating existing guidelines or protocols, which may be applicable to a broad range of clinical applications. PMID:24697606

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

    PubMed

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

    2014-06-01

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

  15. Diagnosis and treatment of dermatofibrosarcoma protuberans. European consensus-based interdisciplinary guideline.

    PubMed

    Saiag, Philippe; Grob, Jean-Jacques; Lebbe, Celeste; Malvehy, Josep; Del Marmol, Veronique; Pehamberger, Hubert; Peris, Ketty; Stratigos, Alexander; Middelton, Mark; Basholt, Lars; Testori, Alessandro; Garbe, Claus

    2015-11-01

    Dermatofibrosarcoma protuberans (DFSP) is a skin fibroblastic tumour that is locally aggressive, with a tendency for local recurrence, but rarely metastasizes. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on DFSP diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is suspected clinically and confirmed by pathology. Analysis by fluorescence in situ hybridisation (FISH) or multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) to detect specific chromosomal translocations and fusion gene transcripts is useful to confirm a difficult DFSP diagnosis. Treatment is mainly surgical, with the aim to achieve complete resection of the tumour. In order to reduce the recurrence rate, the treatment of choice of DFSP seems to be Mohs' micrographic surgery (MMS) and related variants. In hospitals where only standard histopathological procedures are available, standard excision with lateral safety margin of 3cm is advisable. Imatinib (Glivec) is approved in Europe for the treatment of inoperable primary tumours, locally inoperable recurrent disease, and metastatic DFSP. Imatinib has also been given to patients with extensive, difficult-to-operate tumours for preoperative reduction of tumour size, but the usefulness of this attitude should be confirmed by clinical trials. Therapeutic decisions for patients with fibrosarcomatous DFSP should be primarily made by an interdisciplinary oncology team ('tumour board'). PMID:26189684

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Lana-Peixoto, Marco Aurlio; Callegaro, Dagoberto; Moreira, Marcos Aurlio; Campos, Gilberto Belisrio; Marchiori, Paulo Eurpedes; Gabbai, Alberto Alain; Bacheschi, Luiz Alberto; Arruda, Walter Oleschko; Gama, Paulo Diniz; Melo, Alton Souza; Rocha, Fernando Coronetti Gomes; Lino, Angelina Maria Martins; Ferreira, Maria Lcia Brito; Ataide, Luiz

    2002-09-01

    There has been unprecedented advances in knowledge of multiple sclerosis (MS) in the last few years. A new set of criteria for its diagnosis and a bunch of recent clinical trials with disease-modifying agents (DMA) have been published. All of that has made it necessary to update and expand the previous consensus for MS treatment as formulated by the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) two years ago. The BCTRIMS Expanded Consensus emphasizes the need to (1) consider MS treatment on an individual basis; (2) educate patients about the potential benefits and risks of treatment; (3) monitor drugs side effects; (4) have a signed Informed Consent Form; (5) consider the relative cost of the drug. The various clinical possibilities and the indications of the DMA and other immunointerventions are considered according to classes of evidences and types of recommendations. The BCTRIMS Expanded Consensus on Treatment of MS may turn out to be a model to other developing countries. PMID:12364967

  18. Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis

    PubMed Central

    Walensky, Rochelle P.; Wood, Robin; Ciaranello, Andrea L.; Paltiel, A. David; Lorenzana, Sarah B.; Anglaret, Xavier; Stoler, Adam W.; Freedberg, Kenneth A.

    2010-01-01

    Background The new 2010 World Health Organization (WHO) HIV treatment guidelines recommend earlier antiretroviral therapy (ART) initiation (CD4<350 cells/µl instead of CD4<200 cells/µl), multiple sequential ART regimens, and replacement of first-line stavudine with tenofovir. This paper considers what to do first in resource-limited settings where immediate implementation of all of the WHO recommendations is not feasible. Methods and Findings We use a mathematical model and local input data to project clinical and economic outcomes in a South African HIV-infected cohort (mean age = 32.8 y, mean CD4 = 375/µl). For the reference strategy, we assume that all patients initiate stavudine-based ART with WHO stage III/IV disease and receive one line of ART (stavudine/WHO/one-line). We rank—in survival, cost-effectiveness, and equity terms—all 12 possible combinations of the following: (1) stavudine replacement with tenofovir, (2) ART initiation (by WHO stage, CD4<200 cells/µl, or CD4<350 cells/µl), and (3) one or two regimens, or lines, of available ART. Projected life expectancy for the reference strategy is 99.0 mo. Considering each of the guideline components separately, 5-y survival is maximized with ART initiation at CD4<350 cells/µl (stavudine/<350/µl/one-line, 87% survival) compared with stavudine/WHO/two-lines (66%) and tenofovir/WHO/one-line (66%). The greatest life expectancies are achieved via the following stepwise programmatic additions: stavudine/<350/µl/one-line (124.3 mo), stavudine/<350/µl/two-lines (177.6 mo), and tenofovir/<350/µl/two-lines (193.6 mo). Three program combinations are economically efficient: stavudine/<350/µl/one-line (cost-effectiveness ratio, US$610/years of life saved [YLS]), tenofovir/<350/µl/one-line (US$1,140/YLS), and tenofovir/<350/µl/two-lines (US$2,370/YLS). Conclusions In settings where immediate implementation of all of the new WHO treatment guidelines is not feasible, ART initiation at CD4<350 cells/µl provides the greatest short- and long-term survival advantage and is highly cost-effective. Please see later in the article for the Editors' Summary PMID:21209794

  19. Italian Society for the Study of Diabetes (SID)/Italian Endocrinological Society (SIE) guidelines on the treatment of hyperglycemia in Cushing's syndrome and acromegaly.

    PubMed

    Baroni, M G; Giorgino, F; Pezzino, V; Scaroni, C; Avogaro, A

    2016-02-01

    Hyperglycemia is a common feature associated with states of increased growth hormone secretion and glucocorticoid levels. The purpose of these guidelines is to assist clinicians and other health care providers to take evidence-based therapeutic decisions for the treatment of hyperglycemia in patients with growth hormone and corticosteroid excess. Both the SID and SIE appointed members to represent each society and to collaborate in Guidelines writing. Members were chosen for their specific knowledge in the field. Each member agreed to produce-and regularly update-conflicts of interest. The authors of these guidelines prepared their contributions following the recommendations for the development of Guidelines, using the standard classes of recommendation shown below. All members of the writing committee provided editing and systematic review of each part of the manuscript, and discussed the grading of evidence. Consensus was guided by a systematic review of all available trials and by interactive discussions. PMID:26718207

  20. Quality Improvement Guidelines for Endovascular Treatment of Iliac Artery Occlusive Disease

    SciTech Connect

    Tsetis, Dimitrios Uberoi, Raman

    2008-03-15

    Endovascular therapy is the treatment of choice for type A and the preferred treatment for type B lesions. In selective patients, this type of treatment can be applied in type C and even type D lesions. Ipsilateral femoral, contralateral femoral, and brachial approach and both the intraluminal and subintimal space can be used for successful recanalization. The application of stents has improved the immediate hemodynamic and probably long-term clinical results of iliac percutaneous transluminal angioplasty. However, the superiority of primary or direct stenting over selective stenting has not been proven yet. The choice of stent type depends on lesion morphology and location but otherwise there is insufficient evidence to support the use of a particular stent design. There is insufficient evidence to justify routine use of covered stents. All patients should receive antiaggregant therapy following endovascular recanalization of iliac arteries. There is no consensus regarding prophylaxis with antibiotics in iliac recanalization procedures.

  1. Treatment Programs in the National Drug Abuse Treatment Clinical Trials Network

    PubMed Central

    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

    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. PMID:17875368

  2. [Update on current care guidelines: prevention, early diagnosis and treatment of chronic periodontitis].

    PubMed

    2010-01-01

    Periodontitis is common in the adult Finnish population. Due to the lack of pain and other symptoms, affected patients seldom seek dental care but require attention through the health care system. A careful periodontal screening, including risk assessment, should form part of regular dental check-ups. Individual brushing and interdental cleaning instructions, as well as tobacco counselling, are important in both the prevention and treatment of periodontitis. When detecting early signs of periodontitis, periodontal treatment, including the necessary maintenance visits, is crucial in preventing the severe form of the disease and its harmful consequences for the patient's dentition and general health. PMID:21125755

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

    PubMed Central

    Macas-Islas, Miguel ngel; Gabbai, Alberto Alan; Correale, Jorge; Bolaa, Carlos; Sotelo, Eduardo Duriez; Bonitto, Juan Garca; Vergara-Edwards, Fernando; Vizcarra-Escobar, Darwin

    2011-01-01

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

  4. EBMPracticeNet: A Bilingual National Electronic Point-Of-Care Project for Retrieval of Evidence-Based Clinical Guideline Information and Decision Support

    PubMed Central

    2013-01-01

    Background In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, evidence-based medicine (EBM) partners, and vendors of electronic health records (EHR) is unique to this project. All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. Objective The objective of this paper was to describe the development strategy, the overall content, and the management of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. Methods Several candidate providers of comprehensive guideline solutions were evaluated and one database was selected. Translation of the guidelines to Dutch and French was done with translation software, post-editing by translators and medical proofreading. A strategy is determined to adapt the guideline content to the Belgian context. Acceptance of the computerized clinical decision support tool has been tested and a randomized controlled trial is planned to evaluate the effect on process and patient outcomes. Results Currently, EBMPracticeNet is in "work in progress" state. Reference is made to the results of a pilot study and to further planned research including a randomized controlled trial. Conclusions The collaboration of government, health care providers, EBM partners, and vendors of EHRs is unique. The potential value of the project is great. The link between all the EHRs from different vendors and a national database held on a single platform that is controlled by all EBM organizations in Belgium are the strengths of EBMPracticeNet. PMID:23842038

  5. Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome.

    PubMed

    Frhlich, Alan Christmann; Eckeli, Alan Luiz; Bacelar, Andrea; Poyares, Dalva; Pachito, Daniela Vianna; Stelzer, Fernando Gustavo; Coelho, Fernando Morgadinho Santos; Rizzo, Geraldo Nunes Vieira; Prado, Gilmar Fernandes do; Sander, Heidi Haueisen; Goulart, Leonardo Ierardi; Lucchesi, Ligia Mendona; Gitai, Lvia Leite Ges; Prado, Lucila Bizari Fernandes do; Atade-Junior, Luiz; Bezerra, Marcio Luciano de Souza; Lopes, Maria Ceclia; Trentin, Marine Meliksetyan; Rodrigues, Raimundo Nonato Delgado; Hasan, Rosa; Alves, Rosana S Cardoso; Schnwald, Suzana Veiga; Moraes, Walter Andr dos Santos

    2015-03-01

    The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine. PMID:25807136

  6. Don't Drink and Drive. Completion of Treatment Guidelines. Driver Education Evaluation Programs.

    ERIC Educational Resources Information Center

    Tremper, Mel

    This booklet sets forth a common framework within which providers of substance abuse services approved by the Maine Division of Driver Education Evaluation Programs (DEEP) can evaluate, treat, and certify the completion of treatment of persons convicted of operating under the influence. It presents criteria for classifying individuals according to

  7. 76 FR 35959 - Capital Adequacy Guidelines; Small Bank Holding Company Policy Statement: Treatment of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-21

    ... Board issued an interim final rule (CPP interim rule) (74 FR 26077) to allow bank holding companies that... Board published a final rule on the capital treatment of the Senior Perpetual Preferred Stock. See 74 FR.... See 74 FR 26077, 26079 (June 1, 2009). The Board received two comments on the CPP interim rule....

  8. 78 FR 28865 - Request for Comment on the Federal Guidelines for Opioid Treatment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-16

    ..., (``Final Rule'' 66 FR 4075-4102, January 17, 2001) include standards for opioid treatment. OTPs are... Representative, Division of Pharmacologic Therapies, 1 Choke Cherry Road, Room 7-1044, Rockville, MD 20857..., Division of Pharmacologic Therapies, 1 Choke Cherry Road, Room 7-1044, Rockville, MD 20850. By hand...

  9. Practical Guidelines for Monitoring Treatment of Attention-Deficit/Hyperactivity Disorder.

    ERIC Educational Resources Information Center

    Katisyannis, Antonis; Landrum, Timothy J.; Vinton, Lori

    1997-01-01

    First identifies salient features of attention deficit/hyperactivity disorder (ADHD) and then offers a model for diagnosis, treatment, and monitoring of students with ADHD. The model assumes cooperation of parent, teacher, and physician, and data-based decisions concerning use and ongoing monitoring of stimulant medication or other…

  10. Assessment and Treatment of Recurrent Abdominal Pain: Guidelines for the School Psychologist.

    ERIC Educational Resources Information Center

    McMahon, Colleen; And Others

    1990-01-01

    Notes that somatic complaints without clear organic origin are also primary indicators for both anxiety and depression in childhood and adolescence. Review of literature provides school psychologists with basic information regarding prevalence, assessment, and treatment of one of most common types of somatic complaints: recurrent abdominal pain.

  11. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis.

    PubMed Central

    1996-01-01

    Summarized in this article are recent experiences in the treatment of human cystic echinococcosis (CE) and alveolar echinococcosis (AE) of the liver caused by the metacestode stages of Echinococcus granulosus and E. multilocularis, respectively. For CE, surgery remains the first choice for treatment with the potential to remove totally the parasite and completely cure the patient. However, chemotherapy with benzimidazole compounds (albendazole or mebendazole) and the recently developed PAIR procedure (puncture-aspiration-injection-re-aspiration) with concomitant chemotherapy offer further options for treatment of CE cases. Chemotherapy is not yet satisfactory: cure can be expected in about 30% of patients and improvement in 30-50%, after 12 months' follow-up. AE is generally a severe disease, with over 90% mortality in untreated patients. Radical surgery is recommended in all operable cases but has to be followed by chemotherapy for at least 2 years. Inoperable cases and patients who have undergone nonradical resection or liver transplantation require continuous chemotherapy for many years. Long-term chemotherapy may significantly prolong survival, even for inoperable patients with severe AE. Liver transplantation may be indicated as a life-saving measure for patients with severe liver dysfunction, but is associated with a relatively high risk of proliferation of intraoperatively undetected parasite remnants. Details of indications, contraindications, treatment schedules and other aspects are discussed. PMID:8789923

  12. Characteristics and Programme-Defined Treatment Outcomes among Childhood Tuberculosis (TB) Patients under the National TB Programme in Delhi

    PubMed Central

    Satyanarayana, Srinath; Shivashankar, Roopa; Vashist, Ram Pal; Chauhan, Lakhbir Singh; Chadha, Sarabjit Singh; Dewan, Puneet Kumar; Wares, Fraser; Sahu, Suvanand; Singh, Varinder; Wilson, Nevin Charles; Harries, Anthony David

    2010-01-01

    Background Childhood tuberculosis (TB) patients under India's Revised National TB Control Programme (RNTCP) are managed using diagnostic algorithms and directly observed treatment with intermittent thrice-weekly short-course treatment regimens for 68 months. The assignment into pre-treatment weight bands leads to drug doses (milligram per kilogram) that are lower than current World Health Organization (WHO) guidelines for some patients. Objectives The main aim of our study was to describe the baseline characteristics and treatment outcomes reported under RNTCP for registered childhood (age <15 years) TB patients in Delhi. Additionally, we compared the reported programmatic treatment completion rates between children treated as per WHO recommended anti-TB drug doses with those children treated with anti-TB drug doses below that recommended in WHO guidelines. Methods For this cross-sectional retrospective study, we reviewed programme records of all 1089 TB patients aged <15 years registered for TB treatment from January to June, 2008 in 6 randomly selected districts of Delhi. WHO disease classification and treatment outcome definitions are used by RNTCP, and these were extracted as reported in programme records. Results and Conclusions Among 1074 patients with records available, 651 (61%) were females, 122 (11%) were <5 years of age, 1000 (93%) were new cases, and 680 (63%) had extra-pulmonary TB (EP-TB)most commonly peripheral lymph node disease [310 (46%)]. Among 394 pulmonary TB (PTB) cases, 165 (42%) were sputum smear-positive. The overall reported treatment completion rate was 95%. Similar reported treatment completion rates were found in all subgroups assessed, including those patients whose drug dosages were lower than that currently recommended by WHO. Further studies are needed to assess the reasons for the low proportion of under-5 years of age TB case notifications, address challenges in reaching all childhood TB patients by RNTCP, the accuracy of diagnosis, and the clinical validity of reported programme defined treatment completion. PMID:20967279

  13. A national survey of substance abuse treatment for juvenile offenders.

    PubMed

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

    2007-04-01

    Despite consensus about the value of substance abuse treatment for delinquent youth, information about its prevalence and availability is inadequate and inconsistent. This article presents findings about treatment and other correctional service provision from a national survey of directors of 141 juvenile institutional and community corrections (CC) facilities. Educational/General Educational Development programming and drug and alcohol education were the most prevalent types of correctional and substance abuse services. Other common services included physical health services and mental health assessment, provided to about 60% of youth across facilities, and mental health counseling, life and communication skills, and anger management, provided to about half of the youth. Substance abuse treatment, as with most other services, were more prevalent in large, state-funded residential facilities (where 66% provided treatment) than in local detention centers (20%) and CC facilities (56%). More detailed data showed that the number of youth attending treatment in all types of facilities on any given day was very low. PMID:17383550

  14. Current Fat Guidelines and Recommendations

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  15. National Guideline Clearinghouse

    MedlinePLUS

    ... Oncology Ophthalmology Optometry Orthopedic Surgery Otolaryngology Pathology Pediatrics Pharmacology Physical Medicine and Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry ...

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

    PubMed Central

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

    2015-01-01

    Purpose To investigate the postmenstrual (PMA) age at treatment of severe retinopathy of prematurity (i.e. Type 1 prethreshold or threshold) in infants in a tertiary referral center in China. Principal Findings 76.6% (359/469) of infants were treated for threshold disease. 67.5% (317/469) of infants had a birth weight (BW) of 1250g or above and almost 30% (126) had a gestational age (GA) of 32 weeks or above. There was little difference in the characteristics of infants treated for Type 1 prethreshold or threshold ROP. After controlling for GA, PMA age at treatment was highest in infants with BW ?2000g (mean PMA 40.34.4 weeks, p<0.001); after controlling for BW, higher GA was associated with higher PMA at treatment (mean PMA 41.5 weeks for gestational age >34 weeks, p<0.001). For every three weeks increase in GA there was a two-week increase in PMA at treatment (R2 = 0.20, p<0.001). The time at treatment of Type 1 prethreshold disease was similar to that for threshold disease i.e. chronological age 5.6?7.4 weeks, or PMA 34.1?40.2 weeks but the lower end of the 95% confidence interval for chronological age for Type 1 prethreshold disease among infants with BW ?2000g was 3.7 weeks (i.e. before the recommended interval of 4?6 weeks after birth). Significance The Chinese guidelines regarding timing of the first examination are appropriate for infants with BW <2000g, but more mature infants should be examined a little earlier, at 3 weeks after birth, in order to detect Type 1 prethreshold disease which has a better prognosis than threshold. PMID:25664992

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

    PubMed Central

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

    1999-01-01

    Representatives from eight European countries compared the legal, ethical and professional settings within which decision making for neonates takes place. When it comes to limiting treatment there is general agreement across all countries that overly aggressive treatment is to be discouraged. Nevertheless, strong emphasis has been placed on the need for compassionate care even where cure is not possible. Where a child will die irrespective of medical intervention, there is widespread acceptance of the practice of limiting aggressive treatment or alleviating suffering even if death may be hastened as a result. Where the infant could be saved but the future outlook is bleak there is more debate, but only two countries have tested the courts with such cases. When it comes to the active intentional ending of life, the legal position is standard across Europe; it is prohibited. However, recognising those intractable situations where death may be lingering and unpleasant, Dutch paediatricians have reported that they do sometimes assist babies to die with parental consent. Two cases have been tried through the courts and recent official recommendations have set out standards by which such actions may be assessed. PMID:10635495

  18. Guidelines for diagnosis and treatment of Hunter Syndrome for clinicians in Latin America

    PubMed Central

    Giugliani, Roberto; Villarreal, Martha Luz Solano; Valdez, C. Araceli Arellano; Hawilou, Antonieta Mahfoud; Guelbert, Norberto; Garzn, Luz Norela Correa; Martins, Ana Maria; Acosta, Angelina; Cabello, Juan Francisco; Lemes, Ada; Santos, Mara Lucia Schmitz Ferreira; Amartino, Hernn

    2014-01-01

    This review aims to provide clinicians in Latin America with the most current information on the clinical aspects, diagnosis, and management of Hunter syndrome, a serious and progressive disease for which specific treatment is available. Hunter syndrome is a genetic disorder where iduronate-2-sulfatase (I2S), an enzyme that degrades glycosaminoglycans, is absent or deficient. Clinical manifestations vary widely in severity and involve multiple organs and tissues. An attenuated and a severe phenotype are recognized depending on the degree of cognitive impairment. Early diagnosis is vital for disease management. Clinical signs common to children with Hunter syndrome include inguinal hernia, frequent ear and respiratory infections, facial dysmorphisms, macrocephaly, bone dysplasia, short stature, sleep apnea, and behavior problems. Diagnosis is based on screening urinary glycosaminoglycans and confirmation by measuring I2S activity and analyzing I2S gene mutations. Idursulfase (recombinant I2S) (Elaprase, Shire) enzyme replacement therapy (ERT), designed to address the underlying enzyme deficiency, is approved treatment and improves walking capacity and respiratory function, and reduces spleen and liver size and urinary glycosaminoglycan levels. Additional measures, responding to the multi-organ manifestations, such as abdominal/inguinal hernia repair, carpal tunnel surgery, and cardiac valve replacement, should also be considered. Investigational treatment options such as intrathecal ERT are active areas of research, and bone marrow transplantation is in clinical practice. Communication among care providers, social workers, patients and families is essential to inform and guide their decisions, establish realistic expectations, and assess patients responses. PMID:25071396

  19. The European Federation of Organisations for Medical Physics Policy Statement No. 6.1: Recommended Guidelines on National Registration Schemes for Medical Physicists.

    PubMed

    Christofides, Stelios; Isidoro, Jorge; Pesznyak, Csilla; Bumbure, Lada; Cremers, Florian; Schmidt, Werner F O

    2016-01-01

    This EFOMP Policy Statement is an update of Policy Statement No. 6 first published in 1994. The present version takes into account the European Union Parliament and Council Directive 2013/55/EU that amends Directive 2005/36/EU on the recognition of professional qualifications and the European Union Council Directive 2013/59/EURATOM laying down the basic safety standards for protection against the dangers arising from exposure to ionising radiation. The European Commission Radiation Protection Report No. 174, Guidelines on Medical Physics Expert and the EFOMP Policy Statement No. 12.1, Recommendations on Medical Physics Education and Training in Europe 2014, are also taken into consideration. The EFOMP National Member Organisations are encouraged to update their Medical Physics registration schemes where these exist or to develop registration schemes taking into account the present version of this EFOMP Policy Statement (Policy Statement No. 6.1"Recommended Guidelines on National Registration Schemes for Medical Physicists"). PMID:26851162

  20. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population

    PubMed Central

    Kahoul, Riad; Gueyffier, Franois; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, Franois-Henri; Boissel, Jean-Pierre

    2014-01-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMESin French: Objectif thrapeutique Modle Effet Seuil (in English: Therapeutic ObjectiveThresholdEffect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M yr?1). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  1. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population.

    PubMed

    Kahoul, Riad; Gueyffier, Franois; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, Franois-Henri; Boissel, Jean-Pierre

    2014-11-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES-in French: Objectif thrapeutique Modle Effet Seuil (in English: Therapeutic Objective-Threshold-Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M yr(-1)). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  2. Practice Guidelines for the Assessment of Clinically Significant Treatment Outcomes in the Children's Mental Health System.

    PubMed

    Chomycz, Suzanne; Schmidt, Fred

    2016-01-01

    The use of program evaluation to monitor client change and improve intervention effectiveness is gaining increasing importance in the mental health field. However, there is a lack of literature available in community-based clinics for those who desire to evaluate the effectiveness of services. Through this article the authors review the literature on the best methods to assess clinically significant treatment outcomes in community-based children's mental health services. The strengths and weaknesses of commonly recommended methods of evaluating change are discussed (i.e., reliable change index, percentage of improvement, normative comparisons, and effect size) using a dataset from a community-based parenting program (N=308). PMID:26086975

  3. Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions

    PubMed Central

    Liddle, Jacki; Hall, Wayne; Chenery, Helen

    2015-01-01

    Mobile phones and other remote monitoring devices, collectively referred to as "mHealth," promise to transform the treatment of a range of conditions, including movement disorders, such as Parkinson’s disease. In this viewpoint paper, we use Parkinson’s disease as an example, although most considerations discussed below are valid for a wide variety of conditions. The ability to easily collect vast arrays of personal data over long periods will give clinicians and researchers unique insights into disease treatment and progression. These capabilities also pose new ethical challenges that health care professionals will need to manage if this promise is to be realized with minimal risk of harm. These challenges include privacy protection when anonymity is not always possible, minimization of third-party uses of mHealth data, informing patients of complex risks when obtaining consent, managing data in ways that maximize benefit while minimizing the potential for disclosure to third parties, careful communication of clinically relevant information gleaned via mHealth technologies, and rigorous evaluation and regulation of mHealth products before widespread use. Given the complex array of symptoms and differences in comfort and literacy with technology, it is likely that these solutions will need to be individualized. It is therefore critical that developers of mHealth apps engage with patients throughout the development process to ensure that the technology meets their needs. These challenges will be best met through early and ongoing engagement with patients and other relevant stakeholders. PMID:26474545

  4. [Technical guidelines for the prevention, diagnosis and treatment of Zika virus infection].

    PubMed

    Barrera-Cruz, Antonio; Díaz-Ramos, Rita Delia; López-Morales, Ana Belem; Grajales-Muñiz, Concepción; Viniegra-Osorio, Arturo; Zaldívar-Cervera, Jaime Antonio; Arriaga-Dávila, José Jesús

    2016-01-01

    Infection Zika virus is an emerging disease in the Americas region, which is caused by Zika virus (ZIKV), an arbovirus of the flavivirus genus. The ZIKV is transmitted by the bite of Aedes mosquitoes, both in urban and jungle area. After the mosquito bite, the disease symptoms usually appear after an incubation period of three to twelve days. The infection may be asymptomatic or presented with fever and not purulent conjunctivitis, headache, myalgia, arthralgia, asthenia, maculopapular rash, edema in lower limbs and, less frequently, retro-orbital pain, anorexia, vomiting, diarrhea or pain abdominal. Symptoms last for 4-7 days and are self-limiting. Neurological and autoimmune complications are rare. Since 2014 it has been detected native circulation of Zika virus in the Americas. So far, there is no specific antiviral treatment or effective vaccine, so it´s giving priority symptomatic and supportive treatment for the acute phase and make an early diagnosis of atypical and severe forms. PMID:26960050

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

    PubMed Central

    2010-01-01

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

  6. Danish guidelines for lipid-lowering treatment in patients with chronic renal failure.

    PubMed

    Dieperink, Hans; Christensen, Jeppe Hagstrup; Feldt-Rasmussen, Bo; Schmidt, Erik Berg

    2014-04-01

    Measurement of lipid profile in adults with CKD 1-5: We recommend measuring the lipid profile (T cholesterol, LDL cholesterol, HDL cholesterol and triglycerides) in all adults with newly diagnosed CKD 1-5 (including patients in renal replacement therapy). Monitoring of lipid profile in adults with CKD 1-5: In many cases it is not necessary to regularly monitor the lipid profile. Patients ? 50 years with CKD 1-5 ND: We recommend that these patients be treated with a statin (CKD 1-2, evidence level B), and in CKD patients in stages 3-5 ND that a statin or the combination statin/ezetimibe be used (evidence level A). Patients aged 18-49 years with CKD 1-5 ND: We suggest treating these patients with a statin if they also have one or more of the following conditions (evidence level A): known CVD, DM, Prior ischaemic stroke, Estimated 10-year risk of coronary death or non-fatal AMI > 10 % or risk of fatal cardiovascular disease > 5% (SCORE). Patients with CKD stage 5D: We suggest that these patients not be given a statin or started on statin/ezetimibe treatment (evidence level A). Patients who start dialysis and are already being treated with a statin or statin/ezetimibe: We suggest that treatment be continued (evidence level C). Adult kidney transplanted patients: We suggest that these patients be treated with a statin (evidence level B). PMID:24814603

  7. Mobile Phones in Research and Treatment: Ethical Guidelines and Future Directions.

    PubMed

    Carter, Adrian; Liddle, Jacki; Hall, Wayne; Chenery, Helen

    2015-01-01

    Mobile phones and other remote monitoring devices, collectively referred to as "mHealth," promise to transform the treatment of a range of conditions, including movement disorders, such as Parkinson's disease. In this viewpoint paper, we use Parkinson's disease as an example, although most considerations discussed below are valid for a wide variety of conditions. The ability to easily collect vast arrays of personal data over long periods will give clinicians and researchers unique insights into disease treatment and progression. These capabilities also pose new ethical challenges that health care professionals will need to manage if this promise is to be realized with minimal risk of harm. These challenges include privacy protection when anonymity is not always possible, minimization of third-party uses of mHealth data, informing patients of complex risks when obtaining consent, managing data in ways that maximize benefit while minimizing the potential for disclosure to third parties, careful communication of clinically relevant information gleaned via mHealth technologies, and rigorous evaluation and regulation of mHealth products before widespread use. Given the complex array of symptoms and differences in comfort and literacy with technology, it is likely that these solutions will need to be individualized. It is therefore critical that developers of mHealth apps engage with patients throughout the development process to ensure that the technology meets their needs. These challenges will be best met through early and ongoing engagement with patients and other relevant stakeholders. PMID:26474545

  8. The emerging problem of biological treatment in migrant and travelling populations: it is time to extend guidelines for the screening of infectious diseases.

    PubMed

    Bartalesi, F; Bartoloni, A; Bisoffi, Z; Spinicci, M; Gimnez Snchez, F; Muoz, J; Richi, P; Minisola, G; Muoz-Fernandez, S; Matucci-Cerinic, M

    2014-05-01

    The use of biological agents in the treatment of rheumatic diseases has been widely associated with an increased risk of reactivation of several latent infections. National and international guidelines recommend screening for infectious diseases before starting these drugs. In Western countries screening is limited to latent tuberculosis infection, HIV and viral hepatitis. However, the increasing globalisation and the remarkable number of migrating and travelling people worldwide make this approach no longer adequate. The Italian and Spanish Societies of Rheumatology and Tropical Medicine wish to issue a warning about the need to improve awareness of doctors about the risk of reactivation of infectious tropical diseases in migrant or travelling patients who undergo biological therapy. Thus, the Italian and Spanish Societies are now planning to issue specific recommendations, based on a multidisciplinary contribution and a systematic review of the literature, for screening and follow-up of active and latent chronic infections in candidate patients for biological agents, taking into account the patient's area of origin and risk of infectious diseases. PMID:24335919

  9. SEOM clinical guidelines for the treatment of follicular non-Hodgkin's lymphoma.

    PubMed

    Rodrguez-Abreu, Delvys; Llanos Muoz, Marta; Provencio Pulla, Mariano; Rueda Domnguez, Antonio; Isla Casado, Dolores

    2010-11-01

    Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin's lymphoma (NHL) in the Western world. FL constitutes the most frequent indolent lymphoma, well characterized by its clinical presentation related to nodal involvement and its morphologic and biologic features. It is often managed as an incurable disease. However, several active therapeutic approaches from the "wait and watch" strategy to the allogeneic transplantation are available for management of patients with FL and clearly have changed the natural history of this disease, achieving a long-term disease-free survival. Therapeutic decision is mostly conditioned by patient's characteristics, stage, histological grade, tumor burden, and risk-predicting factors. This article try to summarizes the diagnosis and treatment of this heterogeneous group of patients. PMID:20974569

  10. When Depression Complicates Childbearing: Guidelines for Screening and Treatment during Antenatal and Postpartum Obstetric Care

    PubMed Central

    Muzik, Maria; Marcus, Sheila M.; Heringhausen, Julie E.; Flynn, Heather

    2015-01-01

    Synopsis Prevalence studies show that one in five women experience an episode of major depressive disorder during their lifetime. The peripartum period constitutes a prime time for symptom exacerbation and relapse of depressive episodes. It is important for health care providers, specifically those in obstetric care, to be aware of (1) the frequency of depression in pregnant and postpartum women; (2) signs, symptoms, and appropriate screening methods; and (3) the health risks for the mother and growing fetus if depression is undetected or untreated. Because management of depressed peripartum women also includes care of a growing fetus or breastfeeding infant, treatment may be complex and requires input from a multidisciplinary team, including an obstetrician, psychiatrist, and pediatrician, to provide optimal care. PMID:19944300

  11. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension associated with hemolytic anemia.

    PubMed

    Saleemi, Sarfraz

    2014-07-01

    Hereditary hemoglobin disorders affecting the globin chain synthesis namely thalassemia syndromes and sickle cell disease (SCD) are the most common genetic disorders in human. Around 7% of the world population carries genes for these disorders, mainly the Mediterranean Basin, Middle and Far East, and Sub-Saharan Africa. An estimated 30 million people worldwide are living with sickle cell disease, while 60-80 million carry beta thalassemia trait. About 400,000 children are born with severe hemoglobinopathies each year. Cardiovascular complications of hemoglobinopathies include left and right ventricular (RV) dysfunction, arrhythmias, pericarditis, myocarditis, valvular heart disease, myocardial ischemia, and notably pulmonary hypertension (PH). Because of a unique pathophysiology, pulmonary hypertension associated with hemolytic disorders was moved from WHO group I to group V PH diseases. Treatment strategies are also unique and include blood transfusion, iron chelation, hydroxyurea, and oxygen therapy. The role of PH-specific agents has not been established. PMID:25077000

  12. Nutrition Content in a National Nutrition Education Program for Low-Income Adults: Content Analysis and Comparison With the 2010 Dietary Guidelines for Americans.

    PubMed

    Murray, Erin K; Auld, Garry; Inglis-Widrick, Ruth; Baker, Susan

    2015-01-01

    The purpose of this study was to identify nutrition-related content employed nationally by the Expanded Food and Nutrition Education Program (EFNEP) with adult participants. A content analysis was used to assess the type, frequency, and depth of nutrition content in adult curricula most used by EFNEP nationally compared with the 2010 Dietary Guidelines for Americans (2010 DGA). All EFNEP curricula reviewed employed the vast majority of the 2010 DGA nutrition recommendations, with differences in the frequency and depth of nutrition content. Further research is needed to determine which 2010 DGA recommendations are most important to teach and evaluate within a low-income population. PMID:26566098

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

    SciTech Connect

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

    1994-12-01

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

  14. Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda

    PubMed Central

    Mutimura, Eugene; Addison, Diane; Anastos, Kathryn; Hoover, Donald; Dusingize, Jean Claude; Karenzie, Ben; Izimukwiye, Isabelle; Mutesa, Leo; Nsanzimana, Sabin; Nashi, Denis

    2015-01-01

    Background Initiation of antiretroviral therapy (ART) in the advanced stages of HIV infection remains a major challenge in sub-Saharan Africa. This study was conducted to better understand barriers and enablers to timely ART initiation in Rwanda where ART coverage is high and national ART eligibility guidelines first expanded in 20072008. Methods Using data on 6326 patients (?15 years) at five Rwandan clinics, we assessed trends and correlates of CD4+ cell count at ART initiation and the proportion initiating ART with advanced HIV disease (CD4+ <200 cells/l or WHO stage IV). Results Out of 6326 patients, 4486 enrolling in HIV care initiated ART with median CD4+ cell count of 211 cells/l [interquartile range: 131300]. Median CD4+ cell counts at ART initiation increased from 183 cells/l in 2007 to 293 cells/l in 20112012, and the proportion with advanced HIV disease decreased from 66.2 to 29.4%. Factors associated with a higher odds of advanced HIV disease at ART initiation were male sex [adjusted odds ratios (AOR) = 1.7; 95% confidence interval (CI): 1.32.1] and older age (AOR4655+ vs. <25 = 2.3; 95% CI: 1.24.3). Among those initiating ART more than 1 year after enrollment in care, those who had a gap in care of 12 or more months prior to ART initiation had higher odds of advanced HIV disease (AOR = 5.2; 95% CI: 1.221.1). Conclusion Marked improvements in the median CD4+ cell count at ART initiation and proportion initiating ART with advanced HIV disease were observed following the expansion of ART eligibility criteria in Rwanda. However, sex disparities in late treatment initiation persisted through 20112012, and appeared to be driven by later diagnosis and/or delayed linkage to care among men. PMID:25562492

  15. Guidelines for Prevention and Treatment of Cognitive Impairment in the Elderly

    PubMed Central

    Brodziak, Andrzej; Wolińska, Agnieszka; Kołat, Estera; Różyk-Myrta, Alicja

    2015-01-01

    The aim of this study is to present the available and verified methods of prevention of cognitive decline in healthy older adults and to review clinical trials of therapies to improve impaired cognitive performance. We discuss data about the actual possibility of pharmacological treatment, usefulness of physical exercises, and effectiveness of different cognitive training methods. In a separate chapter we discuss why older people cope much better in life challenges then it would appear from the measurements made by use of neuro-psychological tests. We also discuss the so-called issue of transfers, ie, the question of how certain cognitive characteristics, improved through cognitive training, are transferred to other mental skills. We distinguish between simple and sophisticated (usually computerized) forms of cognitive training and pay particular attention to methods that are simple and easy to use. In particular, we discuss the so-called “learning therapy”, which amounts to “reading aloud and simple arithmetic calculations”, the method based on “switching between words and imagination”, and also the method consisting of personal counseling, support, and assistance in learning, especially in the form of home visits. In the final chapter we formulate practical advice, not only for individuals who want to undertake the preventing or correction activities alone with eventual help of medical professionals, but also for the members of health institutions that wish to implement preventive and therapeutic actions directed to a chosen population. We also discuss the indications and rationale for further research and clinical trials. PMID:25708246

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

    PubMed

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

    2013-08-01

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

  17. Calcium hydroxylapatite associated soft tissue necrosis: a case report and treatment guideline.

    PubMed

    Tracy, Lauren; Ridgway, James; Nelson, J Stuart; Lowe, Nelson; Wong, Brian

    2014-04-01

    We present an uncommon case of nasal alar and facial necrosis following calcium hydroxylapatite filler injection performed elsewhere without direct physician supervision. The patient developed severe full-thickness necrosis of cheek and nasal alar skin 24 h after injections into the melolabial folds. Management prior to referral included oral antibiotics, prednisone taper, and referral to a dermatologist (day 3) who prescribed valacyclovir for a presumptive herpes zoster reactivation induced by the injection. Referral to our institution was made on day 11, and after herpetic outbreak was ruled out by a negative Tzanck smear, debridement with aggressive local wound care was initiated. After re-epithelialization and the fashioning of a custom intranasal stent to prevent vestibular stenosis, pulsed dye laser therapy was performed for wound modification. The patient healed with an acceptable cosmetic outcome. This report underscores the importance of facial vasculature anatomy, injection techniques, and identification of adverse events when using fillers. A current treatment paradigm for such events is also presented. PMID:23993752

  18. PREVENTION GUIDELINES SYSTEM/DATABASE

    EPA Science Inventory

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

  19. Overuse and Underuse of Antiosteoporotic Treatments According to Highly Influential Osteoporosis Guidelines: A Population-Based Cross-Sectional Study in Spain

    PubMed Central

    Sanflix-Gimeno, Gabriel; Hurtado, Isabel; Sanflix-Genovs, Jos; Baixauli-Prez, Cristbal; Rodrguez-Bernal, Clara L.; Peir, Salvador

    2015-01-01

    Inappropriate prescribing of antiosteoporotic medications has been observed; however, the joint study of both overuse and underuse has barely been attempted. Spain, with its high utilization rates, constitutes a good example to assess differences in over and under use according to diverse highly-influential osteoporosis guidelines (HIOG) worldwide. We used data of a population-based cross-sectional study including 824 post-menopausal women ?50 years old living in the city of Valencia, Spain and aimed to estimate the percentage of women eligible for treatment, and the proportion of overuse and underuse of antiosteoporotic treatment according to HIOG. The prevalence of antiosteoporotic treatment in postmenopausal women ? 50 in Valencia was 20.9% (95%CI:17.624.4). The type of antiosteoporotic drugs prescribed varied greatly depending on the medical specialty responsible of the initial prescription. When applying the HIOG, the percentage of women 50 and over who should be treated varied from less than 9% to over 44%. In real terms, from the approximately eight million women of 50 years old and over in Spain, the number eligible for treatment would range from 0.7 to 3.8 million, depending on the guideline used. A huge proportion of inappropriate treatments was found when applying these guidelines to the Spanish population, combining a high overuse (4278% depending on the guideline used) and underuse (741%). In conclusion, we found that the pharmacological management of osteoporosis in women of 50 and over in this population combines an important overuse and, to a lesser extent, underuse, although the level of inappropriateness varied strikingly depending on the CPG used. It seems urgent to reduce treatment overuse without neglecting underuse, as is urgent an attempt to reach wider agreement worldwide regarding osteoporosis management, in order to facilitate appropriate treatment and development of policies to reduce effectively treatment inappropriateness. PMID:26317872

  20. ABM Clinical Protocol #1: Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014

    PubMed Central

    Wight, Nancy

    2014-01-01

    A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. PMID:24823918

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

    ERIC Educational Resources Information Center

    Songhua, Tan; Wang, Catherine Yan

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Songhua, Tan; Wang, Catherine Yan

    2012-01-01

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

  3. Early presentation of hemispheric intracerebral hemorrhage: prediction of outcome and guidelines for treatment allocation.

    PubMed

    Lisk, D R; Pasteur, W; Rhoades, H; Putnam, R D; Grotta, J C

    1994-01-01

    Criteria for selecting patients for possible surgery in the management of intracerebral hemorrhage (ICH) are needed to plan a prospective therapeutic evaluation of surgical intervention. This study specifically addressed patients seen in the emergency room within a few hours of the ictus, many of whom were still awake, to identify and subsequently exclude from surgical procedure those expected to recover completely and those expected to die regardless of treatment. We retrospectively studied 75 patients evaluated at a mean time of 3 hours and 37 minutes after hemispheric ICH to determine factors that would predict both good and poor outcomes at the time of discharge. Eighty percent of our patients presented within 6 hours of symptom onset. These patients were younger and had more severe lesions than did those presenting later, yet most were still awake (mean admission Glasgow Coma Scale [GCS] score = 11.0). Using multivariate regression, we created two models. The first model predicts independent outcome, ie, Rankin 0 to 2, of all patients with a GCS score greater than 9 on admission who do not undergo surgery. The significant factors in this model were hemorrhage diameter, intraventricular extension, and age. The second model predicts poor outcome, ie, Rankin 5 and death, of all patients. GCS score, hemorrhage volume, age, and gender were the important factors in this model. We conclude that ICH patients presenting early to the emergency room have more severe lesions radiologically, although their initial clinical status may not be different from those seen late. Our models should identify and thus exclude those with very good and very poor prognoses from future randomized surgical trials. PMID:8290048

  4. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline.

    PubMed

    Mathus-Vliegen, Elisabeth M H

    2012-01-01

    The prevalence of obesity is rising progressively, even among older age groups. By the year 2030-2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity - a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone - is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded. PMID:22797374

  5. How well are national guidelines relating to the general sales of aspirin and paracetamol, adhered to by retail stores: a mystery shopper study

    PubMed Central

    Molloy, Phillip; Chambers, Ruth; Cork, Tania

    2016-01-01

    Objective To determine whether non-pharmaceutical retail outlets are aboding to the current Medicines and Healthcare products Regulatory Agency (MHRA) national guidelines for over-the-counter (OTC) sales of aspirin and paracetamol. Methods Stages 1 and 2 of the study deployed eight and four medical students, respectively, to undertake a mystery shopper style investigation. Stage 1: eight medical students attempted to buy ≥96 tablets/capsules aspirin or paracetamol in one transaction in 62 shops. Stage 2: four medical students attempted to purchase 32 paracetamol 500 mg along with a ‘flu remedy preparation also containing paracetamol, in 54 shops. Results Stage 1 data revealed that 58% and 57% retailers sold more than the MHRA guidelines recommended for paracetamol and aspirin, respectively. We observed that 23% and 28% retailers were willing to sell ≥96 tablets of paracetamol or aspirin with no questions asked. Stage 2 results showed that 57% retailers sold 32×500 mg paracetamol in conjunction with a paracetamol-containing ‘flu preparation; while 98% shops sold 16×paracetamol 500 mg along with a paracetamol-containing ‘flu remedy, with no questions asked of the shopper or advice given. Discussion MHRA national guidelines for OTC medicines sales appear to be poorly adhered to in non-pharmacy shops. Sales of aspirin and paracetamol OTC must be better regulated in the UK to ultimately reduce morbidity and mortality rates of deliberate and accidental overdoses. PMID:26781508

  6. [Opinion of the Czech Atherosclerosis Society's committee (CSAT) on the ESC/EAS guidelines related to the diagnostics and treatment of dyslipidemias issued in 2011].

    PubMed

    Soka, V; Vaverkov, H; Vrblk, M; Blha, V; Cfkov, R; Freiberger, T; Kraml, P; Pi?ha, J; Rosolov, H; Stulc, T; Urbanov, Z

    2013-02-01

    This position statement of the Executive Committee of the Czech Society for Atherosclerosis (CSAT) summarizes the most important aspects and novelties of the latest European guidelines for the management of dyslipidemia. In particular the position statement comments on: cardiovascular risk stratification, indications for plasma lipid and lipoprotein levels assessment as well as target lipid values, evaluation of current options for both lifestyle and pharmacological treatment of lipid metabolism disorders and, also, recommendation for laboratory monitoring of patients treated with lipid lowering agents. The statement deals with actual concepts of management of dyslipiemia in everyday practice, e.g. therapy of dyslipidemia in special patients groups. This statement does not replace the latest guidelines but focuses on the changes from the former guidelines for dyslipidemia management, published by CSAT in 2007. PMID:23461401

  7. A New Guideline on Treatment of Hypertension in Those with Coronary Artery Disease: Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension About Treatment of Hypertension in Patients with Coronary Artery Disease.

    PubMed

    Jennings, Garry L R

    2015-11-01

    Hypertension is a major risk factor for coronary artery disease (CAD) and the two frequently coexist. The peak cardiology and hypertension societies of the United States recently published new guidelines on the treatment of hypertension in people with CAD. The guidelines update those previously issued eight years previously in the light of new trial data. However, for the most part they will validate what cardiologists are already doing in these patients. The major change is resetting of the blood pressure general treatment target for most people with hypertension and CAD from 130/80mm Hg to 140/90mm Hg. It is arguable that the evidence supporting the new target is any stronger than that supporting the old. While this will remain controversial in the absence of good data on the relative benefits of different treatment targets in hypertension it is in line with trends from a number of other general hypertension guidelines. PMID:26205991

  8. Adding Genetic Testing to Evidence-Based Guidelines to Determine the Safest and Most Effective Chronic Pain Treatment for Injured Workers

    PubMed Central

    Meshkin, Brian; Lewis, Katrina; Kantorovich, Svetlana; Anand, Natasha; Davila, Lisa

    2015-01-01

    Published guidelines for treating injured workers include the need for personalized treatment to manage chronic pain symptoms and increase functional status. However, they often fail to clarify how to objectively personalize these treatments. Further, certain patients need analgesic relief beyond the short term. In these cases, it is not sufficient or reasonable to utilize the typical broad protocol-based justifications for reduction of opioids and other medications in a haphazard manner based purely on poor response, without attempting to elucidate possible pharmacogenetic reasons for this. These guidelines acknowledge the problem of substance abuse and set forth methods for treatment and prevention. Although it has been established in the scientific community that an individual’s experience of pain and likelihood for addiction both have genetic components, genetic testing is not routinely included as part of the overall treatment plan for injured workers with chronic pain. Because decisions in cases of workplace injury should be based on scientific evidence, genetic testing results can add some objective information to the existing subjective and objective clinical data; help ascertain the efficacy and potential for toxicity of treatment; and therefore provide more information for accurate clinical decisions. We propose the addition of genetic testing to consensus guidelines for treating injured workers in order to improve patients’ functional status, increase productivity, improve safety of prescribing, decrease the likelihood of substance abuse, and save on overall healthcare costs. PMID:26759531

  9. Nationally-representative trends and geographic variation in treatment of localized prostate cancer: the Urologic Diseases in America Project

    PubMed Central

    Cary, K. Clint; Punnen, Sanoj; Odisho, Anobel Y.; Litwin, Mark S.; Saigal, Christopher S.; Cooperberg, Matthew R.

    2015-01-01

    Introduction Several treatment options for clinically localized prostate cancer currently exist under established guidelines. We aim to assess nationally-representative trends in treatment over time and determine potential geographic variation using two large national claims registries. Methods Men with prostate cancer insured by Medicare (19982006) or a private insurer (Ingenix database, 20022006) were identified using ICD-9 and CPT-4 codes. Geographic variation and trends in the type of treatment utilized over time were assessed. Geographic data was mapped using the GeoCommons online mapping platform. Predictors of any treatment were determined using a hierarchical generalized linear mixed model using the logit link function. Results The use of radical prostatectomy (RP) increased, 33% to 48%, in the privately insured i3 database, while remaining stable at 12% in the Medicare population. There was a rapid uptake in the use of newer technologies over time in both the Medicare and i3 cohorts. The use of laparoscopic assisted prostatectomy increased from 1% in 2002 to 41% in 2006 in i3 patients, while the incidence increased from 3% in 2002 to 35% in 2006 for Medicare patients. The use of neoadjuvant/adjuvant androgen deprivation therapy (ADT) was lower in the i3 cohort and has decreased over time in both i3 and Medicare. Physician density had an impact on type of primary treatment received in the New England region, however, this trend was not seen in the Western or Southern regions of the United States. Conclusion Using two large national claims registries, we have demonstrated trends over time and substantial geographic variation in the type of primary treatment used for localized prostate cancer. Specifically, there has been a large increase in the use of newer technologies, (i.e. laparoscopic-assisted prostatectomy and IMRT). These results elucidate the need for improved data collection on prostate cancer treatment outcomes to reduce unwarranted variation in care. PMID:25667110

  10. How can information extraction ease formalizing treatment processes in clinical practice guidelines? A method and its evaluation☆

    PubMed Central

    Kaiser, Katharina; Akkaya, Cem; Miksch, Silvia

    2010-01-01

    Summary Objective: Formalizing clinical practice guidelines (CPGs) for a subsequent computer-supported processing is a challenging, but burdensome and time-consuming task. Existing methods and tools to support this task demand detailed medical knowledge, knowledge about the formal representations, and a manual modeling. Furthermore, formalized guideline documents mostly fall far short in terms of readability and understandability for the human domain modeler. Methods and material: We propose a new multi-step approach using information extraction methods to support the human modeler by both automating parts of the modeling process and making the modeling process traceable and comprehensible. This paper addresses the first steps to obtain a representation containing processes which 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. PMID:16962747

  11. AAPM Medical Physics Practice Guideline 5.a.: Commissioning and QA of Treatment Planning Dose Calculations - Megavoltage Photon and Electron Beams.

    PubMed

    Smilowitz, Jennifer B; Das, Indra J; Feygelman, Vladimir; Fraass, Benedick A; Kry, Stephen F; Marshall, Ingrid R; Mihailidis, Dimitris N; Ouhib, Zoubir; Ritter, Timothy; Snyder, Michael G; Fairobent, Lynne

    2015-01-01

    The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances. PMID:26699330

  12. General design, construction, and operation guidelines: Constructed wetlands wastewater treatment systems for small users including individual residences. Second edition

    SciTech Connect

    Steiner, G.R.; Watson, J.T.

    1993-05-01

    One of the Tennessee Valley Authority`s (TVA`s) major goals is cleanup and protection of the waters of the Tennessee River system. Although great strides have been made, point source and nonpoint source pollution still affect the surface water and groundwater quality in the Tennessee Valley and nationally. Causes of this pollution are poorly operating wastewater treatment systems or the lack of them. Practical solutions are needed, and there is great interest and desire to abate water pollution with effective, simple, reliable and affordable wastewater treatment processes. In recognition of this need, TVA began demonstration of the constructed wetlands technology in 1986 as an alternative to conventional, mechanical processes, especially for small communities. Constructed wetlands can be downsized from municipal systems to small systems, such as for schools, camps and even individual homes.

  13. 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

    1990-01-01

    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. PMID:2190685

  14. French Experience with Buprenorphine : Do Physicians Follow the Guidelines?

    PubMed Central

    Guillou Landreat, Morgane; Rozaire, Charles; Guillet, Jean yves; Victorri Vigneau, Caroline; Le Reste, Jean Yves; Grall Bronnec, Marie

    2015-01-01

    Opiate dependence affects about 15,479,000 people worldwide. The effectiveness of opiate substitution treatments (OST) has been widely demonstrated. Buprenorphine plays a particular role in opiate dependence care provision in France. It is widely prescribed by physicians and national opiate substitution treatment guidelines have been available since 2004. In order to study the prescribing of buprenorphine, we used a questionnaire sent by email, to a large sample of physicians. These physicians were either in practice, or belonged to an addiction treatment network or a hospital. The main objective of this work was to measure the extent to which the theoretical, clinical attitude of physicians towards prescribing buprenorphine (BHD) complied with the statutory guidelines. We showed that the physicians we interviewed rarely took into account the guidelines regarding buprenorphine prescription. The actual prescribing of Buprenorphine differed from the guidelines. Only 42% of independent Family Physicians (FPs), working outside the national health care system, had prescribed buprenorphine as a first-time prescription and 40% of FPs do not follow up patients on buprenorphine. In terms of compliance with the guidelines, 55% of FPs gave theoretical answers that only partially complied with the guidelines. The variations in compliance with the guidelines was noted according to different variables and took into particular account whether the physician were affiliated to a network or in training. PMID:26479400

  15. Diagnosis and treatment of invasive squamous cell carcinoma of the skin: European consensus-based interdisciplinary guideline.

    PubMed

    Stratigos, Alexander; Garbe, Claus; Lebbe, Celeste; Malvehy, Josep; del Marmol, Veronique; Pehamberger, Hubert; Peris, Ketty; Becker, Jürgen C; Zalaudek, Iris; Saiag, Philippe; Middleton, Mark R; Bastholt, Lars; Testori, Alessandro; Grob, Jean-Jacques

    2015-09-01

    Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in Caucasian populations, accounting for 20% of all cutaneous malignancies. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on cSCC diagnosis and management, based on a critical review of the literature, existing guidelines and the expert's experience. The diagnosis of cSCC is primarily based on clinical features. A biopsy or excision and histologic confirmation should be performed in all clinically suspicious lesions in order to facilitate the prognostic classification and correct management of cSCC. The first line treatment of cutaneous SCC is complete surgical excision with histopathological control of excision margins. The EDF-EADO-EORTC consensus group recommends a standardised minimal margin of 5 mm even for low-risk tumours. For tumours, with histological thickness of >6 mm or in tumours with high risk pathological features, e.g. high histological grade, subcutaneous invasion, perineural invasion, recurrent tumours and/or tumours at high risk locations an extended margin of 10 mm is recommended. As lymph node involvement by cSCC increases the risk of recurrence and mortality, a lymph node ultrasound is highly recommended, particularly in tumours with high-risk characteristics. In the case of clinical suspicion or positive findings upon imaging, a histologic confirmation should be sought either by fine needle aspiration or by open lymph node biopsy. In large infiltrating tumours with signs of involvement of underlying structures, additional imaging tests, such as CT or MRI imaging may be required to accurately assess the extent of the tumour and the presence of metastatic spread. Current staging systems for cSCC are not optimal, as they have been developed for head and neck tumours and lack extensive validation or adequate prognostic discrimination in certain stages with heterogeneous outcome measures. Sentinel lymph node biopsy has been used in patients with cSCC, but there is no conclusive evidence of its prognostic or therapeutic value. In the case of lymph node involvement by cSCC, the preferred treatment is a regional lymph node dissection. Radiation therapy represents a fair alternative to surgery in the non-surgical treatment of small cSCCs in low risk areas. It generally should be discussed either as a primary treatment for inoperable cSCC or in the adjuvant setting. Stage IV cSCC can be responsive to various chemotherapeutic agents; however, there is no standard regimen. EGFR inhibitors such as cetuximab or erlotinib, should be discussed as second line treatments after mono- or polychemotherapy failure and disease progression or within the framework of clinical trials. There is no standardised follow-up schedule for patients with cSCC. A close follow-up plan is recommended based on risk assessment of locoregional recurrences, metastatic spread or development of new lesions. PMID:26219687

  16. Challenges of implementing national guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus colonization or infection in acute care hospitals in the Republic of Ireland.

    PubMed

    Fitzpatrick, Fidelma; Roche, Fiona; Cunney, Robert; Humphreys, Hilary

    2009-03-01

    Of the 49 acute care hospitals in Ireland that responded to the survey questionnaire drafted by the Infection Control Subcommittee of the Health Protection Surveillance Centre's Strategy for the Control of Antimicrobial Resistance in Ireland, 43 reported barriers to the full implementation of national guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus infection; these barriers included poor infrastructure (42 hospitals), inadequate laboratory resources (40 hospitals), inadequate staffing (39 hospitals), and inadequate numbers of isolation rooms and beds (40 hospitals). Four of the hospitals did not have an educational program on hand hygiene, and only 17 had an antibiotic stewardship program. PMID:19193017

  17. [Use of guidelines and heterogeneity of decision making for adjuvant chemotherapy in hormone-receptor positive, HER2-negative, early breast cancer: results of a French national survey].

    PubMed

    Fekih, Mahmoud; Petit, Thierry; Zarca, Daniel; Guinebretire, Jean-Marc; Andr, Fabrice; Pierga, Jean-Yves; Namer, Mose; Gligorov, Joseph; Delaloge, Suzette

    2014-10-01

    Adjuvant chemotherapy for localised breast cancer aims at reducing the risk of relapse and at increasing overall survival. Decision criteria include tumour burden and biological profile. It appears currently difficult to evaluate the benefit/risk ratio in certain borderline cases, which are more and more frequent. We have evaluated through an anonymous web survey conducted as part of the 2013 Annual Saint-Paul-de-Vence breast conference, the chemotherapy decisions, use of guidelines and level of certainty with decisions in this type of situation through four clinical cases. The survey was proposed to 1,190 French physicians who are directly in charge of breast cancer care, whatever their specialty. Three hundred and fifty-three of them replied, of whom 67 % were oncologists and 15 % surgeons. A significantly heterogeneous decision was observed for two out of four cases, in which 52 and 69 % of the physicians opted for adjuvant chemotherapy, versus 48 and 21 % for abstention respectively. Eighty seven percent of responding physicians used guidelines to guide their decision. These guidelines were regional for 63 %, national for 36 %, local in 21 % and international in 16 % of the cases. The level of certainty varied with clinical cases but not with the physician's specialty, nor type of decision. PMID:25373691

  18. Uniform Labeling of Blocks and Slides in Surgical Pathology: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center and the National Society for Histotechnology.

    PubMed

    Brown, Richard W; Speranza, Vincent Della; Alvarez, Janice O; Eisen, Richard N; Frishberg, David P; Rosai, Juan; Santiago, Jerry; Tunnicliffe, Janet; Colasacco, Carol; Lacchetti, Christina; Thomas, Nicole E

    2015-12-01

    Context .- The labeling of paraffin blocks and microscopic glass slides in the practice of surgical pathology varies from institution to institution and introduces potential risk of preanalytic error. Currently there are no evidence-based guidelines regarding the uniform labeling of these materials. Objective .- To develop recommendations that will address the need for adequate patient identification and provide a consistent method of identifying slides originating from a particular block. Design .- The College of American Pathologists Pathology and Laboratory Quality Center and the National Society for Histotechnology convened a panel of pathologists and histotechnologists with expertise in histology laboratory quality practices to develop labeling recommendations. A systematic evidence review was conducted to address 6 main key questions. Recommendations were derived from strength of evidence, open comment feedback, and expert panel consensus. Results .- Twelve guideline statements were established to assist pathology laboratories in developing standardized block and slide labeling practices. These guidelines call for the use of 2 patient identifiers, 1 of which includes the accession number and case type, on all paraffin blocks and slides. Recommendations were also developed to address the order and format in which identifying elements should appear. Conclusions .- Uniform labeling of paraffin blocks and slides derived from patient specimens will provide an important enhancement to patient safety by assuring that all preparations derived from a patient's tissue can be uniquely and unambiguously linked to that patient. Adoption of standardized practices additionally will improve patient care by facilitating interpretation of histologic sections when they are referred in consultation to a second institution. PMID:25897820

  19. The Impact of a National Guideline on the Management of Cancer Pain on the Practice of Pain Assessment and Registration.

    PubMed

    Besse, Kees; Vernooij-Dassen, Myrra; Vissers, Kris; Engels, Yvonne

    2016-02-01

    The Dutch clinical practice guideline on the diagnosis and management of pain in patients with cancer was published in 2008 and intensively promoted to healthcare professionals who see patients with cancer. One of the most important recommendations is the systematic registering of the pain and its intensity. To evaluate in which degree this part of the practice guideline is implemented, we analyzed the medical records of patients attending the outpatient oncological clinic in an academic hospital, a large teaching hospital, and 4 smaller peripheral hospitals. None of the participating hospitals assessed pain by a standardized scale. Reference to pain in the medical record happened more frequently in the academic hospital than in the other hospitals. The frequency of recording pain in the medical record in the academic hospital was much higher in this study than the one previously reported, whereas the findings in the other hospitals were comparable. There may be several reasons for the difference in reporting rate of pain in patients with cancer. Our findings indicate that the clinical practice guideline with regard to pain registration is poorly implemented in oncology outpatient clinics. More efforts should be made to generate the awareness for the need of pain registration. PMID:25546262

  20. Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study.

    PubMed

    Miedema, Michael D; Lopez, Faye L; Blaha, Michael J; Virani, Salim S; Coresh, Josef; Ballantyne, Christie M; Folsom, Aaron R

    2015-09-01

    The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly affect the aging US population. We performed a cross-sectional analysis of black and white participants in Atherosclerosis Risk in Communities who participated in the fifth study visit (2011-2013). Sitting blood pressure was calculated from the average of 3 successive readings taken after a 5-minute rest. Currently, prescribed antihypertensive medications were recorded by reviewing medication containers brought to the visit. Blood pressure control was defined using both the Seventh and Eighth Joint National Committee thresholds. Of 6088 participants (mean age, 75.6 [range, 66-90] years, 58.4% women; 23.2% black), 54.9% had either diabetes mellitus or chronic kidney disease. The prevalence of hypertension according to Seventh Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the Eighth Joint National Committee thresholds, 79.4% were at blood pressure goal (16.6% were reclassified as at-goal). Reclassification was higher for individuals with diabetes mellitus or chronic kidney disease (20.6%) when compared with individuals without either condition (11.6%). The use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least 1 antihypertensive medication and 46.7% on ?2 antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, ?1 in 6 individuals were reclassified as having blood pressure at goal by Eighth Joint National Committee guidelines. Despite these less aggressive goals, >20% remain uncontrolled by the new criteria. PMID:26150438

  1. Implications of Changing National Cholesterol Education Program Goals for the Treatment and Control of Hypercholesterolemia

    PubMed Central

    Persell, Stephen D; Lloyd-Jones, Donald M; Baker, David W

    2006-01-01

    BACKGROUND Modifications to the National Cholesterol Education Program (NCEP) guidelines lowered optional low-density lipoprotein cholesterol (LDL-C) treatment goals. OBJECTIVE We evaluated the implications of widely adopting these optional goals in clinical practice. DESIGN AND PARTICIPANTS We performed a cross-sectional study using 1999 to 2002 data from 3,281 U.S. adults aged 20 to 79 years participating the National Health and Nutrition Examination Survey. MEASUREMENTS The primary outcomes were the proportions of adults whose fasting LDL-C levels exceeded NCEP recommended and optional targets from 2001 and 2004. We used survey weights to estimate the size of the U.S. population exceeding targets. We examined outcomes for 4 coronary disease risk subgroups described by the NCEP. RESULTS Low-density lipoprotein cholesterol values exceeded 2001 NCEP goals for 30.0% of adults, and 35.8% had levels above optional 2004 goals. An estimated 24,900,000 individuals (14.2%) exceeded 2001 thresholds for drug therapy, 46,200,000 (26.3%) exceeded optional 2001 thresholds for drug therapy, and 56,500,000 (32.2%) were above the optional 2004 thresholds for drug therapy. For lower, moderate, moderately high, and high-risk groups, 13.4%, 44.2%, 58.8%, and 71.8%, respectively, exceeded 2001 NCEP goals; 13.4%, 15.7%, 87.4%, and 96.0% of these groups exceeded optional 2004 thresholds for drug therapy. CONCLUSIONS In 1999 to 2002, LDL-C levels commonly exceeded 2001 NCEP goals, especially for moderately high and high-risk individuals, and cholesterol-lowering medications were underused. Optional goals promulgated by the NCEP in 2001 and 2004 moderately increased the number of adults with LDL-C above their goal, and greatly increased the number of low, moderately high, and high-risk adults who exceeded LDL-C thresholds, for cholesterol-lowering medication. PMID:16390501

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

    SciTech Connect

    Goodman, Karyn A.; Regine, William F.; Dawson, Laura A.; Ben-Josef, Edgar; Haustermans, Karin; Bosch, Walter R.; Turian, Julius; Abrams, Ross A.

    2012-07-01

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

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

    SciTech Connect

    Lim, Karen; Portelance, Lorraine; Creutzberg, Carien; Juergenliemk-Schulz, Ina M.; Mundt, Arno; Mell, Loren K.; Mayr, Nina; Viswanathan, Akila; Jhingran, Anuja; Erickson, Beth; De Los Santos, Jennifer; Gaffney, David; Yashar, Catheryn; Beriwal, Sushil; Wolfson, Aaron

    2011-02-01

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

  4. Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation.

    PubMed

    Picchietti, Daniel L; Hensley, Jennifer G; Bainbridge, Jacquelyn L; Lee, Kathryn A; Manconi, Mauro; McGregor, James A; Silver, Robert M; Trenkwalder, Claudia; Walters, Arthur S

    2015-08-01

    Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is common during pregnancy, affecting approximately one in five pregnant women in Western countries. Many report moderate or severe symptoms and negative impact on sleep. There is very little information in the medical literature for practitioners on the management of this condition during pregnancy. Accordingly, a task force was chosen by the International RLS Study Group (IRLSSG) to develop guidelines for the diagnosis and treatment of RLS/WED during pregnancy and lactation. A committee of nine experts in RLS/WED and/or obstetrics developed a set of 12 consensus questions, conducted a literature search, and extensively discussed potential guidelines. Recommendations were approved by the IRLSSG executive committee, reviewed by IRLSSG membership, and approved by the WED Foundation Medical Advisory Board. These guidelines address diagnosis, differential diagnosis, clinical course, and severity assessment of RLS/WED during pregnancy and lactation. Nonpharmacologic approaches, including reassurance, exercise and avoidance of exacerbating factors, are outlined. A rationale for iron supplementation is presented. Medications for RLS/WED are risk/benefit rated for use during pregnancy and lactation. A few are rated "may be considered" when RLS/WED is refractory to more conservative approaches. An algorithm summarizes the recommendations. These guidelines are intended to improve clinical practice and promote further research. PMID:25553600

  5. 2014 Guideline for the Management of High Blood Pressure (Eighth Joint National Committee): Take-Home Messages.

    PubMed

    Farooq, Umar; Ray, Sunita G

    2015-07-01

    The JNC 8 guidelines focus on 3 highest-ranked clinical questions that include BP thresholds for starting therapy, specific BP goals, and risks and benefits of specific antihypertensive drugs. Only randomized controlled trial data were used and JNC 8 panel did not include observational studies, systematic reviews, or meta-analyses. The investigators also suggested that benefit of lowering BP to less than 140/90 is not clear. Lifestyle modifications were considered very important for all patients with hypertension. These recommendations are not alternatives for clinical judgment, and decisions about medical care must be individualized to each patient. PMID:26042879

  6. Recent Update of Guidelines for Neurointerventional Procedures

    PubMed Central

    Shin, Shang Hun; Kwon, Soon Chan

    2013-01-01

    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. PMID:24024069

  7. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest

    PubMed Central

    2012-01-01

    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

  8. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary hypertension due to lung diseases and/or hypoxia

    PubMed Central

    Sakkijha, Husam; Idrees, Majdy M.

    2014-01-01

    Chronic lung diseases are common causes of pulmonary hypertension. It ranks second after the left heart disease. Both obstructive and restrictive lung diseases are know to cause pulmonary hypertension. The pathophysiology of the disease is complex, and includes factors affecting the blood vessels, airways, and lung parenchyma. Hypoxia and the inhalation of toxic materials are another contributing factors. Recent guidelines have further clarified the association between pulmonary hypertension and chronic lung disease and made general guidelines concerning the diagnosis and management. In this article, we will provide a detailed revision about the new classification and give general recommendations about the management of pulmonary hypertension in chronic lung diseases. PMID:25076998

  9. Antiviral usage for H1N1 treatment: pros, cons and an argument for broader prescribing guidelines in the United States.

    PubMed

    Goldstein, Edward; Lipsitch, Marc

    2009-01-01

    Current CDC guidelines for antiviral treatment of people with influenza like illness (ILI) effectively discourage treatment of people with no underlying medical conditions unless they exhibit severe symptoms, such as evidence of lower respiratory tract infection or clinical deterioration. This guidance is unlike that provided by some other countries, which allow for treatment of most moderately symptomatic individuals. We examine evidence for benefits of antiviral usage for influenza treatment, including its relation to severe outcomes for the current pandemic H1N1 strain. We also discuss some of the potential cons of antiviral usage. In the current situation in the US, with an elevated and evidently growing burden of influenza hospitalizations and mortality, a high percentage of individuals infected with influenza (with almost all of those carrying the H1N1pdm strain) among those who exhibit ILI and get tested for influenza virus, very low levels of antiviral resistance and little time left for antiviral resistance to take off before large quantities of vaccine become available, we think it is worthwhile to consider a revision to the current antiviral usage recommendations, such that physicians would be encouraged to consider prescribing antivirals to individuals with moderate to severe symptoms who present for treatment.Note: Very recently CDC has adopted clarifications for its antiviral usage guidelines: http://www.cdc.gov/H1N1flu/antivirals/facts_clinicians.htm. PMID:20029660

  10. Application of New Cholesterol Guidelines to the Korean Adult Diabetic Patients

    PubMed Central

    Kim, Bu Kyung; Kim, Hyeon Chang; Ha, Kyoung Hwa

    2015-01-01

    The American College of Cardiology and the American Heart Association (ACC/AHA) 2013 joint guidelines for the treatment of hypercholesterolemia expand the indications for statin therapy. This study was performed to estimate the numbers of diabetic patients indicated for statin therapy according to the Third Adult Treatment Panel (ATP-III) of the National Cholesterol Education Program guidelines and the new ACC/AHA guidelines in Korea. We analyzed the data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. Patients with diabetes over 30 yr of age were analyzed by the two guidelines. Of the total 1,975 diabetic patients, only 377 (19.1%) were receiving drugs for dyslipidemia. Among 1,598 patients who had not taken any medications for dyslipidemia, 65.6% would be indicated for statin therapy according to the ATP-III guidelines. When we apply the new guidelines, 94.3% would be eligible for statin therapy. Among the total diabetic patients, the new guidelines, compared with the ATP-III guidelines, increase the number eligible for statin therapy from 53.1% to 76.2%. The new guidelines would increase the indication for statin therapy for most diabetic patients. At present, many diabetic patients do not receive appropriate statin therapy. Therefore efforts should be made to develop the Korean guidelines and to ensure that more diabetic patients receive appropriate statin therapy. PMID:26539005

  11. [AUTOIMMUNE LIVER DISEASES: CLINICAL FEATURES, DIAGNOSIS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

    PubMed

    Golovanova, E V; Lazebnik, L B; Konev, Yu V; Radchenko, V G; Seliverstov, P V; Sitkin, S I; Tkachenko, E I

    2015-01-01

    The group of liver autoimmune diseases (LAD) includes autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC) and Primary sclerosing cholangitis (PSC) The guidelines on clinical diagnosis and management of patients based on a review and analysis of recent publications on this topic in the global and domestic literature and on the authors'experience in treating patients with autoimmune liver disease. PMID:26817128

  12. Do general treatment guidelines for Asian American families have applications to specific ethnic groups? The case of culturally-competent therapy with Korean Americans.

    PubMed

    Kim, Elena Young-Kyong; Bean, Roy A; Harper, James M

    2004-07-01

    To serve Korean American families effectively, marriage and family therapists need to develop a level of cultural competence. This content analysis of the relevant treatment literature was conducted to discover the most common expert recommendations for family therapy with Asian Americans and to examine their application to Korean Americans. Eleven specific guidelines were generated: Assess support systems, assess immigration history establish professional credibility, provide role induction, facilitate "saving face," accept somatic complaints, be present/problem focused, be directive, respect family structure, be nonconfrontational, and provide positive reframes. Empirical support (clinical and nonclinical research) and conceptual support for each guideline are discussed, and conclusions are reached regarding culturally competent therapy with Korean American families. PMID:15293653

  13. The truth of treating patients with phenylketonuria after childhood: the need for a new guideline.

    PubMed

    van Spronsen, F J; Burgard, P

    2008-12-01

    In recent years, an increasing number of national guidelines on the treatment of phenylketonuria (PKU) have emerged. Most of these guidelines are dedicated to the care of children, while less attention is paid to the care of adults, although all guidelines underline the importance of diet for life. This review aims to summarize issues that need to be addressed within a guideline on the treatment of PKU, especially when care for patients beyond childhood is concerned. In this respect, it is of importance that adult patients, both willing and unwilling to be treated, need a guideline for care and follow-up. In PKU there is certainly a need for an improved unified guideline, especially after childhood, although many of the considerations in this article also apply to recommendations for treatment of children. Such a guideline will be a tool to improve treatment in PKU patients but should also include recommendations for collecting data for clinical and research purposes. Guideline development should also focus on nutritional, neuropsychological and psychosocial issues and not only on target plasma phenylalanine concentrations. In addition, guidelines must address not only what has to be done but also how it can be done, thereby improving concordance with the recommendations for treatment and management. PMID:18690552

  14. A controversial step forward: a commentary on the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults

    PubMed Central

    Ades, Philip A.

    2014-01-01

    The 2013 ACC/AHA guidelines on the treatment of blood cholesterol in adults is a major step forward in the field of preventive cardiology but it is not without controversy. It should be well accepted that in individuals with established atherosclerotic vascular disease, individuals with a low-density lipoprotein cholesterol of greater than 190 mg/dl and individuals with diabetes, treatment with an appropriate fixed dose of a statin, without titration to a specific low-density lipoprotein goal, will provide substantial protection against future atherosclerotic vascular disease events. More controversial is the utilization of a risk calculator in primary care to determine which individuals will require a statin. For as long as these risk calculators are in question, primary care practitioners will struggle to make treatment decisions. Factors such as cardiovascular fitness, measures of adiposity, and details of the family history will aid in treatment decisions. PMID:24518291

  15. A Narrative Review of the Confluence of Breast Cancer and Low-wage Employment and Its Impact on Receipt of Guideline-recommended Treatment

    PubMed Central

    Swanberg, Jennifer E.; Chambers, Mara D.

    2013-01-01

    Breast cancer is the leading cause of cancer among women in the United States, costing the healthcare system, employers, and society billions of dollars each year. Despite improvements in screening and treatment, significant breast cancer treatment and survivorship disparities exist among various groups of women. One variable that has not been explored extensively as a possible contributor to breast cancer treatment disparities is employment. This is concerning, given the changing economic and employment trends in the United States favoring low-wage employment. Currently, one-quarter to one-third of all US workers are considered to be working poor, and women are disproportionally represented in this group. Characteristics of low-wage worklimited paid time off, minimal health benefits, schedule inflexibility, and economic insecuritymay become even more significant in the event of a breast cancer diagnosis. To date, there has been limited research into how job conditions inherent to low-wage work may influence working poor survivors' receipt of guideline-recommended breast cancer treatment. Therefore, the purpose of this narrative review was to critically examine the current literature to further our understanding of how employment context may impact treatment decisions and adherenceand th