Science.gov

Sample records for medicine iom recommendations

  1. Pilot trial of IOM duty hour recommendations in neurology residency programs: unintended consequences.

    PubMed

    Schuh, L A; Khan, M A; Harle, H; Southerland, A M; Hicks, W J; Falchook, A; Schultz, L; Finney, G R

    2011-08-30

    To study the potential effect of the 2008 Institute of Medicine (IOM) work duty hour (WDH) recommendations on neurology residency programs. This study evaluated resident sleepiness, personal study hours, quality of life, and satisfaction and faculty satisfaction during a control month using the Accreditation Council for Graduate Medical Education WDH requirements and during an intervention month using the IOM WDH recommendations. Resident participation in both schedules was mandatory, but both resident and faculty participation in the outcome measures was voluntary. Thirty-four residents (11 postgraduate year [PGY]-4, 9 PGY-3, and 14 PGY-2) participated. End-of-work shift sleepiness, mean weekly sleep hours, personal study hours, and hours spent in lectures did not differ between the control and intervention months. Resident quality of life measured by the Maslach Burnout Inventory declined for 1 subscore in the intervention month (p = 0.03). Resident education satisfaction declined during the intervention month for issues related to continuity of care, patient hand-offs, and knowledge of their patients. Faculty satisfaction declined during the intervention month, without a decline in quality of life. The results from 3 residency programs suggest that the IOM WDH recommendations may negatively affect neurology resident education. This study was limited by the short duration of implementation, negative bias against the IOM recommendations, and inability to blind faculty. Additional study of the IOM WDH recommendations is warranted before widespread implementation.

  2. Recommendations of the IOM clinical preventive services for women committee: implications for obstetricians and gynecologists.

    PubMed

    Gee, Rebekah E; Brindis, Claire D; Diaz, Angela; Garcia, Francisco; Gregory, Kimberly; Peck, Magda G; Reece, E Albert

    2011-12-01

    In July 2011, in response to language in the Affordable Care Act (ACA) the Office of the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services (HHS) tasked the Institute of Medicine (IOM) to develop a report on the clinical preventive services necessary for women. The committee proposed eight new clinical preventive service recommendations aimed at closing significant gaps in preventive healthcare. This article reviews the process, findings, and the implications for obstetrician gynecologists and other primary care clinicians. Obstetricians and gynecologists play a major role in delivering primary care to women and many of the services recommended by the Committee are part of the core set of obstetrics and gynecology services. The women's health amendment to the ACA (Federal Register, 2010) requires that new private health plans cover - with no cost-sharing requirements - preventive healthcare services for women. Congress requested that a review be conducted to ascertain whether there were any additional needed preventive services specific to women's health that should be included. The IOM Committee on Preventive Services for Women recommended eight clinical measures specific to women's health that should be considered for coverage without co-payment. The US Department of HHS reviewed and adopted these recommendations, and, as a result, new health plans will need to include these services as part of insurance policies with plan years beginning on or after 1 August 2012. The authors discuss the implications of the IOM recommendations on practicing clinicians and on their potential impact on women's health and well being.

  3. Texas Team: Academic Progression and IOM Toolkit.

    PubMed

    Reid, Helen; Tart, Kathryn; Tietze, Mari; Joseph, Nitha Mathew; Easley, Carson

    The Institute of Medicine (IOM) Future of Nursing report, identified eight recommendations for nursing to improve health care for all Americans. The Texas Team for Advancing Health Through Nursing embraced the challenge of implementing the recommendations through two diverse projects. One group conducted a broad, online survey of leadership, practice, and academia, focusing on the IOM recommendations. The other focused specifically on academic progression through the use of CABNET (Consortium for Advancing Baccalaureate Nursing Education in Texas) articulation agreements. The survey revealed a lack of knowledge and understanding of the IOM recommendations, prompting development of an online IOM toolkit. The articulation agreements provide a clear pathway for students to the RN-to-BSN degree students. The toolkit and articulation agreements provide rich resources for implementation of the IOM recommendations.

  4. Texas Team: Academic Progression and IOM Toolkit.

    PubMed

    Reid, Helen; Tart, Kathryn; Tietze, Mari; Joseph, Nitha Mathew; Easley, Carson

    2017-08-04

    The Institute of Medicine (IOM) Future of Nursing report, identified eight recommendations for nursing to improve health care for all Americans. The Texas Team for Advancing Health Through Nursing embraced the challenge of implementing the recommendations through two diverse projects. One group conducted a broad, online survey of leadership, practice, and academia, focusing on the IOM recommendations. The other focused specifically on academic progression through the use of CABNET (Consortium for Advancing Baccalaureate Nursing Education in Texas) articulation agreements. The survey revealed a lack of knowledge and understanding of the IOM recommendations, prompting development of an online IOM toolkit. The articulation agreements provide a clear pathway for students to the RN-to-BSN degree students. The toolkit and articulation agreements provide rich resources for implementation of the IOM recommendations.

  5. Changing national guidelines is not enough: The impact of 1990 IOM recommendations on gestational weight gain among U.S. women

    PubMed Central

    Hamad, Rita; Cohen, Alison K.; Rehkopf, David H.

    2016-01-01

    Background and Objectives Gestational weight gain (GWG) is associated with both long- and short-term maternal and child health outcomes, particularly obesity. Targeting maternal nutrition through policies is a potentially powerful pathway to influence these outcomes. Yet prior research has often failed to evaluate national policies and guidelines that address maternal and child health. In 1990, the U.S. Institute of Medicine (IOM) released guidelines recommending different GWG thresholds based on women’s pre-pregnancy body mass index (BMI), with the goal of improving infant birth weight. In this study, we employ quasi-experimental methods to examine whether the release of the IOM guidelines led to changes in GWG among a diverse and nationally representative sample of women. Methods Our sample included female participants of the National Longitudinal Survey of Youth who self-reported GWG for pregnancies during 1979–2000 (N = 7,442 pregnancies to 4,173 women). We compared GWG before and after the guidelines were released using difference-in-differences (DID) and regression discontinuity (RD) analyses. Results In DID analyses we found no reduction in GWG among overweight/obese women relative to normal/underweight women. Meanwhile, RD analyses demonstrated no changes in GWG by pre-pregnancy BMI for either overweight/obese or normal/underweight women. Results were similar for women regardless of educational attainment, race, or parity. Conclusions The findings suggest that national guidelines had no effect on weight gain among pregnant women. These results have implications for the implementation of policies targeting maternal and child health via dietary behaviors. PMID:27200502

  6. AGREE II assessments of recent acne treatment guidelines: how well do they reveal trustworthiness as defined by the Institute of Medicine (IOM) criteria?

    PubMed

    Eady, E A; Layton, A M; Sprakel, J; Arents, B W M; Fedorowicz, Z; van Zuuren, E J

    2017-07-01

    Up-to-date, trustworthy guidelines are a widely relied-upon means of promoting excellent patient care. To determine the quality of recently published acne treatment guidelines by utilizing the Appraisal of Guidelines for Research and Evaluation (AGREE) II Reporting Checklist, the US Institute of Medicine's (IOM) criteria of trustworthiness, Lenzer et al's red flags and CheckUp. Systematic searches were conducted in bibliographic databases, guideline depositories and using Google(™) to identify acne treatment guidelines published since 2013. Six assessors independently scored each guideline using the AGREE II Reporting Checklist. Guidelines were concomitantly assessed for trustworthiness using the IOM criteria and for Lenzer et al's red flags indicative of potential bias. Updates were screened using CheckUp. Eight guidelines were identified, two of which were updates. Lowest scoring AGREE II domains across all guidelines were rigour (6/8 poor, one fair, one average) and applicability (4/8 poor, one fair, three average). Two out of the three highest scoring guidelines were developed using AGREE II. No guideline fully met each IOM criterion and all raised at least one red flag indicative of potential bias. One updated guideline did not address seven of 16 items on CheckUp and the other did not address four. Patient involvement in guideline development was minimal. Use of the AGREE II Instrument during guideline development did not have as great an effect on guideline quality as might be expected. There is considerable room for improvement in acne treatment guidelines in order to satisfy the IOM trustworthiness criteria and avoid bias. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  7. Review of institute of medicine and national research council recommendations for one health initiative.

    PubMed

    Rubin, Carol; Myers, Tanya; Stokes, William; Dunham, Bernadette; Harris, Stic; Lautner, Beth; Annelli, Joseph

    2013-12-01

    Human health is inextricably linked to the health of animals and the viability of ecosystems; this is a concept commonly known as One Health. Over the last 2 decades, the Institute of Medicine (IOM) and the National Research Council (NRC) have published consensus reports and workshop summaries addressing a variety of threats to animal, human, and ecosystem health. We reviewed a selection of these publications and identified recommendations from NRC and IOM/NRC consensus reports and from opinions expressed in workshop summaries that are relevant to implementation of the One Health paradigm shift. We grouped these recommendations and opinions into thematic categories to determine if sufficient attention has been given to various aspects of One Health. We conclude that although One Health themes have been included throughout numerous IOM and NRC publications, identified gaps remain that may warrant targeted studies related to the One Health approach.

  8. Review of Institute of Medicine and National Research Council Recommendations for One Health Initiative

    PubMed Central

    Myers, Tanya; Stokes, William; Dunham, Bernadette; Harris, Stic; Lautner, Beth; Annelli, Joseph

    2013-01-01

    Human health is inextricably linked to the health of animals and the viability of ecosystems; this is a concept commonly known as One Health. Over the last 2 decades, the Institute of Medicine (IOM) and the National Research Council (NRC) have published consensus reports and workshop summaries addressing a variety of threats to animal, human, and ecosystem health. We reviewed a selection of these publications and identified recommendations from NRC and IOM/NRC consensus reports and from opinions expressed in workshop summaries that are relevant to implementation of the One Health paradigm shift. We grouped these recommendations and opinions into thematic categories to determine if sufficient attention has been given to various aspects of One Health. We conclude that although One Health themes have been included throughout numerous IOM and NRC publications, identified gaps remain that may warrant targeted studies related to the One Health approach. PMID:24274461

  9. Children in school cafeterias select foods containing more saturated fat and energy than the Institute of Medicine recommendations.

    PubMed

    Martin, Corby K; Thomson, Jessica L; LeBlanc, Monique M; Stewart, Tiffany M; Newton, Robert L; Han, Hongmei; Sample, Alicia; Champagne, Catherine M; Williamson, Donald A

    2010-09-01

    In this study, we examined if children's food selection met the School Meals Initiative (SMI) standards and the recently released Institute of Medicine (IOM) recommendations. Mean food selection, plate waste, and food intake were also examined. Food intake of 2049 4th-6th grade students was measured objectively at lunch over 3 d with digital photography in 33 schools. The percent of children whose food selection met the SMI standards and IOM recommendations for energy (kJ), fat and saturated fat, calcium, iron, and vitamin A and C were calculated. The SMI standards provide lower limits for most nutrients; the IOM provides a range of values, including an upper limit for energy. Seventy-seven percent of children's energy selection met the SMI lower limit, but only 16% of children met the IOM's recommended range and 74% of children exceeded the upper limit. More than 70% of children exceeded the SMI and IOM's saturated fat recommendations. Children selected (mean +/- SD) 3168 +/- 621 kJ, discarded 882 +/- 581 kJ, and consumed 2286 +/- 716 kJ. Children were less likely to discard fat than carbohydrate, resulting in proportionally more fat being consumed. Most children met SMI and IOM recommendations for protein, calcium, iron, and vitamin A. With few exceptions, energy selection was similar among groups of children, but plate waste differed (P < 0.001), resulting in greater energy intake among boys compared with girls, Caucasians compared with African Americans, and heavier compared with lighter children. Children's selection was high in saturated fat and, based on IOM criteria, included excess energy.

  10. Middle-school students' school lunch consumption does not meet the new Institute of Medicine's National School Lunch Program recommendations

    USDA-ARS?s Scientific Manuscript database

    The objective of this study was to compare the school lunch consumption of Texas middle-school students with the 2009 Institute of Medicine's (IOM) school meal report recommendations. These new lunch menu patterns increase fruit to one serving and vegetables to two servings, with 50 percent wholegra...

  11. Children in school cafeterias select foods containing more saturated fat and energy than the Institute of Medicine recommendations.

    USDA-ARS?s Scientific Manuscript database

    In this study, we examined if children’s food selection met the School Meals Initiative (SMI) standards, and the recently released Institute of Medicine (IOM) recommendations. Mean food selection, plate waste, and food intake were also examined. Food intake of 2,049 4th-6th grade students were measu...

  12. Children in school cafeterias select foods containing more saturated fat and energy than the institute of medicine recommends.

    USDA-ARS?s Scientific Manuscript database

    In this study, we examined if children’s food selections met the School Meals Initiative (SMI) standards, and the recently released Institute of Medicine (IOM) recommendations. Mean food selection, plate waste, and food intake were also examined. Food intake of 2,049 4th-6th grade students were meas...

  13. What the IOM Report on Graduate Medical Education Means for Physician Assistants.

    PubMed

    Cawley, James F

    2015-06-01

    Graduate medical education (GME) is funded by taxpayers through Medicare subsidies that pay for physician residency training, primarily to teaching hospitals. The Institute of Medicine (IOM) recently conducted a study of US GME and issued a series of recommendations for future policy reform. This commentary examines the major elements of proposed reforms for GME and offers analysis of those that may pertain specifically to physician assistant education now and in the future.

  14. Is the Physician Shortage Real? Implications for the Recommendations of the Institute of Medicine Committee on the Governance and Financing of Graduate Medical Education.

    PubMed

    Salsberg, Edward S

    2015-09-01

    In July 2014, the Institute of Medicine (IOM) Committee on the Governance and Financing of Graduate Medical Education released its report calling for a major overhaul of the financing of graduate medical education (GME). Several national organizations with an interest in GME faulted the report on the basis that the IOM Committee recommendations would worsen physician shortages. However, this conclusion is based on two questionable assumptions: first, that the nation is already facing a general physician shortage; and second, that the IOM Committee recommendations would make shortages worse. The author argues that although some communities and specialties do face shortages, currently and in the future a general national physician shortage is unlikely. Reasons cited include changes in the delivery system with an increased focus on efficiency and effectiveness; the increased use of interprofessional teams facilitated by the increasing supply of nurse practitioners, physician assistants and other health professionals; and technological advances.The author concludes that the IOM Committee recommendations would support an increase in GME positions in locations and specialties where there is a documented need, in effect removing the current cap on Medicare-funded GME positions. Given the current fiscal environment, the approach recommended by the IOM Committee--steady funding levels but improved targeting to meet documented needs--may be the best strategy for maintaining GME funds and meeting the nation's physician workforce needs.

  15. Institute of medicine recommendations for improving the quality of cancer care: what do they mean for the general internist?

    PubMed

    Nekhlyudov, Larissa; Wenger, Neil

    2014-10-01

    In order to evaluate and address the deficiencies in the U.S. cancer care system, particularly affecting the growing elderly population, the Institute of Medicine (IOM) convened a panel representing oncology providers, surgeons, primary care providers, researchers, policy makers and patients. The Committee concluded that cancer care is on the brink of crisis and issued recommendations targeting all stakeholders involved in cancer care. General internists play a critical role in the care of cancer patients, from the time of diagnosis, through treatment, survivorship and end of life care. We review the IOM recommendations, highlight those that are particularly relevant to the general internist, and outline clinical, research and educational opportunities where general internists should take an expanded role.

  16. Gestational weight gain in adolescents: a comparison to the new Institute of Medicine recommendations.

    PubMed

    Fernandez, I D; Hoffmire, C A; Olson, C M

    2011-12-01

    To examine the gestational weight gain distributions of healthy adolescents with optimal birth outcomes and compare them to the current 2009 Institute of Medicine (IOM) recommendations. Secondary data analysis to conduct a population-based, cross-sectional study. The Central and Finger Lakes regions of New York state (Perinatal Database System). 6995 adolescents with healthy singleton pregnancies (1996 to 2002). Percentiles of the gestational weight gain distributions were compared within body mass index (BMI) groups categorized using 2 different classification schemes: adolescent BMI percentiles and adult BMI cut-points. We compared these distributions overall and within racial and age groups. The gestational weight gain distribution does not differ considerably when BMI is classified using adolescent or adult cutoffs. Adolescents have good birth outcomes across a wider gestational weight gain range than recommended by the Institute of Medicine regardless of how pre-pregnancy weight status is categorized. For example, overweight adolescents by adult cutoffs have a range of gestational weight gain from 5.0 kg to 30.0 kg, and overweight adolescents by percentile cutoffs have a range from 5.4 kg to 29.5 kg, whereas the IOM range is 7.5-11.5 kg. Black and young adolescents have a similar distribution to their white and older counterparts. Practitioners can safely use the new IOM gestational weight gain ranges to monitor weight gain in pregnant adolescent patients using adult BMI classifications. Future research should examine the range of gestational weight gain in adolescents considering a broader scope of birth and maternal outcomes. Copyright © 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  17. Is it appropriate for Korean women to adopt the 2009 Institute of Medicine recommendations for gestational weight gain?

    PubMed

    Wie, Jeong Ha; Park, In Yang; Namkung, Jeong; Seo, Hae Won; Jeong, Min Jin; Kwon, Ji Young

    2017-01-01

    The 2009 Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) are intended for use among women in the United States. Little data are available on whether the 2009 IOM recommendations can be applied to Asian women. This study aimed to evaluate whether the recommendations are related to adverse pregnancy outcomes in Korean pregnant women. A retrospective cohort study was conducted for all singleton-pregnant women at a university hospital in Korea. After classifying the enrolled women into four Korean pre-pregnancy body mass index (BMI) categories, the risk of adverse pregnancy outcomes were analyzed for women who gained inadequate or excessive GWG based on 2009 IOM recommendations. Of 7,843 pregnancies, 64.0% of women had normal pre-pregnancy BMI and 42.7% achieved optimal GWG. Across all BMI categories, adverse pregnancies outcomes such as small for gestational age (SGA), large for gestational age (LGA), preterm birth, preeclampsia, and cesarean due to dystocia were significantly associated with GWG (all P ≤ 0.001).Women with normal BMI who gained inadequate weight were more likely to develop SGA and preterm birth and less likely to develop LGA (adjusted odds ratio (aOR) 2.21, 1.33, and 0.54, respectively). Whereas, women with normal BMI who gained excessive weight were more likely to develop LGA, preterm birth, preeclampsia, and cesarean section due to dystocia (aOR 2.10, 1.33, 1.37, and 1.37, respectively) and less likely to develop SGA (aOR 0.60). It is tolerable for Korean women to follow recommended GWG from the 2009 IOM guidelines to decrease adverse pregnancy outcomes. This will be helpful for antenatal care on GWG not only for Korean pregnant women, but also other Asian women who have lower BMI criteria than Caucasian women.

  18. Present at the Creation: Perspectives on the IOM Report.

    ERIC Educational Resources Information Center

    Gershen, Jay A.

    1996-01-01

    This article reviews the background of the 1995 report of the Institute of Medicine (IOM) on the status and needs of dental education in the United States, notes the report's value as a database and information resource, urges its use by dental schools as a stimulus for considering options, and stresses the need for funding to stimulate…

  19. Are the Institute of Medicine's trustworthiness guidelines trustworthy?

    PubMed

    Young, Benjamin K; Greenberg, Paul B

    2013-07-30

    The Institute of Medicine (IOM) has published a set of eight standards for guideline development groups (GDGs) to derive trustworthy clinical practice guidelines (CPGs). We investigated the adherence of these IOM guidelines to its own standards. The IOM document passed two of its own standards ("GDG-Systematic Review Team Interaction" and "GDG Composition"), only partially passed two others ("Articulation of Recommendation" and "External Review") and failed to pass four ("Establishing Transparency," "Management of Conflict of Interest," "Establishing Evidence Foundations" and "Updating"). The IOM standards for the development of CPGs do not meet their own criteria of trustworthiness. Further study is needed to determine the best methodology to evaluate CPGs.

  20. Dietary sodium: where science and policy conflict: impact of the 2013 IOM Report on Sodium Intake in Populations.

    PubMed

    Graudal, Niels

    2015-02-01

    The 2013 Institute of Medicine (IOM) report "Sodium Intake in Populations: Assessment of Evidence" did not support the current recommendations of the IOM and the American Heart Association (AHA) to reduce daily dietary sodium intake to below 2,300 mg. The report concluded that the population-based health outcome evidence was not sufficient to define a safe upper intake level for sodium. Recent studies have extended this conclusion to show that a sodium intake below 2,300 mg/day is associated with increased mortality. In spite of this increasing body of evidence, the AHA, Centers for Disease Control (CDC), other public health advisory bodies, and major medical journals have continued to support the current policy of reducing dietary sodium.

  1. Duty hours in emergency medicine: balancing patient safety, resident wellness, and the resident training experience: a consensus response to the 2008 institute of medicine resident duty hours recommendations.

    PubMed

    Wagner, Mary Jo; Wolf, Stephen; Promes, Susan; McGee, Doug; Hobgood, Cheri; Doty, Christopher; McErlean, Mara Ann; Janssen, Alan; Smith-Coggins, Rebecca; Ling, Louis; Mattu, Amal; Tantama, Stephen; Beeson, Michael; Brabson, Thomas; Christiansen, Greg; King, Brent; Luerssen, Emily; Muelleman, Robert

    2010-09-01

    Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education (ACGME), the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous on-site supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. One recommendation from the IOM was a required 5-hour rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes. 2010 by the Society for Academic Emergency Medicine

  2. Evaluation of IOM personal sampler at different flow rates.

    PubMed

    Zhou, Yue; Cheng, Yung-Sung

    2010-02-01

    The Institute of Occupational Medicine (IOM) personal sampler is usually operated at a flow rate of 2.0 L/min, the rate at which it was designed and calibrated, for sampling the inhalable mass fraction of airborne particles in occupational environments. In an environment of low aerosol concentrations only small amounts of material are collected, and that may not be sufficient for analysis. Recently, a new sampling pump with a flow rate up to 15 L/min became available for personal samplers, with the potential of operating at higher flow rates. The flow rate of a Leland Legacy sampling pump, which operates at high flow rates, was evaluated and calibrated, and its maximum flow was found to be 10.6 L/min. IOM samplers were placed on a mannequin, and sampling was conducted in a large aerosol wind tunnel at wind speeds of 0.56 and 2.22 m/s. Monodisperse aerosols of oleic acid tagged with sodium fluorescein in the size range of 2 to 100 microm were used in the test. The IOM samplers were operated at flow rates of 2.0 and 10.6 L/min. Results showed that the IOM samplers mounted in the front of the mannequin had a higher sampling efficiency than those mounted at the side and back, regardless of the wind speed and flow rate. For the wind speed of 0.56 m/s, the direction-averaged (the average value of all orientations facing the wind direction) sampling efficiency of the samplers operated at 2.0 L/min was slightly higher than that of 10.6 L/min. For the wind speed of 2.22 m/s, the sampling efficiencies at both flow rates were similar for particles < 60 microm. The results also show that the IOM's sampling efficiency at these two different flow rates follows the inhalable mass curve for particles in the size range of 2 to 20 microm. The test results indicate that the IOM sampler can be used at higher flow rates.

  3. Duty hours in emergency medicine: balancing patient safety, resident wellness, and the resident training experience: a consensus response to the 2008 Institute of Medicine resident duty hours recommendations.

    PubMed

    Wagner, Mary Jo; Wolf, Stephen; Promes, Susan; McGee, Doug; Hobgood, Cheri; Doty, Christopher; McErlean, Mara Ann; Janssen, Alan; Smith-Coggins, Rebecca; Ling, Louis; Mattu, Amal; Tantama, Stephen; Beeson, Michael; Brabson, Thomas; Christiansen, Greg; King, Brent; Luerssen, Emily; Muelleman, Robert

    2010-09-01

    Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education, the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous onsite supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. One recommendation from the IOM was a required 5-h rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes. Copyright © 2010 Elsevier Inc. All rights reserved.

  4. Physical activity recommendations: an alternative approach using energy expenditure.

    PubMed

    Mudd, Lanay M; Rafferty, Ann P; Reeves, Mathew J; Pivarnik, James M

    2008-10-01

    Most adults do not meet the American College of Sports Medicine and Centers for Disease Control and Prevention (ACSM/CDC) physical activity recommendations. Even fewer meet the more extreme Institute of Medicine (IOM) physical activity recommendations. Compliance with either recommendation has been conventionally assessed by combining frequencies and durations of self-reported activities. Leisure-time energy expenditure is a cumulative measure of activity that offers an alternative method of defining compliance. To calculate the leisure-time energy expenditure of adults complying with the ACSM/CDC or the IOM physical activity recommendations determined by conventional measures and to reexamine compliance with the IOM recommendation using energy expenditure criteria. National, cross-sectional data from the 2000 Behavioral Risk Factor Surveillance System determined the mode, frequency, and duration of up to two leisure-time activities performed by adults. Four mutually exclusive activity groups (Non-, Low-, ACSM/CDC-, and IOM-Active) were defined on the basis of frequencies and durations of reported activities. Leisure-time energy expenditure (kcal x kg(-1) x wk(-1)) was calculated per respondent. The energy expenditure threshold for meeting the IOM recommendation was calculated as 21 kcal x kg(-1) x wk(-1). Of the 162,669 respondents included in the analyses, 29.9% were Nonactive, whereas 42.3%, 23.3%, and 4.5% were Low-, ACSM/CDC-, and IOM-Active, respectively. Median leisure-time energy expenditure values were 9.0, 27.4, and 63.0 kcal x kg(-1) x wk(-1) for Low-, ACSM/CDC-, and IOM-Active groups, respectively. When using energy expenditure criteria, compliance with the IOM recommendation rose to 27.7% of respondents. Compliance with the IOM physical activity recommendation dramatically increased when assessed by energy expenditure compared with conventional criteria, thereby highlighting the potential bias of conventional methods. A significant proportion of adults

  5. From Recommendations to Reality: Educators Respond.

    ERIC Educational Resources Information Center

    Tedesco, Lisa A.

    1996-01-01

    This paper responds to the 1995 report of the Institute of Medicine concerning the present status and future needs of dental education in the United States. It describes the effort of the American Association of Dental Schools to systematically survey professional responses the IOM Report's recommendations. Among nine themes identified are…

  6. Veterinary medicine books recommended for academic libraries

    PubMed Central

    Crawley-Low, Jill

    2004-01-01

    This bibliography of in-print veterinary medical books published in English may be used as an acquisitions or evaluation tool for developing the monograph component of new veterinary medicine collections or existing science, technology, and medicine collections where veterinary medicine is in the scope of the collection. The bibliography is divided into 34 categories and consists of bibliographic information for 419 titles. The appendix contains an author/editor index. Prices for all entries are in US dollars, except where another currency is noted. The total cost of all books in the bibliography is $43,602.13 (US). PMID:15494763

  7. Veterinary medicine books recommended for academic libraries.

    PubMed

    Crawley-Low, Jill

    2004-10-01

    This bibliography of in-print veterinary medical books published in English may be used as an acquisitions or evaluation tool for developing the monograph component of new veterinary medicine collections or existing science, technology, and medicine collections where veterinary medicine is in the scope of the collection. The bibliography is divided into 34 categories and consists of bibliographic information for 419 titles. The appendix contains an author/editor index. Prices for all entries are in US dollars, except where another currency is noted. The total cost of all books in the bibliography is $43,602.13 (US).

  8. The University of Florida College of Dentistry Response to the IOM Report on Dental Education.

    ERIC Educational Resources Information Center

    Catalanotto, Frank A.; Heft, Marc W.

    1996-01-01

    This response of the University of Florida College of Dentistry to the Institute of Medicine's 1995 report concerning the present status and future needs of dental education stresses implications of eroding state funding for higher education. It notes use of the IOM report in the university's reorganization of the predoctoral curriculum as well as…

  9. Organizational technologies for transforming care: measures and strategies for pursuit of IOM quality aims.

    PubMed

    Gamm, Larry; Kash, Bita; Bolin, Jane

    2007-01-01

    Progress on the Institute of Medicine's (IOM's) 6 aims to bridge the "quality chasm" requires both measurement and the concerting of multiple organizational technologies. The basic thesis of this article is that rapid progress on the IOM's multiple aims calls for transformative change within and among healthcare organizations. The promise of a number of types of transformative approaches is closely linked to their ability to simultaneously build upon several organizational technologies: clinical, social, information, and administrative technologies. To encourage and advance such efforts, this article identifies illustrative measures of attainment of the IOM's 6 aims or targeted areas for improvement that reflect the contributions of the 4 organizational technologies. It discusses examples of relationships between the IOM aims and the organizational technologies considered. Finally, the article offers illustrations of the interplay of these organizational technologies and IOM aims-across an array of organizational innovations with transformative potential. Included among such innovations are information technology in the form of electronic medical records, computer-based physician order entry, and patient health records; organization-wide patient-centered cultural change such as Studer's Hardwiring Excellence; Six Sigma and Toyota Production Management/LEAN; major clinical technology change, for example, minimally invasive cardiac surgery and broader treatment innovations such as disease management.

  10. Disparities in Revascularization After ST Elevation Myocardial Infarction (STEMI) Before and After the 2002 IOM Report.

    PubMed

    Bolorunduro, Oluwaseyi B; Kiladejo, Adekunle V; Animashaun, Islamiyat Babs; Akinboboye, Olakunle O

    2016-05-01

    To examine nationwide trends for racial disparities in Percutaneous Coronary Intervention after ST elevated Myocardial Infarction (STEMI). The Institute of Medicine (IOM) report published in 2002 showed that African Americans were less likely to receive coronary revascularization such as CABG and stents even after controlling for socioeconomics. It recommended increased awareness of these disparities among health professionals to reduce this. We hypothesized that increased awareness of disparities since this report would have translated to reduction in racial disparities in percutaneous coronary intervention. A retrospective analysis was conducted using data from the Agency of Healthcare Research and Quality's (AHRQ) National Inpatient Sample (NIS) 1998-2007. All patients with STEMI during this period were identified. The proportion that received Percutaneous Coronary Intervention (PCI) during the incident admission was compared by different ethnicities over the time period. Multivariable regression for each year was conducted using Poisson regression with robust variances. The analysis controlled for gender, insurance status, co-morbidities, hospital bed size, location and teaching status. Based on the database, about 2.04 million patients were managed for acute Myocardial Infarction from 1998 to 2007, of these 938,176 had STEMI. The primary PCI rate after STEMI among Caucasians was 29.1%, African Americans-23.3% and Hispanics-28.3% [P < 0.001] On multivariate regression, compared to Caucasians, African Americans and Hispanics respectively were 26% (IRR = 0.74) and 16% (IRR = 0.84) less likely to receive PCI (both with P < 0.001) during the entire study period. Ethnic disparities in primary PCI after STEMI persist despite the 2002 IOM report. Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.

  11. The future of nursing: monitoring the progress of recommended change in hospitals, nurse-led clinics, and home health and hospice agencies.

    PubMed

    Pittman, Patricia; Bass, Emily; Hargraves, John; Herrera, Carolina; Thompson, Pamela

    2015-02-01

    The objective of this study was to assess the implementation of recommendations of the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health. In 2010, the IOM made a series of recommendations aimed at transforming the role of nurses in healthcare delivery. We conducted a multiyear survey, in 2011 and 2013, with nurse leaders who were members of the American Organization of Nurse Executives, the National Nursing Centers Consortium, or the Visiting Nurses Association of America. When comparing 2013 to 2011, we find progress in instituting the IOM's recommendations in 3 areas: (1) raising the proportion of employed RNs with at least a bachelor's degree; (2) expanding the proportion of healthcare institutions with nurse residency programs; and (3) offering opportunities for continuing nurse education Our findings suggest that healthcare organizations are transforming to support the recommendations of the IOM.

  12. Tobacco company efforts to influence the Food and Drug Administration-commissioned Institute of Medicine report clearing the smoke: an analysis of documents released through litigation.

    PubMed

    Tan, Crystal E; Kyriss, Thomas; Glantz, Stanton A

    2013-01-01

    Spurred by the creation of potential modified risk tobacco products, the US Food and Drug Administration (FDA) commissioned the Institute of Medicine (IOM) to assess the science base for tobacco "harm reduction," leading to the 2001 IOM report Clearing the Smoke. The objective of this study was to determine how the tobacco industry organized to try to influence the IOM committee that prepared the report. We analyzed previously secret tobacco industry documents in the University of California, San Francisco Legacy Tobacco Documents Library, and IOM public access files. (A limitation of this method includes the fact that the tobacco companies have withheld some possibly relevant documents.) Tobacco companies considered the IOM report to have high-stakes regulatory implications. They developed and implemented strategies with consulting and legal firms to access the IOM proceedings. When the IOM study staff invited the companies to provide information on exposure and disease markers, clinical trial design for safety and efficacy, and implications for initiation and cessation, tobacco company lawyers, consultants, and in-house regulatory staff shaped presentations from company scientists. Although the available evidence does not permit drawing cause-and-effect conclusions, and the IOM may have come to the same conclusions without the influence of the tobacco industry, the companies were pleased with the final report, particularly the recommendations for a tiered claims system (with separate tiers for exposure and risk, which they believed would ease the process of qualifying for a claim) and license to sell products comparable to existing conventional cigarettes ("substantial equivalence") without prior regulatory approval. Some principles from the IOM report, including elements of the substantial equivalence recommendation, appear in the 2009 Family Smoking Prevention and Tobacco Control Act. Tobacco companies strategically interacted with the IOM to win several

  13. Tobacco Company Efforts to Influence the Food and Drug Administration-Commissioned Institute of Medicine Report Clearing the Smoke: An Analysis of Documents Released through Litigation

    PubMed Central

    Tan, Crystal E.; Kyriss, Thomas; Glantz, Stanton A.

    2013-01-01

    Background Spurred by the creation of potential modified risk tobacco products, the US Food and Drug Administration (FDA) commissioned the Institute of Medicine (IOM) to assess the science base for tobacco “harm reduction,” leading to the 2001 IOM report Clearing the Smoke. The objective of this study was to determine how the tobacco industry organized to try to influence the IOM committee that prepared the report. Methods and Findings We analyzed previously secret tobacco industry documents in the University of California, San Francisco Legacy Tobacco Documents Library, and IOM public access files. (A limitation of this method includes the fact that the tobacco companies have withheld some possibly relevant documents.) Tobacco companies considered the IOM report to have high-stakes regulatory implications. They developed and implemented strategies with consulting and legal firms to access the IOM proceedings. When the IOM study staff invited the companies to provide information on exposure and disease markers, clinical trial design for safety and efficacy, and implications for initiation and cessation, tobacco company lawyers, consultants, and in-house regulatory staff shaped presentations from company scientists. Although the available evidence does not permit drawing cause-and-effect conclusions, and the IOM may have come to the same conclusions without the influence of the tobacco industry, the companies were pleased with the final report, particularly the recommendations for a tiered claims system (with separate tiers for exposure and risk, which they believed would ease the process of qualifying for a claim) and license to sell products comparable to existing conventional cigarettes (“substantial equivalence”) without prior regulatory approval. Some principles from the IOM report, including elements of the substantial equivalence recommendation, appear in the 2009 Family Smoking Prevention and Tobacco Control Act. Conclusions Tobacco companies

  14. Recommendations on strengthening the development of nuclear medicine in China.

    PubMed

    Wang, Shih-chen

    2009-03-01

    This paper outlines briefly the role of nuclear medicine in life sciences and health care. Molecular imaging by using isotopic tracers can noninvasively visualize the chemistry or hidden process in the cells and tissues inside the body, obtaining "functional" images to provide early information of any disease and revealing the secrets of life. The vitality of nuclear medicine is its ability to translate bench into new clinical application that can benefits the patients. Although nuclear medicine community in China has made significant achievement with a great effort since 1950s, there are many obstacles to future development. Recommended measures are proposed here in an attempt to solve our existing problems.

  15. Personalized Lifestyle Medicine: Relevance for Nutrition and Lifestyle Recommendations

    PubMed Central

    Minich, Deanna M.; Bland, Jeffrey S.

    2013-01-01

    Public health recommendations for lifestyle modification, including diet and physical activity, have been widely disseminated for the prevention and treatment of disease. These guidelines are intended for the overall population without significant consideration for the individual with respect to one's genes and environment. Personalized lifestyle medicine is a newly developed term that refers to an approach to medicine in which an individual's health metrics from point-of-care diagnostics are used to develop lifestyle medicine-oriented therapeutic strategies for improving individual health outcomes in managing chronic disease. Examples of the application of personalized lifestyle medicine to patient care include the identification of genetic variants through laboratory tests and/or functional biomarkers for the purpose of designing patient-specific prescriptions for diet, exercise, stress, and environment. Personalized lifestyle medicine can provide solutions to chronic health problems by harnessing innovative and evolving technologies based on recent discoveries in genomics, epigenetics, systems biology, life and behavioral sciences, and diagnostics and clinical medicine. A comprehensive, personalized approach to medicine is required to promote the safety of therapeutics and reduce the cost of chronic disease. Personalized lifestyle medicine may provide a novel means of addressing a patient's health by empowering them with information they need to regain control of their health. PMID:23878520

  16. Is traditional Chinese medicine recommended in Western medicine clinical practice guidelines in China? A systematic analysis

    PubMed Central

    Ren, Jun; Li, Xun; Sun, Jin; Han, Mei; Yang, Guo-Yan; Li, Wen-Yuan; Robinson, Nicola; Lewith, George; Liu, Jian-Ping

    2015-01-01

    Background Evidence-based medicine promotes and relies on the use of evidence in developing clinical practice guidelines (CPGs). The Chinese healthcare system includes both traditional Chinese medicine (TCM) and Western medicine, which are expected to be equally reflected in Chinese CPGs. Objective To evaluate the inclusion of TCM-related information in Western medicine CPGs developed in China and the adoption of high level evidence. Methods All CPGs were identified from the China Guideline Clearinghouse (CGC), which is the main Chinese organisation maintaining the guidelines issued by the Ministry of Health of China, the Chinese Medical Association and the Chinese Medical Doctors’ Association. TCM-related contents were extracted from all the CPGs identified. Extracted information comprised the institution issuing the guideline, date of issue, disease, recommendations relating to TCM, evidence level of the recommended content and references supporting the recommendations. Results A total of 604 CPGs were identified, only a small number of which (74/604; 12%) recommended TCM therapy and only five guidelines (7%) had applied evidence grading. The 74 CPGs involved 13 disease systems according to the International Classification of Diseases 10th edition. TCM was mainly recommended in the treatment part of the guidelines (73/74, 99%), and more than half of the recommendations (43/74, 58%) were related to Chinese herbal medicine (single herbs or herbal treatment based on syndrome differentiation). Conclusions Few Chinese Western medicine CPGs recommend TCM therapies and very few provide evidence grading for the TCM recommendation. We suggest that future guideline development should be based on systematic searches for evidence to support CPG recommendations and involve a multidisciplinary approach including TCM expertise. PMID:26041487

  17. Calling in the feds. IOM's new report says government must take lead in quality, but can Congress, hospitals find the money and support?

    PubMed

    Tieman, Jeff

    2002-11-04

    A new report by the Institute of Medicine calls for the federal government to "take the lead" in healthcare quality. Janet Corrigan, director of the IOM's Board of Health Care Services, and other members of the IOM say only the nation's largest provider and payer has what it takes to build a safer environment for patients. Can Congress come up with the money and support necessary to sustain such an undertaking?

  18. Toward clinical genomics in everyday medicine: perspectives and recommendations.

    PubMed

    Delaney, Susan K; Hultner, Michael L; Jacob, Howard J; Ledbetter, David H; McCarthy, Jeanette J; Ball, Michael; Beckman, Kenneth B; Belmont, John W; Bloss, Cinnamon S; Christman, Michael F; Cosgrove, Andy; Damiani, Stephen A; Danis, Timothy; Delledonne, Massimo; Dougherty, Michael J; Dudley, Joel T; Faucett, W Andrew; Friedman, Jennifer R; Haase, David H; Hays, Tom S; Heilsberg, Stu; Huber, Jeff; Kaminsky, Leah; Ledbetter, Nikki; Lee, Warren H; Levin, Elissa; Libiger, Ondrej; Linderman, Michael; Love, Richard L; Magnus, David C; Martland, AnneMarie; McClure, Susan L; Megill, Scott E; Messier, Helen; Nussbaum, Robert L; Palaniappan, Latha; Patay, Bradley A; Popovich, Bradley W; Quackenbush, John; Savant, Mark J; Su, Michael M; Terry, Sharon F; Tucker, Steven; Wong, William T; Green, Robert C

    2016-01-01

    Precision or personalized medicine through clinical genome and exome sequencing has been described by some as a revolution that could transform healthcare delivery, yet it is currently used in only a small fraction of patients, principally for the diagnosis of suspected Mendelian conditions and for targeting cancer treatments. Given the burden of illness in our society, it is of interest to ask how clinical genome and exome sequencing can be constructively integrated more broadly into the routine practice of medicine for the betterment of public health. In November 2014, 46 experts from academia, industry, policy and patient advocacy gathered in a conference sponsored by Illumina, Inc. to discuss this question, share viewpoints and propose recommendations. This perspective summarizes that work and identifies some of the obstacles and opportunities that must be considered in translating advances in genomics more widely into the practice of medicine.

  19. Toward clinical genomics in everyday medicine: perspectives and recommendations

    PubMed Central

    Delaney, Susan K.; Hultner, Michael L.; Jacob, Howard J.; Ledbetter, David H.; McCarthy, Jeanette J.; Ball, Michael; Beckman, Kenneth B.; Belmont, John W.; Bloss, Cinnamon S.; Christman, Michael F.; Cosgrove, Andy; Damiani, Stephen A.; Danis, Timothy; Delledonne, Massimo; Dougherty, Michael J.; Dudley, Joel T.; Faucett, W. Andrew; Friedman, Jennifer R.; Haase, David H.; Hays, Tom S.; Heilsberg, Stu; Huber, Jeff; Kaminsky, Leah; Ledbetter, Nikki; Lee, Warren H.; Levin, Elissa; Libiger, Ondrej; Linderman, Michael; Love, Richard L.; Magnus, David C.; Martland, AnneMarie; McClure, Susan L.; Megill, Scott E.; Messier, Helen; Nussbaum, Robert L.; Palaniappan, Latha; Patay, Bradley A.; Popovich, Bradley W.; Quackenbush, John; Savant, Mark J.; Su, Michael M.; Terry, Sharon F.; Tucker, Steven; Wong, William T.; Green, Robert C.

    2016-01-01

    ABSTRACT Precision or personalized medicine through clinical genome and exome sequencing has been described by some as a revolution that could transform healthcare delivery, yet it is currently used in only a small fraction of patients, principally for the diagnosis of suspected Mendelian conditions and for targeting cancer treatments. Given the burden of illness in our society, it is of interest to ask how clinical genome and exome sequencing can be constructively integrated more broadly into the routine practice of medicine for the betterment of public health. In November 2014, 46 experts from academia, industry, policy and patient advocacy gathered in a conference sponsored by Illumina, Inc. to discuss this question, share viewpoints and propose recommendations. This perspective summarizes that work and identifies some of the obstacles and opportunities that must be considered in translating advances in genomics more widely into the practice of medicine. PMID:26810587

  20. Higher adherence to Mediterranean diet prior to pregnancy is associated with decreased risk for deviation from the maternal recommended gestational weight gain.

    PubMed

    Koutelidakis, Antonios E; Alexatou, Olga; Kousaiti, Savvina; Gkretsi, Elisavet; Vasios, George; Sampani, Anastasia; Tolia, Maria; Kiortsis, Dimitrios N; Giaginis, Constantinos

    2017-06-14

    The present retrospective study was conducted on 1482 women in order to evaluate whether their pre-pregnancy adherence to the Mediterranean diet may affect maternal gestational weight gain (GWG). For this purpose, the study population was classified according to the Institute of Medicine (IOM) recommendations concerning GWG. Pre-pregnancy adherence to the Mediterranean diet was assessed with 11 food patterns groups based on their contribution in the Mediterranean diet pyramid. Women with high adherence to the Mediterranean diet were more frequently characterised by GWG inside the IOM recommendations. In multivariate analysis, women with low Mediterranean diet adherence were almost twice at risk in presenting deflection from recommended GWG regardless of various confounding factors. These findings suggested that high pre-pregnancy adherence to the Mediterranean diet may be associated with reduced risk for GWG outside the IOM recommendations. However, larger prospective studies are strongly recommended in order for more precise conclusions to be drawn.

  1. Strong agreement of nationally recommended retention measures from the Institute of Medicine and Department of Health and Human Services.

    PubMed

    Rebeiro, Peter F; Horberg, Michael A; Gange, Stephen J; Gebo, Kelly A; Yehia, Baligh R; Brooks, John T; Buchacz, Kate; Silverberg, Michael J; Gill, John; Moore, Richard D; Althoff, Keri N

    2014-01-01

    We sought to quantify agreement between Institute of Medicine (IOM) and Department of Health and Human Services (DHHS) retention indicators, which have not been compared in the same population, and assess clinical retention within the largest HIV cohort collaboration in the U.S. Observational study from 2008-2010, using clinical cohort data in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Retention definitions used HIV primary care visits. The IOM retention indicator was: ≥2 visits, ≥90 days apart, each calendar year. This was extended to a 2-year period; retention required meeting the definition in both years. The DHHS retention indicator was: ≥1 visit each semester over 2 years, each ≥60 days apart. Kappa statistics detected agreement between indicators and C statistics (areas under Receiver-Operating Characteristic curves) from logistic regression analyses summarized discrimination of the IOM indicator by the DHHS indicator. Among 36,769 patients in 2008-2009 and 34,017 in 2009-2010, there were higher percentages of participants retained in care under the IOM indicator than the DHHS indicator (80% vs. 75% in 2008-2009; 78% vs. 72% in 2009-2010, respectively) (p<0.01), persisting across all demographic and clinical characteristics (p<0.01). There was high agreement between indicators overall (κ = 0.83 in 2008-2009; κ = 0.79 in 2009-2010, p<0.001), and C statistics revealed a very strong ability to predict retention according to the IOM indicator based on DHHS indicator status, even within characteristic strata. Although the IOM indicator consistently reported higher retention in care compared with the DHHS indicator, there was strong agreement between IOM and DHHS retention indicators in a cohort demographically similar to persons living with HIV/AIDS in the U.S. Persons with poorer retention represent subgroups of interest for retention improvement programs nationally, particularly in light of the White House

  2. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety.

    PubMed

    Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

    2011-01-01

    should not be left unsupervised to care for critically ill patients. In settings in which the acuity is high, physicians who have completed residency should provide direct supervision for resident physicians. Supervising physicians should always be physically in the hospital for supervision of resident physicians who care for critically ill patientsThe ACGME should explicitly define "good" supervision by specialty and by year of training. Explicit requirements for intensity and level of training for supervision of specific clinical scenarios should be providedCenters for Medicare and Medicaid Services (CMS) should use graduate medical education funding to provide incentives to programs with proven, effective levels of supervision. Although this action would require federal legislation, reimbursement rules would help to ensure that hospitals pay attention to the importance of good supervision and require it from their training programs. RESIDENT PHYSICIAN WORK HOURS: Although the IOM "Sleep, supervision and safety" report provides a comprehensive review and discussion of all aspects of graduate medical education training, the report's focal point is its recommendations regarding the hours that resident physicians are currently required to work. A considerable body of scientific evidence, much of it cited by the Institute of Medicine report, describes deteriorating performance in fatigued humans, as well as specific studies on resident physician fatigue and preventable medical errors. The question before this conference was what work redesign and cultural changes are needed to reform work hours as recommended by the Institute of Medicine's evidence-based report? Extensive scientific data demonstrate that shifts exceeding 12-16 hours without sleep are unsafe. Several principles should be followed in efforts to reduce consecutive hours below this level and achieve safer work schedules. The recommendations are: Limit resident physician work hours to 12-16 hour maximum shifts

  3. Recommendations from the Society for Academic Emergency Medicine (SAEM) Taskforce on women in academic emergency medicine.

    PubMed

    Kuhn, Gloria J; Abbuhl, Stephanie B; Clem, Kathleen J

    2008-08-01

    The Society for Academic Emergency Medicine (SAEM) convened a taskforce to study issues pertaining to women in academic emergency medicine (EM). The charge to the Taskforce was to "Create a document for the SAEM Board of Directors that defines and describes the unique recruitment, retention, and advancement needs for women in academic emergency medicine." To this end, the Taskforce and authors reviewed the literature to highlight key data points in understanding this issue and made recommendations for individuals at four levels of leadership and accountability: leadership of national EM organizations, medical school deans, department chairs, and individual women faculty members. The broad range of individuals targeted for recommendations reflects the interdependent and shared responsibility required to address changes in the culture of academic EM. The following method was used to determine the recommendations: 1) Taskforce members discussed career barriers and potential solutions that could improve the recruitment, retention, and advancement of women in academic EM; 2) the authors reviewed recommendations in the literature by national consensus groups and experts in the field to validate the recommendations of Taskforce members and the authors; and 3) final recommendations were sent to all Taskforce members to obtain and incorporate additional comments and ensure a consensus. This article contains those recommendations and cites the relevant literature addressing this topic.

  4. Making Personalized Health Care Even More Personalized: Insights From Activities of the IOM Genomics Roundtable.

    PubMed

    David, Sean P; Johnson, Samuel G; Berger, Adam C; Feero, W Gregory; Terry, Sharon F; Green, Larry A; Phillips, Robert L; Ginsburg, Geoffrey S

    2015-01-01

    Genomic research has generated much new knowledge into mechanisms of human disease, with the potential to catalyze novel drug discovery and development, prenatal and neonatal screening, clinical pharmacogenomics, more sensitive risk prediction, and enhanced diagnostics. Genomic medicine, however, has been limited by critical evidence gaps, especially those related to clinical utility and applicability to diverse populations. Genomic medicine may have the greatest impact on health care if it is integrated into primary care, where most health care is received and where evidence supports the value of personalized medicine grounded in continuous healing relationships. Redesigned primary care is the most relevant setting for clinically useful genomic medicine research. Taking insights gained from the activities of the Institute of Medicine (IOM) Roundtable on Translating Genomic-Based Research for Health, we apply lessons learned from the patient-centered medical home national experience to implement genomic medicine in a patient-centered, learning health care system.

  5. Making Personalized Health Care Even More Personalized: Insights From Activities of the IOM Genomics Roundtable

    PubMed Central

    David, Sean P.; Johnson, Samuel G.; Berger, Adam C.; Feero, W. Gregory; Terry, Sharon F.; Green, Larry A.; Phillips, Robert L.; Ginsburg, Geoffrey S.

    2015-01-01

    Genomic research has generated much new knowledge into mechanisms of human disease, with the potential to catalyze novel drug discovery and development, prenatal and neonatal screening, clinical pharmacogenomics, more sensitive risk prediction, and enhanced diagnostics. Genomic medicine, however, has been limited by critical evidence gaps, especially those related to clinical utility and applicability to diverse populations. Genomic medicine may have the greatest impact on health care if it is integrated into primary care, where most health care is received and where evidence supports the value of personalized medicine grounded in continuous healing relationships. Redesigned primary care is the most relevant setting for clinically useful genomic medicine research. Taking insights gained from the activities of the Institute of Medicine (IOM) Roundtable on Translating Genomic-Based Research for Health, we apply lessons learned from the patient-centered medical home national experience to implement genomic medicine in a patient-centered, learning health care system. PMID:26195686

  6. [Criminal implication of sponsoring in medicine: legal ramifactions and recommendations].

    PubMed

    Mahnken, A H; Theilmann, M; Bolenz, M; Günther, R W

    2005-08-01

    As a consequence of the so-called "Heart-Valve-Affair" in 1994, the German public became aware of the potential criminal significance of industrial sponsoring and third-party financial support in medicine. Since 1997, when the German Anti-Corruption Law came into effect, the penal regulations regarding bribery and benefits for public officers were tightened. Due to the lack of explicit and generally accepted guidelines in combination with regional differences of jurisdiction, there is a lingering uncertainty regarding the criminal aspects of third-party funding and industrial sponsoring. The aim of this review is to summarize the penal and professional implications of third-party funding and sponsoring in medicine including recent aspects of jurisdiction. The currently available recommendations on this issue are introduced.

  7. Ensuring quality cancer care: a follow-up review of the Institute of Medicine's 10 recommendations for improving the quality of cancer care in America.

    PubMed

    Spinks, Tracy; Albright, Heidi W; Feeley, Thomas W; Walters, Ron; Burke, Thomas W; Aloia, Thomas; Bruera, Eduardo; Buzdar, Aman; Foxhall, Lewis; Hui, David; Summers, Barbara; Rodriguez, Alma; Dubois, Raymond; Shine, Kenneth I

    2012-05-15

    Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US health care system in the late 1990s. The National Cancer Policy Board (NCPB), a 20-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system in which patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. The report outlined 10 recommendations, which, when implemented, would: 1) improve the quality of cancer care, 2) increase the current understanding of quality cancer care, and 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating health care costs, has prompted national efforts to reform the health care system. These efforts by health care providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States.

  8. The Cease Smoking Today (CS2day) initiative: a guide to pursue the 2010 IOM report vision for CPD.

    PubMed

    Cervero, Ronald M; Moore, Donald E

    2011-01-01

    This article reviews the articles in this supplement that describe a smoking cessation project, Cease Smoking Today (CS2day) that demonstrated successful outcomes: physician adoption of a smoking cessation guideline and an increase in smoking quit rates. The authors examine how the activities of the CS2day project compared to the principles and characteristics of the vision for a future system of continuing professional development that was described in the 2010 Institute of Medicine (IOM) report, Redesigning Continuing Education in the Health Professions. While it did not meet all the characteristics of the IOM's vision, the CS2day Initiative met enough of them for the authors to suggest that the momentum that the IOM report generated has been sustained. The authors point out two strengths and two weaknesses that further strategic and organizational efforts should consider. The two strengths were the collaborative nature of the project and an approach to continuous outcomes assessment that was based on competencies derived from a practice guideline. The authors also suggested that future similar efforts should place more emphasis on instructional design and developing a program theory to guide program operations and educational development. The authors encouraged members of the CME profession to consider the accomplishments of the CS2day project as they are planning to move their CME programs toward the vision described in the IOM Report. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  9. The Institute of Medicine Guidelines for Gestational Weight Gain after a Diagnosis of Gestational Diabetes and Pregnancy Outcomes

    PubMed Central

    Harper, Lorie M.; Tita, Alan; Biggio, Joseph R.

    2014-01-01

    Objective To assess the impact of gestational weight gain outside the Institute of Medicine (IOM) recommendations after the diagnosis of gestational diabetes (GDM) on perinatal outcomes. Methods Retrospective cohort study. Women were classified as GWG within, less than, or greater than IOM recommendations for body mass index (BMI) as calculated by gestational weight gain per week after a diagnosis of GDM. Outcomes assessed were preeclampsia, cesarean delivery, A2 GDM, birth weight, small for gestational age, large for gestational age, macrosomia, and preterm delivery. Groups were compared using analysis of variance and chi-squared test for trend, as appropriate. Backwards stepwise logistic regression was used to adjust for significant confounding factors. Results Of 635 subjects, 92 gained within, 175 gained less than, and 368 gained more than IOM recommendations. The risk of cesarean delivery and A2 GDM was increased in those gaining above the IOM recommendations compared to within. For every 1-lb/week increase in weight gain after diagnosis of GDM, there was a 36–83% increase in the risk of preeclampsia, cesarean, A2 GDM, macrosomia, and LGA, without decreases in SGA or preterm delivery. Conclusions Weight gain more than the IOM recommendations per week of gestation after a diagnosis of GDM is associated with adverse pregnancy outcomes. PMID:24971568

  10. The Institute of Medicine's Report on "Research Training in Psychiatry Residency: Strategies for Reform"--Background, Results, and Follow Up

    ERIC Educational Resources Information Center

    Yager, Joel; Greden, John; Abrams, Michael; Riba, Michelle

    2004-01-01

    Objective: The National Institute of Mental Health (NIMH) determined that declines in the psychiatrist-researcher workforce are harming public needs and that significant steps are necessary to alter current trends. Method: The NIMH commissioned the Institute of Medicine (IOM) to examine the undersupply and recommend solutions. The NIMH…

  11. Medicines and the media: news reports of medicines recommended for government reimbursement in Australia

    PubMed Central

    2013-01-01

    Background Previous analyses of the listings of trastuzumab on the Australian Pharmaceutical Benefits Scheme (PBS) and HPV vaccine on the National Immunisation Program (NIP) suggest a media influence on policy makers. We examined the timing and content of Australian newspaper reports of medicines in relation to Pharmaceutical Benefits Advisory Committee (PBAC) decisions. Methods We identified newspaper reports (2005-2008) of medicines recommended for PBS listing in 2006–2007, analysing the content for mentions of the medicine, PBS and medicine costs to the patient and the government and counting the numbers of articles published in the six months before, the month of, and the six months after the relevant PBAC meeting. Case studies examined reporting for infliximab for Crohn’s Disease, pemetrexed for mesothelioma, and ADHD (Attention Deficit Hyperactivity Disorder) medicines atomoxetine and methylphenidate. Results Of 79 eligible medicines, 62 had news reports. Most often reported were HPV vaccine (1230 stories), trastuzumab (410), pemetrexed (83), botulinum toxin (71), lapatinib (65), methylphenidate (57), atomoxetine (54), infliximab (49), rotavirus vaccine (45). Eighteen medicines had ≥20 news reports (total 2350 stories); nine of these cost more than AU$10,000 per course or year of treatment. For these 18 medicines, 31% of stories appeared in the six months prior to the PBAC meeting, 14% in the meeting month and 33% in the six months post-meeting. 38% of the stories had ≥3 medicine mentions, 37% referred to the PBS, 24% to cost to the patient, and 9% cost to Government. There was active patient lobby group campaigning in support of listing of infliximab and pemetrexed; the stories for ADHD were often more negative, referring to the dangers of the medicines and sometimes questioning the appropriateness of treatment and public subsidy. There was little discussion of the PBAC’s evidence-based decision-making processes. Conclusions While there was no

  12. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety

    PubMed Central

    Blum, Alexander B; Shea, Sandra; Czeisler, Charles A; Landrigan, Christopher P; Leape, Lucian

    2011-01-01

    services. Resident physicians should not be left unsupervised to care for critically ill patients. In settings in which the acuity is high, physicians who have completed residency should provide direct supervision for resident physicians. Supervising physicians should always be physically in the hospital for supervision of resident physicians who care for critically ill patientsThe ACGME should explicitly define “good” supervision by specialty and by year of training. Explicit requirements for intensity and level of training for supervision of specific clinical scenarios should be providedCenters for Medicare and Medicaid Services (CMS) should use graduate medical education funding to provide incentives to programs with proven, effective levels of supervision. Although this action would require federal legislation, reimbursement rules would help to ensure that hospitals pay attention to the importance of good supervision and require it from their training programs Resident physician work hours Although the IOM “Sleep, supervision and safety” report provides a comprehensive review and discussion of all aspects of graduate medical education training, the report’s focal point is its recommendations regarding the hours that resident physicians are currently required to work. A considerable body of scientific evidence, much of it cited by the Institute of Medicine report, describes deteriorating performance in fatigued humans, as well as specific studies on resident physician fatigue and preventable medical errors. The question before this conference was what work redesign and cultural changes are needed to reform work hours as recommended by the Institute of Medicine’s evidence-based report? Extensive scientific data demonstrate that shifts exceeding 12–16 hours without sleep are unsafe. Several principles should be followed in efforts to reduce consecutive hours below this level and achieve safer work schedules. The recommendations are: Limit resident physician

  13. Regulatory agencies' recommendations for medicine information leaflets: Are they in line with research findings?

    PubMed

    Young, Amber; Tordoff, June; Smith, Alesha

    2017-03-04

    The design of medicine information leaflets can determine whether a leaflet will be read or discarded by patients. It may also influence patients' ability to understand the information about their medicines within the leaflet. Researchers compared regulatory agencies' recommendations for medicine information leaflet design from New Zealand, the United Kingdom, Europe, and the United States against recommended good design principles to determine the appropriateness, comprehensiveness, and consistency of their recommendations. Recommendations for medicine information leaflets varied between the regulatory agencies. There were some inconsistencies between the recommendations and some gaps were identified. There was little regulatory guidance given to creators of medicine information leaflets in New Zealand compared to other countries, and this could lead to manufacturer-produced information leaflets of a poorer quality. Up-to-date and enforceable guidance for creators of medicine information leaflets should be provided in all countries to ensure they are of an appropriate standard.

  14. Essential medicines for cancer: WHO recommendations and national priorities

    PubMed Central

    Robertson, Jane; Barr, Ronald; Shulman, Lawrence N; Forte, Gilles B

    2016-01-01

    Abstract Objective To examine, for essential anti-cancer medicines, the alignment of national lists of essential medicines and national reimbursable medicines lists with the World Health Organization’s (WHO’s) Model Lists. Methods National medicine lists for 135 countries with per-capita gross national incomes below 25 000 United States dollars in 2015 were compared with WHO’s 2013 and 2015 Model Lists of Essential Medicines. Correlations between numbers of anti-cancer medicines included in national lists and gross national income (GNI), government health expenditure and number of physicians per 1000 population were evaluated. Findings Of the 25 anti-cancer medicines on the 2013 Model List and the 16 added via the 2015 revision of the Model List, 0–25 (median: 17) and 0–15 (median: 3) appeared in national lists, respectively. There was considerable variability in these numbers within and between World Bank income groups. Of the 16 new medicines included in the 2015 Model List, for example, 0–10 (median: 1) and 2–15 (median: 10) were included in the national lists of low-income and high-income countries, respectively. The numbers of these new medicines included in national lists were significantly correlated (P ≤ 0.0001) with per-capita GNI (r = 0.45), per-capita annual government health expenditure (r = 0.33) and number of physicians per 1000 population (r = 0.48). Twenty-one countries (16%) included the targeted anti-cancer medicines imatinib, rituximab and trastuzumab in their national lists. Conclusion Substantial numbers of anti-cancer medicines are included in national lists of low- and middle-income countries but the availability, affordability, accessibility and administration feasibility of these medicines, at country-level, need assessment. PMID:27843163

  15. Reflections on market access for personalized medicine: recommendations for Europe.

    PubMed

    Payne, Katherine; Annemans, Lieven

    2013-01-01

    This article aims to provide an overview of the current literature focusing on the reimbursement of personalized medicine across the European Union. The article starts by describing types of perspectives that are possible (general public, patient, payer, provider, service commissioner, and policymaker). The description of perspectives also explains the importance of understanding the different possible decision criteria and processes from the various perspectives by taking into account budget constraints. The article then focuses on an example of personalized medicine, namely, the use of companion diagnostic-medicine combinations, to describe the role of reimbursement/payer agencies across the European Union to control the introduction and coverage of such companion diagnostic-medicine technologies. The article touches on the strategic challenges and the use of economic evidence to introduce personalized medicine from a health policy perspective. The article also draws on empirical studies that have explored patients' and clinicians' views of examples of personalized medicine to illustrate the challenges for developing patient-centered and timely health care services.

  16. [Intratumoral administration of biological preparations--recommendation for integrative medicine].

    PubMed

    Ebina, T

    2001-10-01

    The antitumor effect of biological preparations was examined in a double grafted tumor system. PSK is a hot water extract of cultured mycelia from Coliolus versicolor. Its protein content is about 38% and the main glycoside portion of PSK is beta-D-glucan. Lentinan is purified from fruit bodies of Lentinus edodes and is a beta-1, 3-glucan. Cepharanthin is an extract from the root of Stephania cepharantha HAYATA, consisting of 4 kinds of biscoclaurine alkaloids. TAHEEBO tea is a hot water extract of Tabebuia avellanedae, the active ingredient of which is naphthoquinones. If protein-bound polysaccharides were to be used in Western medicine, these polysaccharides would be purified, but purified beta-glucan loses its beneficial effects. Similarly, when raw Cepharanthin is purified to isolate its active ingredient (an alkaloid cepharanthine), its anti-tumor effect is weakened. Clear IAP induction was observed in serum of mice treated with extracts of Coliolus versicolor and Stephania cepharantha. However, IAP induction was not observed in the serum of mice treated with purified beta-glucan or purified alkaloid. This suggests that macrophages may recognize extracts but not purified substances. In Western medicine, purified substances with known chemical structures are recognized as drugs, but overdoses of these drugs are toxic to the body, thus adverse reactions are always an issue. In Chinese medicine, mixtures containing several crude drugs are recognized as drugs, whose active ingredients are not identified. In integrative medicine, drugs are extracts that contain active ingredients with known structures and functions. We propose a Japanese version of integrative medicine which is neither Western nor Chinese.

  17. CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration (Traditional Chinese Version).

    PubMed

    Cheng, Chung-Wah; Wu, Tai-Xiang; Shang, Hong-Cai; Li, You-Ping; Altman, Douglas G; Moher, David; Bian, Zhao-Xiang

    2017-07-18

    Editors' Note: This article is the traditional Chinese version of the CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration. (Cheng C, Wu T, Shang H, Li, Y, Altman D, Moher D; CONSORT-CHM Formulas 2017 Group. CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration. Ann Intern Med. 2017;167:112-21. [Epub 27 June 2017]. doi:10.7326/M16-2977).

  18. CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration (Simplified Chinese Version).

    PubMed

    Cheng, Chung-Wah; Wu, Tai-Xiang; Shang, Hong-Cai; Li, You-Ping; Altman, Douglas G; Moher, David; Bian, Zhao-Xiang

    2017-07-18

    Editors' Note: This article is the simplified Chinese version of the CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration. (Cheng C, Wu T, Shang H, Li, Y, Altman D, Moher D; CONSORT-CHM Formulas 2017 Group. CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, Explanation, and Elaboration. Ann Intern Med. 2017;167:112-21. [Epub 27 June 2017]. doi:10.7326/M16-2977).

  19. Implementing the Association of Teachers of Preventive Medicine's Recommendations into the Undergraduate Medical School Curriculum.

    ERIC Educational Resources Information Center

    Altekruse, Joan; And Others

    1991-01-01

    Ideas for integrating preventive medicine into the undergraduate medical curriculum include options for curricula in quantitative skills, clinical preventive medicine, primary care rotation, community health services, and independent continuing education. Recommendations are based on a guide assessing the effectiveness of 169 types of preventive…

  20. Implementing the Association of Teachers of Preventive Medicine's Recommendations into the Undergraduate Medical School Curriculum.

    ERIC Educational Resources Information Center

    Altekruse, Joan; And Others

    1991-01-01

    Ideas for integrating preventive medicine into the undergraduate medical curriculum include options for curricula in quantitative skills, clinical preventive medicine, primary care rotation, community health services, and independent continuing education. Recommendations are based on a guide assessing the effectiveness of 169 types of preventive…

  1. Nuclear medicine survey recommendations for a changing regulatory environment.

    PubMed

    Vernig, P G; Schumacher, T A

    2001-11-01

    The revision of 10 CFR 35 approved on 23 September 2000 and due for implementation in 2001, reduces the number of required radiation and contamination surveys to one ambient radiation survey each day when an administration requiring a written directive is used. This paper compares the current requirements in 10 CFR 35; the single, remaining, specific requirement in the revised part 35; the Nuclear Regulatory Commission's guidance in the proposed NUREG SR1556 and the general requirement for surveys to demonstrate compliance with 10 CFR 20. We also make recommendations on what periodic surveys are prudent.

  2. Analysis of the Italian generic medicines retail market: recommendations to enhance long-term sustainability.

    PubMed

    Dylst, Pieter; Vulto, Arnold; Simoens, Steven

    2015-02-01

    Italy is among the European countries with the lowest uptake of generic medicines. This paper provides a perspective on the Italian generic medicines retail market. Fast market entrance of generic medicines in Italy is hindered by several factors: the existence of Complementary Protection Certificates in the past, the large market for copies and multiple cases of patent linkage. Prices of generic medicines in Italy are low compared to other European countries. To contain pharmaceutical expenditure, pharmaceutical companies are currently forced to pay back in case of overspending, which disproportionally penalizes small and fast growing companies, to which most generic companies belong to. Current demand-side policies do not successfully stimulate the use of generic medicines. The current market environment surrounding the Italian generic medicines retail market (i.e., low prices, low volumes) threatens its long-term sustainability. Recommendations to enhance the long-term sustainability of the Italian generic medicines retail market round off this perspective paper.

  3. American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships.

    PubMed

    Finnoff, Jonathan T; Berkoff, David; Brennan, Fred; DiFiori, John; Hall, Mederic M; Harmon, Kimberly; Lavallee, Mark; Martin, Sean; Smith, Jay; Stovak, Mark

    2015-02-01

    The American Medical Society for Sports Medicine (AMSSM) developed a musculoskeletal ultrasound curriculum for sports medicine fellowships in 2010. As the use of diagnostic and interventional ultrasound in sports medicine has evolved, it became clear that the curriculum needed to be updated. Furthermore, the name 'musculoskeletal ultrasound' was changed to 'sports ultrasound' (SPORTS US) to reflect the broad range of diagnostic and interventional applications of ultrasound in sports medicine. This document was created to outline the core competencies of SPORTS US and to provide sports medicine fellowship directors and others interested in SPORTS US education with a guide to create a SPORTS US curriculum. By completing this SPORTS US curriculum, sports medicine fellows and physicians can attain proficiency in the core competencies of SPORTS US required for the practice of sports medicine.

  4. Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group.

    PubMed

    Ma, Irene W Y; Arishenkoff, Shane; Wiseman, Jeffrey; Desy, Janeve; Ailon, Jonathan; Martin, Leslie; Otremba, Mirek; Halman, Samantha; Willemot, Patrick; Blouw, Marcus

    2017-05-11

    Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1-3) and expanded (general internal medicine PGY 4-5) training programs. We recommend four POCUS applications for the core PGY 1-3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4-5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.

  5. Critical assessment of high-circulation print newspaper coverage of the Institute of Medicine report Dietary Reference Intakes for Calcium and Vitamin D.

    PubMed

    Hatfield, Daniel P; Sweeney, Kathryn P; Lau, Joseph; Lichtenstein, Alice H

    2014-08-01

    To evaluate high-circulation US and Canadian newspaper coverage of the Institute of Medicine (IOM) report Dietary Reference Intakes for Calcium and Vitamin D and assess pre-report and post-report reporter-specific vitamin D-related coverage. Two independent reviewers analysed the newspaper articles. The key report findings cited, proportion of sentences describing the IOM report and proportion of sentences describing critical viewpoints on the report were calculated. The content of articles written by reporters with a history of pre-report vitamin D-related articles was compared with that of articles written by reporters without such a history. Factiva and LexisNexis searches of the top thirty US and three English-language Canadian print newspapers, by circulation. Articles on the IOM report published from 30 November to 21 December 2010 and previous vitamin D-related articles written by the same reporters. Only ten articles met inclusion/exclusion criteria. Articles inconsistently cited the key findings in the IOM report. Reporters with a history of pre-report articles highlighting the benefits of vitamin D dedicated a greater proportion of sentences to viewpoints critical of the IOM report (P < 0·01). There was no significant difference between pre-report publication history and proportion of sentences focused on the IOM report. A borderline-significant difference (P = 0·058) was observed between pre-report articles highlighting the benefits of vitamin D and the absence of reference to potential risks of vitamin D overconsumption. Our findings suggest that newspaper articles did not consistently or comprehensively report the IOM recommendations and that pre-report publication history of reporters was related to post-report article content.

  6. The suitability of the IOM foam sampler for bioaerosol sampling in Occupational Environments.

    PubMed

    Haatainen, Susanna; Laitinen, Juha; Linnainmaa, Markku; Reponen, Tiina; Kalliokoski, Pentti

    2010-01-01

    Concurrent samples were collected with Andersen and IOM foam samplers to determine whether if the IOM foam sampler can be applied to collect culturable microorganisms. Two different kinds of aerosols were studied: peat dust in a power plant and mist from coolant fluid aerosolized during grinding of blades and rollers in a paper mill. In the power plant, the concentrations of fungi were 2-3 times higher in the IOM samples than in the Andersen samples. However, more fungal genera were identified in the latter case. The methods yielded similar concentrations of bacteria and actinobacteria in the power plant. On the other hand, the performance of the IOM foam sampler was very poor in the paper mill, where stress-sensitive gram-negative bacteria dominated; low concentration of bacteria was detected in only one IOM sample even though the concentration of bacteria often exceeded even the upper detection limit in the Andersen impactor samples. It could be concluded that the IOM foam sampler performs quite well for collecting inhalable fungi and actinobacteria. However, the Andersen sampler provides better information on fungal genera and concentrations of gram-negative bacteria. Personal sampling with the IOM foam sampler provided an important benefit in the power plant, where the concentration ratio of personal to stationary samples was much higher for bacteria than for inhalable or respirable dust.

  7. Choosing Wisely® in Preventive Medicine: The American College of Preventive Medicine's Top 5 List of Recommendations.

    PubMed

    Livingston, Catherine J; Freeman, Randall J; Mohammad, Amir; Costales, Victoria C; Titus, Tisha M; Harvey, Bart J; Sherin, Kevin M

    2016-07-01

    The Choosing Wisely(®) initiative is a national campaign led by the American Board of Internal Medicine Foundation, focused on quality improvement and advancing a dialogue on avoiding wasteful or unnecessary medical tests, procedures, and treatments. The American College of Preventive Medicine (ACPM) Prevention Practice Committee is an active participant in the Choosing Wisely project. The committee created the ACPM Choosing Wisely Task Force to lead the development of ACPM's recommendations with the intention of facilitating wise decisions about the appropriate use of preventive care. After utilizing an iterative process that involved reviewing evidence-based literature, the ACPM Choosing Wisely Task Force developed five recommendations targeted toward overused services within the field of preventive medicine. These include: (1) don't take a multivitamin, vitamin E, or beta carotene to prevent cardiovascular disease or cancer; (2) don't routinely perform prostate-specific antigen-based screening for prostate cancer; (3) don't use whole-body scans for early tumor detection in asymptomatic patients; (4) don't use expensive medications when an equally effective and lower-cost medication is available; and (5) don't perform screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease. The Task Force also reviewed some of the barriers to implementing these recommendations, taking into account the interplay between system and environmental characteristics, and identified specific strategies necessary for timely utilization of these recommendations. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

  8. The Association of Teachers of Preventive Medicine's Recommendations for Postgraduate Education in Prevention.

    ERIC Educational Resources Information Center

    Collins, Terence R.; And Others

    1991-01-01

    Detailed recommendations for integrating preventive medicine into residency education and the continuum of medical care are outlined, with the goal of putting the patient's health rather than disease process into the forefront of primary care. Suggestions are based on a guide assessing the effectiveness of 169 types of preventive intervention.…

  9. Veterinary Medicine Program Review. State University System of Florida. Consultant's Report and Recommendations.

    ERIC Educational Resources Information Center

    Anderson, David P.

    This report reviews the University of Florida's College of Veterinary Medicine and provides an analysis of the institution's strengths and weaknesses, along with recommendations to improve the college's programs. It examines the college's degree programs, students, faculty, facilities, and resources, as well as actions taken to meet…

  10. Consensus-based recommendations for case report in Chinese medicine (CARC).

    PubMed

    Fu, Shu-Fei; Cheng, Chung-Wah; Zhang, Li; Zhong, Linda Li-Dan; Kun, Wai; Lin, Jia; Zhang, Bo-Li; Wang, Yong-Yan; Shang, Hong-Cai; Bian, Zhao-Xiang

    2016-01-01

    Case reports are valuable clinical evidence in traditional Chinese medicine (TCM). However, the general reporting quality is suboptimal. A working group comprising 20 members was set up to develop systematic recommendations on case report in Chinese medicine (CARC). The working group (CARC group) developed a primary checklist based on reviewing the general reporting quality of case reports in TCM and thorough internal discussion. Two-round consensus process had been carried out among clinical experts, evidence-based medicine methodologists, medical journal editors and clinical practitioners with designated questionnaire embedded with the primary checklist. In total, 118 participants from 17 provinces of China and Korea completed the questionnaires. Their feedback was analyzed and discussed by the CARC group. The checklist was amended accordingly, and the final version, comprising 16-item, is presented here. Under the framework of CARC recommendations, the reporting quality of case reports in TCM can be improved.

  11. CAEP 2015 Academic Symposium: Recommendations for University Governance and Administration for Emergency Medicine.

    PubMed

    Petrie, David; Chopra, Anil; Chochinov, Alecs; Artz, Jennifer D; Schull, Michael; Tallon, John; Jones, Gordon; MacPhee, Shannon; Ackerman, Margaret; Stiell, Ian G; Christenson, Jim

    2016-04-05

    1) To identify the strengths and challenges of governance structures in academic emergency medicine (EM), and 2) to make recommendations on principles and approaches that may guide improvements. Over the course of 9 months, eight established EM leaders met by teleconference, reviewed the literature, and discussed their findings and experiences to arrive at recommendations on governance in academic units of EM. The results and recommendations were presented at the annual Canadian Association of Emergency Physicians (CAEP) Academic Symposium, where attendees provided feedback. The updated recommendations were subsequently distributed to the CAEP Academic Section for further input, and the final recommendations were decided by consensus. The panel identified four governance areas of interest: 1) the elements of governance; 2) the relationships between emergency physicians and academic units of EM, and between the academic units of EM and faculty of medicine; 3) current status of governance in Canadian academic units of EM; and 4) essential elements of good governance. Six recommendations were developed around three themes, including 1) the importance of good governance; 2) the purposes of an academic unit of EM; and 3) essential elements for better governance for academic units of EM. Recommendations included identifying the importance of good governance, recognizing the need to adapt to the different models depending on the local environment; seeking full departmental status, provided it is mutually beneficial to EM and the faculty of medicine (and health authority); using a consultation service to learn from the experience of other academic units of EM; and establishing an annual forum for EM leaders. Although governance of academic EM is complex, there are ways to iteratively improve the mission of academic units of EM: providing exceptional patient care through research and education. Although there is no one-size-fits-all guide, there are practical recommended

  12. American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships.

    PubMed

    Finnoff, Jonathan T; Berkoff, David; Brennan, Fred; DiFiori, John; Hall, Mederic M; Harmon, Kimberly; Lavallee, Mark; Martin, Sean; Smith, Jay; Stovak, Mark

    2015-01-01

    The following sports ultrasound (SPORTS US) curriculum is a revision of the curriculum developed by the American Medical Society for Sports Medicine (AMSSM) in 2010. Several changes have been made to the curriculum with the primary aim of providing a pathway by which a sports medicine fellow can obtain sufficient SPORTS US training to become proficient in the core competencies of SPORTS US. The core competencies of SPORTS US are outlined in the learning objectives section of this document. The term "SPORTS US" was purposefully chosen rather than "musculoskeletal ultrasound" (MSK US) because it was recognized by the panel that the evolving field of SPORTS US encompasses non-MSK applications of ultrasound such as the FAST examination (focused assessment with sonography for trauma). Although the SPORTS US core competencies in this curriculum are all MSK in nature, they represent the minimum SPORTS US knowledge a sports medicine fellow should acquire during fellowship. However, additional training in more advanced MSK and non-MSK applications of ultrasound can be provided at the fellowship director's discretion. Completion of this SPORTS US curriculum fulfills the American Institute of Ultrasound in Medicine's (AIUM) requirements to perform an MSK US examination and the prerequisites for the American Registry for Diagnostic Medical Sonography's (ARDMS) MSK sonography certification examination.

  13. Development and evaluation of an Individualized Outcome Measure (IOM) for randomized controlled trials in mental health.

    PubMed

    Pesola, Francesca; Williams, Julie; Bird, Victoria; Freidl, Marion; Le Boutillier, Clair; Leamy, Mary; Macpherson, Rob; Slade, Mike

    2015-12-01

    Pre-defined, researcher-selected outcomes are routinely used as the clinical end-point in randomized controlled trials (RCTs); however, individualized approaches may be an effective way to assess outcome in mental health research. The present study describes the development and evaluation of the Individualized Outcome Measure (IOM), which is a patient-specific outcome measure to be used for RCTs of complex interventions. IOM was developed using a narrative review, expert consultation and piloting with mental health service users (n = 20). The final version of IOM comprises two components: Goal Attainment (GA) and Personalized Primary Outcome (PPO). For GA, patients identify one relevant goal at baseline and rate its attainment at follow-up. For PPO, patients choose an outcome domain related to their goal from a pre-defined list at baseline, and complete a standardized questionnaire assessing the chosen outcome domain at baseline and follow-up. A feasibility study indicated that IOM had adequate completion (89%) and acceptability (96%) rates in a clinical sample (n = 84). IOM was then evaluated in a RCT (ISRCTN02507940). GA and PPO components were associated with each other and with the trial primary outcome. The use of the PPO component of IOM as the primary outcome could be considered in future RCTs. Copyright © 2015 John Wiley & Sons, Ltd.

  14. The Italian Society of Physical and Rehabilitation Medicine (SIMFER) recommendations for neck pain.

    PubMed

    Monticone, Marco; Iovine, Roberto; de Sena, Giampaolo; Rovere, Giancarlo; Uliano, Domenico; Arioli, Giovanni; Bonaiuti, Donatella; Brugnoni, Guido; Ceravolo, Gabriella; Cerri, Cesare; Dalla Toffola, Elena; Fiore, Pietro; Foti, Calogero

    2013-01-01

    The paper represents the Italian Society of Physical " and Rehabilitation Medicine (SIMFER) recommendations to Neck Pain. We searched the principal scientific databases for papers concerning the main approaches to NP, including international guidelines, clinical trials of high methodological value and systematic reviews without any temporal limits. The recommendations were graded on the basis of the National Plan for Guidelines of the Italian Istituto Superiore di Sanità, which includes the level of evidence and strength of the recommendation. The principal sections of the recommendations deal with the Evaluation and Therapy for Neck Pain. The first describes the main evidence concerning the evaluation of patients with NP with or without limb involvement and/or headache: medical history, physical examination, neurological examination, laboratory tests, electrodiagnostics, diagnostic imaging and self-administered questionnaires. The second describes the best evidence synthesis concernig the therapy for Neck Pain: education, exercise, medical therapy, manual therapy, traction, physical therapy, acupuncture, orthoses, multimodal treatment, behavioural treatment.

  15. Reflections on the Institute of Medicine's systemic exertion intolerance disease.

    PubMed

    Jason, Leonard A; Sunnquist, Madison; Brown, Abigail; McManimen, Stephanie; Furst, Jacob

    2015-01-01

    The Institute of Medicine (IOM) in the United States has recently proposed that the term systemic exertion intolerance disease (SEID) replace chronic fatigue syndrome. In addition, the IOM proposed a new case definition for SEID, which includes substantial reductions or impairments in the ability to engage in pre‑illness activities, unrefreshing sleep, postexertional malaise, and either cognitive impairment or orthostatic intolerance. Unfortunately, these recommendations for a name change were not vetted with patient and professional audiences, and the new criteria were not evaluated with data sets of patients and controls. A recent poll suggests that the majority of patients reject this new name. In addition, studies have found that prevalence rates will dramatically increase with the new criteria, particularly due to the ambiguity revolving around exclusionary illnesses. Findings suggest that the new criteria select more patients who have less impairment and fewer symptoms than several other criteria. The implications of these findings are discussed in the current review.

  16. Attitudes, Knowledge, Use, and Recommendation of Complementary and Alternative Medicine by Health Professionals in Western Mexico.

    PubMed

    Brambila-Tapia, Aniel Jessica Leticia; Rios-Gonzalez, Blanca Estela; Lopez-Barragan, Liliana; Saldaña-Cruz, Ana Miriam; Rodriguez-Vazquez, Katya

    2016-01-01

    The use of complementary and alternative medicine (CAM) has increased in many countries, and this has altered the knowledge, attitudes, and treatment recommendations of health professionals in regard to CAM. Considering Mexican health professionals׳ lack of knowledge of CAM, in this report we surveyed 100 biomedical researchers and Ph.D. students and 107 specialized physicians and residents of a medical specialty in Guadalajara, México (Western Mexico) with a questionnaire to address their attitudes, knowledge, use, and recommendation of CAM. We observed that significantly more researchers had ever used CAM than physicians (83% vs. 69.2%, P = .023) and that only 36.4% of physicians had ever recommended CAM. Female researchers tended to have ever used CAM more than male researchers, but CAM use did not differ between genders in the physician group or by age in either group. Homeopathy, herbal medicine, and massage therapy were the most commonly used CAMs in both the groups. Physicians more frequently recommended homeopathy, massage therapy, and yoga to their patients than other forms of CAM, and physicians had the highest perception of safety and had taken the most courses in homeopathy. All CAMs were perceived to have high efficacy (>60%) in both the groups. The attitude questionnaire reported favorable attitudes toward CAM in both the groups. We observed a high rate of Mexican health professionals that had ever used CAM, and they had mainly used homeopathy, massage therapy, and herbal medicine. However, the recommendation rate of CAM by Mexican physicians was significantly lower than that in other countries, which is probably due to the lack of CAM training in most Mexican medical schools. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Factors affecting pharmacists’ recommendation of complementary medicines – a qualitative pilot study of Australian pharmacists

    PubMed Central

    2012-01-01

    Background Complementary medicines (CMs) are widely used by the Australian public, and pharmacies are major suppliers of these medicines. The integration of CMs into pharmacy practice is well documented, but the behaviours of pharmacists in recommending CMs to customers are less well studied. This study reports on factors that influence whether or not pharmacists in Australia recommend CMs to their customers. Methods Data were collected from semi-structured interviews with twelve practicing pharmacists based in Brisbane, Australia. The qualitative data were analysed by thematic analysis. Results The primary driver of the recommendation of CMs was a desire to provide a health benefit to the customer. Other important drivers were an awareness of evidence of efficacy, customer feedback and pharmacy protocols to recommend a CM alongside a particular pharmaceutical medication. The primary barrier to the recommendation of CMs was safety concerns around patients on multiple medications or with complex health issues. Also, a lack of knowledge of CMs, a perceived lack of evidence or a lack of time to counsel patients were identified as barriers. There was a desire to see a greater integration of CM into formal pharmacy education. Additionally, the provision of good quality educational materials was seen as important to allow pharmacists to assess levels of evidence for CMs and educate them on their safe and appropriate use. Conclusions Pharmacists who frequently recommend CMs identify many potential benefits for patients and see it as an important part of providing a ‘healthcare solution’. To encourage the informed use of CMs in pharmacy there is a need for the development of accessible, quality resources on CMs. In addition, incorporation of CM education into pharmacy curricula would better prepare graduate pharmacists for community practice. Ultimately, such moves would contribute to the safe and effective use of CMs to the benefit of consumers. PMID:23051066

  18. Use of medicines recommended for secondary prevention of acute coronary syndrome

    PubMed Central

    Gaedke, Mari Ângela; da Costa, Juvenal Soares Dias; Manenti, Euler Roberto Fernandes; Henn, Ruth Liane; Paniz, Vera Maria Vieira; Nunes, Marcelo Felipe; da Motta, Monique Adriane; Olinto, Maria Teresa Anselmo

    2015-01-01

    ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition

  19. Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015).

    PubMed

    Hatzimouratidis, Konstantinos; Salonia, Andrea; Adaikan, Ganesan; Buvat, Jacques; Carrier, Serge; El-Meliegy, Amr; McCullough, Andrew; Torres, Luiz Otavio; Khera, Mohit

    2016-04-01

    ) Counterfeit medicines are potentially dangerous. It is strongly recommended that physicians educate their patients to avoid taking any medication from unauthorized sources (LE = 2, GR = A). The first seven recommendations are the same as those from the Third International Consultation for Sexual Medicine and the last three are new recommendations. PDE5 inhibitors remain a first-line treatment option because of their excellent efficacy and safety profile. This class of drugs is continually developed with new molecules and new formulations. Intracavernosal injections continue to be an established treatment modality, and intraurethral and topical alprostadil provide an alternative, less invasive treatment option. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  20. IOM committee members respond to Endocrine Society vitamin D guideline

    USDA-ARS?s Scientific Manuscript database

    In early 2011, a committee convened by the Institute of Medicine issued a report on the Dietary Reference Intakes for calcium and vitamin D. The Endocrine Society Task Force in July 2011 published a guideline for the evaluation, treatment, and prevention of vitamin D deficiency. Although these repor...

  1. USC's Response to the IOM Report on Dental Education.

    ERIC Educational Resources Information Center

    Landesman, Howard M.

    1996-01-01

    This response of the University of Southern California to the Institute of Medicine's 1995 report concerning the present status and future needs of dental education focuses on the report's influence in implementing a problem-based learning (PBL) option at USC. The PBL program's philosophy, goals, organization, faculty, admissions process, and…

  2. Recommendations

    ERIC Educational Resources Information Center

    Brazelton, G. Blue; Renn, Kristen A.; Stewart, Dafina-Lazarus

    2015-01-01

    In this chapter, the editors provide a summary of the information shared in this sourcebook about the success of students who have minoritized identities of sexuality or gender and offer recommendations for policy, practice, and further research.

  3. Recommendations

    ERIC Educational Resources Information Center

    Brazelton, G. Blue; Renn, Kristen A.; Stewart, Dafina-Lazarus

    2015-01-01

    In this chapter, the editors provide a summary of the information shared in this sourcebook about the success of students who have minoritized identities of sexuality or gender and offer recommendations for policy, practice, and further research.

  4. The future of general internal medicine. Report and recommendations from the Society of General Internal Medicine (SGIM) Task Force on the Domain of General Internal Medicine.

    PubMed

    Larson, Eric B; Fihn, Stephan D; Kirk, Lynne M; Levinson, Wendy; Loge, Ronald V; Reynolds, Eileen; Sandy, Lewis; Schroeder, Steven; Wenger, Neil; Williams, Mark

    2004-01-01

    The Society of General Internal Medicine asked a task force to redefine the domain of general internal medicine. The task force believes that the chaos and dysfunction that characterize today's medical care, and the challenges facing general internal medicine, should spur innovation. These are our recommendations: while remaining true to its core values and competencies, general internal medicine should stay both broad and deep-ranging from uncomplicated primary care to continuous care of patients with multiple, complex, chronic diseases. Postgraduate and continuing education should develop mastery. Wherever they practice, general internists should be able to lead teams and be responsible for the care their teams give, embrace changes in information systems, and aim to provide most of the care their patients require. Current financing of physician services, especially fee-for-service, must be changed to recognize the value of services performed outside the traditional face-to-face visit and give practitioners incentives to improve quality and efficiency, and provide comprehensive, ongoing care. General internal medicine residency training should be reformed to provide both broad and deep medical knowledge, as well as mastery of informatics, management, and team leadership. General internal medicine residents should have options to tailor their final 1 to 2 years to fit their practice goals, often earning a certificate of added qualification (CAQ) in special generalist fields. Research will expand to include practice and operations management, developing more effective shared decision making and transparent medical records, and promoting the close personal connection that both doctors and patients want. We believe these changes constitute a paradigm shift that can benefit patients and the public and reenergize general internal medicine.

  5. Benefits, issues, and recommendations for personalized medicine in oncology in Canada.

    PubMed

    Butts, C; Kamel-Reid, S; Batist, G; Chia, S; Blanke, C; Moore, M; Sawyer, M B; Desjardins, C; Dubois, A; Pun, J; Bonter, K; Ashbury, F D

    2013-10-01

    would review research and provide recommendations on tests for funding or reimbursement, guidelines, service delivery models, laboratory quality assurance, education, and communication. More has to be known about the current state of personalized cancer medicine in Canada, and strategies have to be developed to inform and improve understanding and appropriate coordination and delivery. Our hope is that the perspectives emphasized in this paper will stimulate discussion and further research to create a more informed response.

  6. A field comparison of the IOM inhalable aerosol sampler and a modified 37-mm cassette.

    PubMed

    Clinkenbeard, R E; England, E C; Johnson, D L; Esmen, N A; Hall, T A

    2002-09-01

    This research focused on comparing a modified 37-mm (Mod37) sampling cassette with an IOM inhalable dust sampler. Paired IOM and Mod37 breathing-zone air samples were collected for workers engaged in corrosion control maintenance operations on several types of aircraft at several U.S. Air Force bases in the United States. Sampled operations included hand and power sanding, blow-down and wipe-down to remove dust, and spray finishing. The cassettes' interior surfaces were swabbed and the swabs combined with the filters for chromium analysis by NIOSH Method 7300. This approach utilized total chromium as a sensitive surrogate indicator of total aspirated mass. The influences of work location, work type, sample duration, and sampler type on measured concentration were evaluated using analysis of variance techniques. Only work type (process) was found to be a statistically significant predictor of measured concentration. The relationship between IOM- and Mod37-measured values for paired samples was evaluated by work type using linear regression techniques. Linear regressions showed that the modified 37-mm cassette over-samples aerosol by 35 percent compared to the IOM when a wide range of aerosol concentrations and compositions for divergent work tasks in multiple field locations are sampled. Interpretation of these results in light of previous results involving filter-only Mod37 analyses suggests that while the Mod37 has a higher aspiration efficiency than the IOM, substantial Mod37 wall losses result in underestimation of exposure when only the 37-mm filter is analyzed rather than filters plus wall swabs.

  7. Sudden cardiac death in forensic medicine – Swiss recommendations for a multidisciplinary approach.

    PubMed

    Wilhelm, Matthias; Bolliger, Stephan A; Bartsch, Christine; Fokstuen, Siv; Gräni, Christoph; Martos, Viktor; Medeiros Domingo, Argelia; Osculati, Antonio; Rieubland, Claudine; Sabatasso, Sara; Saguner, Ardan M; Schyma, Christian; Tschui, Joelle; Wyler, Daniel; Bhuiyan, Zahurul A; Fellmann, Florence; Michaud, Katarzyna

    2015-01-01

    Sudden cardiac death (SCD) is by definition unexpected and cardiac in nature. The investigation is almost invariably performed by a forensic pathologist. Under these circumstances the role of the forensic pathologist is twofold: (1.) to determine rapidly and efficiently the cause and manner of death and (2.) to initiate a multidisciplinary process in order to prevent further deaths in existing family members. If the death is determined to be due to "natural" causes the district attorney in charge often refuses further examinations. However, additional examinations, i.e. extensive histopathological investigations and/or molecular genetic analyses, are necessary in many cases to clarify the cause of death. The Swiss Society of Legal Medicine created a multidisciplinary working group together with clinical and molecular geneticists and cardiologists in the hope of harmonising the approach to investigate SCD. The aim of this paper is to close the gap between the Swiss recommendations for routine forensic post-mortem cardiac examination and clinical recommendations for genetic testing of inherited cardiac diseases; this is in order to optimise the diagnostic procedures and preventive measures for living family members. The key points of the recommendations are (1.) the forensic autopsy procedure for all SCD victims under 40 years of age, (2.) the collection and storage of adequate samples for genetic testing, (3.) communication with the families, and (4.) a multidisciplinary approach including cardiogenetic counselling.

  8. Internal medicine residency training for unhealthy alcohol and other drug use: recommendations for curriculum design

    PubMed Central

    2010-01-01

    Background Unhealthy substance use is the spectrum from use that risks harm, to use associated with problems, to the diagnosable conditions of substance abuse and dependence, often referred to as substance abuse disorders. Despite the prevalence and impact of unhealthy substance use, medical education in this area remains lacking, not providing physicians with the necessary expertise to effectively address one of the most common and costly health conditions. Medical educators have begun to address the need for physician training in unhealthy substance use, and formal curricula have been developed and evaluated, though broad integration into busy residency curricula remains a challenge. Discussion We review the development of unhealthy substance use related competencies, and describe a curriculum in unhealthy substance use that integrates these competencies into internal medicine resident physician training. We outline strategies to facilitate adoption of such curricula by the residency programs. This paper provides an outline for the actual implementation of the curriculum within the structure of a training program, with examples using common teaching venues. We describe and link the content to the core competencies mandated by the Accreditation Council for Graduate Medical Education, the formal accrediting body for residency training programs in the United States. Specific topics are recommended, with suggestions on how to integrate such teaching into existing internal medicine residency training program curricula. Summary Given the burden of disease and effective interventions available that can be delivered by internal medicine physicians, teaching about unhealthy substance use must be incorporated into internal medicine residency training, and can be done within existing teaching venues. PMID:20230607

  9. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine

    PubMed Central

    Paruthi, Shalini; Brooks, Lee J.; D'Ambrosio, Carolyn; Hall, Wendy A.; Kotagal, Suresh; Lloyd, Robin M.; Malow, Beth A.; Maski, Kiran; Nichols, Cynthia; Quan, Stuart F.; Rosen, Carol L.; Troester, Matthew M.; Wise, Merrill S.

    2016-01-01

    Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine. Citation: Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016;12(6):785–786. PMID:27250809

  10. Inaccuracy of the global assessment score in the emergency medicine standard letter of recommendation.

    PubMed

    Oyama, Leslie C; Kwon, Manon; Fernandez, Jorge A; Fernández-Frackelton, Madonna; Campagne, Danielle D; Castillo, Edward M; Lin, Michelle

    2010-10-01

    The standard letter of recommendation (SLOR) is used by most emergency medicine (EM) faculty to submit evaluations for medical students applying for EM residency programs. In the global assessment score (GAS) section, there is a crucial summative question that asks letter writers to estimate the applicant's rank order list (ROL) position in their own program. The primary aim of the study was to determine if these estimated global assessment tiers agreed with the actual ROL, using the criteria recommended by the Council of Emergency Medicine Residency Directors (CORD). Data from SLORs written by EM faculty from five California institutions were retrospectively collected from the 2008-2009 residency application year. Descriptive and comparative statistical analyses were performed using the documented GAS tiers and actual ROL positions. A total of 105 SLORs were reviewed from the five participating institutions. Three SLORs were excluded and 102 were analyzed. Only 27 (26%) SLORs documented a GAS tier that accurately predicted the applicant's actual ROL position. The GAS tier overestimated the applicant's position on the ROL in 67 (66%) SLORs, whereas it underestimated the position in eight (8%) SLORs. Accuracy was poor regardless of the number of letter writers on the SLOR (p = 0.890), the writer's administrative title (p = 0.326), whether the student was a home or visiting student (p = 0.801), or if the student had prior EM rotation experience (p = 0.793). Standard letter of recommendation writers are inaccurate in estimating the ROL position of the applicant using the GAS tier criteria. The GAS tiers were accurate only 26% of the time. Because of the valuable role that the SLOR plays in determining an applicant's competitiveness in the National Resident Matching Program (NRMP) in EM, future discussion should focus on improving the consistency and accuracy of the GAS section. Furthermore, there needs to be a national dialogue to reassess the utility of the

  11. Institute of Medicine recommends a continuing professional development institute for U.S. health professions.

    PubMed

    Mazmanian, Paul E

    2010-01-01

    A workforce of knowledgeable professionals is critical to the discovery and application of best health care practices; yet, today in the United States, the professional health workforce is not consistently prepared to provide safe, high-quality health care, even as the nation spends more per capita on health care than any other country. The Institute of Medicine recently recommended creation of a continuing professional development institute (CPDI) supported as a public-private initiative. The CPDI would coordinate and guide efforts that align: (a) content and knowledge among health professions; (b) regulation across states and national continuing professional development (CPD) providers; and (c) the financing of CPD, not only for improving professional performance and patient outcomes, but also for strengthening the scientific basis for the practice of CPD. With a strong scientific foundation, the community of health professions educators and regulators may advance the development of health care practitioners, enhance the discipline of CPD, and improve health outcomes for patients.

  12. [Constipation in Patients with Incurable Cancer - Recommendations of the German S3 Guideline 'Palliative Medicine'].

    PubMed

    Wirz, Stefan; Simon, Steffen; Frieling, Thomas; Bausewein, Claudia; Voltz, Raymond; Pralong, Anne; Mönig, Stefan; Follmann, Markus; Holtmann, Martin; Becker, Gerhild

    2016-08-01

    According to the German S3-guideline 'Palliative Medicine' which has been supported by the German Guideline Program in Oncology, constipation in palliative patients requires a consistent prophylaxis and therapy. Constipation is caused by immobilisation, poor health, exsiccosis, a low-fiber diet or a preexisting functional constipation. Further important causes are substances with constipating side effects, such as opioids or anticholinergic drugs. Pragmatically, constipation should be assessed by subjective parameters such as the feeling of incomplete evacuation, straining, or other complaints. Objective parameters are hard stool or reduced number of bowel movements. For the early detection of constipation the amount of the stool mass and the stool frequency are applicable. If constipation occurs, a standardized escalating protocol applying adequate fluid intake, a high fibre diet, and laxatives is recommended. New prokinetic agents, secretagogues, or opioid antagonists may be used as reserve drugs. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Cosmetic gynecology in the view of evidence-based medicine and ACOG recommendations: a review.

    PubMed

    Ostrzenski, Adam

    2011-09-01

    To conduct a methodological review of the existing scientific literature within the field of cosmetic gynecology in the view of evidence-based medicine and to establish their relevance to the ACOG Committee Opinion No. 378. The appropriate medical subject heading terms were selected and applied in the search of the Internet multiple databases since 1900 until January 2010. Articles focusing on cosmetic gynecology were reviewed. Also, anecdotal and advertising literatures were analyzed. A methodological review of the literatures was conducted. In peer review journals, 72 relevant articles related to cosmetic gynecology were identified. Anecdotal information was identified in 3 sources and over 1,100 published marketing literatures were identified on the Internet and no scientific journals. Among reviewed articles on cosmetic gynecology, only two articles met the level II-2 in evidence-based medicine. The absence of documentations on the safety and effectiveness of cosmetic vaginal procedures in the scientific literatures was ACOG's main concern. Practicing cosmetic gynecology within ACOG recommendations is desirable and possible. Currently, the standard of practice of cosmetic gynecology cannot be determined due to the absence of the documentation on safety and effectiveness. Traditional gynecologic surgical procedures cannot be called cosmetic procedures, since it is a deceptive form of practice and marketing. Creating medical terminology trademarks and establishing a business model that tries to control clinical-scientific knowledge dissemination is unethical.

  14. Croatian Society of Medical Biochemistry and Laboratory Medicine: national recommendations for venous blood sampling

    PubMed Central

    Nikolac, Nora; Šupak-Smolčić, Vesna; Šimundić, Ana-Maria; Ćelap, Ivana

    2013-01-01

    Phlebotomy is one of the most complex medical procedures in the diagnosis, management and treatment of patients in healthcare. Since laboratory test results are the basis for a large proportion (60–80%) of medical decisions, any error in the phlebotomy process could have serious consequences. In order to minimize the possibility of errors, phlebotomy procedures should be standardised, well-documented and written instructions should be available at every workstation. Croatia is one of the few European countries that have national guidelines for phlebotomy, besides the universally used CLSI (Clinical Laboratory Standards Institute) H3-A6 Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; approved Standard-Sixth Edition (CLSI, 2007) and WHO (World Health Organization) guidelines on drawing blood: best practices in phlebotomy (WHO, 2010). However, the growing body of evidence in importance of preanalytical phase management resulted in a need for evidence based revision and expansion of existing recommendations. The Croatian Society for Medical Biochemistry and Laboratory Medicine, Working Group for the Preanalytical Phase issued this recommendation. This document is based on the CLSI guideline H3-A6, with significant differences and additional information. PMID:24266294

  15. A National Cancer Clinical Trials Network: Recommendations from the Institute of Medicine

    PubMed Central

    Nass, Sharyl J.; Balogh, Erin; Mendelsohn, John

    2010-01-01

    Oncology has become one of the most active areas of drug discovery, with more than 800 cancer therapeutics in development. This presents an unprecedented opportunity to improve the outcome for patients with cancer, but also requires an effective and efficient clinical trials network to generate the evidence necessary for regulatory approval and optimal integration of new treatments into clinical care. The Clinical Trials Cooperative Group Program supported by the National Cancer Institute has been instrumental in establishing standards of care in oncology over the last 50 years, but it currently faces numerous challenges that threaten its ability to undertake the large-scale, multi-institutional trials that advance patient care. The Institute of Medicine recently appointed a consensus study committee to assess the organization and operation of the Cooperative Group Program and recommend ways to improve the quality of cancer clinical trials conducted by the Groups and others. The committee developed a set of recommendations, summarized here, that aim to improve the speed and efficiency of trials; incorporate innovative science and trial design; improve prioritization, selection, and support of trials; and increase participation by patients and physicians. PMID:21326081

  16. Recommendations for Exploration Space Medicine from the Apollo Medical Operations Project

    NASA Technical Reports Server (NTRS)

    Scheuring, R. a.; Davis, J. R.; Duncan, J. M.; Polk, J. D.; Jones, J. A.; Gillis, D. B.

    2007-01-01

    Introduction: A study was requested in December, 2005 by the Space Medicine Division at the NASA-Johnson Space Center (JSC) to identify Apollo mission issues relevant to medical operations that had impact to crew health and/or performance. The objective was to use this new information to develop medical requirements for the future Crew Exploration Vehicle (CEV), Lunar Surface Access Module (LSAM), Lunar Habitat, and Advanced Extravehicular Activity (EVA) suits that are currently being developed within the exploration architecture. Methods: Available resources pertaining to medical operations on the Apollo 7 through 17 missions were reviewed. Ten categories of hardware, systems, or crew factors were identified in the background research, generating 655 data records in a database. A review of the records resulted in 280 questions that were then posed to surviving Apollo crewmembers by mail, face-to-face meetings, or online interaction. Response analysis to these questions formed the basis of recommendations to items in each of the categories. Results: Thirteen of 22 surviving Apollo astronauts (59%) participated in the project. Approximately 236 pages of responses to the questions were captured, resulting in 107 recommendations offered for medical consideration in the design of future vehicles and EVA suits based on the Apollo experience. Discussion: The goals of this project included: 1) Develop or modify medical requirements for new vehicles; 2) create a centralized database for future access; and 3) take this new knowledge and educate the various directorates at NASA-JSC who are participating in the exploration effort. To date, the Apollo Medical Operations recommendations are being incorporated into the exploration mission architecture at various levels and a centralized database has been developed. The Apollo crewmembers input has proved to be an invaluable resource, prompting ongoing collaboration as the requirements for the future exploration missions continue

  17. AxIOM: Amphipod crustaceans from insular Posidonia oceanica seagrass meadows

    PubMed Central

    Heughebaert, André; Lepoint, Gilles

    2016-01-01

    Abstract Background The Neptune grass, Posidonia oceanica (L.) Delile, 1813, is the most widespread seagrass of the Mediterranean Sea. This foundation species forms large meadows that, through habitat and trophic services, act as biodiversity hotspots. In Neptune grass meadows, amphipod crustaceans are one of the dominant groups of vagile invertebrates, forming an abundant and diverse taxocenosis. They are key ecological components of the complex, pivotal, yet critically endangered Neptune grass ecosystems. Nevertheless, comprehensive qualitative and quantitative data about amphipod fauna found in Mediterranean Neptune grass meadows remain scarce, especially in insular locations. New information Here, we provide in-depth metadata about AxIOM, a sample-based dataset published on the GBIF portal. AxIOM is based on an extensive and spatially hierarchized sampling design with multiple years, seasons, day periods, and methods. Samples were taken along the coasts of Calvi Bay (Corsica, France) and of the Tavolara-Punta Coda Cavallo Marine Protected Area (Sardinia, Italy). In total, AxIOM contains 187 samples documenting occurrence (1775 records) and abundance (10720 specimens) of amphipod crustaceans belonging to 72 species spanning 29 families. The dataset is available at http://ipt.biodiversity.be/resource?r=axiom. PMID:27660521

  18. Official Position of the American Academy of Clinical Neuropsychology Social Security Administration Policy on Validity Testing: Guidance and Recommendations for Change.

    PubMed

    Chafetz, M D; Williams, M A; Ben-Porath, Y S; Bianchini, K J; Boone, K B; Kirkwood, M W; Larrabee, G J; Ord, J S

    2015-01-01

    The milestone publication by Slick, Sherman, and Iverson (1999) of criteria for determining malingered neurocognitive dysfunction led to extensive research on validity testing. Position statements by the National Academy of Neuropsychology and the American Academy of Clinical Neuropsychology (AACN) recommended routine validity testing in neuropsychological evaluations. Despite this widespread scientific and professional support, the Social Security Administration (SSA) continued to discourage validity testing, a stance that led to a congressional initiative for SSA to reevaluate their position. In response, SSA commissioned the Institute of Medicine (IOM) to evaluate the science concerning the validation of psychological testing. The IOM concluded that validity assessment was necessary in psychological and neuropsychological examinations (IOM, 2015 ). The AACN sought to provide independent expert guidance and recommendations concerning the use of validity testing in disability determinations. A panel of contributors to the science of validity testing and its application to the disability process was charged with describing why the disability process for SSA needs improvement, and indicating the necessity for validity testing in disability exams. This work showed how the determination of malingering is a probability proposition, described how different types of validity tests are appropriate, provided evidence concerning non-credible findings in children and low-functioning individuals, and discussed the appropriate evaluation of pain disorders typically seen outside of mental consultations. A scientific plan for validity assessment that additionally protects test security is needed in disability determinations and in research on classification accuracy of disability decisions.

  19. 78 FR 39741 - Announcement of Agency Decision: Recommendations on the Use of Chimpanzees in NIH-Supported Research

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-02

    ...This notice announces the responses to public comments and decisions of the National Institutes of Health (NIH) regarding the use of chimpanzees in research. In February 2012, the NIH charged a working group of the Council of Councils, a federal advisory committee, to provide advice on implementing recommendations made by the Institute of Medicine (IOM) Committee on the Use of Chimpanzees in Biomedical and Behavioral Research in its 2011 report, Chimpanzees in Biomedical and Behavioral Research: Assessing the Necessity. On January 22, 2013, the NIH Council of Councils (Council) accepted recommendations presented by the Working Group on the Use of Chimpanzees in NIH-Supported Research and provided these recommendations to the NIH. The NIH subsequently issued a request for comments to obtain broad public input on the 28 Council recommendations that the NIH is considering as it determines how to implement the IOM Committee's recommendations. This notice summarizes the comments received in response to the request for comments and announces the agency's decisions with respect to the Council recommendations. The NIH plans to prepare subsequent procedural guidance and technical assistance, as appropriate, to implement some of these decisions. Investigators should continue to follow existing guidance (see NOT-OD-12-025 at http://grants.nih.gov/grants/guide/ notice-files/NOT-OD-12-025.html) regarding the submission of applications, proposals, or protocols for research involving chimpanzees until the NIH announces the procedural guidance.

  20. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society.

    PubMed

    Watson, Nathaniel F; Badr, M Safwan; Belenky, Gregory; Bliwise, Donald L; Buxton, Orfeu M; Buysse, Daniel; Dinges, David F; Gangwisch, James; Grandner, Michael A; Kushida, Clete; Malhotra, Raman K; Martin, Jennifer L; Patel, Sanjay R; Quan, Stuart F; Tasali, Esra; Twery, Michael; Croft, Janet B; Maher, Elise; Barrett, Jerome A; Thomas, Sherene M; Heald, Jonathan L

    2015-06-15

    Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine. © 2015 American Academy of Sleep Medicine.

  1. Side-by-side determination of workers' exposure to wood dust with IOM and open-faced samplers.

    PubMed

    Cavlović, Anka Ozana; Beljo Lučić, Ružica; Jug, Matija; Radmanović, Kristijan; Bešlić, Ivan

    2013-09-01

    Woodworkers' exposure to airborne particles is measured with different sampling techniques throughout the world. Due to a great number of exposure data obtained with different samplers, European countries have aimed over the last ten years to find a conversion factor for mass concentrations that would render these measurements comparable. Following the accepted EU standards and regulations, we replaced a 25 mm open-faced (OF) filter holder with an IOM head to determine woodworkers' exposure to inhalable dust and establish an IOM/OF sampler ratio that might serve as a reliable factor for converting the existing OF data to IOM dust mass concentration in the industrial environment. For this side-by-side sampling we used personal 25 mm OF (N=29) and IOM (N=29) sampling heads over eight working hours. The obtained IOM/OF ratios ranged between 0.7 and 2.3. However, mass concentrations obtained by IOM and OF samplers did not significantly differ. Our findings suggest that there is no need for conversion of the existing OF data for workers exposed to wood dust, provided that dust mass concentrations in the working environment range between 1 mg m-3 and 7 mg m-3. Future side-by-side measurements should also involve environments with low wood dust mass concentrations.

  2. Peer Feedback, Learning, and Improvement: Answering the Call of the Institute of Medicine Report on Diagnostic Error.

    PubMed

    Larson, David B; Donnelly, Lane F; Podberesky, Daniel J; Merrow, Arnold C; Sharpe, Richard E; Kruskal, Jonathan B

    2017-04-01

    In September 2015, the Institute of Medicine (IOM) published a report titled "Improving Diagnosis in Health Care," in which it was recommended that "health care organizations should adopt policies and practices that promote a nonpunitive culture that values open discussion and feedback on diagnostic performance." It may seem counterintuitive that a report addressing a highly technical skill such as medical diagnosis would be focused on organizational culture. The wisdom becomes clearer, however, when examined in the light of recent advances in the understanding of human error and individual and organizational performance. The current dominant model for radiologist performance improvement is scoring-based peer review, which reflects a traditional quality assurance approach, derived from manufacturing in the mid-1900s. Far from achieving the goals of the IOM, which are celebrating success, recognizing mistakes as an opportunity to learn, and fostering openness and trust, we have found that scoring-based peer review tends to drive radiologists inward, against each other, and against practice leaders. Modern approaches to quality improvement focus on using and enhancing interpersonal professional relationships to achieve and maintain high levels of individual and organizational performance. In this article, the authors review the recommendations set forth by the recent IOM report, discuss the science and theory that underlie several of those recommendations, and assess how well they fit with the current dominant approach to radiology peer review. The authors also offer an alternative approach to peer review: peer feedback, learning, and improvement (or more succinctly, "peer learning"), which they believe is better aligned with the principles promoted by the IOM. (©) RSNA, 2016.

  3. Obstetric outcomes in normal weight and obese women in relation to gestational weight gain: comparison between Institute of Medicine guidelines and Cedergren criteria.

    PubMed

    Potti, Sushma; Sliwinski, Christopher S; Jain, Neetu J; Dandolu, Vani

    2010-05-01

    We compared obstetric outcomes based on gestational weight gain in normal-weight and obese women using traditional Institute of Medicine (IOM) guidelines and newly recommended Cedergren criteria. Using the New Jersey Pregnancy Risk Assessment Monitoring System (PRAMS) database and electronic birth records, perinatal outcomes were analyzed to estimate the independent effects of prepregnancy body mass index (BMI) and gestational weight gain by IOM versus Cedergren criteria. Of 9125 subjects in PRAMS database from 2002 to 2006, 53.7% had normal BMI, 12.3% were overweight, 18.2% were obese, and the rest were underweight. Among normal-weight mothers, when compared with the IOM guidelines, macrosomia (6.45% versus 4.27%) and cesarean delivery rates (30.42% versus 29.83%) were lower using Cedergren criteria but the rates of preterm delivery (5.06% versus 9.44%), low birth weight (0.38% versus 2.42%), and neonatal intensive care unit (NICU) admissions (7.02% versus 10.86%) were higher with the Cedergren criteria. Similarly, among obese patients, when compared with IOM guidelines, macrosomia (10.79% versus 5.47%) and cesarean delivery rates (43.95% versus 40.71%) were lower using Cedergren criteria but the rates of preterm delivery (6.83% versus 8.32%), low birth weight (0.87% versus 1.88%), and NICU admissions (8.92% versus 13.78%) were higher with the Cedergren criteria. Based on our results, ideal gestational weight gain is presumably somewhere between the IOM and Cedergren's guidelines.

  4. Examining the Institute of Medicine's Recommendations Regarding Chronic Fatigue Syndrome: Clinical Versus Research Criteria.

    PubMed

    Jason, Leonard A; McManimen, Stephanie; Sunnquist, Madison; Brown, Abigail; Newton, Julia L; Strand, Elin Bolle

    The Institute of Medicine (2015) has proposed a new clinical case definition for what had been known as chronic fatigue syndrome (CFS). This new criteria involved the following domains: substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities; post-exertional malaise; unrefreshing sleep; and at least one of the two following symptoms: cognitive impairment or orthostatic intolerance. In addition, in August of 2015, the CFS Advisory Committee, which makes recommendations to the Secretary of US Department of Health and Human Services, proposed that the Canadian 2003 criteria should serve as the research case for CFS. Up to now, there have not been any published investigations comparing these clinical and research criteria. Using patient samples collected in the United States, Great Britain, and Norway, the current study compared and contrasted patients who met the clinical and research criteria. Overall findings indicated that those meeting the research criteria in comparison to those meeting the clinical criteria were significantly more impaired on a wide variety of symptoms and functional areas. The implications of these findings are discussed.

  5. Challenges and Recommendations for Placebo Controls in Randomized Trials in Physical and Rehabilitation Medicine

    PubMed Central

    Fregni, Felipe; Imamura, Marta; Chien, Hsin Fen; Lew, Henry L.; Boggio, Paulo; Kaptchuk, Ted J; Riberto, Marcelo; Hsing, Wu Tu; Battistella, Linamara Rizzo; Furlan, Andrea

    2010-01-01

    Compared to other specialties, the field of Physical and Rehabilitation Medicine (PRM) has not received the deserved recognition from clinicians and researchers in the scientific community. One of the reasons is the lack of sound evidence to support the traditional PRM treatments. The best way to change this disadvantage is through well-conducted clinical research, such as the standard placebo or sham-controlled randomized clinical trials. Therefore, having placebo groups in clinical trials is essential to improve the level of evidence-based practice in PRM that ultimately translates in a better clinical care. To address the challenges for the use of placebo in PRM randomized clinical trials, and to create useful recommendations, we convened a working group during the inaugural International Symposium in Placebo (February 2009, in Sao Paulo, Brazil) in which the following topics were discussed: (1) current status of randomized clinical trials in PRM, (2) challenges for the use of placebo in PRM, (3) bioethical issues, (4) use of placebo in acupuncture trials and for the treatment of low-back pain, (5) mechanisms of placebo, and (6) insights from other specialties. The current article represents the consensus report from the working group. PMID:20090428

  6. International recommendations and guidelines for the safe use of diagnostic ultrasound in medicine.

    PubMed

    Barnett, S B; Ter Haar, G R; Ziskin, M C; Rott, H D; Duck, F A; Maeda, K

    2000-03-01

    Modern sophisticated ultrasonographic equipment is capable of delivering substantial levels of acoustic energy into the body when used at maximum outputs. The risk of producing bioeffects has been studied by international expert groups during symposia supported by the World Federation for Ultrasound in Medicine and Biology (WFUMB). These have resulted in the publication of internationally accepted conclusions and recommendations. National ultrasound safety committees have published guidelines as well. These recommendations and safety guidelines offer valuable information to help users apply diagnostic ultrasound in a safe and effective manner. Acoustic output from ultrasound medical devices is directly regulated only in the USA and this is done by the Food and Drug Administration (FDA). However, there is also a modern trend towards self-regulation which has implications for the worldwide use of diagnostic ultrasound. It has resulted in a move away from the relatively simple scheme of FDA-enforced, application-specific limits on acoustic output to a scheme whereby risk of adverse effects of ultrasound exposure is assessed from information provided by the equipment in the form of a real-time display of safety indices. Under this option, the FDA allows a relaxation of some intensity limits, specifically approving the use of medical ultrasound devices that can expose the fetus or embryo to nearly eight times the intensity that was previously allowed. The shift of responsibility for risk assessment from a regulatory authority to the user creates an urgent need for awareness of risk and the development of knowledgeable and responsible attitudes to safety issues. To encourage this approach, it is incumbent on authorities, ultrasound societies and expert groups to provide relevant information on biological effects that might result from ultrasonographic procedures. It is obvious from the continued stream of enquiries received by ultrasound societies that effective

  7. [Theory of toxic classification of traditional Chinese medicine and recommendations for revision of China pharmacopeia (volume 1)].

    PubMed

    Zhao, Junning; Ye, Zuguang

    2012-08-01

    Toxic classification of traditional Chinese medicine, as a contribution of traditional Chinese medicine (TCM) to the recognition of medicinal toxicity and rational use of medicinal materials by Chinese people, is now a great issue related to safe medication, sustainable development and internationalization of Chinese medicine. In this article, the origination and development of toxic classification theory was summarized and analyzed. Because toxic classification is an urgent issue related to TCM industrialization, modernization and internationalization, this article made a systematic analysis on the nature and connotation of toxic classification as well as risk control for TCM industry due to the medicinal toxicity. Based on the toxic studies, this article made some recommendations on toxic classification of Chinese medicinal materials for the revision of China Pharmacopeia (volume 1). From the aspect of scientific research, a new technical guideline for research on toxic classification of Chinese medicine should be formulated based on new biological toxicity test technology such as Microtox and ADME/Tox, because the present classification of acute toxicity of mice/rats can not met the modern development of Chinese medicine any more. The evaluation system and technical SOP of TCM toxic classification should also be established, and they should well balance TCM features, superiority and international requirements. From the aspect of medicine management, list of toxic medicines and their risk classification should be further improved by competent government according to scientific research. In China Pharmacopeia (volume I), such descriptions of strong toxicity, toxicity or mild toxicity should be abandoned when describing medicine nature and flavor. This revision might help promote TCM sustainable development and internationalization, and enhance the competitive capacity of Chinese medicine in both domestic and international market. However, description of strong

  8. Environmental risk assessment of medicinal products for human use according to European Commission recommendations.

    PubMed

    Huschek, Gerd; Hansen, Peter D; Maurer, Hans H; Krengel, Dietmar; Kayser, Anja

    2004-06-01

    Presented here, based on new recommendations of the European Commission, is an environmental risk assessment (ERA) of a selected group of pharmaceuticals for Phase I, environmental exposure assessment, and Phase II Tier A, initial environmental fate and effect analysis. This pharmaceutical group is composed of the 111 highest-selling human drug substances that have annual sales in Germany of more than 5,000 kg. The data required for this ERA came from analyzing: (1) sales annually (in kg or IU) of the 2671 active pharmaceutical drug substances (2001) on the German market in all medicinal products sold by pharmacies (with and without prescriptions) and used in hospitals in 1996-2001; (2) the use pattern of drug substances as categorized according to Anatomical Therapeutic Chemical (ATC) classification indexes ATC3 and ATC7; (3) data for excretion, toxicity, and metabolites of the 111 selected human drug substances; (4) the physicochemical properties of these substances; and (5) the degradability of selected drug substances in sewage treatment plants (STPs) by using a validated and accredited liquid chromatography-electrospray ionization tandem mass spectrometry method. A correction factor for the pharmaceutical therapeutic (PT) activity of metabolites, the PT(Index) (excretion rate/100) for drug substances and PT active metabolites was established to refine the predicted environmental concentration (PEC(SURFACEWATER)). A refinement of the PEC(SURFACEWATER) was carried out with the market penetration factor of the human drug substances in Germany. In addition, for effect analysis the predicted no-effects concentration (PNEC) was calculated using assessment factors. The estimated PEC results were validated with the exposure results of effluents of the STPs. All results on ERA of drug substances have been documented in a Microsoft Access 2000 database.

  9. Incoming interns' perspectives on the institute of medicine recommendations for residents' duty hours.

    PubMed

    Arora, Vineet M; Farnan, Jeanne M; Lypson, Monica L; Anderson, R Andy; Prochaska, Meryl H; Humphrey, Holly J

    2010-12-01

    The Accreditation Council for Graduate Medical Education (ACGME) has announced revisions to the resident duty hour standards in light of a 2008 Institute of Medicine report that recommended further limits. Soliciting resident input regarding the future of duty hours is critical to ensure trainee buy-in. To assess incoming intern perceptions of duty hour restrictions at 3 teaching hospitals. We administered an anonymous survey to incoming interns during orientation at 3 teaching hospitals affiliated with 2 Midwestern medical schools in 2009. Survey questions assessed interns' perceptions of maximum shift length, days off, ACGME oversight, and preferences for a "fatigued post-call intern who admitted patient" versus "well-rested covering intern who just picked up patient" for various clinical scenarios. Eighty-six percent (299/346) of interns responded. Although 59% agreed that residents should not work over 16 hours without a break, 50% of interns favored the current limits. The majority (78%) of interns desired ability to exceed shift limit for rare cases or clinical opportunities. Most interns (90%) favored oversight by the ACGME, and 97% preferred a well-rested intern for performing a procedure. Meanwhile, only 48% of interns preferred a well-rested intern for discharging a patient or having an end of life discussion. Interns who favored 16-hour limits were less concerned with negative consequences of duty hour restrictions (handoffs, reduced clinical experience) and more likely to choose the well-rested intern for certain scenarios (odds ratio 2.33, 95% confidence interval 1.42-3.85, P  =  .001). Incoming intern perceptions on limiting duty hours vary. Many interns desire flexibility to exceed limits for interesting clinical opportunities and favor ACGME oversight. Clinical context matters when interns consider the tradeoffs between fatigue and discontinuity.

  10. Incoming Interns' Perspectives on the Institute of Medicine Recommendations for Residents' Duty Hours

    PubMed Central

    Arora, Vineet M.; Farnan, Jeanne M.; Lypson, Monica L.; Anderson, R. Andy; Prochaska, Meryl H.; Humphrey, Holly J.

    2010-01-01

    Background The Accreditation Council for Graduate Medical Education (ACGME) has announced revisions to the resident duty hour standards in light of a 2008 Institute of Medicine report that recommended further limits. Soliciting resident input regarding the future of duty hours is critical to ensure trainee buy-in. Purpose To assess incoming intern perceptions of duty hour restrictions at 3 teaching hospitals. Methods We administered an anonymous survey to incoming interns during orientation at 3 teaching hospitals affiliated with 2 Midwestern medical schools in 2009. Survey questions assessed interns' perceptions of maximum shift length, days off, ACGME oversight, and preferences for a “fatigued post-call intern who admitted patient” versus “well-rested covering intern who just picked up patient” for various clinical scenarios. Results Eighty-six percent (299/346) of interns responded. Although 59% agreed that residents should not work over 16 hours without a break, 50% of interns favored the current limits. The majority (78%) of interns desired ability to exceed shift limit for rare cases or clinical opportunities. Most interns (90%) favored oversight by the ACGME, and 97% preferred a well-rested intern for performing a procedure. Meanwhile, only 48% of interns preferred a well-rested intern for discharging a patient or having an end of life discussion. Interns who favored 16-hour limits were less concerned with negative consequences of duty hour restrictions (handoffs, reduced clinical experience) and more likely to choose the well-rested intern for certain scenarios (odds ratio 2.33, 95% confidence interval 1.42–3.85, P  =  .001). Conclusions Incoming intern perceptions on limiting duty hours vary. Many interns desire flexibility to exceed limits for interesting clinical opportunities and favor ACGME oversight. Clinical context matters when interns consider the tradeoffs between fatigue and discontinuity. PMID:22132274

  11. The Development of Best Practice Recommendations to Support the Hiring, Recruitment, and Advancement of Women Physicians in Emergency Medicine.

    PubMed

    Choo, Esther K; Kass, Dara; Westergaard, Mary; Watts, Susan H; Berwald, Nicole; Regan, Linda; Promes, Susan B; Clem, Kathleen J; Schneider, Sandra M; Kuhn, Gloria J; Abbuhl, Stephanie; Nobay, Flavia

    2016-11-01

    Women in medicine continue to experience disparities in earnings, promotion, and leadership roles. There are few guidelines in place defining organization-level factors that promote a supportive workplace environment beneficial to women in emergency medicine (EM). We assembled a working group with the goal of developing specific and feasible recommendations to support women's professional development in both community and academic EM settings. We formed a working group from the leadership of two EM women's organizations, the Academy of Women in Academic Emergency Medicine (AWAEM) and the American Association of Women Emergency Physicians (AAWEP). Through a literature search and discussion, working group members identified four domains where organizational policies and practices supportive of women were needed: 1) global approaches to supporting the recruitment, retention, and advancement of women in EM; 2) recruitment, hiring, and compensation of women emergency physicians; 3) supporting development and advancement of women in EM; and 4) physician health and wellness (in the context of pregnancy, childbirth, and maternity leave). Within each of these domains, the working group created an initial set of specific recommendations. The working group then recruited a stakeholder group of EM physician leaders across the country, selecting for diversity in practice setting, geographic location, age, race, and gender. Stakeholders were asked to score and provide feedback on each of the recommendations. Specific recommendations were retained by the working group if they achieved high rates of approval from the stakeholder group for importance and perceived feasibility. Those with >80% agreement on importance and >50% agreement on feasibility were retained. Finally, recommendations were posted in an open online forum (blog) and invited public commentary. An initial set of 29 potential recommendations was created by the working group. After stakeholder voting and feedback, 16

  12. Chirality of meteoritic free and IOM-derived monocarboxylic acids and implications for prebiotic organic synthesis

    NASA Astrophysics Data System (ADS)

    Aponte, José C.; Tarozo, Rafael; Alexandre, Marcelo R.; Alexander, Conel M. O.'D.; Charnley, Steven B.; Hallmann, Christian; Summons, Roger E.; Huang, Yongsong

    2014-04-01

    The origin of homochirality and its role in the development of life on Earth are among the most intriguing questions in science. It has been suggested that carbonaceous chondrites seeded primitive Earth with the initial organic compounds necessary for the origin of life. One of the strongest pieces of evidence supporting this theory is that certain amino acids in carbonaceous chondrites display a significant L-enantiomeric excess (ee), similar to those use by terrestrial life. Analyses of ee in meteoritic molecules other than amino acids would shed more light on the origins of homochirality. In this study we investigated the stereochemistry of two groups of compounds: (1) free monocarboxylic acids (MCAs) from CM2 meteorites LON 94101 and Murchison; and (2) the aliphatic side chains present in the insoluble organic matter (IOM) and extracted in the form of monocarboxylic acids (MCAs) from EET 87770 (CR2) and Orgueil (CI1). Contrary to the well-known ee observed for amino acids in meteorites, we found that meteoritic branched free and IOM-derived MCAs with 5-8 carbon atoms are essentially racemic. The racemic nature of these compounds is used to discuss the possible influence of ultraviolet circularly polarized light (UVCPL) and aqueous alterations on the parent body on chirality observed in in carbonaceous chondrites.

  13. Penile Prosthesis Surgery: Current Recommendations From the International Consultation on Sexual Medicine.

    PubMed

    Levine, Laurence A; Becher, Edgardo; Bella, Anthony; Brant, William; Kohler, Tobias; Martinez-Salamanca, Juan Ignacio; Trost, Landon; Morey, Allen

    2016-04-01

    Penile prosthesis implantation has emerged as a definitive treatment to restore sexual function to the motivated man with erectile dysfunction. Substantial improvements in the design of inflatable devices have been made since they first became available more than four decades ago. To review the history of the penile prosthesis, the indications, preoperative evaluation, and patient and partner satisfaction. The current approaches to addressing intra- and postoperative complications, provide an understanding of prosthesis infection, and placement of these devices will be reviewed. A committee of worldwide experts in this field was assembled during the 2015 International Consultation on Sexual Medicine (ICSM) and performed a systematic review of the peer-reviewed published medical literature pertaining to penile prosthesis. Particular attention was given to higher level trials when available. Recommendations are based upon the Oxford Criteria. Unfortunately there is limited level 1 and 2 evidence, and where expert opinion was utilized, the decision was unanimous within the committee with a goal of presenting a clinically relevant guideline pertaining to penile prostheses. Penile prosthesis has undergone an evolution over the past 40 years resulting in a more effective and reliable treatment for advanced erectile dysfunction not responding to less invasive methods including oral treatment with PDE5 inhibitors, vacuum erection device, and intracorporal injection therapy. It should be considered an appropriate treatment option for the man who wishes to restore erectile function and who understands the potential risk of mechanical failure and infection, both of which are less common now as a result of improvements made in device design as well as surgical protocols adhered to in the operating room. Patients must be clearly informed of the risks associated with penile prosthesis including mechanical failure, infection, shortening of the penis, change in sensation and

  14. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society.

    PubMed

    Watson, Nathaniel F; Badr, M Safwan; Belenky, Gregory; Bliwise, Donald L; Buxton, Orfeu M; Buysse, Daniel; Dinges, David F; Gangwisch, James; Grandner, Michael A; Kushida, Clete; Malhotra, Raman K; Martin, Jennifer L; Patel, Sanjay R; Quan, Stuart F; Tasali, Esra

    2015-06-01

    Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine. © 2015 Associated Professional Sleep Societies, LLC.

  15. Consistency of Nutrition Recommendations for Foods Marketed to Children in the United States, 2009–2010

    PubMed Central

    Quilliam, Elizabeth Taylor; Paek, Hye-Jin; Kim, Sookyong; Venkatesh, Sumathi; Plasencia, Julie; Lee, Mira; Rifon, Nora J.

    2013-01-01

    Introduction Food marketing has emerged as an environmental factor that shapes children’s dietary behaviors. “Advergames,” or free online games designed to promote branded products, are an example of evolving food marketing tactics aimed at children. Our primary objective was to classify foods marketed to children (aged 2–11 y) in advergames as those meeting or not meeting nutrition recommendations of the US Department of Agriculture (USDA), Food & Drug Administration (FDA), Center for Science in the Public Interest (CSPI), and the Institute of Medicine (IOM). We document the consistency of classification of those foods across agency guidelines and offer policy recommendations. Methods We used comScore Media Builder Metrix to identify 143 websites that marketed foods (n = 439) to children aged 2 to 11 years through advergames. Foods were classified on the basis of each of the 4 agency criteria. Food nutrient labels provided information on serving size, calories, micronutrients, and macronutrients. Results The websites advertised 254 meals, 101 snacks, and 84 beverages. Proportions of meals and snacks meeting USDA and FDA recommendations were similarly low, with the exception of saturated fat in meals and sodium content in snacks. Inconsistency in recommendations was evidenced by only a small proportion of meals and fewer snacks meeting the recommendations of all the agencies per their guidelines. Beverage recommendations were also inconsistent across the 3 agencies that provide recommendations (USDA, IOM, and CSPI). Most (65%–95%) beverages advertised in advergames did not meet some of these recommendations. Conclusion Our findings indicate that a large number of foods with low nutritional value are being marketed to children via advergames. A standardized system of food marketing guidance is needed to better inform the public about healthfulness of foods advertised to children. PMID:24070037

  16. Recommendations for teaching upon sensitive topics in forensic and legal medicine in the context of medical education pedagogy.

    PubMed

    Kennedy, Kieran M; Scriver, Stacey

    2016-11-01

    Undergraduate medical curricula typically include forensic and legal medicine topics that are of a highly sensitive nature. Examples include suicide, child abuse, domestic and sexual violence. It is likely that some students will have direct or indirect experience of these issues which are prevalent in society. Those students are vulnerable to vicarious harm from partaking in their medical education. Even students with no direct or indirect experience of these issues may be vulnerable to vicarious trauma, particularly students who are especially empathetic to cases presented. Despite these risks, instruction relating to these topics is necessary to ensure the competencies of graduating doctors to respond appropriately to cases they encounter during their professional careers. However, risk can be minimised by a well-designed and thoughtfully delivered educational programme. We provide recommendations for the successful inclusion of sensitive forensic and legal medicine topics in undergraduate medical curricula. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  17. Best educational practices in pediatric emergency medicine during emergency medicine residency training: guiding principles and expert recommendations.

    PubMed

    Cloutier, Robert L; Walthall, Jennifer D H; Mull, Colette C; Nypaver, Michele M; Baren, Jill M

    2010-10-01

    The state of pediatric emergency medicine (PEM) education within emergency medicine (EM) residency programs is reviewed and discussed in the context of shifting practice environments and new demands for a greater focus on the availability and quality of PEM services. The rapid growth of PEM within pediatrics has altered the EM practice landscape with regard to PEM. The authors evaluate the composition, quantity, and quality of PEM training in EM residency programs, with close attention paid to the challenges facing programs. A set of best practices is presented as a framework for discussion of future PEM training that would increase the yield and relevance of knowledge and experiences within the constraints of 3- and 4-year residencies. Innovative educational modalities are discussed, as well as the role of simulation and pediatric-specific patient safety education. Finally, barriers to PEM fellowship training among EM residency graduates are discussed in light of the shortage of practitioners from this training pathway and in recognition of the ongoing importance of the EM voice in PEM. © 2010 by the Society for Academic Emergency Medicine.

  18. Guidelines for pharmacoeconomic studies. Recommendations from the panel on cost effectiveness in health and medicine. Panel on cost Effectiveness in Health and Medicine.

    PubMed

    Siegel, J E; Torrance, G W; Russell, L B; Luce, B R; Weinstein, M C; Gold, M R

    1997-02-01

    This article reports the recommendations of the Panel on Cost Effectiveness in Health and Medicine, sponsored by the US Public Health Service, on standardised methods for conducting cost-effectiveness analyses. Although not expressly directed at analyses of pharmaceutical agents, the Panel's recommendations are relevant to pharmacoeconomic studies. The Panel outlines a 'Reference Case' set of methodological practices to improve quality and comparability of analyses. Designed for studies that inform resource-allocation decisions, the Reference Case includes recommendations for study framing and scope, components of the numerator and denominator of cost-effectiveness ratios, discounting, handling uncertainty and reporting. The Reference Case analysis is conducted from the societal perspective, and includes all effects of interventions on resource use and health. Resource use includes 'time' resources, such as for caregiving or undergoing an intervention. The quality-adjusted life-year (QALY) is the common measure of health effect across Reference Case studies. Although the Panel does not endorse a measure for obtaining quality-of-life weights, several recommendations address the QALY. The Panel recommends a 3% discount rate for costs and health effects. Pharmacoeconomic studies have burgeoned in recent years. The Reference Case analysis will improve study quality and usability, and permit comparison of pharmaceuticals with other health interventions.

  19. Promoting diversity in emergency medicine: summary recommendations from the 2008 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly Diversity Workgroup.

    PubMed

    Heron, Sheryl L; Lovell, Elise O; Wang, Ernest; Bowman, Steven H

    2009-05-01

    Although the U.S. population continues to become more diverse, ethnic and racial health care disparities persist. The benefits of a diverse medical workforce have been well described, but the percentage of emergency medicine (EM) residents from underrepresented groups (URGs) is small and has not significantly increased over the past 10 years. The Council of Emergency Medicine Resident Directors (CORD) requested that a panel of CORD members review the current state of ethnic and racial diversity in EM training programs. The objective of the discussion was to develop strategies to help EM residency programs examine and improve diversity in their respective institutions. Specific recommendations focus on URG applicant selection and recruitment strategies, cultural competence curriculum development, involvement of URG faculty, and the availability of institutional and national resources to improve and maintain diversity in EM training programs.

  20. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know

    USDA-ARS?s Scientific Manuscript database

    This article summarizes the new 2011 report on dietary requirements for calcium and vitamin D from the Institute of Medicine (IOM). An IOM Committee, charged with determining the population needs for these nutrients in North America, conducted a comprehensive review of the evidence for both skeletal...

  1. Recommendations for Nuclear Medicine Technologists Drawn from an Analysis of Errors Reported in Australian Radiation Incident Registers.

    PubMed

    Kearney, Nicole; Denham, Gary

    2016-12-01

    When a radiation incident occurs in nuclear medicine in Australia, the incident is reported to the relevant state or territory authority, which performs an investigation and sends its findings to the Australian Radiation Protection and Nuclear Safety Agency. The agency then includes these data in its Australian Radiation Incident Register and makes them available to the public as an annual summary report on its website. The aim of this study was to analyze the radiation incidents included in these annual reports and in the publically available state and territory registers, identify any recurring themes, and make recommendations to minimize future incidents.

  2. The orientation-averaged aspiration efficiency of IOM-like personal aerosol samplers mounted on bluff bodies.

    PubMed

    Paik, Samuel Y; Vincent, James H

    2004-01-01

    This paper describes two sets of experiments that were intended to characterize the orientation-averaged aspiration efficiencies of IOM samplers mounted on rotating bluff bodies. IOM samplers were mounted on simplified, three-dimensional rectangular bluff bodies that were rotated horizontally at a constant rate. Orientation-averaged aspiration efficiencies (A360) were measured as a function of Stokes' number (St), velocity ratio (R) and dimension ratio (r). Aspiration efficiency (A) is the efficiency with which particles are transported from the ambient air into the body of a sampler, and A360 is A averaged over all orientations to the wind. St is a dimensionless variable that represents particle inertia, R is the ratio of the air velocity in the freestream and that at the plane of the sampler's entry orifice, and r is the ratio of the sampler's orifice diameter and the bluff body's width. The first set of experiments were instrumental in establishing a hierarchy of effects on orientation-averaged A. It was clear that compared to r, St had a much larger influence on A. It was also clear, however, that the effects of St were overpowered by the effects of R in many cases. As concluded in previous studies, R and St were considered the most important factors in determining A, even for A360. The second set of experiments investigated A360 of IOM samplers for a much wider range of r than examined in previous research. Two important observations were made from the experimental results. One was that the A360 of IOM samplers, as a function of St, did not change for an r-range of 0.066-0.4. This meant that an IOM sampler mounted on a near life-size mannequin would measure the same aerosol concentration as one not mounted on anything. The second observation was that the aspiration efficiency curve of the IOM sampler was close to the inhalability curve. This gave further evidence that the bluff body did not play a major role in influencing A360, as the IOM samplers, in these

  3. Blood gas testing and related measurements: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine

    PubMed Central

    Dukić, Lora; Kopčinović, Lara Milevoj; Dorotić, Adrijana; Baršić, Ivana

    2016-01-01

    Blood gas analysis (BGA) is exposed to risks of errors caused by improper sampling, transport and storage conditions. The Clinical and Laboratory Standards Institute (CLSI) generated documents with recommendations for avoidance of potential errors caused by sample mishandling. Two main documents related to BGA issued by the CLSI are GP43-A4 (former H11-A4) Procedures for the collection of arterial blood specimens; approved standard – fourth edition, and C46-A2 Blood gas and pH analysis and related measurements; approved guideline – second edition. Practices related to processing of blood gas samples are not standardized in the Republic of Croatia. Each institution has its own protocol for ordering, collection and analysis of blood gases. Although many laboratories use state of the art analyzers, still many preanalytical procedures remain unchanged. The objective of the Croatian Society of Medical Biochemistry and Laboratory Medicine (CSMBLM) is to standardize the procedures for BGA based on CLSI recommendations. The Working Group for Blood Gas Testing as part of the Committee for the Scientific Professional Development of the CSMBLM prepared a set of recommended protocols for sampling, transport, storage and processing of blood gas samples based on relevant CLSI documents, relevant literature search and on the results of Croatian survey study on practices and policies in acid-base testing. Recommendations are intended for laboratory professionals and all healthcare workers involved in blood gas processing. PMID:27812301

  4. Capillary blood sampling: national recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine.

    PubMed

    Krleza, Jasna Lenicek; Dorotic, Adrijana; Grzunov, Ana; Maradin, Miljenka

    2015-01-01

    Capillary blood sampling is a medical procedure aimed at assisting in patient diagnosis, management and treatment, and is increasingly used worldwide, in part because of the increasing availability of point-of-care testing. It is also frequently used to obtain small blood volumes for laboratory testing because it minimizes pain. The capillary blood sampling procedure can influence the quality of the sample as well as the accuracy of test results, highlighting the need for immediate, widespread standardization. A recent nationwide survey of policies and practices related to capillary blood sampling in medical laboratories in Croatia has shown that capillary sampling procedures are not standardized and that only a small proportion of Croatian laboratories comply with guidelines from the Clinical Laboratory Standards Institute (CLSI) or the World Health Organization (WHO). The aim of this document is to provide recommendations for capillary blood sampling. This document has been produced by the Working Group for Capillary Blood Sampling within the Croatian Society of Medical Biochemistry and Laboratory Medicine. Our recommendations are based on existing available standards and recommendations (WHO Best Practices in Phlebotomy, CLSI GP42-A6 and CLSI C46-A2), which have been modified based on local logistical, cultural, legal and regulatory requirements. We hope that these recommendations will be a useful contribution to the standardization of capillary blood sampling in Croatia.

  5. Blood gas testing and related measurements: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine.

    PubMed

    Dukić, Lora; Kopčinović, Lara Milevoj; Dorotić, Adrijana; Baršić, Ivana

    2016-10-15

    Blood gas analysis (BGA) is exposed to risks of errors caused by improper sampling, transport and storage conditions. The Clinical and Laboratory Standards Institute (CLSI) generated documents with recommendations for avoidance of potential errors caused by sample mishandling. Two main documents related to BGA issued by the CLSI are GP43-A4 (former H11-A4) Procedures for the collection of arterial blood specimens; approved standard - fourth edition, and C46-A2 Blood gas and pH analysis and related measurements; approved guideline - second edition. Practices related to processing of blood gas samples are not standardized in the Republic of Croatia. Each institution has its own protocol for ordering, collection and analysis of blood gases. Although many laboratories use state of the art analyzers, still many preanalytical procedures remain unchanged. The objective of the Croatian Society of Medical Biochemistry and Laboratory Medicine (CSMBLM) is to standardize the procedures for BGA based on CLSI recommendations. The Working Group for Blood Gas Testing as part of the Committee for the Scientific Professional Development of the CSMBLM prepared a set of recommended protocols for sampling, transport, storage and processing of blood gas samples based on relevant CLSI documents, relevant literature search and on the results of Croatian survey study on practices and policies in acid-base testing. Recommendations are intended for laboratory professionals and all healthcare workers involved in blood gas processing.

  6. Capillary blood sampling: national recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine

    PubMed Central

    Krleza, Jasna Lenicek; Dorotic, Adrijana; Grzunov, Ana; Maradin, Miljenka

    2015-01-01

    Capillary blood sampling is a medical procedure aimed at assisting in patient diagnosis, management and treatment, and is increasingly used worldwide, in part because of the increasing availability of point-of-care testing. It is also frequently used to obtain small blood volumes for laboratory testing because it minimizes pain. The capillary blood sampling procedure can influence the quality of the sample as well as the accuracy of test results, highlighting the need for immediate, widespread standardization. A recent nationwide survey of policies and practices related to capillary blood sampling in medical laboratories in Croatia has shown that capillary sampling procedures are not standardized and that only a small proportion of Croatian laboratories comply with guidelines from the Clinical Laboratory Standards Institute (CLSI) or the World Health Organization (WHO). The aim of this document is to provide recommendations for capillary blood sampling. This document has been produced by the Working Group for Capillary Blood Sampling within the Croatian Society of Medical Biochemistry and Laboratory Medicine. Our recommendations are based on existing available standards and recommendations (WHO Best Practices in Phlebotomy, CLSI GP42-A6 and CLSI C46-A2), which have been modified based on local logistical, cultural, legal and regulatory requirements. We hope that these recommendations will be a useful contribution to the standardization of capillary blood sampling in Croatia. PMID:26524965

  7. Field comparison of three inhalable samplers (IOM, PGP-GSP 3.5 and Button) for welding fumes.

    PubMed

    Zugasti, Agurtzane; Montes, Natividad; Rojo, José M; Quintana, M José

    2012-02-01

    Inhalable sampler efficiency depends on the aerodynamic size of the airborne particles to be sampled and the wind speed. The aim of this study was to compare the behaviour of three personal inhalable samplers for welding fumes generated by Manual Metal Arc (MMA) and Metal Active Gas (MAG) processes. The selected samplers were the ones available in Spain when the study began: IOM, PGP-GSP 3.5 (GSP) and Button. Sampling was carried out in a welding training center that provided a homogeneous workplace environment. The static sampling assembly used allowed the placement of 12 samplers and 2 cascade impactors simultaneously. 183 samples were collected throughout 2009 and 2010. The range of welding fumes' mass concentrations was from 2 mg m(-3) to 5 mg m(-3). The pooled variation coefficients for the three inhalable samplers were less than or equal to 3.0%. Welding particle size distribution was characterized by a bimodal log-normal distribution, with MMADs of 0.7 μm and 8.2 μm. For these welding aerosols, the Button and the GSP samplers showed a similar performance (P = 0.598). The mean mass concentration ratio was 1.00 ± 0.01. The IOM sampler showed a different performance (P < 0.001). The mean mass concentration ratios were 0.90 ± 0.01 for Button/IOM and 0.92 ± 0.02 for GSP/IOM. This information is useful to consider the measurements accomplished by the IOM, GSP or Button samplers together, in order to assess the exposure at workplaces over time or to study exposure levels in a specific industrial activity, as welding operations.

  8. [Recommended general principles of good practice relating to psychological examinations in occupational medicine service].

    PubMed

    Waszkowska, Małgorzata; Wagrowska-Koski, Ewa

    2011-01-01

    This paper presents general principles of good practice in prophylactic psychological examinations. The principles are based on the binding law and standards of psychological examinations recommended by the Polish Psychological Association. They also take account of a specific nature of such examinations, resulting from their goals and the subject of their concern. Formal guidelines and health indications concerning this kind examinations, their scope, diagnostic methods, tools and documentation are discussed as well.

  9. Commentary: Missing the elephant in my office: recommendations for part-time careers in academic medicine.

    PubMed

    Helitzer, Deborah

    2009-10-01

    Several recent articles in this journal, including the article by Linzer and colleagues in this issue, discuss and promote the concept of part-time careers in academic medicine as a solution to the need to achieve a work-life balance and to address the changing demographics of academic medicine. The article by Linzer and colleagues presents the consensus of a task force that attempted to address practical considerations for part-time work in academic internal medicine. Missing from these discussions, however, are a consensus on the definition of part-time work, consideration of how such strategies would be available to single parents, how time or resources will be allocated to part-time faculty to participate in professional associations, develop professional networks, and maintain currency in their field, and how part-time work can allow for the development of expertise in research and scholarly activity. Most important, the discussions about the part-time solution do not address the root cause of dissatisfaction and attrition: the ever-increasing and unsustainable workload of full-time faculty. The realization that an academic full-time career requires a commitment of 80 hours per week begs the question of whether part-time faculty would agree to work 40 hours a week for part-time pay. The historical underpinnings of the current situation, the implications of part-time solutions for the academy, and the consequences of choosing part-time work as the primary solution are discussed. Alternative strategies for addressing some of the problems facing full-time faculty are proposed.

  10. Validation of the American Society for Reproductive Medicine guidelines/recommendations in white European men presenting for couple's infertility.

    PubMed

    Ventimiglia, Eugenio; Capogrosso, Paolo; Boeri, Luca; Ippolito, Silvia; Scano, Roberta; Moschini, Marco; Gandaglia, Giorgio; Papaleo, Enrico; Montorsi, Francesco; Salonia, Andrea

    2016-10-01

    To retrospectively validate the American Society for Reproductive Medicine (ASRM) guidelines/recommendations concerning endocrine evaluation in a cohort of white European men presenting for couple's infertility. Retrospective study. Academic reproductive medicine outpatient clinic. Cohort of 1,056 consecutive infertile men (noninterracial infertile couples). Testicular volume was assessed with a Prader orchidometer. Serum hormones were measured (8-10 a.m.) in all cases. Hypogonadism was defined as total T < 3 ng/mL, according to the Endocrine Society definition. Semen analysis values were assessed based on the 2010 World Health Organisation reference criteria. ASRM indications for endocrine assessment in infertile men (sperm concentration <10 million/mL, impaired sexual function, and other clinical findings suggesting a specific endocrinopathy) were used to predict hypogonadism in our cohort. Moreover, a clinically user-friendly three-item nomogram was developed to predict hypogonadism and was compared to the ASRM guidelines assessment. Biochemical hypogonadism was diagnosed in 156 (14.8%) men. Overall, 669 (63.4%) patients would have necessitated total T assessment according to the ASRM criteria; of these, only 119 (17.8%) were actually hypogonadal according to the Endocrine Society classification criteria. Conversely, 37 (23.7%) out of 156 patients with biochemical hypogonadism would have been overlooked. The overall predictive accuracy, sensitivity, and specificity of the ASRM guidelines was 58%, 76%, and 39%, respectively. Our nomogram was not reliable enough to predict hypogonadism, despite demonstrating a significantly higher predictive accuracy (68%) than the ASRM guidelines. The current findings show that the ASRM guidelines/recommendations for male infertility workup may not be suitable for application in white European infertile men. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  11. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations.

    PubMed

    Blomberg, Marie

    2011-05-01

    To estimate whether weight loss or low gestational weight gain in class I-III obese women is associated with adverse maternal and neonatal outcomes compared with gestational weight gain within the new Institute of Medicine recommendations. This was a population-based cohort study, which included 32,991 obesity class I, 10,068 obesity class II, and 3,536 obesity class III women who were divided into four gestational weight gain categories. Women with low (0-4.9 kg) or no gestational weight gain were compared with women gaining the recommended 5-9 kg concerning obstetric and neonatal outcome after suitable adjustments. Women in obesity class III who lost weight during pregnancy had a decreased risk of cesarean delivery (24.4%; odds ratio [OR] 0.77, 95% confidence interval [CI] 0.60-0.99), large-for-gestational-age births (11.2%, OR 0.64, 95% CI 0.46-0.90), and no significantly increased risk for pre-eclampsia, excessive bleeding during delivery, instrumental delivery, low Apgar score, or fetal distress compared with obese (class III) women gaining within the Institute of Medicine recommendations. There was an increased risk for small for gestational age, 3.7% (OR 2.34, 95% CI 1.15-4.76) among women in obesity class III losing weight, but there was no significantly increased risk of small for gestational age in the same group with low weight gain. Obese women (class II and III) who lose weight during pregnancy seem to have a decreased or unaffected risk for cesarean delivery, large for gestational age, pre-eclampsia, excessive postpartum bleeding, instrumental delivery, low Apgar score, and fetal distress. The twofold increased risk of small for gestational age in obesity class III and weight loss (3.7%) is slightly above the overall prevalence of small-for-gestational-age births in Sweden (3.6%).

  12. Recommendations for Reporting Mastery Education Research in Medicine (ReMERM).

    PubMed

    Cohen, Elaine R; McGaghie, William C; Wayne, Diane B; Lineberry, Matthew; Yudkowsky, Rachel; Barsuk, Jeffrey H

    2015-11-01

    Guidelines for reporting several types of medical studies have been described in the literature. However, there are no current guidelines to report studies on mastery learning curriculum development and trainee evaluation in medical education. Such guidelines will be important because medical education is moving toward a competency-based model. The authors sought to define standards for the evaluation of mastery learning curricula using previously published guidelines in related fields and expert review.The authors reviewed previously published guidelines from clinical medicine, medical education, and the social sciences. Six authors with expertise in mastery learning curricula, performance assessment, and medical education compiled and reached agreement about a list of guidelines. The authors later circulated the list to 12 other experts and made revisions. A final list of guidelines was established and received group consensus. The Reporting Mastery Education Research in Medicine (ReMERM) guidelines have 22 categories with 38 items considered to be imperative for reporting a mastery learning research study. Details about each item, with a specific focus on those unique to mastery learning, are discussed.The ReMERM guidelines highlight the importance of developing rigorous curricula that embody reliable measures which yield valid decisions about achievement among medical learners. These guidelines should improve the quality of reporting and help educators, authors, peer reviewers, journal editors, and readers to better understand and evaluate mastery learning research. With this shift to competency-based medical education, the ReMERM guidelines should help meet medical educators' needs to achieve these new goals.

  13. 4Ps medicine of the fatty liver: the research model of predictive, preventive, personalized and participatory medicine-recommendations for facing obesity, fatty liver and fibrosis epidemics.

    PubMed

    Trovato, Francesca Maria; Catalano, Daniela; Musumeci, Giuseppe; Trovato, Guglielmo M

    2014-01-01

    Relationship between adipose tissue and fatty liver, and its possible evolution in fibrosis, is supported by clinical and research experience. Given the multifactorial pathogenesis of non-alcoholic fatty liver disease (NAFLD), treatments for various contributory risk factors have been proposed; however, there is no single validated therapy or drug association recommended for all cases which can stand alone. Mechanisms, diagnostics, prevention and treatment of obesity, fatty liver and insulin resistance are displayed along with recommendations and position points. Evidences and practice can get sustainable and cost-benefit valuable outcomes by participatory interventions. These recommendations can be enhanced by comprehensive research projects, addressed to societal issues and innovation, market appeal and industry development, cultural acceptance and sustainability. The basis of participatory medicine is a greater widespread awareness of a condition which is both a disease and an easy documented and inclusive clue for associated diseases and unhealthy lifestyle. This model is suitable for addressing prevention and useful for monitoring improvement, worsening and adherence with non-invasive imaging tools which allow targeted approaches. The latter include health psychology and nutritional and physical exercise prescription expertise disseminated by continuous medical education but, more important, by concrete curricula for training undergraduate and postgraduate students. It is possible and recommended to do it by early formal teaching of ultrasound imaging procedures and of practical lifestyle intervention strategies, including approaches aimed to healthier fashion suggestions. Guidelines and requirements of research project funding calls should be addressed also to NAFLD and allied conditions and should encompass the goal of training by research and the inclusion of participatory medicine topics. A deeper awareness of ethics of competences in health professionals

  14. Emergency Medicine Resident Assessment of the Emergency Ultrasound Milestones and Current Training Recommendations.

    PubMed

    Stolz, Lori A; Stolz, Uwe; Fields, J Matthew; Saul, Turandot; Secko, Michael; Flannigan, Matthew J; Sheele, Johnathan M; Rifenburg, Robert P; Weekes, Anthony J; Josephson, Elaine B; Bedolla, John; Resop, Dana M; Dela Cruz, Jonathan; Boysen-Osborn, Megan; Caffery, Terrell; Derr, Charlotte; Bengiamin, Rimon; Chiricolo, Gerardo; Backlund, Brandon; Heer, Jagdipak; Hyde, Robert J; Adhikari, Srikar

    2017-03-01

    Emergency ultrasound (EUS) has been recognized as integral to the training and practice of emergency medicine (EM). The Council of Emergency Medicine Residency-Academy of Emergency Ultrasound (CORD-AEUS) consensus document provides guidelines for resident assessment and progression. The Accredited Council for Graduate Medical Education (ACGME) has adopted the EM Milestones for assessment of residents' progress during their residency training, which includes demonstration of procedural competency in bedside ultrasound. The objective of this study was to assess EM residents' use of ultrasound and perceptions of the proposed ultrasound milestones and guidelines for assessment. This study is a prospective stratified cluster sample survey of all U.S. EM residency programs. Programs were stratified based on their geographic location (Northeast, South, Midwest, West), presence/absence of ultrasound fellowship program, and size of residency with programs sampled randomly from each stratum. The survey was reviewed by experts in the field and pilot tested on EM residents. Summary statistics and 95% confidence intervals account for the survey design, with sampling weights equal to the inverse of the probability of selection, and represent national estimates of all EM residents. There were 539 participants from 18 residency programs with an overall survey response rate of 85.1%. EM residents considered several applications to be core applications that were not considered core applications by CORD-AEUS (quantitative bladder volume, diagnosis of joint effusion, interstitial lung fluid, peritonsillar abscess, fetal presentation, and gestational age estimation). Of several core and advanced applications, the Focused Assessment with Sonography in Trauma examination, vascular access, diagnosis of pericardial effusion, and cardiac standstill were considered the most likely to be used in future clinical practice. Residents responded that procedural guidance would be more crucial to

  15. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

    PubMed Central

    Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

    2015-01-01

    Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. SLEEP 2015;38(6):843–844. PMID:26039963

  16. Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

    PubMed Central

    Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

    2015-01-01

    Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 2015;11(6):591–592. PMID:25979105

  17. A Randomized Clinical Trial on Treatment of Chronic Constipation by Traditional Persian Medicine Recommendations Compared to Allopathic Medicine: A Pilot Study

    PubMed Central

    Fattahi, Mohammad Reza; Alorizi, Seyed Morteza Emami; Nimrouzi, Majid; Zarshenas, Mohammad M.; Parvizi, Mohammad Mahdi

    2017-01-01

    Background: The aim of this study was to compare the efficacy and side effects of lactulose plus traditional Persian medicine with only lactulose on the functional chronic constipation. Methods: Participants included 20 patients (10 in each group) aged 18–80 years, with major inclusion criteria of ROME III. They were assigned into two parallel therapeutic groups, including the intervention group (lactulose plus traditional Persian medicine [TPM] advices) and control group (only lactulose) through a block randomization. Weekly follow-up was done for 1 month for both groups. Results: After the intervention, the frequency of bowel habit increased significantly in patients of both groups (P = 0.001), and the frequency of hard stool defecation, sensation of painful defecation, sensation of incomplete evacuation, sensation of anorectal obstruction, and manual maneuver for evacuation were decreased significantly in patients of both groups (P < 0.001 for all comparisons and 0.025 for manual maneuver). However, the only significant difference between the two groups was more reduction in the sensation of painful defecation in the lactulose group versus lactulose plus TPM advices (P = 0.014). Conclusions: Based on the pilot study, no significant difference was shown between TPM with lactulose and lactulose only in the management of chronic functional constipation. However, the easy recommendations of TPM can be useful in improving chronic constipation. PMID:28757927

  18. Improving Hospital Care and Collaborative Communications for the 21st Century: Key Recommendations for General Internal Medicine

    PubMed Central

    Lo, Vivian; Rossos, Peter; Kuziemsky, Craig; O’Leary, Kevin J; Cafazzo, Joseph A; Reeves, Scott; Wong, Brian M; Morra, Dante

    2012-01-01

    Background Communication and collaboration failures can have negative impacts on the efficiency of both individual clinicians and health care system delivery as well as on the quality of patient care. Recognizing the problems associated with clinical and collaboration communication, health care professionals and organizations alike have begun to look at alternative communication technologies to address some of these inefficiencies and to improve interprofessional collaboration. Objective To develop recommendations that assist health care organizations in improving communication and collaboration in order to develop effective methods for evaluation. Methods An interprofessional meeting was held in a large urban city in Canada with 19 nationally and internationally renowned experts to discuss suitable recommendations for an ideal communication and collaboration system as well as a research framework for general internal medicine (GIM) environments. Results In designing an ideal GIM communication and collaboration system, attendees believed that the new system should possess attributes that aim to: a) improve workflow through prioritization of information and detection of individuals’ contextual situations; b) promote stronger interprofessional relationships with adequate exchange of information; c) enhance patient-centered care by allowing greater patient autonomy over their health care information; d) enable interoperability and scalability between and within institutions; and e) function across different platforms. In terms of evaluating the effects of technology in GIM settings, participants championed the use of rigorous scientific methods that span multiple perspectives and disciplines. Specifically, participants recommended that consistent measures and definitions need to be established so that these impacts can be examined across individual, group, and organizational levels. Conclusions Discussions from our meeting demonstrated the complexities of

  19. Improving hospital care and collaborative communications for the 21st century: key recommendations for general internal medicine.

    PubMed

    Wu, Robert C; Lo, Vivian; Rossos, Peter; Kuziemsky, Craig; O'Leary, Kevin J; Cafazzo, Joseph A; Reeves, Scott; Wong, Brian M; Morra, Dante

    2012-09-24

    Communication and collaboration failures can have negative impacts on the efficiency of both individual clinicians and health care system delivery as well as on the quality of patient care. Recognizing the problems associated with clinical and collaboration communication, health care professionals and organizations alike have begun to look at alternative communication technologies to address some of these inefficiencies and to improve interprofessional collaboration. To develop recommendations that assist health care organizations in improving communication and collaboration in order to develop effective methods for evaluation. An interprofessional meeting was held in a large urban city in Canada with 19 nationally and internationally renowned experts to discuss suitable recommendations for an ideal communication and collaboration system as well as a research framework for general internal medicine (GIM) environments. In designing an ideal GIM communication and collaboration system, attendees believed that the new system should possess attributes that aim to: a) improve workflow through prioritization of information and detection of individuals' contextual situations; b) promote stronger interprofessional relationships with adequate exchange of information; c) enhance patient-centered care by allowing greater patient autonomy over their health care information; d) enable interoperability and scalability between and within institutions; and e) function across different platforms. In terms of evaluating the effects of technology in GIM settings, participants championed the use of rigorous scientific methods that span multiple perspectives and disciplines. Specifically, participants recommended that consistent measures and definitions need to be established so that these impacts can be examined across individual, group, and organizational levels. Discussions from our meeting demonstrated the complexities of technological implementations in GIM settings

  20. Recommendations for protecting National Library of Medicine Computing and Networking Resources

    SciTech Connect

    Feingold, R.

    1994-11-01

    Protecting Information Technology (IT) involves a number of interrelated factors. These include mission, available resources, technologies, existing policies and procedures, internal culture, contemporary threats, and strategic enterprise direction. In the face of this formidable list, a structured approach provides cost effective actions that allow the organization to manage its risks. We face fundamental challenges that will persist for at least the next several years. It is difficult if not impossible to precisely quantify risk. IT threats and vulnerabilities change rapidly and continually. Limited organizational resources combined with mission restraints-such as availability and connectivity requirements-will insure that most systems will not be absolutely secure (if such security were even possible). In short, there is no technical (or administrative) {open_quotes}silver bullet.{close_quotes} Protection is employing a stratified series of recommendations, matching protection levels against information sensitivities. Adaptive and flexible risk management is the key to effective protection of IT resources. The cost of the protection must be kept less than the expected loss, and one must take into account that an adversary will not expend more to attack a resource than the value of its compromise to that adversary. Notwithstanding the difficulty if not impossibility to precisely quantify risk, the aforementioned allows us to avoid the trap of choosing a course of action simply because {open_quotes}it`s safer{close_quotes} or ignoring an area because no one had explored its potential risk. Recommendations for protecting IT resources begins with discussing contemporary threats and vulnerabilities, and then procedures from general to specific preventive measures. From a risk management perspective, it is imperative to understand that today, the vast majority of threats are against UNIX hosts connected to the Internet.

  1. Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

    PubMed Central

    Stoneking, LR; Waterbrook, AL; Garst Orozco, J; Johnston, D; Bellafiore, A; Davies, C; Nuño, T; Fatás-Cabeza, J; Beita, O; Ng, V; Grall, KH; Adamas-Rappaport, W

    2016-01-01

    Background After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit. Objectives To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency. Methods Our ED has two Emergency Medicine Residency Programs, University Campus (UC) and South Campus (SC). SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions. Results Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study. Complete outcome data were available for 55 patients. Overall, resident physicians spoke Spanish 58% of the time. SC resident physicians spoke Spanish with 66% of the patients versus 45% for UC resident physicians. Patients rated resident physician Spanish ability as very good in 13% of encounters – 17% for SC versus 5% for UC. Patient satisfaction with their ED visit was rated as very good in 35% of encounters – 40% for SC resident physicians versus 25% for UC resident physicians. Of the 13 patients for whom Spanish was the language used during the medical encounter who followed medical recommendations, ten (77%) of these encounters were with SC resident physicians

  2. Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

    PubMed

    Stoneking, L R; Waterbrook, A L; Garst Orozco, J; Johnston, D; Bellafiore, A; Davies, C; Nuño, T; Fatás-Cabeza, J; Beita, O; Ng, V; Grall, K H; Adamas-Rappaport, W

    2016-01-01

    After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit. To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency. Our ED has two Emergency Medicine Residency Programs, University Campus (UC) and South Campus (SC). SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient's native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions. Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study. Complete outcome data were available for 55 patients. Overall, resident physicians spoke Spanish 58% of the time. SC resident physicians spoke Spanish with 66% of the patients versus 45% for UC resident physicians. Patients rated resident physician Spanish ability as very good in 13% of encounters - 17% for SC versus 5% for UC. Patient satisfaction with their ED visit was rated as very good in 35% of encounters - 40% for SC resident physicians versus 25% for UC resident physicians. Of the 13 patients for whom Spanish was the language used during the medical encounter who followed medical recommendations, ten (77%) of these encounters were with SC resident physicians and three (23%) encounters were with UC

  3. Consensus-Based Recommendations for an Emergency Medicine Pain Management Curriculum.

    PubMed

    Poon, Sabrina J; Nelson, Lewis S; Hoppe, Jason A; Perrone, Jeanmarie; Sande, Margaret K; Yealy, Donald M; Beeson, Michael S; Todd, Knox H; Motov, Sergey M; Weiner, Scott G

    2016-08-01

    Increased prescribing of opioid pain medications has paralleled the subsequent rise of prescription medication-related overdoses and deaths. We sought to define key aspects of a pain management curriculum for emergency medicine (EM) residents that achieve the balance between adequate pain control, limiting side effects, and not contributing to the current public health opioid crisis. We convened a symposium to discuss pain management education in EM and define the needs and objectives of an EM-specific pain management curriculum. Multiple pertinent topics were identified a priori and presented before consensus work. Subgroups then sought to define perceived gaps and needs, to set a future direction for development of a focused curriculum, and to prioritize the research needed to evaluate and measure the impact of a new curriculum. The group determined that an EM pain management curriculum should include education on both opioid and nonopioid analgesics as well as nonpharmacologic pain strategies. A broad survey is needed to better define current knowledge gaps and needs. To optimize the impact of any curriculum, a modular, multimodal, and primarily case-based approach linked to achieving milestones is best. Subsequent research should focus on the impact of curricular reform on learner knowledge and patient outcomes, not just prescribing changes. This consensus group offers a path forward to enhance the evidence, knowledge, and practice transformation needed to improve emergency analgesia. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Efficacy and safety of Ayurvedic medicines: Recommending equivalence trial design and proposing safety index.

    PubMed

    Sarmukaddam, Sanjeev; Chopra, Arvind; Tillu, Girish

    2010-07-01

    Ayurvedic drugs have begun to be evaluated in controlled clinical trials. The trials, often placebo controlled, are usually designed to demonstrate superiority. Though the results have been usually reported as encouraging, statistical significance has been elusive. In this melee to show efficacy, several positive results related to safety and other purported advantages with Ayurvedic drugs, including improved quality of life, easy drug availability and less cost, get drowned. Though safety is the prime concern, efficacy ultimately matters in trials. Excellent safety profile offset modest efficacy, especially for long-term management of chronic difficult to treat disorders. There is a trade-off between efficacy and safety but we have no means to put them together in a mathematical evaluation to judge the overall performance of a drug. However, we need more suitable modern science methods/techniques to unravel the true therapeutic role of Ayurvedic drugs. We propose "equivalence trials" using modern medicine benchmark as a comparator and a "safety/tolerability index" on this perspective. We believe that several Ayurvedic drugs are capable of demonstrating equal efficacy but superior safety. Our concept may also be applicable for pragmatic trials that are more suitable for Ayurvedic therapy.

  5. Performance evaluation of three computed radiography systems using methods recommended in American Association of Physicists in Medicine Report 93.

    PubMed

    Muhogora, Wilbroad; Padovani, Renato; Bonutti, Faustino; Msaki, Peter; Kazema, R

    2011-07-01

    The performances of three clinical computed radiography (CR) systems, (Agfa CR 75 (with CRMD 4.0 image plates), Kodak CR 850 (with Kodak GP plates) and Kodak CR 850A (with Kodak GP plates)) were evaluated using six tests recommended in American Association of Physicists in Medicine Report 93. The results indicated variable performances with majority being within acceptable limits. The variations were mainly attributed to differences in detector formulations, plate readers' characteristics, and aging effects. The differences of the mean low contrast scores between the imaging systems for three observers were statistically significant for Agfa and Kodak CR 850A (P=0.009) and for Kodak CR systems (P=0.006) probably because of the differences in ages. However, the differences were not statistically significant between Agfa and Kodak CR 850 (P=0.284) suggesting similar perceived image quality. The study demonstrates the need to implement quality control program regularly.

  6. Physical therapy in critically ill adult patients: recommendations from the Brazilian Association of Intensive Care Medicine Department of Physical Therapy.

    PubMed

    França, Eduardo Ériko Tenório de; Ferrari, Francimar; Fernandes, Patrícia; Cavalcanti, Renata; Duarte, Antonio; Martinez, Bruno Prata; Aquim, Esperidião Elias; Damasceno, Marta Cristina Paulete

    2012-03-01

    Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.

  7. Addressing the nation's physician workforce needs: The Society of General Internal Medicine (SGIM) recommendations on graduate medical education reform.

    PubMed

    Jackson, Angela; Baron, Robert B; Jaeger, Jeffrey; Liebow, Mark; Plews-Ogan, Margaret; Schwartz, Mark D

    2014-11-01

    The Graduate Medical Education (GME) system in the United States (US) has garnered worldwide respect, graduating over 25,000 new physicians from over 8,000 residency and fellowship programs annually. GME is the portal of entry to medical practice and licensure in the US, and the pathway through which resident physicians develop the competence to practice independently and further develop their career plans. The number and specialty distribution of available GME positions shapes the overall composition of our national workforce; however, GME is failing to provide appropriate programs that support the delivery of our society's system of healthcare. This paper, prepared by the Health Policy Education Subcommittee of the Society of General Internal Medicine (SGIM) and unanimously endorsed by SGIM's Council, outlines a set of recommendations on how to reform the GME system to best prepare a physician workforce that can provide high quality, high value, population-based, and patient-centered health care, aligned with the dynamic needs of our nation's healthcare delivery system. These recommendations include: accurate workforce needs assessment, broadened GME funding sources, increased transparency of the use of GME dollars, and implementation of incentives to increase the accountability of GME-funded programs for the preparation and specialty selection of their program graduates.

  8. Recommended strategies for the oral administration of paediatric medicines with food and drinks in the context of their biopharmaceutical properties: a review.

    PubMed

    Martir, Joana; Flanagan, Talia; Mann, James; Fotaki, Nikoletta

    2017-04-01

    This review focuses on the recommended strategies for the oral administration of paediatric medicines with food in the context of their biopharmaceutical properties. Acceptability of oral medicines in young patients is more challenging than in adult patients. Mixing oral dosage forms with foods and drinks is sometimes suggested to administer a specific dose and enhance compliance in the paediatric population. In this review, the strategies for the co-administration of paediatric medicines with food and drinks are discussed. Current administration practices as reported by healthcare professionals and parents/carers are compared with the relevant guidelines. Differences in the type of vehicles recommended to be used and actually used in current practice were identified. Correlations of the type of food recommended, the type of formulation and the drug's biopharmaceutical classification system (BCS) class were performed and revealed that recommendations should be made on a case-by-case basis. The propensity for physiochemical or bioavailability changes that may occur from the co-administration of medicines with food and drinks in the paediatric population should be considered, and harmonisation of the recommended administration strategies is needed. © 2016 Royal Pharmaceutical Society.

  9. Patient-centered integrated networks of emergency care: consensus-based recommendations and future research priorities.

    PubMed

    Govindarajan, Prasanthi; Larkin, Gregory Luke; Rhodes, Karin V; Piazza, Gina; Byczkowski, Terri L; Edwards, Meredith; Baren, Jill M

    2010-12-01

    Patient-centered care is defined by the Institute of Medicine (IOM) as care that is responsive to individual patient needs and values and that guides the treatment decisions. This article is a result of a breakout session of the 2010 Academic Emergency Medicine (AEM) consensus conference and describes the process of developing consensus-based recommendations for providing patient-centered emergency care. The objectives of the working group were to identify and describe the critical gaps in the provision of patient-centered care, develop a consensus-based research agenda, and create a list of future research priorities. Using e-mail and in-person meetings, knowledge gaps were identified in the areas of respect for patient preferences, coordination of clinical care, and communication among health care providers. Four consensus-based recommendations were developed on the following themes: enhancing communication and patient advocacy in emergency departments (EDs), facilitating care coordination after discharge, defining metrics for patient-centered care, and placing the locus of control of medical information into patients' hands. The set of research priorities based on these recommendations was created to promote research and advance knowledge in this dimension of clinical care. 2010 by the Society for Academic Emergency Medicine.

  10. Impact of European medicines agency recommendations for hypersensitivity reactions on intravenous iron prescription in haemodialysis centres of the Lombardy region.

    PubMed

    Rivera, Rodolfo F; Guido, Davide; Del Vecchio, Lucia; Corghi, Enzo; D'Amico, Marco; Camerini, Corrado; Spotti, Donatella; Galassi, Andrea; Pozzi, Claudio; Cancarini, Giovanni; Pontoriero, Giuseppe; Locatelli, Francesco

    2016-10-01

    The European Medicines Agency (EMA) has recommended measures to minimize the risk of hypersensitivity reactions (HSRs) to intravenous iron (IVFe). We analysed the effects of these recommendations on IVFe clinical management among haemodialysis centres (HDCs) in Lombardy, Italy. A questionnaire was sent to all 117 HDCs to collect information on centre characteristics, e.g. HDC type [hospital centre (HC) vs. centre with limited assistance (CAL)], presence/absence of intensive care unit (ICU) and/or emergency trained staff, IVFe therapy regarding molecules, administration modalities, side effects, and percentage variations in iron prescription between 2014 and 2013 (outcome, Δ-IVFe%). A linear regression model was applied to evaluate the focus effect (β) of HDC type on the outcome, controlling for possible confounding effects of the other characteristics. Response rate was 73.5 %. IVFe therapy was used in 69.1 % (HDC range 11-100) of patients. Following EMA recommendations, prescription was reduced by 12.6 %, with the largest reduction observed in CALs. No severe HSRs were reported. HCs had more frequently an ICU [97.2 vs. 20 %, odds ratio (OR) = 63.6 (95 % confidence interval 15.56; 537.47), p < 0.001], emergency trained staff [97.2 vs. 61.2 %, OR = 10.7 (2.68; 85.33), p < 0.001] and instrumental facilities (91.7 vs. 58 %, OR = 5.8 (2.03; 23.55), p < 0.001] than CALs. Linear regression demonstrated a significant raw effect of HDC type on Δ- IVFe% [β =  19.6 (9.82; 30.63), p < 0.001]. No association was found when HDC type was adjusted for ICU-presence [β = 6.7 (-2.32; 18.30), p = 0.199] or for all-confounding factors [β = 5.6 (-5.50; 17.08), p = 0.337]. This survey shows a disparity in IVFe therapy prescription following EMA recommendations, which is largely influenced by the presence/absence of ICUs in HD centres.

  11. US Military Dietary Protein Recommendations: A Simple But Often Confused Topic.

    PubMed

    Pasiakos, Stefan M; Sepowitz, John J; Deuster, Patricia A

    2015-01-01

    Military recommendations for dietary protein are based on the recommended dietary allowance (RDA) of 0.8 g of protein per kilogram of body mass (BM) established by the Food and Nutrition Board, Institute of Medicine (IOM) of the National Academies. The RDA is likely adequate for most military personnel, particularly when activity levels are low and energy intake is sufficient to maintain a healthy body weight. However, military recommendations account for periods of increased metabolic demand during training and real-world operations, especially those that produce an energy deficit. Under those conditions, protein requirements are higher (1.5-2.0 g/kg BM) in an attempt to attenuate the unavoidable loss of muscle mass that occurs during prolonged or repeated exposure to energy deficits. Whole foods are recommended as the primary method to consume more protein, although there are likely operational scenarios where whole foods are not available and consuming supplemental protein at effective, not excessive, doses (20-25 g or 0.25-0.3 g/kg BM per meal) is recommended. Despite these evidence-based, condition-specific recommendations, the necessity of protein supplements and the requirements and rationale for consuming higher-protein diets are often misunderstood, resulting in an overconsumption of dietary protein and unsubstantiated health-related concerns. This review will provide the basis of the US military dietary protein requirements and highlight common misconceptions associated with the amount and safety of protein in military diets.

  12. Physical Activity and Public Health in Older Adults: Recommendation from the American College of Sports Medicine and the American Heart Association

    USDA-ARS?s Scientific Manuscript database

    Objective: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. Participants: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. Evidence: The ...

  13. Research implications of the Institute of Medicine Report, Epilepsy Across the Spectrum: Promoting Health and Understanding

    PubMed Central

    Hesdorffer, Dale C.; Beck, Vicki; Begley, Charles E.; Bishop, Malachy L.; Cushner-Weinstein, Sandra; Holmes, Gregory L.; Shafer, Patricia O.; Sirven, Joseph I.; Austin, Joan K.

    2012-01-01

    In March 2012 the Institute of Medicine (IOM) released the report, Epilepsy Across The Spectrum: Promoting Health And Understanding. This report examined the public health dimensions of the epilepsies with a focus on four areas: public health surveillance and data collection and integration; population and public health research; health policy, health care, and human services; and education for providers, people with epilepsy and their families, and the public. The report provided recommendations and research priorities for future work in the field of epilepsy that relate to: increasing the power of data on epilepsy; prevention of epilepsy; improving health care for people with epilepsy; improving health professional education about epilepsy; improving quality of life for people with epilepsy; improving education about epilepsy for people with epilepsy and families; and raising public awareness about epilepsy. For this article, the authors selected one research priority from each of the major chapter themes in the IOM report: expanding and improving the quality of epidemiological surveillance in epilepsy; developing improved interventions for people with epilepsy and depression; expanding early identification/screening for learning impairments in children with epilepsy; evaluating and promoting effective innovative teaching strategies; accelerating research on the identification of risk factors and interventions that increase employment and improve quality of life for people with epilepsy and their families; assessing the information needs of people with epilepsy and their families associated with epilepsy-related risks, specifically sudden unexpected death in epilepsy; and developing and conducting surveys to capture trends in knowledge, awareness, attitudes, and beliefs about epilepsy over time and in specific population subgroups. For each research priority selected, examples of research are provided that will advance the field of epilepsy and improve the lives

  14. The Institute of Medicine, the Food and Drug Administration, and the calcium conundrum.

    PubMed

    Neupane, Shristi; Knohl, Stephen J

    2014-08-01

    In the present article we aim to bring forward the apparent disconnect between two US government-sponsored entities - the Institute of Medicine (IOM) and the Food and Drug Administration (FDA) - regarding the safe upper limit of Ca intake. In light of the 2011 US Congress-appointed IOM report indicating an upper limit of elemental Ca intake of 2000-2500 mg/d in adults (based on age group), it is perplexing that the FDA has not yet required a change on the labelling of over-the-counter Ca-containing antacids, some of which indicate an upper limit of elemental Ca intake of 2800-3000 mg/d. Even more concerning is that Ca intake is rarely from supplementation in isolation. National Health and Nutrition Examination Survey (NHANES) data from 2003-2006 indicate that mean dietary Ca intakes for males ranged from 871 to 1266 mg/d and for females from 748 to 968 mg/d depending on the age group. The estimated total Ca (diet + supplements) intake exceeded the upper limit in 5 % of the population older than 50 years. Furthermore, NHANES data from 1999-2000 indicate that when Ca is taken as part of an antacid preparation, patients often fail to report this as Ca intake. Thus, individuals taking the maximum allowable dose of supplemental Ca as antacids are at high risk for complications associated with excess Ca intake. Our hope is that by describing Ca homeostasis and highlighting the risks and dangers of Ca overload, the FDA will align its recommendation with the IOM and solve the current Ca conundrum in the USA for the sake of patient safety.

  15. [Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (ÖGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013].

    PubMed

    Singler, K; Stuck, A E; Masud, T; Goeldlin, A; Roller, R E

    2014-11-01

    Sound knowledge in the care and management of geriatric patients is essential for doctors in almost all medical subspecialties. Therefore, it is important that pregraduate medical education adequately covers the field of geriatric medicine. However, in most medical faculties in Europe today, learning objectives in geriatric medicine are often substandard or not even explicitly addressed. As a first step to encourage undergraduate teaching in geriatric medicine, the European Union of Medical Specialists -Geriatric Medicine Section (UEMS-GMS) recently developed a catalogue of learning goals using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end of their studies.In order to ease the implementation of this new, competence-based curriculum among the medical faculties in universities teaching in the German language, the authors translated the published English language curriculum into German and adapted it according to medical language and terms used at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties adapt their curricula for undergraduate teaching based on this catalogue.

  16. The experiences of implementing generic medicine policy in eight countries: A review and recommendations for a successful promotion of generic medicine use

    PubMed Central

    Hassali, Mohamed Azmi; Alrasheedy, Alian A.; McLachlan, Andrew; Nguyen, Tuan Anh; AL-Tamimi, Saleh Karamah; Ibrahim, Mohamed Izham Mohamed; Aljadhey, Hisham

    2013-01-01

    Generic medicines are clinically interchangeable with original brand medicines and have the same quality, efficacy and safety profiles. They are, nevertheless, much cheaper in price. Thus, while providing the same therapeutic outcomes, generic medicines lead to substantial savings for healthcare systems. Therefore, the quality use of generic medicines is promoted in many countries. In this paper, we reviewed the role of generic medicines in healthcare systems and the experiences of promoting the use of generic medicines in eight selected countries, namely the United States (US), the United Kingdom (UK), Sweden, Finland, Australia, Japan, Malaysia and Thailand. The review showed that there are different main policies adopted to promote generic medicines such as generic substitution in the US, generic prescribing in the UK and mandatory generic substitution in Sweden and Finland. To effectively and successfully implement the main policy, different complementary policies and initiatives were necessarily introduced. Barriers to generic medicine use varied between countries from negative perceptions about generic medicines to lack of a coherent generic medicine policy, while facilitators included availability of information about generic medicines to both healthcare professionals and patients, brand interchangeability guidelines, regulations that support generic substitution by pharmacists, and incentives to both healthcare professionals and patients. PMID:25561861

  17. Sexual Rehabilitation After Treatment For Prostate Cancer-Part 2: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015).

    PubMed

    Salonia, Andrea; Adaikan, Ganesh; Buvat, Jacques; Carrier, Serge; El-Meliegy, Amr; Hatzimouratidis, Kostas; McCullough, Andrew; Morgentaler, Abraham; Torres, Luiz Otavio; Khera, Mohit

    2017-03-01

    Sexual dysfunction is common in patients after radical prostatectomy (RP) for prostate cancer. To provide the International Consultation for Sexual Medicine (ICSM) 2015 recommendations concerning management strategies for post-RP erectile function impairment and to analyze post-RP sexual dysfunction other than erectile dysfunction. A literature search was performed using Google and PubMed database for English-language original and review articles published up to August 2016. Levels of evidence (LEs) and grades of recommendations (GRs) are provided based on a thorough analysis of the literature and committee consensus. Nine recommendations are provided by the ICSM 2015 committee on sexual rehabilitation after RP. Recommendation 6 states that the recovery of postoperative erectile function can take several years (LE = 2, GR = C). Recommendation 7 states there are conflicting data as to whether penile rehabilitation with phosphodiesterase type 5 inhibitors improves recovery of spontaneous erections (LE = 1, GR = A). Recommendation 8 states that the data are inadequate to support any specific regimen as optimal for penile rehabilitation (LE = 3, GR = C). Recommendation 9 states that men undergoing RP (any technique) are at risk of sexual changes other than erectile dysfunction, including decreased libido, changes in orgasm, anejaculation, Peyronie-like disease, and changes in penile size (LE = 2, GR = B). This article discusses Recommendations 6 to 9 of the ICSM 2015 committee on sexual rehabilitation after RP. Salonia A, Adaikan G, Buvat J, et al. Sexual Rehabilitation After Treatment For Prostate Cancer-Part 2: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med 2017;14:297-315. Copyright © 2017. Published by Elsevier Inc.

  18. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion.

    PubMed

    Watson, Nathaniel F; Badr, M Safwan; Belenky, Gregory; Bliwise, Donald L; Buxton, Orfeu M; Buysse, Daniel; Dinges, David F; Gangwisch, James; Grandner, Michael A; Kushida, Clete; Malhotra, Raman K; Martin, Jennifer L; Patel, Sanjay R; Quan, Stuart F; Tasali, Esra

    2015-08-15

    The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health. © 2015 American Academy of Sleep Medicine.

  19. Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s Ten Recommendations for Improving the Quality of Cancer Care in America

    PubMed Central

    Spinks, Tracy; Albright, Heidi W.; Feeley, Thomas W.; Walters, Ron; Burke, Thomas W.; Aloia, Thomas; Bruera, Eduardo; Buzdar, Aman; Foxhall, Lewis; Hui, David; Summers, Barbara; Rodriguez, Alma; DuBois, Raymond; Shine, Kenneth I.

    2011-01-01

    Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US healthcare system in the late 1990s. The National Cancer Policy Board (NCPB), a twenty-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system, where patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. This report outlined ten recommendations, which, when implemented, would: 1) improve the quality of cancer care; 2) increase our understanding of quality cancer care; and, 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating healthcare costs, has prompted national efforts to reform the healthcare system. These efforts by healthcare providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States. PMID:22045610

  20. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

    PubMed Central

    Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

    2015-01-01

    The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. J Clin Sleep Med 2015;11(8):931–952. PMID:26235159

  1. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion

    PubMed Central

    Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

    2015-01-01

    The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. SLEEP 2015;38(8):1161–1183. PMID:26194576

  2. Challenges and recommendations for placebo controls in randomized trials in physical and rehabilitation medicine: a report of the international placebo symposium working group.

    PubMed

    Fregni, Felipe; Imamura, Marta; Chien, Hsin Fen; Lew, Henry L; Boggio, Paulo; Kaptchuk, Ted J; Riberto, Marcelo; Hsing, Wu Tu; Battistella, Linamara Rizzo; Furlan, Andrea

    2010-02-01

    Compared with other specialties, the field of physical and rehabilitation medicine has not received the deserved recognition from clinicians and researchers in the scientific community. One of the reasons is the lack of sound evidence to support the traditional physical and rehabilitation medicine treatments. The best way to change this disadvantage is through a well conducted clinical research, such as standard placebo- or sham-controlled randomized clinical trials. Therefore, having placebo groups in clinical trials is essential to improve the level of evidence-based practice in physical and rehabilitation medicine that ultimately translates to better clinical care. To address the challenges for the use of placebo in physical and rehabilitation medicine and randomized clinical trials and to create useful recommendations, we convened a working group during the inaugural International Symposium in Placebo (February 2009, in Sao Paulo, Brazil) in which the following topics were discussed: (1) current status of randomized clinical trials in physical and rehabilitation medicine, (2) challenges for the use of placebo in physical and rehabilitation medicine, (3) bioethics, (4) use of placebo in acupuncture trials and for the treatment of low-back pain, (5) mechanisms of placebo, and (6) insights from other specialties. The current article represents the consensus report from the working group.

  3. Pre-graduate and post-graduate education in personalized medicine in the Czech Republic: statistics, analysis and recommendations.

    PubMed

    Polivka, Jiri; Polivka, Jiri; Karlikova, Marie; Topolcan, Ondrej

    2014-01-01

    The main goal of personalized medicine is the individualized approach to the patient's treatment. It could be achieved only by the integration of the complexity of novel findings in diverse "omics" disciplines, new methods of medical imaging, as well as implementation of reliable biomarkers into the medical care. The implementation of personalized medicine into clinical practice is dependent on the adaptation of pre-graduate and post-graduate medical education to these principles. The situation in the education of personalized medicine in the Czech Republic is analyzed together with novel educational tools that are currently established in our country. The EPMA representatives in the Czech Republic in cooperation with the working group of professionals at the Faculty of Medicine in Pilsen, Charles University in Prague have implemented the survey of personalized medicine awareness among students of Faculty of Medicine in Pilsen-the "Personalized Medicine Questionnaire". The results showed lacking knowledge of personalized medicine principles and students' will of education in this domain. Therefore, several educational activities addressed particularly to medical students and young physicians were realized at our facility with very positive evaluation. These educational activities (conferences, workshops, seminars, e-learning and special courses in personalized medicine (PM)) will be a part of pre-graduate and post-graduate medical education, will be extended to other medical faculties in our country. The "Summer School of Personalized Medicine in Plzen 2015" will be organized at the Faculty of Medicine and Faculty Hospital in Pilsen as the first event on this topic in the Czech Republic.

  4. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion.

    PubMed

    Watson, Nathaniel F; Badr, M Safwan; Belenky, Gregory; Bliwise, Donald L; Buxton, Orfeu M; Buysse, Daniel; Dinges, David F; Gangwisch, James; Grandner, Michael A; Kushida, Clete; Malhotra, Raman K; Martin, Jennifer L; Patel, Sanjay R; Quan, Stuart F; Tasali, Esra

    2015-08-01

    The American Academy of Sleep Medicine and Sleep Research Society recently released a Consensus Statement regarding the recommended amount of sleep to promote optimal health in adults. This paper describes the methodology, background literature, voting process, and voting results for the consensus statement. In addition, we address important assumptions and challenges encountered during the consensus process. Finally, we outline future directions that will advance our understanding of sleep need and place sleep duration in the broader context of sleep health.

  5. Recommendations from recent graduates in medicine, nursing and pharmacy on improving interprofessional education in university programs: a qualitative study.

    PubMed

    Gilligan, Conor; Outram, Sue; Levett-Jones, Tracy

    2014-03-18

    Interprofessional education (IPE) has been recognized as an innovative approach for the development of a collaborative, practice-ready health workforce, but is not used consistently in undergraduate health professional programs. We sought to explore the reflections of graduates on the IPE experiences they had during their undergraduate education and training. It was anticipated that having completed their pre-vocational education and spent up to two years working in a clinical environment, recent graduates would be well-placed to provide insights into the value of the IPE opportunities they had, and to suggest approaches for improving these opportunities in undergraduate programs. This study was part of a larger research project (Interprofessional Education for the Quality use of Medicines; IPE for QuM) which used focus groups as part of an interpretive research design to inform other aspects of the research. Here, we report on focus groups with recent graduates recruited from area health services across Australia. Sixty-eight recent graduates working in New South Wales, Western Australia, and Tasmania participated in 12 focus group sessions. In this paper, we report on new graduates' reflections on their experiences of IPE as part of their university degree, as well as their recommendations to improve interprofessional education before graduation. The new graduates were unanimous in valuing IPE from their current perspective of being in the health workforce. Most IPE experiences recalled were regarded as positive, but those valued most highly were experiences that involved genuine engagement and opportunities to interact with students in other professions working on a relevant problem. Clinical placement was a missed opportunity with few structured meaningful interprofessional learning experiences. Surprisingly there was little social contact between professions in universities even when programs were co-located, thus reinforcing professional silos. The graduates

  6. Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients.

    PubMed

    Hernández-Tejedor, A; Peñuelas, O; Sirgo Rodríguez, G; Llompart-Pou, J A; Palencia Herrejón, E; Estella, A; Fuset Cabanes, M P; Alcalá-Llorente, M A; Ramírez Galleymore, P; Obón Azuara, B; Lorente Balanza, J A; Vaquerizo Alonso, C; Ballesteros Sanz, M A; García García, M; Caballero López, J; Socias Mir, A; Serrano Lázaro, A; Pérez Villares, J M; Herrera-Gutiérrez, M E

    The standardization of the Intensive Care Medicine may improve the management of the adult critically ill patient. However, these strategies have not been widely applied in the Intensive Care Units (ICUs). The aim is to elaborate the recommendations for the standardization of the treatment of critical patients. A panel of experts from the thirteen working groups (WG) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2002 to 2016 was extracted. The clinical evidence was discussed and summarised by the experts in the course of a consensus finding of every WG and finally approved by the WGs after an extensive internal review process that was carried out between December 2015 and December 2016. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and are intended as a guide for the intensivists in the management of critical patients. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  7. Curriculum for education and training of medical physicists in nuclear medicine: recommendations from the EANM Physics Committee, the EANM Dosimetry Committee and EFOMP.

    PubMed

    Del Guerra, Alberto; Bardies, Manuel; Belcari, Nicola; Caruana, Carmel J; Christofides, Stelios; Erba, Paola; Gori, Cesare; Lassmann, Michael; Lonsdale, Markus Nowak; Sattler, Bernhard; Waddington, Wendy

    2013-03-01

    To provide a guideline curriculum covering theoretical and practical aspects of education and training for Medical Physicists in Nuclear Medicine within Europe. National training programmes of Medical Physics, Radiation Physics and Nuclear Medicine physics from a range of European countries and from North America were reviewed and elements of best practice identified. An independent panel of experts was used to achieve consensus regarding the content of the curriculum. Guidelines have been developed for the specialist theoretical knowledge and practical experience required to practice as a Medical Physicist in Nuclear Medicine in Europe. It is assumed that the precondition for the beginning of the training is a good initial degree in Medical Physics at master level (or equivalent). The Learning Outcomes are categorised using the Knowledge, Skill and Competence approach along the lines recommended by the European Qualifications Framework. The minimum level expected in each topic in the theoretical knowledge and practical experience sections is intended to bring trainees up to the requirements expected of a Medical Physicist entering the field of Nuclear Medicine. This new joint EANM/EFOMP European guideline curriculum is a further step to harmonise specialist training of Medical Physicists in Nuclear Medicine within Europe. It provides a common framework for national Medical Physics societies to develop or benchmark their own curricula. The responsibility for the implementation and accreditation of these standards and guidelines resides within national training and regulatory bodies. Copyright © 2012 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  8. Medicines

    MedlinePlus

    ... better. In the United States, the Food and Drug Administration is in charge of assuring the safety ... prescription and over-the-counter medicines. Even safe drugs can cause unwanted side effects or interactions with ...

  9. Self-Efficacy in Situation Background Assessment and Recommendation Communication Using Information Technology in Baccalaureate Nursing

    ERIC Educational Resources Information Center

    Espinoza, Kelly Etcheberry

    2016-01-01

    Strong communication skills are essential in establishing a foundation for safe delivery of care. A report from the Institute of Medicine (IOM) titled: "To Err is Human: Building a Safer Health System" estimated 44,000 to 98,000 deaths occur due to medical errors annually. Communication failure was found to be the root cause in 70% of…

  10. Can the Institute of Medicine trump the dominant logic of nursing? Leading change in advanced practice education.

    PubMed

    Dreher, Melanie C; Clinton, Patricia; Sperhac, Arlene

    2014-01-01

    The Institute of Medicine (IOM; 2010) has called for a transformation of the nursing profession to lead the redesign of health care in the United States. It acknowledges the need for profound change in nursing education, particularly advanced practice education, to produce the next generation of leaders in sufficient quantity to expand access, improve quality, and reduce cost. Although the IOM provides welcome validation of nursing's significant role, most of the recommendations are not new and have been advocated by nurse educators for decades. What has prevented us from creating the nimble and responsive educational programs that would ensure a sufficient corpus of advanced practice nurses with the relevant knowledge and skill to transform our ailing health system? Conceptualizing nursing as a complex, adaptive system (J.W. Begun and K. White, 1997), this article explores three examples of the dominant logic, grounded in a historical legacy that has kept the nursing profession from realizing its promise as a potent force: (a) the continuing preference for experience over education, (b) the belief that only nurses can teach nurses, and (c) the hegemony of the research doctorate. © 2014.

  11. World Workshop on Oral Medicine VI: Controversies regarding dental management of medically complex patients: assessment of current recommendations.

    PubMed

    Napeñas, Joel J; Kujan, Omar; Arduino, Paolo G; Sukumar, Suma; Galvin, Sheila; Baričević, Marinka; Costella, John; Czerninski, Rakefet; Peterson, Douglas E; Lockhart, Peter B

    2015-08-01

    Current recommendations for safe and effective dental management are less than optimal for some medical conditions because of limited evidence, conflicting conclusions, or both. This review (1) compiled and evaluated dental management recommendations for select medical conditions; (2) summarized recommendations and their assigned levels of evidence; (3) identified areas of conflict, ambiguity, or both; and (4) identified issues that warrant future research, enhanced consensus statements, or both. Systematic literature searches were performed for guideline publications, systematic and narrative reviews, and opinion documents containing recommendations for (1) medication-related osteonecrosis of the jaw (MRONJ); (2) cardiovascular diseases (CVDs); (3) prosthetic joints (PJs); and (4) systemic steroid therapy (SST). The search yielded the following numbers of publications that met the inclusion criteria: MRONJ - 116; CVDs - 54; prosthetic joints - 39; and systemic steroids - 12. Very few of the compiled recommendations were assigned or linked to levels of evidence by their authors. Key conclusions include the following: MRONJ-expert recommendations trend toward proceeding with dental treatment with little to no modification in osteoporotic patients on bisphosphonates; CVDs-current recommendations are primarily directed to general surgery and applied to dentistry; PJs-routine antibiotic prophylaxis is not indicated for dental treatment; and SST-steroid supplementation is not indicated for most patients undergoing dental procedures under local anesthesia. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Not so fast: IOM report warns of danger in rushing IT training, as providers, vendors push for keeping safety reporting voluntary.

    PubMed

    Daly, Rich

    2011-11-14

    Hospitals need to be vigilant in giving staff adequate training in using health IT, according to an IOM report. One hospital that's fully implemented an EHR can attest to the importance of engaging physicians in the process. "When needed, we were relentless in going after them to receive the training," says Denni McColm, of Citizens Memorial Healthcare, Bolivar, Mo..

  13. Medicinal plants recommended by the world health organization: DNA barcode identification associated with chemical analyses guarantees their quality.

    PubMed

    Palhares, Rafael Melo; Gonçalves Drummond, Marcela; Dos Santos Alves Figueiredo Brasil, Bruno; Pereira Cosenza, Gustavo; das Graças Lins Brandão, Maria; Oliveira, Guilherme

    2015-01-01

    Medicinal plants are used throughout the world, and the regulations defining their proper use, such as identification of the correct species and verification of the presence, purity and concentration of the required chemical compounds, are widely recognized. Herbal medicines are made from vegetal drugs, the processed products of medicinal species. These processed materials present a number of challenges in terms of botanical identification, and according to the World Health Organization (WHO), the use of incorrect species is a threat to consumer safety. The samples used in this study consisted of the dried leaves, flowers and roots of 257 samples from 8 distinct species approved by the WHO for the production of medicinal herbs and sold in Brazilian markets. Identification of the samples in this study using DNA barcoding (matK, rbcL and ITS2 regions) revealed that the level of substitutions may be as high as 71%. Using qualitative and quantitative chemical analyses, this study identified situations in which the correct species was being sold, but the chemical compounds were not present. Even more troubling, some samples identified as substitutions using DNA barcoding contained the chemical compounds from the correct species at the minimum required concentration. This last situation may lead to the use of unknown species or species whose safety for human consumption remains unknown. This study concludes that DNA barcoding should be used in a complementary manner for species identification with chemical analyses to detect and quantify the required chemical compounds, thus improving the quality of this class of medicines.

  14. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion

    PubMed Central

    Paruthi, Shalini; Brooks, Lee J.; D'Ambrosio, Carolyn; Hall, Wendy A.; Kotagal, Suresh; Lloyd, Robin M.; Malow, Beth A.; Maski, Kiran; Nichols, Cynthia; Quan, Stuart F.; Rosen, Carol L.; Troester, Matthew M.; Wise, Merrill S.

    2016-01-01

    Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. Commentary: A commentary on this article apears in this issue on page 1439. Citation: Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion. J Clin Sleep Med 2016;12(11):1549–1561. PMID:27707447

  15. [Preoperative evaluation of adult patients before elective, noncardiothoracic surgery : Joint recommendation of the German Society of Anesthesiology and Intensive Care Medicine, the German Society of Surgery, and the German Society of Internal Medicine].

    PubMed

    Zwissler, B

    2017-06-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e. g. blood chemistry, ECG, spirometry, chest x‑ray) can contribute to a reduction of perioperative risk is often not very well known or is controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate recommendations on the preoperative evaluation of adult patients prior to elective, noncardiothoracic surgery, which were initially published in 2010. These recommendations have now been updated based on the current literature and existing international guidelines. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and

  16. Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine.

    PubMed

    Sanders, Gillian D; Neumann, Peter J; Basu, Anirban; Brock, Dan W; Feeny, David; Krahn, Murray; Kuntz, Karen M; Meltzer, David O; Owens, Douglas K; Prosser, Lisa A; Salomon, Joshua A; Sculpher, Mark J; Trikalinos, Thomas A; Russell, Louise B; Siegel, Joanna E; Ganiats, Theodore G

    2016-09-13

    Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years. To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers. In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process. The concept of a "reference case" and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an "impact inventory," which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health

  17. Support of personalized medicine through risk-stratified treatment recommendations - an environmental scan of clinical practice guidelines.

    PubMed

    Yu, Tsung; Vollenweider, Daniela; Varadhan, Ravi; Li, Tianjing; Boyd, Cynthia; Puhan, Milo A

    2013-01-09

    Risk-stratified treatment recommendations facilitate treatment decision-making that balances patient-specific risks and preferences. It is unclear if and how such recommendations are developed in clinical practice guidelines (CPGs). Our aim was to assess if and how CPGs develop risk-stratified treatment recommendations for the prevention or treatment of common chronic diseases. We searched the United States National Guideline Clearinghouse for US, Canadian and National Institute for Health and Clinical Excellence (United Kingdom) CPGs for heart disease, stroke, cancer, chronic obstructive pulmonary disease and diabetes that make risk-stratified treatment recommendations. We included only those CPGs that made risk-stratified treatment recommendations based on risk assessment tools. Two reviewers independently identified CPGs and extracted information on recommended risk assessment tools; type of evidence about treatment benefits and harms; methods for linking risk estimates to treatment evidence and for developing treatment thresholds; and consideration of patient preferences. We identified 20 CPGs that made risk-stratified treatment recommendations out of 133 CPGs that made any type of treatment recommendations for the chronic diseases considered in this study. Of the included 20 CPGs, 16 (80%) used evidence about treatment benefits from randomized controlled trials, meta-analyses or other guidelines, and the source of evidence was unclear in the remaining four (20%) CPGs. Nine CPGs (45%) used evidence on harms from randomized controlled trials or observational studies, while 11 CPGs (55%) did not clearly refer to harms. Nine CPGs (45%) explained how risk prediction and evidence about treatments effects were linked (for example, applying estimates of relative risk reductions to absolute risks), but only one CPG (5%) assessed benefit and harm quantitatively and three CPGs (15%) explicitly reported consideration of patient preferences. Only a small proportion of CPGs

  18. Support of personalized medicine through risk-stratified treatment recommendations - an environmental scan of clinical practice guidelines

    PubMed Central

    2013-01-01

    Background Risk-stratified treatment recommendations facilitate treatment decision-making that balances patient-specific risks and preferences. It is unclear if and how such recommendations are developed in clinical practice guidelines (CPGs). Our aim was to assess if and how CPGs develop risk-stratified treatment recommendations for the prevention or treatment of common chronic diseases. Methods We searched the United States National Guideline Clearinghouse for US, Canadian and National Institute for Health and Clinical Excellence (United Kingdom) CPGs for heart disease, stroke, cancer, chronic obstructive pulmonary disease and diabetes that make risk-stratified treatment recommendations. We included only those CPGs that made risk-stratified treatment recommendations based on risk assessment tools. Two reviewers independently identified CPGs and extracted information on recommended risk assessment tools; type of evidence about treatment benefits and harms; methods for linking risk estimates to treatment evidence and for developing treatment thresholds; and consideration of patient preferences. Results We identified 20 CPGs that made risk-stratified treatment recommendations out of 133 CPGs that made any type of treatment recommendations for the chronic diseases considered in this study. Of the included 20 CPGs, 16 (80%) used evidence about treatment benefits from randomized controlled trials, meta-analyses or other guidelines, and the source of evidence was unclear in the remaining four (20%) CPGs. Nine CPGs (45%) used evidence on harms from randomized controlled trials or observational studies, while 11 CPGs (55%) did not clearly refer to harms. Nine CPGs (45%) explained how risk prediction and evidence about treatments effects were linked (for example, applying estimates of relative risk reductions to absolute risks), but only one CPG (5%) assessed benefit and harm quantitatively and three CPGs (15%) explicitly reported consideration of patient preferences

  19. Emigration dynamics in the Arab region. IOM / UNFPA workshop, 7-8 October 1996, Geneva, Switzerland.

    PubMed

    Appleyard, R

    1996-01-01

    This paper describes the four research monographs on emigration that were presented at the December 1995 Regional Workshop in the Arab Region. The workshop was an exchange of views and discussion of policy implications of emigration. Monographs were presented by Dr. Mayar Farrag on emigration in Egypt, Professor Nadji Safir on migration in the Maghreb, Dr. Setenay Shami on emigration dynamics in Jordan, and Dr. Lynn Evans on behalf of Dr. Ivy Papps on migration in Gulf Cooperation Council (GCC) countries. Dr. Farrag identified three periods of migration. During the mid-1960s to the mid-1970s, migrants were officially encouraged by Egypt to fill education positions. During the 1970s, many migrants left for the oil-producing countries on a temporary basis. Since the mid-1980s, the influences on Egyptian migration have been the economic recession and oil prices in the Gulf states, the completion of infrastructure projects in most Gulf states, and the replacement of foreign labor with nationals. Dr. Farrag recommended improving the migrants' skills in English and technology in order to maintain a dominant flow of temporary migrants to the Gulf region. Professor Safir reported that persons from the Maghreb region (Tunisia, Algeria, and Morocco) migrated to France before independence and subsequently to West Germany and the Benelux countries. Algeria had the highest migration potential, and Morocco had the highest migration. Morocco had established networks in destination countries, high population growth rates, and high unemployment. Maghreb countries are receiving migrants from the south. Professor Safir recommended regional integration. Dr. Shami separated step migration from stepwise migration, which complicates push-pull theories. Dr. Papps argued that use of foreign labor may not be the best option for development, and that sending countries should be more aware of skill needs in GCC countries.

  20. From Systems Understanding to Personalized Medicine: Lessons and Recommendations Based on a Multidisciplinary and Translational Analysis of COPD.

    PubMed

    Roca, Josep; Cano, Isaac; Gomez-Cabrero, David; Tegnér, Jesper

    2016-01-01

    Systems medicine, using and adapting methods and approaches as developed within systems biology, promises to be essential in ongoing efforts of realizing and implementing personalized medicine in clinical practice and research. Here we review and critically assess these opportunities and challenges using our work on COPD as a case study. We find that there are significant unresolved biomedical challenges in how to unravel complex multifactorial components in disease initiation and progression producing different clinical phenotypes. Yet, while such a systems understanding of COPD is necessary, there are other auxiliary challenges that need to be addressed in concert with a systems analysis of COPD. These include information and communication technology (ICT)-related issues such as data harmonization, systematic handling of knowledge, computational modeling, and importantly their translation and support of clinical practice. For example, clinical decision-support systems need a seamless integration with new models and knowledge as systems analysis of COPD continues to develop. Our experience with clinical implementation of systems medicine targeting COPD highlights the need for a change of management including design of appropriate business models and adoption of ICT providing and supporting organizational interoperability among professional teams across healthcare tiers, working around the patient. In conclusion, in our hands the scope and efforts of systems medicine need to concurrently consider these aspects of clinical implementation, which inherently drives the selection of the most relevant and urgent issues and methods that need further development in a systems analysis of disease.

  1. Toward competency-based curricula in patient-centered spiritual care: recommended competencies for family medicine resident education.

    PubMed

    Anandarajah, Gowri; Craigie, Frederic; Hatch, Robert; Kliewer, Stephen; Marchand, Lucille; King, Dana; Hobbs, Richard; Daaleman, Timothy P

    2010-12-01

    Spiritual care is increasingly recognized as an important component of medical care. Although many primary care residency programs incorporate spiritual care into their curricula, there are currently no consensus guidelines regarding core competencies necessary for primary care training. In 2006, the Society of Teachers of Family Medicine's Interest Group on Spirituality undertook a three-year initiative to address this need. The project leader assembled a diverse panel of eight educators with dual expertise in (1) spirituality and health and (2) family medicine. The multidisciplinary panel members represented different geographic regions and diverse faith traditions and were nationally recognized senior faculty. They underwent three rounds of a modified Delphi technique to achieve initial consensus regarding spiritual care competencies (SCCs) tailored for family medicine residency training, followed by an iterative process of external validation, feedback, and consensus modifications of the SCCs. Panel members identified six knowledge, nine skills, and four attitude core SCCs for use in training and linked these to competencies of the Accreditation Council for Graduate Medical Education. They identified three global competencies for use in promotion and graduation criteria. Defining core competencies in spiritual care clarifies training goals and provides the basis for robust curricula evaluation. Given the breadth of family medicine, these competencies may be adaptable to other primary care fields, to medical and surgical specialties, and to medical student education. Effective training in this area may enhance physicians' ability to attend to the physical, mental, and spiritual needs of patients and better maintain sustainable healing relationships.

  2. Medicinal Plants Recommended by the World Health Organization: DNA Barcode Identification Associated with Chemical Analyses Guarantees Their Quality

    PubMed Central

    Palhares, Rafael Melo; Gonçalves Drummond, Marcela; dos Santos Alves Figueiredo Brasil, Bruno; Pereira Cosenza, Gustavo; das Graças Lins Brandão, Maria; Oliveira, Guilherme

    2015-01-01

    Medicinal plants are used throughout the world, and the regulations defining their proper use, such as identification of the correct species and verification of the presence, purity and concentration of the required chemical compounds, are widely recognized. Herbal medicines are made from vegetal drugs, the processed products of medicinal species. These processed materials present a number of challenges in terms of botanical identification, and according to the World Health Organization (WHO), the use of incorrect species is a threat to consumer safety. The samples used in this study consisted of the dried leaves, flowers and roots of 257 samples from 8 distinct species approved by the WHO for the production of medicinal herbs and sold in Brazilian markets. Identification of the samples in this study using DNA barcoding (matK, rbcL and ITS2 regions) revealed that the level of substitutions may be as high as 71%. Using qualitative and quantitative chemical analyses, this study identified situations in which the correct species was being sold, but the chemical compounds were not present. Even more troubling, some samples identified as substitutions using DNA barcoding contained the chemical compounds from the correct species at the minimum required concentration. This last situation may lead to the use of unknown species or species whose safety for human consumption remains unknown. This study concludes that DNA barcoding should be used in a complementary manner for species identification with chemical analyses to detect and quantify the required chemical compounds, thus improving the quality of this class of medicines. PMID:25978064

  3. The Record-Setting Flood of 2014 in Kelantan: Challenges and Recommendations from an Emergency Medicine Perspective and Why the Medical Campus Stood Dry

    PubMed Central

    BAHARUDDIN, Kamarul Aryffin; ABDULL WAHAB, Shaik Farid; NIK AB RAHMAN, Nik Hisamuddin; NIK MOHAMAD, Nik Arif; TUAN KAMAUZAMAN, Tuan Hairulnizam; MD NOH, Abu Yazid; ABDUL MAJOD, Mohd Roslani

    2015-01-01

    Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a ‘tsunami-like disaster’. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a preparation. The history of how the health campus was constructed with the collaboration of Perunding Alam Bina and Perkins and Willis of Chicago is elaborated. PMID:26023289

  4. The record-setting flood of 2014 in kelantan: challenges and recommendations from an emergency medicine perspective and why the medical campus stood dry.

    PubMed

    Baharuddin, Kamarul Aryffin; Abdull Wahab, Shaik Farid; Nik Ab Rahman, Nik Hisamuddin; Nik Mohamad, Nik Arif; Tuan Kamauzaman, Tuan Hairulnizam; Md Noh, Abu Yazid; Abdul Majod, Mohd Roslani

    2015-01-01

    Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a 'tsunami-like disaster'. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a preparation. The history of how the health campus was constructed with the collaboration of Perunding Alam Bina and Perkins and Willis of Chicago is elaborated.

  5. [Diagnosis and treatment of imported eosinophilia in travellers and immigrants: Recommendations of the Spanish Society of Tropical Medicine and International Health (SEMTSI)].

    PubMed

    Salas-Coronas, J; Ramírez-Olivencia, G; Pérez-Arellano, J L; Belhassen-García, M; Carranza-Rodríguez, C; García-Rodríguez, M; Villar-Garcia, J; Treviño-Maruri, B; Serre-Delcor, N; López-Vélez, R; Norman, F; Gómez-Junyent, J; Soriano-Pérez, M J; Rojo-Marcos, G; Rodríguez de Las Parras, E; Lago-Núñez, M M; Muro, A; Muñoz, J

    2017-02-01

    According to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a parasitic cause is identified in 17% to 75.9% of the individuals. Among the difficulties encountered to compare studies are the heterogeneity of the studied populations, the type of data collection (prospective/retrospective) and different diagnostic protocols. In this document the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported eosinophilia are detailed.

  6. [Preoperative evaluation of adult patients prior to elective, non-cardiac surgery. Joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine].

    PubMed

    2011-09-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non-cardiac and non-lung resection surgery. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

  7. [Preoperative evaluation of adult patients prior to elective, non-cardiac surgery: joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine].

    PubMed

    2010-11-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non-cardiac and non-lung resection surgery. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

  8. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.

    PubMed

    Haskell, William L; Lee, I-Min; Pate, Russell R; Powell, Kenneth E; Blair, Steven N; Franklin, Barry A; Macera, Caroline A; Heath, Gregory W; Thompson, Paul D; Bauman, Adrian

    2007-08-01

    In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates

  9. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.

    PubMed

    Haskell, William L; Lee, I-Min; Pate, Russell R; Powell, Kenneth E; Blair, Steven N; Franklin, Barry A; Macera, Caroline A; Heath, Gregory W; Thompson, Paul D; Bauman, Adrian

    2007-08-28

    In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates

  10. The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound-guided interventional pain procedures.

    PubMed

    Narouze, Samer N; Provenzano, David; Peng, Philip; Eichenberger, Urs; Lee, Sang Chul; Nicholls, Barry; Moriggl, Bernhard

    2012-01-01

    The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.

  11. Child Care Provider Adherence to Infant and Toddler Feeding Recommendations: Findings from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) Study

    PubMed Central

    Davison, Kirsten K.; Hesketh, Kathryn; Taveras, Elsie M.; Gillman, Matthew W.; Benjamin Neelon, Sara E.

    2015-01-01

    Abstract Background: Identifying characteristics associated with the Institute of Medicine's (IOM) recommended feeding practices among infant and toddler care providers in child care centers could help in preventing childhood obesity. Methods: In 2009, at baseline in a pilot intervention study of 29 licensed Massachusetts child care centers with at least 50% of enrolled children identified as racial minorities, 57 infant and 109 toddler providers completed feeding questionnaires. To assess provider adherence to six IOM-recommended behaviors, we used cluster-adjusted multivariable logistic regression models including provider type (infant or toddler), race, education, and center Child and Adult Care Food Program (CACFP) participation. Results: In multivariable analysis, CACFP participation was associated with providers sitting with children at meals (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2–21.7), offering fruits and vegetables (OR, 3.3; 95% CI 1.7–6.2), and limiting fast food (OR, 3.5; 95% CI, 1.8–6.7). Providers at centers serving meals family style were less likely to allow children to leave food unfinished (OR, 0.27; 95% CI, 0.09–0.77). Infant providers were more likely than toddler providers to sit with children at meals (OR, 6.98; 95% CI, 1.51–32.09), allow children to eat when hungry (OR, 3.50; 95% CI, 1.34–9.16), and avoid serving sugary (OR, 8.74; 95% CI, 3.05–25.06) or fast foods (OR, 11.56; 95% CI, 3.20–41.80). Conclusions: CACFP participation may encourage IOM-recommended feeding practices among infant and toddler providers. Child care providers may benefit from education about how to feed infants and toddlers responsively, especially when offering foods family style. Future research should explore ways to promote child-centered feeding practices, while addressing barriers to providing children with nutrient-rich foods. PMID:25918873

  12. Barriers to integration of behavioral and social sciences in the general medicine curriculum and recommended strategies to overcome them: A systematic review

    PubMed Central

    TABATABAEI, ZAHRA; YAZDANI, SHAHRAM; SADEGHI, RAMIN

    2016-01-01

    Introduction The integration of behavioral and social sciences (BSS) into the curriculum of medical students in order to equip them with the necessary knowledge, skills and attitudes is an essential issue, emphasized in many researches. Our aim is to investigate the barriers to integrate BSS into the general medicine curriculum as well as the recommended strategies to overcome such barriers through a systematic review of literature. Methods PubMed, ERIC, Scopus, CINAHL, Google Scholar, and OPENGREY were searched for studies on the barriers to integration of BSS into the general medicine curriculum as well as the strategies employed to overcome them until August 28, 2015. Results Sixteen relevant studies were included and the related domains were categorized as barriers and some strategies were recommended to overcome them. In addition, the quality of the included studies was assessed. Conclusion Despite the prominent role of BSS in the effectiveness of health care, these sciences have not been included in the curriculum of medical students effectively. The identified barriers and the strategies used to overcome them should be considered for all integration programs. Future studies should focus on the process of BSS integration in the medical curricula and should evaluate the efficacy of this integration in more detail. PMID:27382578

  13. Is rest after concussion "the best medicine?": recommendations for activity resumption following concussion in athletes, civilians, and military service members.

    PubMed

    Silverberg, Noah D; Iverson, Grant L

    2013-01-01

    Practice guidelines universally recommend an initial period of rest for people who sustain a sports-related concussion or mild traumatic brain injury (MTBI) in daily life or military service. This practice is difficult to reconcile with the compelling evidence that other health conditions can be worsened by inactivity and improved by early mobilization and exercise. We review the scientific basis for the recommendation to rest after MTBI, the challenges and potential unintended negative consequences of implementing it, and how patient management could be improved by refining it. The best available evidence suggests that complete rest exceeding 3 days is probably not helpful, gradual resumption of preinjury activities should begin as soon as tolerated (with the exception of activities that have a high MTBI exposure risk), and supervised exercise may benefit patients with persistent symptoms.

  14. Recommendations for Modeling Disaster Responses in Public Health and Medicine: A Position Paper of The Society for Medical Decision Making

    PubMed Central

    Brandeau, Margaret L.; McCoy, Jessica H.; Hupert, Nathaniel; Holty, Jon-Erik; Bravata, Dena M.

    2013-01-01

    Purpose Mathematical and simulation models are increasingly used to plan for and evaluate health sector responses to disasters, yet no clear consensus exists regarding best practices for the design, conduct, and reporting of such models. We examined a large selection of published health sector disaster response models to generate a set of best practice guidelines for such models. Methods We reviewed a spectrum of published disaster response models addressing public health or healthcare delivery, focusing in particular on the type of disaster and response decisions considered, decision makers targeted, choice of outcomes evaluated, modeling methodology, and reporting format. We developed initial recommendations for best practices for creating and reporting such models and refined these guidelines after soliciting feedback from response modeling experts and from members of the Society for Medical Decision Making. Results We propose six recommendations for model construction and reporting, inspired by the most exemplary models: Health sector disaster response models should address real-world problems; be designed for maximum usability by response planners; strike the appropriate balance between simplicity and complexity; include appropriate outcomes, which extend beyond those considered in traditional cost-effectiveness analyses; and be designed to evaluate the many uncertainties inherent in disaster response. Finally, good model reporting is particularly critical for disaster response models. Conclusions Quantitative models are critical tools for planning effective health sector responses to disasters. The recommendations we propose can increase the applicability and interpretability of future models, thereby improving strategic, tactical, and operational aspects of preparedness planning and response. PMID:19605887

  15. An overview of the health care system in Georgia: expert recommendations in the context of predictive, preventive and personalised medicine

    PubMed Central

    2013-01-01

    The main aim of this paper is to present the current statistics and situation of health care system in Georgia; the changes in the transition period within the society and the health care system. Also presented are the efforts from the Government and the Ministry of Labour, Health and Social Affairs of Georgia in the way of numerous initiatives and action in order to improve quality care of patients and sustain the health care system. This paper described the institutional framework, process, content and implementation of health and health care policies in Georgia in the context of predictive, preventive and personalised medicine. PMID:23442219

  16. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment.

    PubMed

    Mathieu, Daniel; Marroni, Alessandro; Kot, Jacek

    2017-03-01

    The tenth European Consensus Conference on Hyperbaric Medicine took place in April 2016, attended by a large delegation of experts from Europe and elsewhere. The focus of the meeting was the revision of the European Committee on Hyperbaric Medicine (ECHM) list of accepted indications for hyperbaric oxygen treatment (HBOT), based on a thorough review of the best available research and evidence-based medicine (EBM). For this scope, the modified GRADE system for evidence analysis, together with the DELPHI system for consensus evaluation, were adopted. The indications for HBOT, including those promulgated by the ECHM previously, were analysed by selected experts, based on an extensive review of the literature and of the available EBM studies. The indications were divided as follows: Type 1, where HBOT is strongly indicated as a primary treatment method, as it is supported by sufficiently strong evidence; Type 2, where HBOT is suggested as it is supported by acceptable levels of evidence; Type 3, where HBOT can be considered as a possible/optional measure, but it is not yet supported by sufficiently strong evidence. For each type, three levels of evidence were considered: A, when the number of randomised controlled trials (RCTs) is considered sufficient; B, when there are some RCTs in favour of the indication and there is ample expert consensus; C, when the conditions do not allow for proper RCTs but there is ample and international expert consensus. For the first time, the conference also issued 'negative' recommendations for those conditions where there is Type 1 evidence that HBOT is not indicated. The conference also gave consensus-agreed recommendations for the standard of practice of HBOT.

  17. Status of Emergency Contraceptives in Europe One Year after the European Medicines Agency's Recommendation to Switch Ulipristal Acetate to Non-Prescription Status.

    PubMed

    Italia, Salvatore; Brand, Helmut

    2016-01-01

    In November 2014, the European Medicines Agency (EMA) recommended switching the emergency contraceptive (EMC) ulipristal acetate to non-prescription status. This study's objective is to assess the current legal status of the two EMCs ulipristal acetate and levonorgestrel in Europe and to report on the development of sales figures for EMCs since they were made freely available. Health authorities were contacted in autumn 2015 and asked about the current status of EMCs and whether the sales figures had changed after a switch to non-prescription status. Additionally, data on consumption were collected in 18 German community pharmacies. As of November 2015, most countries in the European Union (EU) have followed the EMA recommendation. Hungary kept the prescription-only status. In Malta, EMC drugs are not authorized. Germany and Croatia switched levonorgestrel to non-prescription status as well. Of the EU candidate and European Free Trade Association countries, ulipristal acetate is available without prescription in Norway and Bosnia and Herzegovina only. Several countries reported an increase in EMC sales since the switch. An EMA recommendation can strongly contribute to the harmonization of a drug's legal status in the EU. In most European countries, ulipristal acetate and/or levonorgestrel are now freely available. © 2016 The Author(s) Published by S. Karger AG, Basel.

  18. Medical standards for mountain rescue operations using helicopters: official consensus recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

    PubMed

    Tomazin, Iztok; Ellerton, John; Reisten, Oliver; Soteras, Inigo; Avbelj, Miha

    2011-01-01

    The purpose of this article is to establish medical recommendations for safe and effective Helicopter Emergency Medical Systems (HEMS) in countries with a dedicated mountain rescue service. A nonsystematic search was undertaken and a consensus among members of International Commission for Mountain Emergency Medicine (ICAR Medcom) was reached. For the severely injured or ill patient, survival depends on approach time and quality of medical treatment by high-level providers. Helicopters can provide significant shortening of the times involved in mountain rescue. Safety is of utmost importance and everything possible should be done to minimize risk. Even in the mountainous environment, the patient should be reached as quickly as possible (optimally<20 min) and provided with on-site and en-route medical treatment according to international standards. The HEMS unit should be integrated into the Emergency Medical System of the region. All dispatchers should be aware of the specific problems encountered in mountainous areas. The nearest qualified HEMS team to the incident site, regardless of administrative boundaries, should be dispatched. The 'air rescue optimal crew' concept with its flexibility and adaptability of crewmembers ensures that all HEMS tasks can be performed. The helicopter and all equipment should be appropriate for the conditions and specific for mountain related emergencies. These recommendations, agreed by ICAR Medcom, establish recommendations for safe and effective HEMS in mountain rescue.

  19. Fluid management in traumatic shock: a practical approach for mountain rescue. Official recommendations of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

    PubMed

    Sumann, Günther; Paal, Peter; Mair, Peter; Ellerton, John; Dahlberg, Tore; Zen-Ruffinen, Gregoire; Zafren, Ken; Brugger, Hermann

    2009-01-01

    Sumann, Günther, Peter Paal, Peter Mair, John Ellerton, Tore Dahlberg, Gregoire Zen-Ruffinen, Ken Zafren, and Hermann Brugger. Fluid management in traumatic shock: a practical approach for mountain rescue. High Alt. Med. Biol. 10:71-75, 2009.-The management of severe injuries leading to traumatic shock in mountains and remote areas is a great challenge for emergency physicians and rescuers. Traumatic brain injury may further aggravate outcome. A mountain rescue mission may face severe limitations from the terrain and required rescue technique. The mission may be characterized by a prolonged prehospital care time, where urban traumatic shock protocols may not apply. Yet optimal treatment is of utmost importance. The aim of this study is to establish scientifically supported recommendations for fluid management that are feasible for the physician or paramedic attending such an emergency. A nonsystematic literature search was performed; the results and recommendations were discussed among the authors and accepted by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM). Diagnostic and therapeutic strategies are discussed, as well as limitations on therapy in mountain rescue. An algorithm for fluid resuscitation, derived from the recommendations, is presented in Fig. 1. Focused on the key criterion of traumatic brain injury, different levels of blood pressure are presented as a goal of therapy, and the practical means for achieving these are given.

  20. The Assessment of Complementary and Alternative Medicine Use Among Individuals with HIV: A Systematic Review and Recommendations for Future Research

    PubMed Central

    DePadilla, Lara; DiClemente, Ralph

    2011-01-01

    Abstract Objectives The use of complementary and alternative medicine (CAM), a group of health care practices and products that are not considered part of conventional medicine, has increased in recent years, particularly among individuals with human immune deficiency virus (HIV). Assessing the prevalence and predictors of CAM use among HIV-positive populations is important because some CAM therapies may adversely affect the efficacy of conventional HIV medications. Unfortunately, CAM use is not comprehensively or systematically assessed among HIV-positive populations. Therefore, the aim of the present study was to evaluate the quality of the instruments employed in observational studies assessing CAM use among HIV-positive populations by examining the degree to which these studies (1) evaluated the psychometric properties of their CAM instruments and (2) assessed the multidimensional nature of CAM use. Design A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. Specifically, articles were included that were published in English and in a peer-reviewed journal between 1997 and 2007, recruited HIV-positive study participants, and assessed CAM use. Thirty-two (32) studies met these inclusion criteria. Results Results suggest that CAM assessment among HIV-positive populations continues to be problematic. For example, approximately 20% of the studies assessed the reliability and 3% assessed the validity of the CAM instrument employed. Conclusions CAM assessment—regardless of the specific study population—is a complex and challenging task. However, CAM instruments will not become more refined over time in the absence of rigorous psychometric evaluation. Future research must assess reliability and validity and report these data in a clear and nuanced manner. PMID:21875350

  1. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion.

    PubMed

    Paruthi, Shalini; Brooks, Lee J; D'Ambrosio, Carolyn; Hall, Wendy A; Kotagal, Suresh; Lloyd, Robin M; Malow, Beth A; Maski, Kiran; Nichols, Cynthia; Quan, Stuart F; Rosen, Carol L; Troester, Matthew M; Wise, Merrill S

    2016-11-15

    Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. A commentary on this article apears in this issue on page 1439.

  2. Assessment of the impacts of traditional Persian medical schemes and recommendations on functional chronic constipation compared to a classic medicine lactulose, a randomized clinical trial.

    PubMed

    Emami Alorizi, Seyed Morteza; Fattahi, Mohammad Reza; Saghebi, Seyed Ahmad; Salehi, Alireza; Rezaeizadeh, Hossein; Nimrouzi, Majid; Zarshenas, Mohammad M

    2015-12-01

    To manage chronic constipation, numerous lifestyle modification schemes and recommendations as well as applications of natural medicaments have been mentioned in manuscripts of traditional Persian medicine (TPM). This study was aimed to compare the impacts of some of those recommendations with lactulose, on functional chronic constipation. Via a blocked randomization, 100 patients were enrolled. Schemes and recommendations from TPM as intervention group were evaluated versus lactulose as control by weekly follow-ups with standard questionnaire for 3 months. Stool frequency, hard stool, painful defecation, incomplete evacuation sensation, anorectal obstruction sensation and manual maneuvers were considered as outcome measures. Eighty-six patients (42 in schemes and 44 in lactulose groups) completed the study. Median weekly stool frequency in 0, 4, 8 and 12 weeks of treatment was 1.76±1.79, 2.88±0.89, 2.95±1.05 and 2.93±1.11 in the schemes and 2.41±1.67, 2.57±0.90, 2.84±0.91 and 2.77±1.00 in lactulose groups, respectively (p=0.10, 0.11, 0.60, 0.51). Thirty-two (76.2%) patients in schemes and 24 (54.5%) patients in lactulose groups were treated at the end of the protocol as they did not meet the Rome III criteria for constipation (p=0.04). In schemes group, patients reported no undesirable effects, whereas seven (15.9%) in lactulose group reported flatulence (p=0.02). Studied schemes were as effective as lactulose, a gold standard to manage constipation. Results demonstrated that TPM schemes and recommendations, as lifestyle modification, for at least 3 months can be introduced as cheap, available and accessible approaches for the management of constipation.

  3. Geographically-weighted regression of knowledge and behaviour determinants to anti-malarial recommending and dispensing practice among medicine retailers in western Kenya: capacitating targeted interventions.

    PubMed

    Rusk, Andria; Highfield, Linda; Wilkerson, J Michael; Harrell, Melissa; Obala, Andrew; Amick, Benjamin

    2016-11-21

    Most patients with malaria seek treatment first in retail drug shops. Myriad studies have examined retailer behaviours and characteristics to understand the determinants to these behaviours. Geospatial methods are helpful in discovering if geographic location plays a role in the relationship between determinants and outcomes. This study aimed to discover if spatial autocorrelation exists in the relationship between determinants and retailer behaviours, and to provide specific geographic locations and target behaviours for tailoring future interventions. Retailer behaviours and characteristics captured from a survey deployed to medicine retailers in the Webuye Demographic and Health Surveillance Site were analysed using geographic weighted regression to create prediction models for three separate outcomes: recommending the first-line anti-malarial therapy to adults, recommending the first-line anti-malarial therapy to children, and selling that therapy more than other anti-malarials. The estimated regression coefficients for each determinant, as well as the pseudo R(2) values for each final model, were then mapped to assess spatial variability and local areas of best model fit. The relationships explored were found to be non-stationary, indicating that spatial heterogeneity exist in the data. The association between having a pharmacy-related health training and recommending the first-line anti-malarial treatment to adults was strongest around the peri-urban centre: comparing those with training in pharmacy to those without training (OR = 5.75, p = 0.021). The association between knowing the first-line anti-malarial and recommending it to children was strongest in the north of the study area compared to those who did not know the MOH-recommended anti-malarial (OR = 2.34, p = 0.070). This is also the area with the strongest association between attending a malaria workshop and selling the MOH-recommended anti-malarial more than other anti-malarials, compared to

  4. ExCEL in Social Work: Excellence in Cancer Education & Leadership An Oncology Social Work Response to the 2008 Institute of Medicine Report

    PubMed Central

    Otis-Green, Shirley; Jones, Barbara; Zebrack, Brad; Kilburn, Lisa; Altilio, Terry A.; Ferrell, Betty

    2014-01-01

    ExCEL in Social Work : Excellence in Cancer Education & Leadership was a multi-year National Cancer Institute (NCI)-funded grant for the development and implementation of an innovative educational program for oncology social workers. The program’s curriculum focused upon six core competencies of psychosocial-spiritual support necessary to meet the standard of care recommended by the 2008 Institute of Medicine (IOM) Report: Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. The curriculum was delivered through a collaborative partnership between the City of Hope National Medical Center and the two leading professional organizations devoted exclusively to representing oncology social workers - the Association of Oncology Social Work and the Association of Pediatric Oncology Social Workers. Initial findings support the feasibility and acceptability of this tailored leadership skills-building program for participating oncology social workers. PMID:25146345

  5. ExCEL in Social Work: Excellence in Cancer Education & Leadership: An Oncology Social Work Response to the 2008 Institute of Medicine Report.

    PubMed

    Otis-Green, Shirley; Jones, Barbara; Zebrack, Brad; Kilburn, Lisa; Altilio, Terry A; Ferrell, Betty

    2015-09-01

    ExCEL in Social Work: Excellence in Cancer Education & Leadership was a multi-year National Cancer Institute (NCI)-funded grant for the development and implementation of an innovative educational program for oncology social workers. The program's curriculum focused upon six core competencies of psychosocial-spiritual support necessary to meet the standard of care recommended by the 2008 Institute of Medicine (IOM) Report: Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. The curriculum was delivered through a collaborative partnership between the City of Hope National Medical Center and the two leading professional organizations devoted exclusively to representing oncology social workers--the Association of Oncology Social Work and the Association of Pediatric Oncology Social Workers. Initial findings support the feasibility and acceptability of this tailored leadership skills-building program for participating oncology social workers.

  6. [The patient blood management concept : Joint recommendation of the German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery].

    PubMed

    Meybohm, P; Schmitz-Rixen, T; Steinbicker, A; Schwenk, W; Zacharowski, K

    2017-09-18

    Patient blood management is a multimodal concept that aims to detect, prevent and treat anemia, optimize hemostasis, minimize iatrogenic blood loss, and support a patient-centered decision to provide optimal use of allogeneic blood products. Although the World Health Organization (WHO) has already recommended patient blood management as a new standard in 2010, many hospitals have not implemented it at all or only in part in clinical practice. The German Society of Anaesthesiology and Intensive Care Medicine and the German Society of Surgery therefore demand that i) all professionals involved in the treatment should implement important aspects of patient blood management considering local conditions, and ii) the structural, administrative and budgetary conditions should be created in the health care system to implement more intensively many of the measures in Germany.

  7. [Diagnosis and treatment of imported malaria in Spain: Recommendations from the Malaria Working Group of the Spanish Society of Tropical Medicine and International Health (SEMTSI)].

    PubMed

    Muñoz, Jose; Rojo-Marcos, Gerardo; Ramírez-Olivencia, Germán; Salas-Coronas, Joaquín; Treviño, Begoña; Perez Arellano, José Luis; Torrús, Diego; Muñoz Vilches, Maria Jose; Ramos, Jose Manuel; Alegría, Iñaki; López-Vélez, Rogelio; Aldasoro, Edelweiss; Perez-Molina, Jose Antonio; Rubio, Jose Miguel; Bassat, Quique

    2015-01-01

    Malaria is a common parasitic disease diagnosed in the returned traveler. Mortality in travelers with imported malaria is around 2-3%, and one of the main factors associated with poor prognosis is the delay in the diagnosis and treatment. Imported malaria cases usually present with fever, headache and myalgia, but other symptoms may appear. The diagnosis should be performed as soon as possible, using thick smear or rapid diagnostic tests, and a blood smear. Treatment should be initiated urgently. In cases of severe malaria, the use of intravenous artemisinins has proved to be superior to intravenous quinine. This document reviews the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported malaria in Spain.

  8. A Strategic Vision for NSF Investments in Antarctic and Southern Ocean Research: Recommendations of a New Study from the National Academes of Sciences, Engineering, and Medicine.

    NASA Astrophysics Data System (ADS)

    Weller, R. A.; Bell, R. E.; Geller, L.

    2015-12-01

    A Committee convened by the National Academies of Sciences, Engineering, and Medicine carried out a study (at the request of NSF's Division of Polar Programs) to develop a strategic vision for the coming decade of NSF's investments in Antarctic and Southern Ocean research. The study was informed by extensive efforts to gather ideas from researchers across the United States. This presentation will provide an overview of the Committee's recommendations—regarding an overall strategic framework for a robust U.S. Antarctic program, regarding the specific areas of research recommended as highest priority for NSF support, and regarding the types of infrastructure, logistical support, data management, and other critical foundations for enabling and adding lasting value to the proposed research .

  9. Consensus Recommendations to NCCIH from Research Faculty in a Transdisciplinary Academic Consortium for Complementary and Integrative Health and Medicine

    PubMed Central

    Weeks, John; Anderson, Belinda; Meeker, William; Calabrese, Carlo; O'Bryon, David; Cramer, Greg D.

    2015-01-01

    Abstract Background: This commentary presents the most impactful, shared priorities for research investment across the licensed complementary and integrative health (CIH) disciplines according to the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). These are (1) research on whole disciplines; (2) costs; and (3) building capacity within the disciplines' universities, colleges, and programs. The issue of research capacity is emphasized. Discussion: ACCAHC urges expansion of investment in the development of researchers who are graduates of CIH programs, particularly those with a continued association with accredited CIH schools. To increase capacity of CIH discipline researchers, we recommend National Center for Complementary and Integrative Health (NCCIH) to (1) continue and expand R25 grants for education in evidence-based healthcare and evidence-informed practice at CIH schools; (2) work to limit researcher attrition from CIH institutions by supporting career development grants for clinicians from licensed CIH fields who are affiliated with and dedicated to continuing to work in accredited CIH schools; (3) fund additional stand-alone grants to CIH institutions that already have a strong research foundation, and collaborate with appropriate National Institutes of Health (NIH) institutes and centers to create infrastructure in these institutions; (4) stimulate higher percentages of grants to conventional centers to require or strongly encourage partnership with CIH institutions or CIH researchers based at CIH institutions, or give priority to those that do; (5) fund research conferences, workshops, and symposia developed through accredited CIH schools, including those that explore best methods for studying the impact of whole disciplines; and (6) following the present NIH policy of giving priority to new researchers, we urge NCCIH to give a marginal benefit to grant applications from CIH clinician-researchers at CIH academic

  10. [Review Model for the Assessment of Psychometric Instruments--Recommendations of the German College of Psychosomatic Medicine (DKPM)].

    PubMed

    Glaesmer, Heide; Forkmann, Thomas; Dinkel, Andreas; Wahl, Inka; Sattel, Heribert; Huber, Dorothea; Spangenberg, Lena; Rabung, Sven; Andreas, Sylke; Tritt, Karin; Franke, Gabriele Helga; Rose, Matthias; Löwe, Bernd

    2015-07-01

    Psychometric instruments are commonly applied in psychotherapeutic research and care for the baseline assessment of symptoms, the planning of therapeutic interventions, the assessment of the longitudinal course of symptoms and outcomes of therapeutic interventions as well as quality management of care. Psychometric properties as well as economic aspects should be considered in the selection of specific instruments. It is assumed that users of psychometric instruments face a great variety of instruments and related information. For that reason, it seems challenging to absorb the current knowledge and to integrate it into clinical practice and research. Thus, it is likely that well-known, established and easily accessible instruments are commonly used, while new developed instruments might not be disseminated in research and healthcare. Based on available international review models, the working group "Psychometrics and Psychodiagnostics" of the German College of Psychosomatic Medicine (DKPM) has developed and tested a review model specifically tailored for psychotherapeutic research and care. The different steps of development, as well as the final review model based on the consensus of the working group are presented. The review model contains 6 generic terms (reliability, validity, objectivity, reference groups and aspects of application) with 21 different criteria to be assessed with 0-3 asterisks (*). The criteria are clearly operationalized and the practical use of the review model is explained and discussed. With the review model for the assessment of psychometric instruments a well-defined evaluation system is made available for research and clinical practice which has been developed by an expert group. The review model facilitates systematic, transparent and comparative evaluation of psychometric instruments along clearly defined criteria. It also supports the selection of psychometric instruments in research and care. Next, the working group aims at

  11. The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a list of recommendations and additional conclusions: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine.

    PubMed

    Le Roux, Peter; Menon, David K; Citerio, Giuseppe; Vespa, Paul; Bader, Mary Kay; Brophy, Gretchen; Diringer, Michael N; Stocchetti, Nino; Videtta, Walter; Armonda, Rocco; Badjatia, Neeraj; Bösel, Julian; Chesnut, Randall; Chou, Sherry; Claassen, Jan; Czosnyka, Marek; De Georgia, Michael; Figaji, Anthony; Fugate, Jennifer; Helbok, Raimund; Horowitz, David; Hutchinson, Peter; Kumar, Monisha; McNett, Molly; Miller, Chad; Naidech, Andrew; Oddo, Mauro; Olson, DaiWai; O'Phelan, Kristine; Provencio, J Javier; Puppo, Corinna; Riker, Richard; Roberson, Claudia; Schmidt, Michael; Taccone, Fabio

    2014-12-01

    Careful patient monitoring using a variety of techniques including clinical and laboratory evaluation, bedside physiological monitoring with continuous or non-continuous techniques and imaging is fundamental to the care of patients who require neurocritical care. How best to perform and use bedside monitoring is still being elucidated. To create a basic platform for care and a foundation for further research the Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to develop recommendations about physiologic bedside monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews as a background to the recommendations. In this article, we highlight the recommendations and provide additional conclusions as an aid to the reader and to facilitate bedside care.

  12. A survey of emergency medical services in mountain areas of Europe and North America: official recommendations of the International Commission for Mountain Emergency Medicine (ICAR Medcom).

    PubMed

    Brugger, Hermann; Elsensohn, Fidel; Syme, Dave; Sumann, Günther; Falk, Markus

    2005-01-01

    Survey of on-site treatment of patients in mountain areas of 14 countries in Europe and North America (nonresponder rate 33%) to compare emergency medical services. Around 37,535 ground rescuers and 747 helicopters are ready for evacuation of casualties and patients in mountain areas. And 1316 physicians and 50,967 paramedics take part in ground and air mountain rescue operations. In Europe, 63.2% of helicopters have a physician on board, 17.8% are staffed with a paramedic, and 19% have no medically trained personnel on board. In North America, 31.6% (p < 0.001) of helicopters are staffed with a doctor, 59.3% (p < 0.001) with a paramedic, and 9.1% (p < 0.001) have no medical personnel. The percentage of on-site treatment according to the recommendations of the International Liaison Committee on Resuscitation (ILCOR) or International Commission for Alpine Rescue (ICAR) varies among all countries (p < 0.001) and is positively related to the percentage of physician-staffed helicopters (r = 0.76, p < 0.001). Paramedics in 90.9% countries are obliged to be medically trained, but physicians only need to have a standardized training in emergency medicine in 50% (p < 0.042). On-site treatment according to ILCOR or ICAR recommendations is performed more often in countries where physicians are regularly involved in mountain rescue operations. However, no conclusions can be drawn from the data as to the efficiency of treatment. The data show a lack of medical education in specific, mountain rescue-related problems. Physicians involved should undergo suitable training.

  13. The role of teamwork in the professional education of physicians: current status and assessment recommendations.

    PubMed

    Baker, David P; Salas, Eduardo; King, Heidi; Battles, James; Barach, Paul

    2005-04-01

    The Institute of Medicine (IOM) has recommended that organizations establish interdisciplinary team training programs that incorporate proven methods for team management. Teamwork can be assessed during physician medical education, board certification, licensure, and continuing practice. Team members must possess specific knowledge, skills, and attitudes (KSAs), such as the ability to exchange information, which enable individual team members to coordinate. KSAs might be elicited and assessed across a physician's career, starting in medical school and continuing through licensure and board certification. Professional bodies should be responsible for the development of specific team knowledge and skill competencies and for promoting specific team attitude competencies. Tools are available to assess medical student, resident, and physician competence in these critical team KSAs. For teamwork skills to be assessed and have credibility, team performance measures must be grounded in team theory, account for individual and team-level performance, capture team process and outcomes, adhere to standards for reliability and validity, and address real or perceived barriers to measurement.

  14. [Policy recommendations based on SWOT analysis for agricultural industrialization of traditional Chinese medicinal materials--a case study of uncariae ramulus cum uncis from Jianhe county in Guizhou province].

    PubMed

    Hu, Yong; Huo, Ke-Yi; Xiang, Hua

    2013-09-01

    This thesis reviews the historical background of agricultural industrialization, and analyzes the major theories of agricultural industrialization. It also utilizes SWOT analysis method to discuss the industrialization of traditional Chinese medicinal materials in Jianhe county, and finally it puts forward the recommendations for its further development.

  15. Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for (90) Y microsphere brachytherapy in the treatment of hepatic malignancies.

    PubMed

    Dezarn, William A; Cessna, Jeffery T; DeWerd, Larry A; Feng, Wenzheng; Gates, Vanessa L; Halama, James; Kennedy, Andrew S; Nag, Subir; Sarfaraz, Mehrdad; Sehgal, Varun; Selwyn, Reed; Stabin, Michael G; Thomadsen, Bruce R; Williams, Lawrence E; Salem, Riad

    2011-08-01

    Yttrium-90 microsphere brachytherapy of the liver exploits the distinctive features of the liver anatomy to treat liver malignancies with beta radiation and is gaining more wide spread clinical use. This report provides a general overview of microsphere liver brachytherapy and assists the treatment team in creating local treatment practices to provide safe and efficient patient treatment. Suggestions for future improvements are incorporated with the basic rationale for the therapy and currently used procedures. Imaging modalities utilized and their respective quality assurance are discussed. General as well as vendor specific delivery procedures are reviewed. The current dosimetry models are reviewed and suggestions for dosimetry advancement are made. Beta activity standards are reviewed and vendor implementation strategies are discussed. Radioactive material licensing and radiation safety are discussed given the unique requirements of microsphere brachytherapy. A general, team-based quality assurance program is reviewed to provide guidance for the creation of the local procedures. Finally, recommendations are given on how to deliver the current state of the art treatments and directions for future improvements in the therapy. © 2011 American Association of Physicists in Medicine.

  16. Following the 2009 American Institute of Medicine recommendations for normal body mass index and overweight women led to an increased risk of fetal macrosomia among Taiwanese women.

    PubMed

    Tsai, Yieh-Loong; Chong, Kian-Mei; Seow, Kok-Min

    2013-09-01

    This study aimed to investigate the risk of birth weights over 4000 g (macrosomia) in association with following the 2009 American Institute of Medicine (AIOM) recommendations. Seventy-six nondiabetic women who delivered a singleton, term macrosomic fetus and 82 women who delivered a singleton, term fetus weighing <4000 g were analyzed retrospectively. The relationship between the risk of macrosomia and gestational weight gain in different periods of pregnancy was investigated using logistic regression. The incidence of macrosomia from January 2008 to December 2009 was 1.8% among the Taiwanese women. The incidences of cesarean delivery (54.5% vs. 18.2%, p < 0.001) and blood loss >1000 mL at delivery (35.5% vs. 6.1%, p < 0.0001) were associated with macrosomia. The risk of macrosomia among normal weight women with gestational weight gain greater than 13 kg increased four-fold [odds ratio (OR) = 4.88; 95% confidence interval (CI) 1.84-12.90]. For overweight women with total gestational weight gain >11.5 kg, the risk of macrosomia increased nine-fold (OR = 9.63; 95% CI 1.76-52.74). Macrosomia resulted in more cesarean deliveries and greater maternal blood loss at birth. In Taiwan, to prevent macrosomia, we suggest that the total gestational weight gain should be <11.5 kg among normal weight women and within 10 kg for overweight women. Copyright © 2013. Published by Elsevier B.V.

  17. Immobilization and splinting in mountain rescue. Official Recommendations of the International Commission for Mountain Emergency Medicine, ICAR MEDCOM, Intended for Mountain Rescue First Responders, Physicians, and Rescue Organizations.

    PubMed

    Ellerton, John; Tomazin, Iztok; Brugger, Hermann; Paal, Peter

    2009-01-01

    Immobilization and splinting of fractures are essential to reduce morbidity and mortality in mountain rescue. Therefore, members of the International Commission for Mountain Emergency Medicine (ICAR MEDCOM) debated the results of a literature review carried out by the authors. Focusing on common immobilization and splinting techniques relevant to mountain rescue, a consensus document was formulated. Pain relief of appropriate speed of onset and strength should be available on scene. Spinal immobilization is recommended for all casualties that have sustained head or spine injury. The preferred method is a vacuum mattress with an appropriately sized rigid cervical collar. In such casualties, only those in an unsafe environment or with time-critical injuries should be evacuated before spinal immobilization is performed. In some casualties, the cervical spine may be cleared and a cervical collar may be omitted. In the presence of hemodynamic instability and where there is a suspicion of a fractured pelvis, an external compression splint should be applied. Splinting of a femoral shaft fracture is important to limit pain and life-threatening blood loss. If time allows, extremity fractures should be adequately splinted and, if the practitioner is skilled, a displaced fracture or joint dislocation should be reduced on scene with the use of appropriate analgesia.

  18. Recommendations for Establishing Policy for Electronic Prescribing in the State of Texas: Graduate Management Project

    DTIC Science & Technology

    2008-06-24

    patient data availability. Safety concerns are not new to the U.S. health system. In 2000, the Institute of Medicine (IOM) illuminated the issue with the... important to delineate the relationship of medication errors to adverse drug events (ADE). Medication errors are mistakes that occur in the process of... documentation of the patients ’ condition. Most hospitals conduct retrospective studies of patient charts or spontaneous reporting than show what occurred and

  19. Validation of the Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition Recommendations for Caloric Provision to Critically Ill Obese Patients: A Pilot Study.

    PubMed

    Mogensen, Kris M; Andrew, Benjamin Y; Corona, Jasmine C; Robinson, Malcolm K

    2016-07-01

    The Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) recommend that obese, critically ill patients receive 11-14 kcal/kg/d using actual body weight (ABW) or 22-25 kcal/kg/d using ideal body weight (IBW), because feeding these patients 50%-70% maintenance needs while administering high protein may improve outcomes. It is unknown whether these equations achieve this target when validated against indirect calorimetry, perform equally across all degrees of obesity, or compare well with other equations. Measured resting energy expenditure (MREE) was determined in obese (body mass index [BMI] ≥30 kg/m(2)), critically ill patients. Resting energy expenditure was predicted (PREE) using several equations: 12.5 kcal/kg ABW (ASPEN-Actual BW), 23.5 kcal/kg IBW (ASPEN-Ideal BW), Harris-Benedict (adjusted-weight and 1.5 stress-factor), and Ireton-Jones for obesity. Correlation of PREE to 65% MREE, predictive accuracy, precision, bias, and large error incidence were calculated. All equations were significantly correlated with 65% MREE but had poor predictive accuracy, had excessive large error incidence, were imprecise, and were biased in the entire cohort (N = 31). In the obesity cohort (n = 20, BMI 30-50 kg/m(2)), ASPEN-Actual BW had acceptable predictive accuracy and large error incidence, was unbiased, and was nearly precise. In super obesity (n = 11, BMI >50 kg/m(2)), ASPEN-Ideal BW had acceptable predictive accuracy and large error incidence and was precise and unbiased. SCCM/ASPEN-recommended body weight equations are reasonable predictors of 65% MREE depending on the equation and degree of obesity. Assuming that feeding 65% MREE is appropriate, this study suggests that patients with a BMI 30-50 kg/m(2) should receive 11-14 kcal/kg/d using ABW and those with a BMI >50 kg/m(2) should receive 22-25 kcal/kg/d using IBW. © 2015 American Society for Parenteral and Enteral Nutrition.

  20. Reproducing social inequality and unequal treatment in the national health information infrastructure: A discourse analysis of IOM executive summaries.

    PubMed

    Trigg, Lisa J

    2006-01-01

    This paper reports on preliminary data analysis for a larger research project whose purpose is to study how the discourse constituting the currently proposed NHII may reproduce existing social inequality in healthcare. The purpose of this preliminary study is to test the methods planned for the larger study. Textually oriented critical discourse analysis and corpus linguistics methods have been used to compare three executive summaries, the first report of two recent series and one stand alone report from the Institute of Medicine: the Quality Chasm and the Insuring Health series, and the report Unequal Treatment. These methods proved to be an effective way to study the social action of language in use in the Institute of Medicine executive summaries and will be useful in studying a larger corpus of the discourse constituting the NHII. Further research along these lines will provide information required to prevent or mitigate the reproduction of social inequality in healthcare through the proposed NHII.

  1. Critical assessment of high-circulation print newspaper coverage of the Institute of Medicine report Dietary Reference Intakes for Calcium and Vitamin D

    USDA-ARS?s Scientific Manuscript database

    The objective of this article is to evaluate high-circulation US and Canadian newspaper coverage of the Institute of Medicine (IOM) report Dietary Reference Intakes for Calcium and Vitamin D and assess pre-report and post-report reporter-specific vitamin D-related coverage. Two independent reviewers...

  2. Ten years after the IOM report: Engaging residents in quality and patient safety by creating a House Staff Quality Council.

    PubMed

    Fleischut, Peter M; Evans, Adam S; Nugent, William C; Faggiani, Susan L; Lazar, Eliot J; Liebowitz, Richard S; Forese, Laura L; Kerr, Gregory E

    2011-01-01

    Ten years after the 1999 Institute of Medicine report, it is clear that despite significant progress, much remains to be done to improve quality and patient safety (QPS). Recognizing the critical role of postgraduate trainees, an innovative approach was developed at New York-Presbyterian Hospital, Weill Cornell Medical Center to engage residents in QPS by creating a Housestaff Quality Council (HQC). HQC leaders and representatives from each clinical department communicate and partner regularly with hospital administration and other key departments to address interdisciplinary quality improvement (QI). In support of the mission to improve patient care and safety, QI initiatives included attaining greater than 90% compliance with medication reconciliation and reduction in the use of paper laboratory orders by more than 70%. A patient safety awareness campaign is expected to evolve into a transparent environment where house staff can openly discuss patient safety issues to improve the quality of care.

  3. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know.

    PubMed

    Ross, A Catharine; Manson, JoAnn E; Abrams, Steven A; Aloia, John F; Brannon, Patsy M; Clinton, Steven K; Durazo-Arvizu, Ramon A; Gallagher, J Christopher; Gallo, Richard L; Jones, Glenville; Kovacs, Christopher S; Mayne, Susan T; Rosen, Clifford J; Shapses, Sue A

    2011-01-01

    This article summarizes the new 2011 report on dietary requirements for calcium and vitamin D from the Institute of Medicine (IOM). An IOM Committee charged with determining the population needs for these nutrients in North America conducted a comprehensive review of the evidence for both skeletal and extraskeletal outcomes. The Committee concluded that available scientific evidence supports a key role of calcium and vitamin D in skeletal health, consistent with a cause-and-effect relationship and providing a sound basis for determination of intake requirements. For extraskeletal outcomes, including cancer, cardiovascular disease, diabetes, and autoimmune disorders, the evidence was inconsistent, inconclusive as to causality, and insufficient to inform nutritional requirements. Randomized clinical trial evidence for extraskeletal outcomes was limited and generally uninformative. Based on bone health, Recommended Dietary Allowances (RDAs; covering requirements of ≥97.5% of the population) for calcium range from 700 to 1300 mg/d for life-stage groups at least 1 yr of age. For vitamin D, RDAs of 600 IU/d for ages 1-70 yr and 800 IU/d for ages 71 yr and older, corresponding to a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/liter), meet the requirements of at least 97.5% of the population. RDAs for vitamin D were derived based on conditions of minimal sun exposure due to wide variability in vitamin D synthesis from ultraviolet light and the risks of skin cancer. Higher values were not consistently associated with greater benefit, and for some outcomes U-shaped associations were observed, with risks at both low and high levels. The Committee concluded that the prevalence of vitamin D inadequacy in North America has been overestimated. Urgent research and clinical priorities were identified, including reassessment of laboratory ranges for 25-hydroxyvitamin D, to avoid problems of both undertreatment and overtreatment.

  4. Health-related quality of life (HR-QOL) and regulatory issues. An assessment of the European Agency for the Evaluation of Medicinal Products (EMEA) recommendations on the use of HR-QOL measures in drug approval.

    PubMed

    Apolone, G; De Carli, G; Brunetti, M; Garattini, S

    2001-01-01

    Interest in measuring qualitative aspects of life that are most closely related to health and healthcare has increased in recent years. Methods of describing patients' subjective health status now incorporate standardised measures, and several psychometric measures are available. Despite the thousands of empirical and conceptual papers in the medical and pharmacological literature on health-related quality of life (HR-QOL), the value of such measures in the regulatory process is still being debated. We conducted an assessment to understand and document the position of the European Agency for the Evaluation of Medicinal Products (EMEA) on the use of HR-QOL measures in studies conducted for regulatory purposes. Official documents produced and circulated by the EMEA containing recommendations on trial design, conduct and analysis for sponsors and scientific experts were independently reviewed by authors to document the position of the Agency on the specific topic of HR-QOL. All documents found in the Agency website on 30 September 1999 were identified and then assessed to: (i) identify diseases or drugs for which formal HR-QOL assessment is recommended; (ii) identify measures and methods recommended; and (iii) evaluate the reliability of recommendations across documents. Of the 189 documents retrieved, none focused directly on health-related quality of life. A few explicit recommendations were identified for 13 specific drugs or conditions. These recommendations were mostly general and vague, and used nonstandard terminology. In addition, terminology and recommendations were not consistent across documents and, in at least one case, were in contrast with the US Food and Drug Administration (FDA) guidelines. EMEA guidelines incorporating quality-of-life outcomes are welcomed but it is obvious that more detailed guidance is required. Closer collaboration between the EMEA and the FDA is also recommended. Experts from different disciplines should be involved in the

  5. Recommendations of the German Society for Medical Education and the German Association of Medical Faculties regarding university-specific assessments during the study of human, dental and veterinary medicine.

    PubMed

    Jünger, Jana; Just, Ingo

    2014-01-01

    The practice of assessing student performance in human, dental and veterinary medicine at universities in German-speaking countries has undergone significant changes in the past decade. Turning the focus to practical requirements regarding medical practice during undergraduate study away from an often theory-dominated curriculum, the academic scrutiny of the basics of teaching medical knowledge and skills, and amendments to legislation, all require ongoing adjustments to curricula and the ways in which assessments are done during undergraduate medical education. To establish quality standards, the Gesellschaft für medizinische Ausbildung (GMA German Society for Medical Education) reached a consensus in 2008 on recommendations for administering medical school-specific exams which have now been updated and approved by the GMA assessments committee, together with the Medizinischer Fakultätentag (MFT German Association of Medical Faculties), as recommendations for the administration of high-quality assessments.

  6. A Multicenter Study of the Family Educational Rights and Privacy Act and the Standardized Letter of Recommendation: Impact on Emergency Medicine Residency Applicant and Faculty Behaviors

    PubMed Central

    Diab, Jessica; Riley, Stephanie; Downes, Andrew; Gaeta, Theodore; Hern, H. Gene; Hwang, Eric; Kass, Lawrence; Kelly, Michael; Luber, Samuel D.; Martel, Marc; Minns, Alicia; Patterson, Leigh; Pazderka, Philip; Sayan, Osman; Thurman, Jason; Vallee, Phyllis; Overton, David

    2014-01-01

    Background Residency applicants have the right to see letters of recommendation written on their behalf. It is not known whether applicants are affected by waiving this right. Objectives Our multicenter study assessed how frequently residency applicants waived their FERPA rights to view their letters of recommendation, and whether this affected the ratings they were given by faculty. Methods We reviewed all ERAS-submitted letters of recommendation to 14 ACGME-accredited programs in 2006–2007. We collected ERAS ID, program name, FERPA declaration, standardized letter of recommendation (SLOR) use, and SLOR Global Assessment ranking. The percentage of applicants who waived their FERPA rights was determined. Chi-square tests of independence assessed whether applicants' decision to waive their FERPA rights was associated with their SLOR Global Assessment. Results We examined 1776 applications containing 6424 letters of recommendations. Of 2736 letters that specified a Global Assessment, 2550 (93%) applicants waived their FERPA rights, while 186 did not. Of the applicants who chose not to waive their rights, 45.6% received a ranking of Outstanding, 35.5% Excellent, 18.3% Very Good, and 1.6% Good. Of applicants who waived their FERPA rights, 35.1% received a ranking of Outstanding, 49.6% Excellent, 13.7% Very Good, and 1.6% Good. Applicants who did not waive their FERPA rights were more likely to receive an Outstanding Assessment (P  =  .003). Conclusions The majority (93%) of residency applicants waived their FERPA rights. Those who did not waive their rights had a statistically higher chance of receiving an Outstanding Assessment than those who did. PMID:24949134

  7. Recommendations for promoting the health and well-being of lesbian, gay, bisexual, and transgender adolescents: a position paper of the Society for Adolescent Health and Medicine.

    PubMed

    2013-04-01

    Adolescent health care providers frequently care for patients who identify as lesbian, gay, bisexual, or transgendered (LGBT), or who may be struggling with or questioning their sexual orientation or gender identity. Whereas these youth have the same health concerns as their non-LGBT peers, LGBT teens may face additional challenges because of the complexity of the coming-out process, as well as societal discrimination and bias against sexual and gender minorities. The Society for Adolescent Health and Medicine encourages adolescent providers and researchers to incorporate the impact of these developmental processes (and understand the impacts of concurrent potential discrimination) when caring for LGBT adolescents. The Society for Adolescent Health and Medicine also encourages providers to help positively influence policy related to LGBT adolescents in schools, the foster care system, and the juvenile justice system, and within the family structure. Consistent with other medical organizations, the Society for Adolescent Health and Medicine rejects the mistaken notion that LGBT orientations are mental disorders, and opposes the use of any type of reparative therapy for LGBT adolescents.

  8. Environmental causes of breast cancer and radiation from medical imaging: findings from the Institute of Medicine report.

    PubMed

    Smith-Bindman, Rebecca

    2012-07-09

    Susan G. Komen for the Cure asked the Institute of Medicine (IOM) to perform a comprehensive review of environmental causes and risk factors for breast cancer. Interestingly, none of the consumer products (ie, bisphenol A, phthalates), industrial chemicals (ie, benzene, ethylene oxide), or pesticides (ie, DDT/DDE) considered could be conclusively linked to an increased risk of breast cancer, although the IOM acknowledged that the available evidence was insufficient to draw firm conclusions for many of these exposures, calling for more research in these areas. The IOM found sufficient evidence to conclude that the 2 environmental factors most strongly associated with breast cancer were exposure to ionizing radiation and to combined postmenopausal hormone therapy. The IOM's conclusion of a causal relation between radiation exposure and cancer is consistent with a large and varied literature showing that exposure to radiation in the same range as used for computed tomography will increase the risk of cancer. It is the responsibility of individual health care providers who order medical imaging to understand and weigh the risk of any medical procedures against the expected benefit.

  9. Functional fitting of interstitial brachytherapy dosimetry data recommended by the AAPM Radiation Therapy Committee Task Group 43. American Association of Physicists in Medicine.

    PubMed

    Furhang, E E; Anderson, L L

    1999-02-01

    This work was undertaken to expedite implementation of the AAPM Task Group 43 recommendations, which call for significant modifications in the way dose is calculated for interstitial sources of 192Ir, 125I, and 103Pd as well as significant changes in the dose rate constant for 125I sources. The TG43 recommendations include a new formalism for dose calculation at points defined by the radial distance, r, from the source center and the angle, theta, that such a radius makes with the source axis. For each source type, values are tabulated for the radial dose function, the anisotropy function, and the anisotropy factor. The TG43 report includes fitting functions for the radial dose function in the form of polynomials, which are poorly behaved outside the range of fitted data. No functions are offered for the anisotropy function data or the anisotropy factor data, both of which could profit from some smoothing by such functions. We have found a double exponential fit to the radial dose function that not only approximates the data adequately but also appropriately approaches zero for very large distances. The anisotropy function is conveniently fit with a form of type 1 - f(r,theta)cos(theta)e(cr), which is exactly 1 at theta=90 degrees and approaches 1 for large r (for c<0), where f(r,theta) is a selected polynomial in the two variables. The form chosen for the anisotropy factor was 1 - (a+br)e(cr), which appropriately approaches 1 for large r (and c<0). Functional fits of these types are expected to facilitate implementation of TG43 recommendations, in that they may be either incorporated into dose algorithms or used to generate lookup tables of either the x, y or the r, theta format.

  10. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults.

    PubMed

    1998-06-01

    ACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chronic exercise has been found to be effective for producing a training effect. The interaction of these factors provide the overload stimulus. In general, the lower the stimulus the lower the training effect, and the greater the stimulus the greater the effect. As a result of specificity of training and the need for maintaining muscular strength and endurance, and flexibility of the major muscle groups, a well-rounded training program including aerobic and resistance training, and flexibility exercises is recommended. Although age in itself is not a limiting factor to exercise training, a more gradual approach in applying the prescription at older ages seems prudent. It has also been shown that aerobic endurance training of fewer than 2 d.wk-1, at less than 40-50% of VO2R, and for less than 10 min-1 is generally not a sufficient stimulus for developing and maintaining fitness in healthy adults. Even so, many health benefits from physical activity can be achieved at lower intensities of exercise if frequency and duration of training are increased appropriately. In this regard, physical activity can be accumulated through the day in shorter bouts of 10-min durations. In the interpretation of this position stand, it must be recognized that the recommendations should be used in the context of participant's needs, goals, and initial abilities. In this regard, a sliding scale as to the amount of time allotted and intensity of effort should be carefully gauged for the cardiorespiratory, muscular strength and endurance, and flexibility components of the program. An appropriate warm-up and cool-down period, which would include flexibility exercises, is also recommended. The important factor

  11. A blueprint for maternal and child health primary care physician education in medical genetics and genomic medicine: recommendations of the United States secretary for health and human services advisory committee on heritable disorders in newborns and children.

    PubMed

    Kemper, Alex R; Trotter, Tracy L; Lloyd-Puryear, Michele A; Kyler, Penny; Feero, W Gregory; Howell, R Rodney

    2010-02-01

    Primary health care providers will play an increasingly important role in delivering genetics-related services for women and children along the reproductive continuum. However, most primary health care providers have received little training in genetics or medical genomics to incorporate such services into routine care. A workshop was convened by the National Institutes of Health, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration to identify practical strategies to educate primary care physicians involved in maternal and child health. These included developing a targeted curriculum for residency training programs, incorporating assessments of genetics and genomic medicine into the initial board certification process and the process for maintenance of certification, providing continuing medical education opportunities at national meetings, establishing an Internet-based repository of recommendations for primary care providers, and forming a learning collaborative to link primary care providers and specialists to evaluate strategies to improve care. Workgroup members underscored the importance of assessing the impact of these interventions on the process and outcomes of health care delivery. The recommendations from this workshop were presented to the United States Secretary for Health and Human Services' Advisory Committee on Heritable Disorders in Newborns and Children Subcommittee on Education and Training. The Subcommittee reviewed the report and put forth recommendations to the Committee, which were adopted by the Committee in September 2009.

  12. Recommendations for standards in transthoracic two-dimensional echocardiography in the dog and cat. Echocardiography Committee of the Specialty of Cardiology, American College of Veterinary Internal Medicine.

    PubMed

    Thomas, W P; Gaber, C E; Jacobs, G J; Kaplan, P M; Lombard, C W; Moise, N S; Moses, B L

    1993-01-01

    Recommendations are presented for standardized imaging planes and display conventions for two-dimensional echocardiography in the dog and cat. Three transducer locations ("windows") provide access to consistent imaging planes: the right parasternal location, the left caudal (apical) parasternal location, and the left cranial parasternal location. Recommendations for image display orientations are very similar to those for comparable human cardiac images, with the heart base or cranial aspect of the heart displayed to the examiner's right on the video display. From the right parasternal location, standard views include a long-axis four-chamber view and a long-axis left ventricular outflow view, and short-axis views at the levels of the left ventricular apex, papillary muscles, chordae tendineae, mitral valve, aortic valve, and pulmonary arteries. From the left caudal (apical) location, standard views include long-axis two-chamber and four-chamber views. From the left cranial parasternal location, standard views include a long-axis view of the left ventricular outflow tract and ascending aorta (with variations to image the right atrium and tricuspid valve, and the pulmonary valve and pulmonary artery), and a short-axis view of the aortic root encircled by the right heart. These images are presented by means of idealized line drawings. Adoption of these standards should facilitate consistent performance, recording, teaching, and communicating results of studies obtained by two-dimensional echocardiography.

  13. [Treatment for pulmonary arterial hypertension under the new French hospital financing system. Recommendations of the Pulmonary Vascular Diseases Working Group of the French Society of Pulmonary Medicine].

    PubMed

    Sitbon, O; Humbert, M; Simonneau, G

    2005-11-05

    Activity-based financing (that is, casemix-based hospital payments, known as T2A) is intended to harmonize and improve the fairness of remuneration of public and private hospitals. T2A will ultimately rely mainly on a flat rate per admission, set according to the diagnosis-related group (DRG). Although payment for drugs is usually included in the DRG price, some expensive drugs will be reimbursed on an additional cost basis after implementation of a "best practices" agreement. Four drugs used for treatment of pulmonary arterial hypertension are eligible for this additional reimbursement: 3 prostacyclin derivatives (intravenous epoprostenol, inhaled iloprost, and subcutaneous treprostinil), and oral bosentan, an endothelin receptor antagonist. The Pulmonary Vascular Diseases working group of the French Society of Pulmonary Medicine has developed guidelines for the best practices in use of these drugs.

  14. Proposed Iraq/Afghanistan War-Lung Injury (IAW-LI) Clinical Practice Recommendations: National Academy of Sciences' Institute of Medicine Burn Pits Workshop.

    PubMed

    Szema, Anthony; Mirsaidi, Niely; Patel, Bhumika; Viens, Laura; Forsyth, Edward; Li, Jonathan; Dang, Sophia; Dukes, Brittany; Giraldo, Jheison; Kim, Preston; Burns, Matthew

    2015-12-14

    High rates of respiratory symptoms (14%) and new-onset asthma in previously healthy soldiers (6.6%) have been reported among military personnel post-deployment to Iraq and Afghanistan. The term Iraq/Afghanistan War-Lung Injury (IAW-LI) is used to describe the constellation of respiratory diseases related to hazards of war, such as exposure to burning trash in burn pits, improvised explosive devices, and sandstorms. Burnpits360.org is a nonprofit civilian website which voluntarily tracks medical symptoms among soldiers post-deployment to the Middle East. Subsequent to initiation of the Burnpits360.org website, the Department of Veterans Affairs started the Airborne Hazards and Open Burn Pit registry. This paper: (a) analyzes the latest 38 patients in the Burnpits360.org registry, validated by DD214 Forms; (b) compares strengths and weaknesses of both registries as outlined at the National Academy of Sciences Institute of Medicine Burn Pits Workshop; (c) further characterizes the spectrum of disease in IAW-LI; (d) describes the risk factors of affected populations; (e) summarizes current practices regarding management of the condition; and (f) defines future research objectives.

  15. [Determining the need for medical rehabilitation services of employed members of the legal pension fund. A recommendation from social medicine and social legal viewpoints].

    PubMed

    Raspe, H; Sulek, C; Héon-Klin, V; Matthis, C; Igl, G

    2001-01-01

    Assessing health care needs in populations has become a major activity of public health medicine worldwide. Its methodology has been developing mainly in the English-speaking world. Concept, methods, and techniques have not yet reached Germany though recently the national expert advisory council for the concerted action in health care (Sachverständigenrat für die Konzertierte Aktion im Gesundheitswesen) provided first "official" definitions of demand, supply, and need to identify over- and undersupply in health care. This article aims at defining, from a combined sociolegal and sociomedical perspective, the need for medical rehabilitation measures among insurees of German pension funds. According to section 15 SGB VI rehabilitation is conceived as a medically coordinated multimodal-multidisciplinary intervention with a cognitive-behavioural orientation. To objectify the need for rehabilitation a series of 9 questions was developed enquiring inter alia about the presence of a disease or disability, the extent or "amplification" of the disorder, its course pattern, the implied risk of permanent work disability and likely success of rehabilitation. Nonspecific back pain served as a paradigmatic condition. One of the main problems encountered is the presently small evidence base to arrive at the necessary prognostic and therapeutic judgements.

  16. Eye problems in mountain and remote areas: prevention and onsite treatment--official recommendations of the International Commission for Mountain Emergency Medicine ICAR MEDCOM.

    PubMed

    Ellerton, John A; Zuljan, Igor; Agazzi, Giancelso; Boyd, Jeffrey J

    2009-01-01

    Although eyes are not frequently injured in the mountains, they are exposed to many adverse factors from the environment. This article, intended for first responders, paramedics, physicians, and mountaineers, is the consensus opinion of the International Commission for Mountain Emergency Medicine (ICAR-MEDCOM). Its aim is to give practical advice on the management of eye problems in mountainous and remote areas. Snow blindness and minor injuries, such as conjunctival and corneal foreign bodies, could immobilize a person and put him or her at risk of other injuries. Blunt or penetrating trauma can result in the loss of sight in the eye; this may be preventable if the injury is managed properly. In almost all cases of severe eye trauma, protecting the eye and arranging an immediate evacuation are necessary. The most common eye problems, however, are due to ultraviolet light and high altitude. People wearing contact lenses and with previous history of eye diseases are more vulnerable. Any sight-threatening eye problem or unexplained visual loss at high altitude necessitates descent. Wearing appropriate eye protection, such as sunglasses with sidepieces and goggles with polarized or photochromic lenses, could prevent most of the common eye problems in mountaineering.

  17. Institute of Medicine core competencies as a foundation for nursing program evaluation.

    PubMed

    Morris, Tama L; Hancock, Dawson R

    2013-01-01

    The purpose of this case study was to explore one institution's experience integrating the Institute of Medicine (IOM) competencies into a pre-licensure baccalaureate nursing curriculum. In response to a growing number of errors in the health care system and efforts to increase patient safety and quality of care, the IOM proposed that students in health care professions learn to implement five core competencies. The program evaluation encompassed a mixed-method, stakeholder-focused methodology using a curriculum matrix triangulated with Student and Faculty Core Competency surveys. Results of the study indicate that all competencies were evident in the curriculum. Students often cited barriers to implementation of the competencies while faculty cited opportunities. Findings suggest that faculty need to raise student awareness of performing the competencies and be deliberate in the design of experiences to facilitate competency implementation.

  18. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine.

    PubMed

    Marik, Paul E; Pastores, Stephen M; Annane, Djillali; Meduri, G Umberto; Sprung, Charles L; Arlt, Wiebke; Keh, Didier; Briegel, Josef; Beishuizen, Albertus; Dimopoulou, Ioanna; Tsagarakis, Stylianos; Singer, Mervyn; Chrousos, George P; Zaloga, Gary; Bokhari, Faran; Vogeser, Michael

    2008-06-01

    To develop consensus statements for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients. A multidisciplinary, multispecialty task force of experts in critical care medicine was convened from the membership of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. In addition, international experts in endocrinology were invited to participate. The task force members reviewed published literature and provided expert opinion from which the consensus was derived. The consensus statements were developed using a modified Delphi methodology. The strength of each recommendation was quantified using the Modified GRADE system, which classifies recommendations as strong (grade 1) or weak (grade 2) and the quality of evidence as high (grade A), moderate (grade B), or low (grade C) based on factors that include the study design, the consistency of the results, and the directness of the evidence. The task force coined the term critical illness-related corticosteroid insufficiency to describe the dysfunction of the hypothalamic-pituitary-adrenal axis that occurs during critical illness. Critical illness-related corticosteroid insufficiency is caused by adrenal insufficiency together with tissue corticosteroid resistance and is characterized by an exaggerated and protracted proinflammatory response. Critical illness-related corticosteroid insufficiency should be suspected in hypotensive patients who have responded poorly to fluids and vasopressor agents, particularly in the setting of sepsis. At this time, the diagnosis of tissue corticosteroid resistance remains problematic. Adrenal insufficiency in critically ill patients is best made by a delta total serum cortisol of < 9 microg/dL after adrenocorticotrophic hormone (250 microg) administration or a random total cortisol of < 10 microg/dL. The benefit of treatment with glucocorticoids at this time seems to be limited to patients with vasopressor

  19. Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for {sup 90}Y microsphere brachytherapy in the treatment of hepatic malignancies

    SciTech Connect

    Dezarn, William A.; Cessna, Jeffery T.; DeWerd, Larry A.; and others

    2011-08-15

    Yttrium-90 microsphere brachytherapy of the liver exploits the distinctive features of the liver anatomy to treat liver malignancies with beta radiation and is gaining more wide spread clinical use. This report provides a general overview of microsphere liver brachytherapy and assists the treatment team in creating local treatment practices to provide safe and efficient patient treatment. Suggestions for future improvements are incorporated with the basic rationale for the therapy and currently used procedures. Imaging modalities utilized and their respective quality assurance are discussed. General as well as vendor specific delivery procedures are reviewed. The current dosimetry models are reviewed and suggestions for dosimetry advancement are made. Beta activity standards are reviewed and vendor implementation strategies are discussed. Radioactive material licensing and radiation safety are discussed given the unique requirements of microsphere brachytherapy. A general, team-based quality assurance program is reviewed to provide guidance for the creation of the local procedures. Finally, recommendations are given on how to deliver the current state of the art treatments and directions for future improvements in the therapy.

  20. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases: A Danish Multidisciplinary Collaboration on Prognostic Factors and Personalised Medicine

    PubMed Central

    Andersen, Vibeke; Holmskov, Uffe; Sørensen, Signe Bek; Jawhara, Mohamad; Andersen, Karina W.; Bygum, Anette; Hvid, Lone; Grauslund, Jakob; Wied, Jimmi; Glerup, Henning; Fredberg, Ulrich; Villadsen, Jan Alexander; Kjær, Søren Geill; Fallingborg, Jan; Moghadd, Seyed A. G. R.; Knudsen, Torben; Brodersen, Jacob; Frøjk, Jesper; Dahlerup, Jens F.; Nielsen, Ole Haagen; Christensen, Robin; Bojesen, Anders Bo; Sorensen, Grith Lykke; Thiel, Steffen; Færgeman, Nils J.; Brandslund, Ivan; Stensballe, Allan; Schmidt, Erik Berg; Franke, Andre; Ellinghaus, David; Rosenstiel, Philip; Raes, Jeroen; Heitmann, Berit; Boye, Mette; Nielsen, Charlotte Lindgaard; Werner, Lars; Kjeldsen, Jens; Ellingsen, Torkell

    2017-01-01

    Chronic inflammatory diseases (CIDs), including Crohn’s disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro-inflammatory molecule tumour necrosis factor-α (TNF) (i.e., TNF inhibitors). Approximately one-third of the patients do not respond to the treatment. Genetics and lifestyle may affect the treatment results. The aims of this multidisciplinary collaboration are to identify (1) molecular signatures of prognostic value to help tailor treatment decisions to an individual likely to initiate TNF inhibitor therapy, followed by (2) lifestyle factors that support achievement of optimised treatment outcome. This report describes the establishment of a cohort that aims to obtain this information. Clinical data including lifestyle and treatment response and biological specimens (blood, faeces, urine, and, in IBD patients, intestinal biopsies) are sampled prior to and while on TNF inhibitor therapy. Both hypothesis-driven and data-driven analyses will be performed according to pre-specified protocols including pathway analyses resulting from candidate gene expression analyses and global approaches (e.g., metabolomics, metagenomics, proteomics). The final purpose is to improve the lives of patients suffering from CIDs, by providing tools facilitating treatment selection and dietary recommendations likely to improve the clinical outcome. PMID:28505128

  1. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases: A Danish Multidisciplinary Collaboration on Prognostic Factors and Personalised Medicine.

    PubMed

    Andersen, Vibeke; Holmskov, Uffe; Sørensen, Signe Bek; Jawhara, Mohamad; Andersen, Karina W; Bygum, Anette; Hvid, Lone; Grauslund, Jakob; Wied, Jimmi; Glerup, Henning; Fredberg, Ulrich; Villadsen, Jan Alexander; Kjær, Søren Geill; Fallingborg, Jan; Moghadd, Seyed A G R; Knudsen, Torben; Brodersen, Jacob; Frøjk, Jesper; Dahlerup, Jens F; Nielsen, Ole Haagen; Christensen, Robin; Bojesen, Anders Bo; Sorensen, Grith Lykke; Thiel, Steffen; Færgeman, Nils J; Brandslund, Ivan; Stensballe, Allan; Schmidt, Erik Berg; Franke, Andre; Ellinghaus, David; Rosenstiel, Philip; Raes, Jeroen; Heitmann, Berit; Boye, Mette; Nielsen, Charlotte Lindgaard; Werner, Lars; Kjeldsen, Jens; Ellingsen, Torkell

    2017-05-15

    Chronic inflammatory diseases (CIDs), including Crohn's disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro-inflammatory molecule tumour necrosis factor-α (TNF) (i.e., TNF inhibitors). Approximately one-third of the patients do not respond to the treatment. Genetics and lifestyle may affect the treatment results. The aims of this multidisciplinary collaboration are to identify (1) molecular signatures of prognostic value to help tailor treatment decisions to an individual likely to initiate TNF inhibitor therapy, followed by (2) lifestyle factors that support achievement of optimised treatment outcome. This report describes the establishment of a cohort that aims to obtain this information. Clinical data including lifestyle and treatment response and biological specimens (blood, faeces, urine, and, in IBD patients, intestinal biopsies) are sampled prior to and while on TNF inhibitor therapy. Both hypothesis-driven and data-driven analyses will be performed according to pre-specified protocols including pathway analyses resulting from candidate gene expression analyses and global approaches (e.g., metabolomics, metagenomics, proteomics). The final purpose is to improve the lives of patients suffering from CIDs, by providing tools facilitating treatment selection and dietary recommendations likely to improve the clinical outcome.

  2. [The Choosing Wisely Initiative of the German Society of Internal Medicine : Recommendations of the German Society for Endocrinology and the German Society for Geriatrics].

    PubMed

    Feldkamp, J; Schott, M; Gogol, M; Quinkler, M; Blüher, M; Diederich, S; Reincke, M

    2016-06-01

    A. After osteoporotic fractures in the elderly, as a rule specific antiosteoporotic therapy should be initiated. a. Osteoporosis as a disease of the elderly should be diagnosed and treated (recommendation of the German Society for Geriatrics). B. All patients with diabetes mellitus should complete a specific diabetes training program when antidiabetic drug medication is initiated. C. In Germany, all pregnant women should be advised to undertake iodine supplementation. D. Endocrine causes of hypertension should be ruled out in younger patients and in patients on multiple antihypertensive drugs. E. All unclear cases of hypercalcemia should be clarified. A. Testosterone substitution therapy should not be initiated on the basis of only one measurement of a reduced testosterone level without clinical signs and clarification of the underlying cause. B. Imaging procedures should only be used after the existence of hormonal disease has been confirmed. C. Sonographic screening for thyroid disease is not advised in the elderly. D. Long-term therapy with levothyroxine for nodular goiter should be avoided. E. In relevant stress situations hydrocortisone replacement therapy should not be continued without dose adjustment in patients with adrenal or pituitary insufficiency.

  3. Standardizing terms, definitions and concepts for describing and interpreting unwanted immunogenicity of biopharmaceuticals: recommendations of the Innovative Medicines Initiative ABIRISK consortium.

    PubMed

    Rup, B; Pallardy, M; Sikkema, D; Albert, T; Allez, M; Broet, P; Carini, C; Creeke, P; Davidson, J; De Vries, N; Finco, D; Fogdell-Hahn, A; Havrdova, E; Hincelin-Mery, A; C Holland, M; H Jensen, P E; Jury, E C; Kirby, H; Kramer, D; Lacroix-Desmazes, S; Legrand, J; Maggi, E; Maillère, B; Mariette, X; Mauri, C; Mikol, V; Mulleman, D; Oldenburg, J; Paintaud, G; R Pedersen, C; Ruperto, N; Seitz, R; Spindeldreher, S; Deisenhammer, F

    2015-09-01

    Biopharmaceuticals (BPs) represent a rapidly growing class of approved and investigational drug therapies that is contributing significantly to advancing treatment in multiple disease areas, including inflammatory and autoimmune diseases, genetic deficiencies and cancer. Unfortunately, unwanted immunogenic responses to BPs, in particular those affecting clinical safety or efficacy, remain among the most common negative effects associated with this important class of drugs. To manage and reduce risk of unwanted immunogenicity, diverse communities of clinicians, pharmaceutical industry and academic scientists are involved in: interpretation and management of clinical and biological outcomes of BP immunogenicity, improvement of methods for describing, predicting and mitigating immunogenicity risk and elucidation of underlying causes. Collaboration and alignment of efforts across these communities is made difficult due to lack of agreement on concepts, practices and standardized terms and definitions related to immunogenicity. The Innovative Medicines Initiative (IMI; www.imi-europe.org), ABIRISK consortium [Anti-Biopharmaceutical (BP) Immunization Prediction and Clinical Relevance to Reduce the Risk; www.abirisk.eu] was formed by leading clinicians, academic scientists and EFPIA (European Federation of Pharmaceutical Industries and Associations) members to elucidate underlying causes, improve methods for immunogenicity prediction and mitigation and establish common definitions around terms and concepts related to immunogenicity. These efforts are expected to facilitate broader collaborations and lead to new guidelines for managing immunogenicity. To support alignment, an overview of concepts behind the set of key terms and definitions adopted to date by ABIRISK is provided herein along with a link to access and download the ABIRISK terms and definitions and provide comments (http://www.abirisk.eu/index_t_and_d.asp).

  4. Standardizing terms, definitions and concepts for describing and interpreting unwanted immunogenicity of biopharmaceuticals: recommendations of the Innovative Medicines Initiative ABIRISK consortium

    PubMed Central

    Rup, B; Pallardy, M; Sikkema, D; Albert, T; Allez, M; Broet, P; Carini, C; Creeke, P; Davidson, J; De Vries, N; Finco, D; Fogdell-Hahn, A; Havrdova, E; Hincelin-Mery, A; C Holland, M; H Jensen, P E; Jury, E C; Kirby, H; Kramer, D; Lacroix-Desmazes, S; Legrand, J; Maggi, E; Maillère, B; Mariette, X; Mauri, C; Mikol, V; Mulleman, D; Oldenburg, J; Paintaud, G; R Pedersen, C; Ruperto, N; Seitz, R; Spindeldreher, S; Deisenhammer, F

    2015-01-01

    Biopharmaceuticals (BPs) represent a rapidly growing class of approved and investigational drug therapies that is contributing significantly to advancing treatment in multiple disease areas, including inflammatory and autoimmune diseases, genetic deficiencies and cancer. Unfortunately, unwanted immunogenic responses to BPs, in particular those affecting clinical safety or efficacy, remain among the most common negative effects associated with this important class of drugs. To manage and reduce risk of unwanted immunogenicity, diverse communities of clinicians, pharmaceutical industry and academic scientists are involved in: interpretation and management of clinical and biological outcomes of BP immunogenicity, improvement of methods for describing, predicting and mitigating immunogenicity risk and elucidation of underlying causes. Collaboration and alignment of efforts across these communities is made difficult due to lack of agreement on concepts, practices and standardized terms and definitions related to immunogenicity. The Innovative Medicines Initiative (IMI; http://www.imi-europe.org), ABIRISK consortium [Anti-Biopharmaceutical (BP) Immunization Prediction and Clinical Relevance to Reduce the Risk; http://www.abirisk.eu] was formed by leading clinicians, academic scientists and EFPIA (European Federation of Pharmaceutical Industries and Associations) members to elucidate underlying causes, improve methods for immunogenicity prediction and mitigation and establish common definitions around terms and concepts related to immunogenicity. These efforts are expected to facilitate broader collaborations and lead to new guidelines for managing immunogenicity. To support alignment, an overview of concepts behind the set of key terms and definitions adopted to date by ABIRISK is provided herein along with a link to access and download the ABIRISK terms and definitions and provide comments (http://www.abirisk.eu/index_t_and_d.asp). PMID:25959571

  5. Public health training in internal medicine residency programs: a national survey.

    PubMed

    Catalanotti, Jillian S; Popiel, David K; Duwell, Monique M; Price, Jessica Hallerman; Miles, Jacqueline Cole

    2014-11-01

    The IOM recommends public health training for all physicians. Data characterizing such training of internal medicine (IM) residents are lacking. To describe the current state of public health education at IM residency programs, characterize programs offering public health education, and quantify interest in expanding training opportunities. IM residency program directors from the 380 Accreditation Council for Graduate Medical Education-accredited residency programs in the U.S were invited to participate in a cross-sectional survey. Responses were received from 127 programs (33%). Data were collected July-December 2012 and analyzed in January 2013. Participants were queried on domestic public health training offered, perceived resident interest in and satisfaction with this training, and interest in expanding training. Eighty-four respondents (66%) provide some form of public health training, but structure and content vary widely. In many programs offering public health training, few residents (<10%) receive it. Although 93 programs (73%) integrate public health into core curricula, only three topics were common to a majority of these programs. Sixty-six respondents (52%) offer clinical training at community-based health centers. Most residency program directors (90%) are very or somewhat interested in expanding their public health training. This study characterizes the structures and content of public health training across IM residency programs. The wide range highlights the diverse definition of "public health training" used by IM residency program directors and lack of universal public health competencies required for IM physicians. Opportunities exist for collaboration among residency programs and between IM and public health educators to share best practices. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  6. Identifying Health Information Technology Needs of Oncologists to Facilitate the Adoption of Genomic Medicine: Recommendations From the 2016 American Society of Clinical Oncology Omics and Precision Oncology Workshop.

    PubMed

    Hughes, Kevin S; Ambinder, Edward P; Hess, Gregory P; Yu, Peter Paul; Bernstam, Elmer V; Routbort, Mark J; Clemenceau, Jean Rene; Hamm, John T; Febbo, Phillip G; Domchek, Susan M; Chen, James L; Warner, Jeremy L

    2017-09-20

    At the ASCO Data Standards and Interoperability Summit held in May 2016, it was unanimously decided that four areas of current oncology clinical practice have serious, unmet health information technology needs. The following areas of need were identified: 1) omics and precision oncology, 2) advancing interoperability, 3) patient engagement, and 4) value-based oncology. To begin to address these issues, ASCO convened two complementary workshops: the Omics and Precision Oncology Workshop in October 2016 and the Advancing Interoperability Workshop in December 2016. A common goal was to address the complexity, enormity, and rapidly changing nature of genomic information, which existing electronic health records are ill equipped to manage. The subject matter experts invited to the Omics and Precision Oncology Workgroup were tasked with the responsibility of determining a specific, limited need that could be addressed by a software application (app) in the short-term future, using currently available genomic knowledge bases. Hence, the scope of this workshop was to determine the basic functionality of one app that could serve as a test case for app development. The goal of the second workshop, described separately, was to identify the specifications for such an app. This approach was chosen both to facilitate the development of a useful app and to help ASCO and oncologists better understand the mechanics, difficulties, and gaps in genomic clinical decision support tool development. In this article, we discuss the key challenges and recommendations identified by the workshop participants. Our hope is to narrow the gap between the practicing oncologist and ongoing national efforts to provide precision oncology and value-based care to cancer patients.

  7. Regionalization and emergency care: the institute of medicine reports and a federal government update.

    PubMed

    Carr, Brendan G; Asplin, Brent R

    2010-12-01

    The 2010 Academic Emergency Medicine consensus conference on regionalization in emergency care began with an update on the Institute of Medicine (IOM) reports on the Future of Emergency Care. This was followed by two presentations from federal officials, focusing on regionalization from the perspective of the White House National Security Staff and the Emergency Care Coordination Center. This article summarizes the content of these presentations. It should be noted that this summary is the perspective of the authors and does not represent the official policy of the U.S. government.

  8. [Educational objectives in the new interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Techniques" under the 9th Revision of the Licensing Regulations for Doctors--consensus recommendations of the German Society for Rehabilitative Sciences and the German Society for Physical Medicine and Rehabilitation].

    PubMed

    Mau, W; Gülich, M; Gutenbrunner, C; Lampe, B; Morfeld, M; Schwarzkopf, S R; Smolenski, U C

    2004-12-01

    In October 2003 the 9 (th) revision of the Federal Medical Training Regulations (Approbationsordnung) came into effect. The new compulsory interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" offers the opportunity to teach all students in comprehensive concepts of Rehabilitation such as the International Classification of Functioning, Disability and Health (ICF) of the WHO and the new book 9 of the German Social Code (SGB 9), as well as Physical Medicine and Naturopathic Treatment. Since the content of this new subject has not been defined up to date a joint task force of the German Society of Rehabilitation Science and the German Society of Physical Medicine and Rehabilitation was founded in order to recommend teaching standards. As part of these teaching standards educational objectives are introduced in this article. They should guide the persons in charge of teaching the subject in the medical faculties. In some areas the students should acquire profound abilities and skills in addition to knowledge. The medical faculties may focus on different educational targets according to their individual teaching profile.

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

    PubMed

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

    2009-04-10

    This report updates and combines earlier versions of guidelines for the prevention and treatment of opportunistic infections (OIs) in HIV-infected adults (i.e., persons aged >/=18 years) and adolescents (i.e., persons aged 13--17 years), last published in 2002 and 2004, respectively. It has been prepared by the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by clinicians and other health-care providers, HIV-infected patients, and policy makers in the United States. These guidelines address several OIs that occur in the United States and five OIs that might be acquired during international travel. Topic areas covered for each OI include epidemiology, clinical manifestations, diagnosis, prevention of exposure; prevention of disease by chemoprophylaxis and vaccination; discontinuation of primary prophylaxis after immune reconstitution; treatment of disease; monitoring for adverse effects during treatment; management of treatment failure; prevention of disease recurrence; discontinuation of secondary prophylaxis after immune reconstitution; and special considerations during pregnancy. These guidelines were developed by a panel of specialists from the United States government and academic institutions. For each OI, a small group of specialists with content-matter expertise reviewed the literature for new information since the guidelines were last published; they then proposed revised recommendations at a meeting held at NIH in June 2007. After these presentations and discussion, the revised guidelines were further reviewed by the co-editors; by the Office of AIDS Research, NIH; by specialists at CDC; and by HIVMA of IDSA before final approval and publication. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of

  10. Health Professions Education: A Bridge to Quality.

    ERIC Educational Resources Information Center

    Greiner, Ann C., Ed.; Knebel, Elisa, Ed.

    The 2001 Institute of Medicine (IOM) report "Crossing the Quality Chasm: A New Health System for the 21st Century" recommended that an interdisciplinary summit be held to develop next steps for reform of health professions education in order to enhance patient care quality and safety. In June 2002, the IOM convened this summit, which included 150…

  11. Implementing the Institute of Medicine definition of disparities: an application to mental health care.

    PubMed

    McGuire, Thomas G; Alegria, Margarita; Cook, Benjamin L; Wells, Kenneth B; Zaslavsky, Alan M

    2006-10-01

    In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care. Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997-1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use. Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities. Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach. A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

  12. Travel medicine

    PubMed Central

    Aw, Brian; Boraston, Suni; Botten, David; Cherniwchan, Darin; Fazal, Hyder; Kelton, Timothy; Libman, Michael; Saldanha, Colin; Scappatura, Philip; Stowe, Brian

    2014-01-01

    Abstract Objective To define the practice of travel medicine, provide the basics of a comprehensive pretravel consultation for international travelers, and assist in identifying patients who might require referral to travel medicine professionals. Sources of information Guidelines and recommendations on travel medicine and travel-related illnesses by national and international travel health authorities were reviewed. MEDLINE and EMBASE searches for related literature were also performed. Main message Travel medicine is a highly dynamic specialty that focuses on pretravel preventive care. A comprehensive risk assessment for each individual traveler is essential in order to accurately evaluate traveler-, itinerary-, and destination-specific risks, and to advise on the most appropriate risk management interventions to promote health and prevent adverse health outcomes during travel. Vaccinations might also be required and should be personalized according to the individual traveler’s immunization history, travel itinerary, and the amount of time available before departure. Conclusion A traveler’s health and safety depends on a practitioner’s level of expertise in providing pretravel counseling and vaccinations, if required. Those who advise travelers are encouraged to be aware of the extent of this responsibility and to refer all high-risk travelers to travel medicine professionals whenever possible. PMID:25500599

  13. Detailed recommendations

    SciTech Connect

    1996-05-01

    The recommendations which have resulted from this workshop have come from several sources, including most importantly the break-out sessions, but also from discussions with other leaders in the field, some www discussions, and least of all the organization committee of the workshop. They may be divided into three sections, the ones which need immediate attention or should happen before the bulk of activities can take place, the priority items that will form the bulk of future research activities, and the important continuing items, that are ancillary to the main objective but help to nurture the field.

  14. Implementation of an Integrative Medicine Curriculum for Preventive Medicine Residents.

    PubMed

    Chiaramonte, Delia R; D'Adamo, Christopher; Amr, Sania

    2015-11-01

    The University of Maryland Department of Epidemiology and Public Health collaborated with the Center for Integrative Medicine at the same institution to develop and implement a unique integrative medicine curriculum within a preventive medicine residency program. Between October 2012 and July 2014, Center for Integrative Medicine faculty provided preventive medicine residents and faculty, and occasionally other Department of Epidemiology and Public Health faculty, with comprehensive exposure to the field of integrative medicine, including topics such as mind-body medicine, nutrition and nutritional supplements, Traditional Chinese Medicine, massage, biofield therapies, manual medicine, stress management, creative arts, and the use of integrative medicine in the inpatient setting. Preventive medicine residents, under the supervision of Department of Epidemiology and Public Health faculty, led integrative medicine-themed journal clubs. Resident assessments included a case-based knowledge evaluation, the Integrative Medicine Attitudes Questionnaire, and a qualitative evaluation of the program. Residents received more than 60 hours of integrative medicine instruction, including didactic sessions, experiential workshops, and wellness retreats in addition to clinical experiences and individual wellness mentoring. Residents rated the program positively and recommended that integrative medicine be included in preventive medicine residency curricula. The inclusion of a wellness-focused didactic, experiential, and skill-based integrative medicine program within a preventive medicine residency was feasible and well received by all six preventive medicine residents. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Assessing Weight Gain by the 2009 Institute of Medicine Guidelines and Perinatal Outcomes in Twin Pregnancy.

    PubMed

    Ozcan, Tulin; Bacak, Stephen J; Zozzaro-Smith, Paula; Li, Dongmei; Sagcan, Seyhan; Seligman, Neil; Glantz, Christopher J

    2017-03-01

    Objective The objective is to estimate the impact of maternal weight gain outside the 2009 Institute of Medicine recommendations on perinatal outcomes in twin pregnancies. Study Design Twin pregnancies with two live births between January 1, 2004 and December 31, 2014 delivered after 23 weeks Finger Lakes Region Perinatal Data System (FLRPDS) and Central New York Region Perinatal Data System were included. Women were classified into three groups using pre-pregnancy body mass index (BMI). Perinatal outcomes in women with low or excessive weekly maternal weight gain were assessed using normal weekly weight gain as the referent in each BMI group. Results Low weight gain increased the risk of preterm delivery, birth weight less than the 10th percentile for one or both twins and decreased risk of macrosomia across all BMI groups. There was a decreased risk of hypertensive disorders in women with normal pre-pregnancy weight and an increased risk of gestational diabetes with low weight gain in obese women. Excessive weight gain increased the risk of hypertensive disorders and macrosomia across all BMI groups and decreased the risk of birth weight less than 10th percentile one twin in normal pre-pregnancy BMI group. Conclusion Among twin pregnancies, low weight gain is associated with low birth weight and preterm delivery in all BMI groups and increased risk of gestational diabetes in obese women. Our study did not reveal any benefit from excessive weekly weight gain with potential harm of an increase in risk of hypertensive disorders of pregnancy. Normal weight gain per 2009 IOM guidelines should be encouraged to improve pregnancy outcome in all pre-pregnancy BMI groups.

  16. [Recommendations for the use of faecal microbiota transplantation "stool transplantation": consensus of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) in cooperation with the Austrian Society of Infectious Diseases and Tropical Medicine].

    PubMed

    Kump, P K; Krause, R; Steininger, C; Gröchenig, H P; Moschen, A; Madl, C; Novacek, G; Allerberger, F; Högenauer, C

    2014-12-01

    The intestinal microbiota has a pivotal role in the maintenance of health of the human organism, especially in the defense against pathogenic microorganisms. Alterations in the microbiota, also termed dysbiosis, seem to be involved in the pathogenesis of a variety of intestinal and extraintestinal diseases. Fecal microbiota transplantation (FMT), also known as stool transplantation, is a therapeutic procedure aiming at restoring an altered intestinal microbiota by administration of stool microorganisms from a healthy donor into the intestinal tract of a patient. FMT is most commonly used for recurrent forms of Clostridium difficile infections (CDI). There are currently many cohort studies in a large number of patients and a randomized controlled trial showing a dramatic effect of FMT for this indication. Therefore FMT is recommended by international medical societies for the treatment of recurrent CDI with high scientific evidence. Other potential indications are the treatment of fulminant CDI or the treatment of inflammatory bowel diseases. In the practical utilization of FMT there are currently several open questions regarding the screening of stool donors, the processing of stool and the mode of FMT application. Different modes of FMT application have been described, the application into the colon has to be preferred due to less reported side effects than the application into the upper gastrointestinal tract. So far only very few side effects due to FMT have been reported, nevertheless the use and risks of FMT are currently intensely debated in the medical community. This consensus report of the Austrian society of gastroenterology and hepatology (ÖGGH) in cooperation with the Austrian society of infectious diseases and tropical medicine provides instructions for physicians who want to use FMT which are based on the current medical literature. © Georg Thieme Verlag KG Stuttgart · New York.

  17. The future of nursing: domestic agenda, global implications.

    PubMed

    Shaffer, Franklin A; Davis, Catherine R; To Dutka, Julia; Richardson, Donna R

    2014-10-01

    The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, challenges the nursing profession to take a key role in redesigning the health care system. Intended to shape the future of nursing in the United States, the IOM report has implications for nursing worldwide. While individual states and nursing organizations are developing initiatives to implement the IOM recommendations in the United States, there must be a concomitant effort to examine the ripple effect on global health and the nursing community. This article addresses four IOM recommendations that are directly relevant to internationally educated nurses who practice across borders: nurse residency programs, lifelong learning, leading change to advance health, and interprofessional health care workforce data. The article discusses the IOM recommendations through a global perspective and offers policy implications for legislators, health care organizations and nurse educators, regulators and administrators.

  18. [Choosing wisely recommendations in gastroenterology].

    PubMed

    Koop, H; Lynen Jansen, P; Zeuzem, S

    2017-06-01

    The Choosing wisely initiative of the German Society of Internal Medicine addresses procedures which are inadequately implemented (deficits in patient care) as well as those which are performed too often but without proven benefits for patients (misuse or overuse of health services). Based on their guidelines, The German Society of Gastroenterology, Digestive and Metabolic Diseases has identified such aspects and incorporated them into the respective recommendations.

  19. [Sugar and diabetes: international recommendations].

    PubMed

    Sanz París, Alejandro; Boj Carceller, Diana; Melchor Lacleta, Isabel; Albero Gamboa, Ramón

    2013-07-01

    Nutrition in the diabetic patient is not just a mere nutrient but his treatment is based. In fact, international scientific societies have called "medical nutrition therapy" to give it the emphasis it deserves. Nutritional recommendations of scientific societies have been changing in recent years with evidence-based medicine. Regarding the consumption of sugar, most believe it does not affect metabolic control if it is replaced by other carbohydrates, but does not indicate a specific amount.

  20. Calling the shots: immunization finance policies and practices. Executive summary of the report of the Institute of Medicine.

    PubMed

    Guyer, B; Smith, D R; Chalk, R

    2000-10-01

    Federal, state, and private-sector investments in vaccine purchases and immunization programs are lagging behind emerging opportunities to reduce the risks of vaccine-preventable disease. Although federal assistance to the states for immunization programs and data collection efforts rapidly expanded in the early part of the 1990s, significant cutbacks have occurred in the last 5 years that have reduced the size of state grant awards by more than 50% from their highest point. During this same period, the vaccine delivery system for children and adults has become more complex and fragmented. This combination of new challenges and reduced resources has led to instability in the public health infrastructure that supports the U. S. immunization system. Many states have reduced the scale of their immunization programs and currently lack adequate strength in areas such as data collection among at-risk populations, strategic planning, program coordination, and assessment of immunization status in communities that are served by multiple health care providers. If unmet immunization needs are not identified and addressed, states will have difficulty in achieving the national goal of 90% coverage by the year 2010 for completion of the childhood immunization series for young children. Furthermore, state and national coverage rates, which reached record levels for vaccines in widespread use (79%, 1998), can be expected to decline and preventable disease outbreaks may occur as a result, particularly among persons who are vulnerable to vaccine-preventable disease because of their underimmunization status. The Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices has therefore concluded that a renewal and strengthening of the federal and state immunization partnership is necessary. The goal of this renewed partnership is to prevent infectious disease; to monitor, sustain, and improve vaccine coverage rates for child and adult populations within more

  1. Medicinal cannabis

    PubMed Central

    Murnion, Bridin

    2015-01-01

    Summary A number of therapeutic uses of cannabis and its derivatives have been postulated from preclinical investigations. Possible clinical indications include spasticity and pain in multiple sclerosis, cancer-associated nausea and vomiting, cancer pain and HIV neuropathy. However, evidence is limited, may reflect subjective rather than objective outcomes, and is not conclusive. Controversies lie in how to produce, supply and administer cannabinoid products. Introduction of cannabinoids therapeutically should be supported by a regulatory and educational framework that minimises the risk of harm to patients and the community. The Regulator of Medicinal Cannabis Bill 2014 is under consideration in Australia to address this. Nabiximols is the only cannabinoid on the Australian Register of Therapeutic Goods at present, although cannabidiol has been recommended for inclusion in Schedule 4. PMID:26843715

  2. Medicinal cannabis.

    PubMed

    Murnion, Bridin

    2015-12-01

    A number of therapeutic uses of cannabis and its derivatives have been postulated from preclinical investigations. Possible clinical indications include spasticity and pain in multiple sclerosis, cancer-associated nausea and vomiting, cancer pain and HIV neuropathy. However, evidence is limited, may reflect subjective rather than objective outcomes, and is not conclusive. Controversies lie in how to produce, supply and administer cannabinoid products. Introduction of cannabinoids therapeutically should be supported by a regulatory and educational framework that minimises the risk of harm to patients and the community. The Regulator of Medicinal Cannabis Bill 2014 is under consideration in Australia to address this. Nabiximols is the only cannabinoid on the Australian Register of Therapeutic Goods at present, although cannabidiol has been recommended for inclusion in Schedule 4.

  3. Physical activity recommendations for older Australians.

    PubMed

    Sims, Jane; Hill, Keith; Hunt, Susan; Haralambous, Betty

    2010-06-01

    The aim of this research was to produce evidence-based recommendations on physical activity designed to improve and maintain the health of older Australians. The authors reviewed existing guidelines and consensus statements, systematic reviews, meta-analyses and research articles. Draft recommendations were circulated to stakeholder agencies and to an expert advisory group. Final recommendations were then forwarded to the Commonwealth Department of Health and Ageing for Ministerial approval. The physical activity recommendations for older Australians complement the current National Physical Activity Guidelines for adults and the American College of Sports Medicine and American Heart Association recommendations for older adults. The recommendations provide advice developed specifically for older Australians. Although the recommendations may be manifested in different ways, according to specific populations or settings, they apply to older people across all levels of health and have application to community dwelling people and those in residential care accommodation.

  4. [Philosophy and medicine].

    PubMed

    Petlenko, V P

    1982-01-01

    Current medicine is a complicated system of knowledge, its construction requiring certain philosophical grounds based on the principles of dialectic materialistic ideology. These principles must rest upon clear understanding of the object and subject of medicine and levels of its investigations. The following problems of medicine require further study: reactive and adaptive essence of disease; correlation of norm and health, pathology and disease, their unity, interrelationships, and qualitative differences, Thus, these problems receive different interpretations causing conflicts. It is necessary to strictly adhere to concepts of dialectic materialism, to strengthen the unity of dialectic materialistic philosophy and natural sciences as recommended by V. I. Lenin.

  5. Aerospace Medicine

    NASA Technical Reports Server (NTRS)

    Michaud, Vince

    2015-01-01

    NASA Aerospace Medicine overview - Aerospace Medicine is that specialty area of medicine concerned with the determination and maintenance of the health, safety, and performance of those who fly in the air or in space.

  6. Nuclear Medicine.

    ERIC Educational Resources Information Center

    Badawi, Ramsey D.

    2001-01-01

    Describes the use of nuclear medicine techniques in diagnosis and therapy. Describes instrumentation in diagnostic nuclear medicine and predicts future trends in nuclear medicine imaging technology. (Author/MM)

  7. Nuclear Medicine.

    ERIC Educational Resources Information Center

    Badawi, Ramsey D.

    2001-01-01

    Describes the use of nuclear medicine techniques in diagnosis and therapy. Describes instrumentation in diagnostic nuclear medicine and predicts future trends in nuclear medicine imaging technology. (Author/MM)

  8. Heart failure - medicines

    MedlinePlus

    CHF - medicines; Congestive heart failure - medicines; Cardiomyopathy - medicines; HF - medicines ... You will need to take most of your heart failure medicines every day. Some medicines are taken ...

  9. The ageing practitioner: ANZCA's recommendations.

    PubMed

    Baker, A B

    2016-04-01

    The aim is to present recommendations of the Australian and New Zealand College of Anaesthetists (ANZCA) with respect to practice implications for ageing specialists, together with brief discussion of effects of ageing on professional medical capabilities and recommendations on preparing to retire from medical practice. Practitioners should recognise that planning for retirement is part of good management of a medical career, and that the ageing process will inevitably compromise their ability to treat patients safely unless they retire at the appropriate time. Planning should include adequate financial preparation, and cultivation of interests and friends outside medicine. Practitioners should also realise that insight is likely to be compromised, so that they should seek colleagues who are trusted to advise them if/when they begin to lose competency. Lastly all practitioners should ensure that they consult a General Practitioner frequently, and that they have arranged all the proper legal instructions such as a Will, a Power of Attorney and an Advanced Health Directive.The ANZCA recommendations concerning ageing specialists have wide application to all medical specialties, not just for anaesthetists, and therefore all Medical Colleges should generate their own specific recommendations for ageing practitioners and the general effects of fatigue particularly for aged practitioners. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  10. Challenges and Opportunities for Genomics Education: Insights from an Institute of Medicine Roundtable Activity.

    PubMed

    Dougherty, Michael J; Wicklund, Catherine; Johansen Taber, Katherine A

    2016-01-01

    Despite the growing availability of genomic tools for clinical care, many health care providers experience gaps in genomics knowledge and skills that serve as impediments to widespread and appropriate integration of genomics into routine care. A workshop recently held by the Institute of Medicine (IOM) Roundtable on Translating Genomics-Based Research for Health explored 1) the barriers that result in a perception among health care providers that the need for genomics education is not urgent and 2) the drivers that may spur a change in that attitude. This commentary promotes continuing and graduate education-informed by an awareness of barriers, drivers, and best practices-as the most effective approaches for preparing the workforce for genomic medicine and ultimately improving patient care, and argues that the time for education is now.

  11. The Institute of Medicine, National Academy of Sciences: formulating AIDS policy.

    PubMed Central

    Weiss, R; Thier, S O

    1988-01-01

    In 1985 the Institute of Medicine, National Academy of Sciences devoted its annual meeting to an exploration of acquired immunodeficiency syndrome (AIDS). The questions raised at the meeting propelled the IOM/NAS to initiate an assessment of the dimensions of the AIDS epidemic and to propose an appropriate national response. The Committee on a National Strategy for AIDS issued its report, "Confronting AIDS: Directions for Public Health, Health Care, and Research," in October 1986. The report detailed strategies for curbing the spread of infection, and for accelerating biomedical and social science research into the causes and possible cures for AIDS. In March 1987, the IOM/NAS established the AIDS Activities Oversight Committee to monitor and assess the nation's progress against AIDS and to coordinate the Academy's growing program of AIDS-related activities. Studies, conferences, and workshops are planned in the areas of drug and vaccine development, modeling the course of the epidemic, research in the behavioral and social sciences, equitable financing of care, pediatric AIDS, early cognitive impairment in HIV infection, IV drug abuse, and other topics. PMID:3131820

  12. Disparities and discrimination in health care coverage: a critique of the Institute of Medicine study.

    PubMed

    Epstein, Richard A

    2005-01-01

    The 2003 Institute of Medicine (IOM) study on Unequal Treatment takes the strong position that many of the current disparities in health care by race are attributable to forms of conscious and unconscious discrimination by health care providers. The study, however, is flawed by imprecise definitions of discrimination that fail to distinguish between differences in treatment due to breakdown in communications and differences in the treated population that are prompted by invidious motives of health care providers. It is doubtful that hidden forms of discrimination are prevalent in a profession whose professional norms are set so strongly against it. In addition, the IOM relies too uncritically on similar studies in unrelated fields to show the ostensible forms of discrimination. These errors have adverse social consequences. A false diagnosis of discrimination where none exists will send a false signal to members of racial minorities that may induce them to avoid receiving needed medical care and instead pursue costly and ineffective remedial devices that will take away funds better spent on providing direct health care.

  13. [Secret medicines].

    PubMed

    Bonnemain, H

    2001-01-01

    Secret medicines had two characteristics: their formula remained unknown and they were prepared by many kinds of people. Before 1728 there were no general laws about these secret medicines but only peculiar rules. From 1728 to 1778, the King edicted rigorous rules in order to limit the number of secret medicines. Between 1778 and 1789, the law became more definite and the Royal Society of Medicine gave advices. The Law of Germinal An-XI forbid secret medicines but since 1805, some compromises took place. Slowly, secret medicines were replaced by pharmaceutics and new set of laws.

  14. Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine's Task Force for intensive care unit triage during an influenza epidemic or mass disaster.

    PubMed

    Sprung, Charles L; Zimmerman, Janice L; Christian, Michael D; Joynt, Gavin M; Hick, John L; Taylor, Bruce; Richards, Guy A; Sandrock, Christian; Cohen, Robert; Adini, Bruria

    2010-03-01

    To provide recommendations and standard operating procedures for intensive care units and hospital preparedness for an influenza pandemic. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics. Key recommendations include: Hospitals should increase their ICU beds to the maximal extent by expanding ICU capacity and expanding ICUs into other areas. Hospitals should have appropriate beds and monitors for these expansion areas. Establish a management system with control groups at facility, local, regional and/or national levels to exercise authority over resources. Establish a system of communication, coordination and collaboration between the ICU and key interface departments. A plan to access, coordinate and increase labor resources is required with a central inventory of all clinical and non-clinical staff. Delegate duties not within the usual scope of workers' practice. Ensure that adequate essential medical equipment, pharmaceuticals and supplies are available. Protect patients and staff with infection control practices and supporting occupational health policies. Maintain staff confidence with reassurance plans for legal protection and assistance. Have objective, ethical, transparent triage criteria that are applied equitably and publically disclosed. ICU triage of patients should be based on the likelihood for patients to benefit most or a 'first come, first served' basis. Develop protocols for safe performance of high-risk procedures. Train and educate staff. Mortality, although inevitable during a severe influenza outbreak or disaster, can be reduced by adequate preparation.

  15. [Social networks and medicine].

    PubMed

    Bastardot, F; Vollenweider, P; Marques-Vidal, P

    2015-11-04

    Social networks (social media or #SoMe) have entered medical practice within the last few years. These new media--like Twitter or Skype--enrich interactions among physicians (telemedicine), among physicians and patients (virtual consultations) and change the way of teaching medicine. They also entail new ethical, deontological and legal issues: the extension of the consultation area beyond the medical office and the access of information by third parties were recently debated. We develop here a review of some social networks with their characteristics, applications for medicine and limitations, and we offer some recommendations of good practice.

  16. Procedures for establishing and maintaining consistent air-kerma strength standards for low-energy, photon-emitting brachytherapy sources: recommendations of the Calibration Laboratory Accreditation Subcommittee of the American Association of Physicists in Medicine.

    PubMed

    DeWerd, Larry A; Huq, M Saiful; Das, Indra J; Ibbott, Geoffrey S; Hanson, William F; Slowey, Thomas W; Williamson, Jeffrey F; Coursey, Bert M

    2004-03-01

    Low dose rate brachytherapy is being used extensively for the treatment of prostate cancer. As of September 2003, there are a total of thirteen 125I and seven 103Pd sources that have calibrations from the National Institute of Standards and Technology (NIST) and the Accredited Dosimetry Calibration Laboratories (ADCLs) of the American Association of Physicists in Medicine (AAPM). The dosimetry standards for these sources are traceable to the NIST wide-angle free-air chamber. Procedures have been developed by the AAPM Calibration Laboratory Accreditation Subcommittee to standardize quality assurance and calibration, and to maintain the dosimetric traceability of these sources to ensure accurate clinical dosimetry. A description of these procedures is provided to the clinical users for traceability purposes as well as to provide guidance to the manufacturers of brachytherapy sources and ADCLs with regard to these procedures.

  17. [Recommendations in neonatal resuscitation].

    PubMed

    2004-01-01

    The recommendations for neonatal resuscitation are not always based on sufficient scientific evidence and thus expert consensus based on current research, knowledge, and experience are useful for formulating practical protocols that are easy to follow. The latest recommendations, in 2000, modified previously published recommendations and are included in the present text.

  18. Nuclear Medicine

    MedlinePlus

    ... Home » Science Education » Science Topics » Nuclear Medicine SCIENCE EDUCATION SCIENCE EDUCATION Science Topics Resource Links for General Public Resource ... Related Documents: Nuclear Medicine Fact Sheet.pdf SCIENCE EDUCATION Science Topics Resource Links for General Public Resource ...

  19. Herbal Medicine

    MedlinePlus

    ... for its scent, flavor, or therapeutic properties. Herbal medicines are one type of dietary supplement. They are ... and fresh or dried plants. People use herbal medicines to try to maintain or improve their health. ...

  20. Retooling for an aging America: building the healthcare workforce. A white paper regarding implementation of recommendation 4.2 of this Institute of Medicine Report of April 14, 2008, that "All licensure, certification and maintenance of certification for healthcare professionals should include demonstration of competence in care of older adults as a criterion.".

    PubMed

    2011-08-01

    In Chicago, Illinois, on May 7, 2009, a group of 53 medical educators representing many U.S. certification boards, residency review committees, and medical societies met to review and approve a white paper intended to promote Recommendation 4.2 of the Institute of Medicine report of April 14, 2008, "Retooling for an Aging America: Building the Healthcare Workforce." This recommendation is one of 14 and states: "All licensure, certification and maintenance of certification for healthcare professionals should include demonstration of competence in care of older adults as a criterion." Background information given included the growing numbers of older adults, review of a 15-year initiative by a section of the American Geriatrics Society (AGS) to include geriatric education in all surgical and some related medical specialties, a recent announcement of 26 elder care competencies to be expected of graduating medical students from association of American Medical Colleges (AAMC) affiliated schools, and the American Board of Medical Specialties (ABMS) approach to 'Reinforcing Geriatric Competencies through Licensure and Certification Examinations." Nine points involved in the implementation of this recommendation received discussion, and approaches to realization were presented. In conclusion, this white paper, which those listed as being in attendance approved, proposes hat all ABMS member boards whose diplomates participate in the care of older adults select the floor competencies enumerated by the AAMC that apply to their specialty and add or subtract those completed during their trainees' initial (intern) year and then define those needed in subsequent years of residency and ultimate practice. This would fulfill the requirements of Recommendation 4.2 above.

  1. [SPORT MEDICINE].

    PubMed

    Constantini, Naama; Mann, Gideon

    2016-06-01

    Sports Medicine is a relatively new subject in medicine and includes a variety of medical and paramedical fields. Although sports medicine is mistakenly thought to be mainly for sports professionals/athletes, it actually encompasses the entire population, including the active and non-active healthy populations, as well as the sick. Sports medicine also engages amateur sportsmen and strives to promote physical activity and quality of life in the general population. Hence, the field involves all ages from childhood to old age, aiming to preserve and support every person at every age. Sports medicine, which started developing in the 19th century, is today a specialty, primary or secondary, in many countries, while in others it is a fellowship or under the jurisdiction of local or sports authorities. In Israel, the field exists since the 1950's and is advanced. The Sports Medicine Society founded a 3-year course of continued education in sport medicine as part of the Tel-Aviv University Faculty of Medicine. Later on, a fellowship in general Sports Medicine and in Orthopedic Sports Medicine were developed within the Israel Medical Association. A year ago, Israel formally became a member of the global "Exercise is Medicine" foundation, and under this title promotes education for health care providers on exercise prescription. The understanding of the importance of physical activity and fitness as part of a healthy lifestyle is increasing in Israel, as well as the number of amateur athletes, and the profession of sports medicine takes a big part in this process.

  2. Pediatric nuclear medicine

    SciTech Connect

    Not Available

    1986-01-01

    This symposium presented the latest techniques and approaches to the proper medical application of radionuclides in pediatrics. An expert faculty, comprised of specialists in the field of pediatric nuclear medicine, discussed the major indications as well as the advantages and potential hazards of nuclear medicine procedures compared to other diagnostic modalities. In recent years, newer radiopharmaceuticals labeled with technetium-99m and other short-lived radionuclides with relatively favorable radiation characteristics have permitted a variety of diagnostic studies that are very useful clinically and carry a substantially lower radiation burden then many comparable X-ray studies. This new battery of nuclear medicine procedures is now widely available for diagnosis and management of pediatric patients. Many recent research studies in children have yielded data concerning the effacacy of these procedures, and current recommendations will be presented by those involved in conducting such studies. Individual papers are processed separately for the Energy Data Base.

  3. Recommendations of the Spanish Societies of Radiation Oncology (SEOR), Nuclear Medicine & Molecular Imaging (SEMNiM), and Medical Physics (SEFM) on 18F-FDG PET-CT for radiotherapy treatment planning

    PubMed Central

    Caballero Perea, Begoña; Villegas, Antonio Cabrera; Rodríguez, José Miguel Delgado; Velloso, María José García; Vicente, Ana María García; Cabrerizo, Carlos Huerga; López, Rosa Morera; Romasanta, Luis Alberto Pérez; Beltrán, Moisés Sáez

    2012-01-01

    Positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) is a valuable tool for diagnosing and staging malignant lesions. The fusion of PET and computed tomography (CT) yields images that contain both metabolic and morphological information, which, taken together, have improved the diagnostic precision of PET in oncology. The main imaging modality for planning radiotherapy treatment is CT. However, PET-CT is an emerging modality for use in planning treatments because it allows for more accurate treatment volume definition. The use of PET-CT for treatment planning is highly complex, and protocols and standards for its use are still being developed. It seems probable that PET-CT will eventually replace current CT-based planning methods, but this will require a full understanding of the relevant technical aspects of PET-CT planning. The aim of the present document is to review these technical aspects and to provide recommendations for clinical use of this imaging modality in the radiotherapy planning process. PMID:24377032

  4. Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid).

    PubMed

    Esposito, Susanna; Bonanni, Paolo; Maggi, Stefania; Tan, Litjan; Ansaldi, Filippo; Lopalco, Pier Luigi; Dagan, Ron; Michel, Jean-Pierre; van Damme, Pierre; Gaillat, Jacques; Prymula, Roman; Vesikari, Timo; Mussini, Cristina; Frank, Uwe; Osterhaus, Albert; Celentano, Lucia Pastore; Rossi, Marta; Guercio, Valentina; Gavazzi, Gaetan

    2016-07-02

    Rapid population aging has become a major challenge in the industrialized world and progressive aging is a key reason for making improvement in vaccination a cornerstone of public health strategy. An increase in age-related disorders and conditions is likely to be seen in the near future, and these are risk factors for the occurrence of a number of vaccine-preventable diseases. An improvement in infectious diseases prevention specifically aimed at adults and the elderly can therefore also decrease the burden of these chronic conditions by reducing morbidity, disability, hospital admissions, health costs, mortality rates and, perhaps most importantly, by improving the quality of life. Among adults, it is necessary to identify groups at increased risk of vaccine-preventable diseases and highlight the epidemiological impact and benefits of vaccinations using an evidence-based approach. This document provides clinical practice guidance on immunization for adults in order to provide recommendations for decision makers and healthcare workers in Europe. Although immunization is considered one of the most impactful and cost-effective public health measures that can be undertaken, vaccination coverage rates among adults are largely lower than the stated goal of ≥ 95% among adults, and stronger efforts are needed to increase coverage in this population. Active surveillance of adult vaccine-preventable diseases, determining the effectiveness of the vaccines approved for marketing in the last 5 y, the efficacy and safety of vaccines in immunocompromised patients, as well as in pregnant women, represent the priorities for future research.

  5. Recommendations of the Spanish Societies of Radiation Oncology (SEOR), Nuclear Medicine & Molecular Imaging (SEMNiM), and Medical Physics (SEFM) on (18)F-FDG PET-CT for radiotherapy treatment planning.

    PubMed

    Caballero Perea, Begoña; Villegas, Antonio Cabrera; Rodríguez, José Miguel Delgado; Velloso, María José García; Vicente, Ana María García; Cabrerizo, Carlos Huerga; López, Rosa Morera; Romasanta, Luis Alberto Pérez; Beltrán, Moisés Sáez

    2012-01-01

    Positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) is a valuable tool for diagnosing and staging malignant lesions. The fusion of PET and computed tomography (CT) yields images that contain both metabolic and morphological information, which, taken together, have improved the diagnostic precision of PET in oncology. The main imaging modality for planning radiotherapy treatment is CT. However, PET-CT is an emerging modality for use in planning treatments because it allows for more accurate treatment volume definition. The use of PET-CT for treatment planning is highly complex, and protocols and standards for its use are still being developed. It seems probable that PET-CT will eventually replace current CT-based planning methods, but this will require a full understanding of the relevant technical aspects of PET-CT planning. The aim of the present document is to review these technical aspects and to provide recommendations for clinical use of this imaging modality in the radiotherapy planning process.

  6. Policies and procedures related to testing for weak D phenotypes and administration of Rh immune globulin: results and recommendations related to supplemental questions in the Comprehensive Transfusion Medicine survey of the College of American Pathologists.

    PubMed

    Sandler, S Gerald; Roseff, Susan D; Domen, Ronald E; Shaz, Beth; Gottschall, Jerome L

    2014-05-01

    Advances in RHD genotyping offer an opportunity to update policies and practices for testing weak D phenotypes and administration of Rh immune globulin to postpartum women. To repeat questions from a 1999 College of American Pathologists proficiency test survey, to evaluate current practices for testing for weak D and administration of Rh immune globulin, and to determine whether there is an opportunity to begin integrating RHD genotyping in laboratory practice. The College of American Pathologists Transfusion Medicine Resource Committee sent questions from the 1999 survey to laboratories that participated in the 2012 proficiency test survey. The results of the 2012 survey were compared with those from 1999. Results from published RHD genotyping studies were analyzed to determine if RHD genotyping could improve current policies and practices for serological Rh typing. More than 3100 survey participants responded to the 2012 questions. The most significant finding was a decrease in the number of transfusion services performing a serological weak D test on patients as a strategy to manage those with a weak D as Rh negative (from 58.2% to 19.8%, P < .001). Data from RHD genotyping studies indicate that approximately 95% of women with a serological weak D could be managed safely and more logically as Rh positive. Selective integration of RHD genotyping policies and practices could improve the accuracy of Rh typing results, reduce unnecessary administration of Rh immune globulin in women with a weak D, and decrease transfusion of Rh-negative red blood cells in most recipients with a serological weak D phenotype.

  7. Recommended immunization schedules for adults: Clinical practice guidelines by the Escmid Vaccine Study Group (EVASG), European Geriatric Medicine Society (EUGMS) and the World Association for Infectious Diseases and Immunological Disorders (WAidid)

    PubMed Central

    Esposito, Susanna; Bonanni, Paolo; Maggi, Stefania; Tan, Litjan; Ansaldi, Filippo; Lopalco, Pier Luigi; Dagan, Ron; Michel, Jean-Pierre; van Damme, Pierre; Gaillat, Jacques; Prymula, Roman; Vesikari, Timo; Mussini, Cristina; Frank, Uwe; Osterhaus, Albert; Celentano, Lucia Pastore; Rossi, Marta; Guercio, Valentina; Gavazzi, Gaetan

    2016-01-01

    ABSTRACT Rapid population aging has become a major challenge in the industrialized world and progressive aging is a key reason for making improvement in vaccination a cornerstone of public health strategy. An increase in age-related disorders and conditions is likely to be seen in the near future, and these are risk factors for the occurrence of a number of vaccine-preventable diseases. An improvement in infectious diseases prevention specifically aimed at adults and the elderly can therefore also decrease the burden of these chronic conditions by reducing morbidity, disability, hospital admissions, health costs, mortality rates and, perhaps most importantly, by improving the quality of life. Among adults, it is necessary to identify groups at increased risk of vaccine-preventable diseases and highlight the epidemiological impact and benefits of vaccinations using an evidence-based approach. This document provides clinical practice guidance on immunization for adults in order to provide recommendations for decision makers and healthcare workers in Europe. Although immunization is considered one of the most impactful and cost-effective public health measures that can be undertaken, vaccination coverage rates among adults are largely lower than the stated goal of ≥ 95% among adults, and stronger efforts are needed to increase coverage in this population. Active surveillance of adult vaccine-preventable diseases, determining the effectiveness of the vaccines approved for marketing in the last 5 y, the efficacy and safety of vaccines in immunocompromised patients, as well as in pregnant women, represent the priorities for future research. PMID:27135390

  8. Beyond a Band-Aid Approach: An Internal Agency Solution to Nurse Staffing.

    PubMed

    Adams, Jewel; Kaplow, Roberta; Dominy, Janet; Stroud, Bridgett

    2015-01-01

    The Institute of Medicine (IOM) affirmed that the employment of temporary or per diem nurses augments risk to patient safety. The IOM recommends health care facilities avoid hiring nurses working from a temporary external agency. The IOM recognizes the need for health care facilities to have a plan in place for situations when confronted with short staffing, higher acuity, and increased patient census. Based on recommendations from the IOM, an internal agency was developed in a university-based health care system. Cost savings were realized because of the collaborative efforts of human resources to fill vacancies, unit management managing their respective budgets by flexing staff based on patient census, and the development and implementation of the Enterprise Staffing Pool.

  9. (Re)introducing medicinal cannabis.

    PubMed

    Mather, Laurence E; Rauwendaal, Evert R; Moxham-Hall, Vivienne L; Wodak, Alex D

    2013-12-16

    • After considering extensive scientific and medical evidence, a New South Wales Legislative Council multiparty committee recommended that medicinal cannabis should lawfully be made available for selected-use pharmacotherapy. • The evidence indicates that cannabis has genuine medicinal utility in patients with certain neuropathic conditions, with acceptable levels of risk from mostly mild side effects. • The potential medical benefits of cannabis pharmacotherapy have largely been overlooked, with research and society's attention, in most parts of the world, being directed towards the hazards of its recreational use. • The NSW Government has since dismissed the unanimous and compassionate recommendations of their committee.

  10. Research recommendations [Chapter 10

    Treesearch

    Daniel G. Neary; Alvin L. Medina; John N. Rinne

    2012-01-01

    This chapter contains a number of research recommendations that have developed from the 15 years of research on the UVR conducted by the Southwest Watershed Science Team, as well as from insights from key cooperators and contacts. It is meant to be our best insight as to where efforts should go now. Achieving these recommendations will depend on a number of factors,...

  11. [Expedition medicine].

    PubMed

    Donlagić, Lana

    2009-01-01

    Expedition and wildeness medicine is a term that combines rescue medicine, sport medicine as well as more specific branches as polar or high altitude medicine. It is being intensively studied both at the reaserch institutes and on expeditions. Ophtalmologists are concentrated on the reaserch of HARH (High Altitude Retinal Hemorrhage), neurologists on HACE reaserch (High Altitude Cerebral Edema), psychologists are developing tests to decsribe cognitive functions and many physicians are being trained to work in extreme enviroment. The result of all this effort are numerous new findings in pathophysiology and therapy of altitude illness, increased security on expedition and further development of expeditionism.

  12. The Current Emphasis on Preventive Medicine

    ERIC Educational Resources Information Center

    Saward, Ernest; Sorensen, Andrew

    1978-01-01

    This is a discussion of preventive medicine. Included is a historical background, a discussion of improving the environment, moderating self-imposed risks, changing consumer expectations, recommendations, and conclusions. (BB)

  13. Medicines, injections, and supplements for arthritis

    MedlinePlus

    ... these medicines without a prescription. Most doctors recommend acetaminophen (such as Tylenol) first. It has fewer side ... talk to your doctor first about how much acetaminophen is right for you. If your pain continues, ...

  14. Teaching medical students rehabilitation medicine.

    PubMed

    Gibson, Jeremy; Lin, Xia; Clarke, Karen; Fish, Helen; Phillips, Margaret

    2010-01-01

    The principles of rehabilitation medicine will become ever more important across many medical and surgical specialties in view of the rising prevalence of chronic and disabling conditions. Yet rehabilitation medicine has traditionally been unpopular with medical students. This article aims to review the existing evidence of problems in teaching medical undergraduates in rehabilitation medicine and provide published recommendations and practical approaches from our own experience. A literature review was carried out to search for publications relating to teaching rehabilitation medicine to undergraduates in order to identify problems that potentially affect undergraduate education in rehabilitation medicine and its future as a medical speciality. The lack of consistent undergraduate curriculum, knowledge of rehabilitation medicine and academic opportunities contribute to the inadequate perception of the speciality to the undergraduates. The attitude of medical students towards rehabilitation medicine is important for its future development as a specialty. Further standardisation of teaching rehabilitation medicine at a national level, promoting research activity in this area and increasing the profile of rehabilitation medicine are warranted.

  15. [Sport medicine].

    PubMed

    Epstein, Yoram

    2012-02-01

    It is only since the late 20th century that Sport and Exercise Medicine has emerged as a distinct entity in health care. In Israel, sports medicine is regulated by a State Law and a sport physician is certified after graduating a structured program. In the past, sports medicine was related to the diagnosis and treatment of injuries encountered by top athletes. In recent years, the scope of sport medicine has broadened to reflect the awareness of modern society of the dangers of physical inactivity. In this perspective the American College of Sport Medicine (ACSM) recently launched a program--"Exercise is Medicine", to promote physical activity in order to improve health and well-being and prevention of diseases through physical activity prescriptions. This program is from doctors and healthcare providers, adjusted to the patient or trainee. The sport physician does not replace a medical specialist, but having a thorough understanding about the etiology of a sport-related injury enables him to better focus on treatment and prevention. Therefore, Team Physicians in Elite Sport often play a role regarding not only the medical care of athletes, but also in the physiological monitoring of the athlete and correcting aberrations, to achieve peak physical performance. The broad spectrum of issues in sport and exercise medicine cannot be completely covered in one issue of the Journal. Therefore, the few reports that are presented to enhance interest and understanding in the broad spectrum of issues in sports and exercise medicine are only the tip of the iceberg.

  16. Aerospace Medicine

    NASA Technical Reports Server (NTRS)

    Davis, Jeffrey R.

    2006-01-01

    This abstract describes the content of a presentation for ground rounds at Mt. Sinai School of Medicine. The presentation contains three sections. The first describes the history of aerospace medicine beginning with early flights with animals. The second section of the presentation describes current programs and planning for future missions. The third section describes the medical challenges of exploration missions.

  17. Behavioral Medicine.

    ERIC Educational Resources Information Center

    Garfield, Sol L., Ed.

    1982-01-01

    Contains 18 articles discussing the uses of behavioral medicine in such areas as obesity, smoking, hypertension, and headache. Reviews include discussions of behavioral medicine and insomnia, chronic pain, asthma, peripheral vascular disease, and coronary-prone behavior. Newly emerging topics include gastrointestinal disorders, arthritis,…

  18. Vulnerable Medicine

    ERIC Educational Resources Information Center

    Bochner, Arthur P.

    2009-01-01

    In "Narrative Medicine: Honoring the Stories of Illness," Rita Charon paints an original and humane portrait of what it can mean to be a doctor, to live a life immersed in sickness and dedicated to wellness. Charon drops the veil, inviting readers to look at the secret, subjective, emotional face of medicine, a zone of self-censored feelings and…

  19. Behavioral Medicine.

    ERIC Educational Resources Information Center

    Garfield, Sol L., Ed.

    1982-01-01

    Contains 18 articles discussing the uses of behavioral medicine in such areas as obesity, smoking, hypertension, and headache. Reviews include discussions of behavioral medicine and insomnia, chronic pain, asthma, peripheral vascular disease, and coronary-prone behavior. Newly emerging topics include gastrointestinal disorders, arthritis,…

  20. Vulnerable Medicine

    ERIC Educational Resources Information Center

    Bochner, Arthur P.

    2009-01-01

    In "Narrative Medicine: Honoring the Stories of Illness," Rita Charon paints an original and humane portrait of what it can mean to be a doctor, to live a life immersed in sickness and dedicated to wellness. Charon drops the veil, inviting readers to look at the secret, subjective, emotional face of medicine, a zone of self-censored feelings and…

  1. Complementary medicine.

    PubMed

    Ernst, E

    2003-03-01

    Complementary medicine has become an important subject for rheumatologists, not least because many patients try complementary treatments. Recent clinical trials yield promising results. In particular, evidence suggests that several herbal medicines and dietary supplements can alleviate the pain of osteoarthritis and rheumatoid arthritis. Clearly, rigorous testing of complementary treatments is possible, and considering their popularity, should be encouraged.

  2. Use Medicines Safely

    MedlinePlus

    ... Medicines Safely Print This Topic En español Use Medicines Safely Browse Sections The Basics Overview Prescription Medicines ... Medicines 1 of 7 sections The Basics: Prescription Medicines There are different types of medicine. The 2 ...

  3. Radiation Safety in Nuclear Medicine Procedures.

    PubMed

    Cho, Sang-Geon; Kim, Jahae; Song, Ho-Chun

    2017-03-01

    Since the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant in 2011, radiation safety has become an important issue in nuclear medicine. Many structured guidelines or recommendations of various academic societies or international campaigns demonstrate important issues of radiation safety in nuclear medicine procedures. There are ongoing efforts to fulfill the basic principles of radiation protection in daily nuclear medicine practice. This article reviews important principles of radiation protection in nuclear medicine procedures. Useful references, important issues, future perspectives of the optimization of nuclear medicine procedures, and diagnostic reference level are also discussed.

  4. [National organization of forensic medicine in France].

    PubMed

    Chariot, Patrick

    2012-06-01

    Forensic medicine has long been characterized, in France, by diverse medical practices, which affected its recognition and development. A change was needed, Harmonization procedure includes the development of professional guidelines and allows forensic medicine to look at itself. However, the implementation of the recommendations is still far from complete. A national reform came into effect on 15 January 2011 and has defined a national reform of forensic medicine which includes funding by global budgets instead of fee-for-service. This reform allows easier organization and identification of forensic medicine units. One year later, tangible results are mixed. Forensic medicine is now more clearly identified but properly defined funding criteria are still lacking.

  5. Recommended Textbooks (Booksearch).

    ERIC Educational Resources Information Center

    English Journal, 1988

    1988-01-01

    Evaluates four textbooks recommended by junior high and high school teachers for teaching writing and literature: "Enjoying Literature" (published by Macmillan, 1985); "Exposition: Critical Writing and Thinking" (Robert J. Gula); "Situational Writing" (Gene Krupa); and "Double Exposure: Composing through Writing…

  6. Updated Lightning Safety Recommendations.

    ERIC Educational Resources Information Center

    Vavrek, R. James; Holle, Ronald L.; Lopez, Raul E.

    1999-01-01

    Summarizes the recommendations of the Lightning Safety Group (LSG), which was first convened during the 1998 American Meteorological Society Conference. Findings outline appropriate actions under various circumstances when lightning threatens. (WRM)

  7. Updated Lightning Safety Recommendations.

    ERIC Educational Resources Information Center

    Vavrek, R. James; Holle, Ronald L.; Lopez, Raul E.

    1999-01-01

    Summarizes the recommendations of the Lightning Safety Group (LSG), which was first convened during the 1998 American Meteorological Society Conference. Findings outline appropriate actions under various circumstances when lightning threatens. (WRM)

  8. Collaborative Education To Ensure Patient Safety.

    ERIC Educational Resources Information Center

    National Advisory Council on Nurse Education and Practice, Rockville, MD.

    Results of a joint meeting between national advisory councils in medicine and nursing on physician-nurse collaboration to enhance patient safety are reported. Recommendations on which participants reached consensus are organized by these Institute of Medicine (IOM) themes: establish a national focus to create leadership through research and…

  9. The practice of travel medicine in Europe.

    PubMed

    Schlagenhauf, P; Santos-O'Connor, F; Parola, P

    2010-03-01

    Europe, because of its geographical location, strategic position on trade routes, and colonial past, has a long history of caring for travellers' health. Within Europe, there is great diversity in the practice of travel medicine. Some countries have travel medicine societies and provisions for a periodic distribution of recommendations, but many countries have no national pre-travel guidelines and follow international recommendations such as those provided by the WHO. Providers of travel medicine include tropical medicine specialists, general practice nurses and physicians, specialist 'travel clinics', occupational physicians, and pharmacists. One of the core functions of the European Centre for Disease Prevention and Control-funded network of travel and tropical medicine professionals, EuroTravNet, is to document the status quo of travel medicine in Europe. A three-pronged approach is used, with a real-time online questionnaire, a structured interview with experts in each country, and web searching.

  10. Social Tagging Recommender Systems

    NASA Astrophysics Data System (ADS)

    Marinho, Leandro Balby; Nanopoulos, Alexandros; Schmidt-Thieme, Lars; Jäschke, Robert; Hotho, Andreas; Stumme, Gerd; Symeonidis, Panagiotis

    The new generation of Web applications known as (STS) is successfully established and poised for continued growth. STS are open and inherently social; features that have been proven to encourage participation. But while STS bring new opportunities, they revive old problems, such as information overload. Recommender Systems are well known applications for increasing the level of relevant content over the "noise" that continuously grows as more and more content becomes available online. In STS however, we face new challenges. Users are interested in finding not only content, but also tags and even other users. Moreover, while traditional recommender systems usually operate over 2-way data arrays, STS data is represented as a third-order tensor or a hypergraph with hyperedges denoting (user, resource, tag) triples. In this chapter, we survey the most recent and state-of-the-art work about a whole new generation of recommender systems built to serve STS.We describe (a) novel facets of recommenders for STS, such as user, resource, and tag recommenders, (b) new approaches and algorithms for dealing with the ternary nature of STS data, and (c) recommender systems deployed in real world STS. Moreover, a concise comparison between existing works is presented, through which we identify and point out new research directions.

  11. Natural and Synthetic Colloids in Veterinary Medicine.

    PubMed

    Brooks, Aimee; Thomovsky, Elizabeth; Johnson, Paula

    2016-06-01

    This review article covers basic physiology underlying the clinical use of natural and artificial colloids as well as provide practice recommendations. It also touches on the recent scrutiny of these products in human medicine and how this may have an effect on their use in veterinary medicine. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Wilderness medicine

    PubMed Central

    Sward, Douglas G.; Bennett, Brad L.

    2014-01-01

    BACKGROUND: Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest. METHODS: The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study. RESULTS: Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals. CONCLUSIONS: The future of wilderness medicine is unfolding on multiple fronts: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes. PMID:25215140

  13. Precision Medicine

    PubMed Central

    Cholerton, Brenna; Larson, Eric B.; Quinn, Joseph F.; Zabetian, Cyrus P.; Mata, Ignacio F.; Keene, C. Dirk; Flanagan, Margaret; Crane, Paul K.; Grabowski, Thomas J.; Montine, Kathleen S.; Montine, Thomas J.

    2017-01-01

    Three key elements to precision medicine are stratification by risk, detection of pathophysiological processes as early as possible (even before clinical presentation), and alignment of mechanism of action of intervention(s) with an individual's molecular driver(s) of disease. Used for decades in the management of some rare diseases and now gaining broad currency in cancer care, a precision medicine approach is beginning to be adapted to cognitive impairment and dementia. This review focuses on the application of precision medicine to address the clinical and biological complexity of two common neurodegenerative causes of dementia: Alzheimer disease and Parkinson disease. PMID:26724389

  14. Medicines management.

    PubMed

    Pegram, Anne; Bloomfield, Jacqueline

    2015-04-15

    All newly registered graduate nurses are required to have the appropriate knowledge and understanding to perform the skills required for patient care, specifically the competencies identified in the Nursing and Midwifery Council's essential skills clusters. This article focuses on the fifth essential skills cluster – medicines management. Nursing students should work to attain the knowledge and skills required for effective medicines management throughout their pre-registration education. The roles and responsibilities of the newly registered graduate nurse in the area of medicines management are discussed in this the final article of the essential skills cluster series.

  15. Trends in gestational weight gain: the Pregnancy Risk Assessment Monitoring System, 2000—2009

    PubMed Central

    Johnson, Jonetta L.; Farr, Sherry L.; Dietz, Patricia M.; Sharma, Andrea J.; Barfield, Wanda D.; Robbins, Cheryl L.

    2015-01-01

    OBJECTIVE Achieving adequate gestational weight gain (GWG) is important for optimal health of the infant and mother. We estimate current population-based trends of GWG. STUDY DESIGN We analyzed data from the Pregnancy Risk Assessment Monitoring System for 124,348 women who delivered live infants in 14 states during 2000 through 2009. We examined prevalence and trends in GWG in pounds as a continuous variable, and within 1990 Institute of Medicine (IOM) recommendations (yes/no) as a dichotomous variable. We examined adjusted trends in mean GWG using multivariable linear regression and GWG within recommendations using multivariable multinomial logistic regression. RESULTS During 2000 through 2009, 35.8% of women gained within IOM GWG recommendations, 44.4% gained above, and 19.8% gained below. From 2000 through 2009, there was a biennial 1.0 percentage point decrease in women gaining within IOM GWG recommendations (P trend < .01) and a biennial 0.8 percentage point increase in women gaining above IOM recommendations (P trend < .01). The percentage of women gaining weight below IOM recommendations remained relatively constant from 2000 through 2009 (P trend = .14). The adjusted odds of gaining within IOM recommendations were lower in 2006 through 2007 (adjusted odds ratio, 0.90; 95% confidence interval, 0.85–0.96) and 2008 through 2009 (adjusted odds ratio, 0.90; 95% confidence interval, 0.85–0.96) relative to 2000 through 2001. CONCLUSION Overall, from 2000 through 2009 the percentage of women gaining within IOM recommendations slightly decreased while mean GWG slightly increased. Efforts are needed to develop and implement strategies to ensure that women achieve GWG within recommendations. PMID:25637844

  16. Diabetes Medicines

    MedlinePlus

    ... Disease, & Other Dental Problems Diabetes & Sexual & Urologic Problems Insulin, Medicines, & Other Diabetes Treatments Taking insulin or other ... medication plan. What are the different types of insulin? Several types of insulin are available. Each type ...

  17. COPD Medicine

    MedlinePlus

    ... Education & Training Home Treatment & Programs Medications COPD Medications COPD Medications Make an Appointment Ask a Question Refer ... control the symptoms of chronic obstructive pulmonary disease (COPD). Most people with COPD take long-acting medicine ...

  18. Distributed Deliberative Recommender Systems

    NASA Astrophysics Data System (ADS)

    Recio-García, Juan A.; Díaz-Agudo, Belén; González-Sanz, Sergio; Sanchez, Lara Quijano

    Case-Based Reasoning (CBR) is one of most successful applied AI technologies of recent years. Although many CBR systems reason locally on a previous experience base to solve new problems, in this paper we focus on distributed retrieval processes working on a network of collaborating CBR systems. In such systems, each node in a network of CBR agents collaborates, arguments and counterarguments its local results with other nodes to improve the performance of the system's global response. We describe D2ISCO: a framework to design and implement deliberative and collaborative CBR systems that is integrated as a part of jcolibritwo an established framework in the CBR community. We apply D2ISCO to one particular simplified type of CBR systems: recommender systems. We perform a first case study for a collaborative music recommender system and present the results of an experiment of the accuracy of the system results using a fuzzy version of the argumentation system AMAL and a network topology based on a social network. Besides individual recommendation we also discuss how D2ISCO can be used to improve recommendations to groups and we present a second case of study based on the movie recommendation domain with heterogeneous groups according to the group personality composition and a group topology based on a social network.

  19. DIETARY INTAKE OF SUBJECTS WITH PERIPHERAL ARTERY DISEASE AND CLAUDICATION

    PubMed Central

    Gardner, Andrew W.; Bright, Brianna C.; Ort, Kelly A.; Montgomery, Polly S.

    2013-01-01

    We compared the dietary intakes of subjects with peripheral artery disease (PAD) and claudication with diet recommendations of the National Cholesterol Education Program (NCEP) and dietary reference intake values recommended by the Institute of Medicine (IOM) of the National Academy of Sciences. Forty-six subjects consumed a mean macronutrient composition of 17% protein, 51% carbohydrate, and 30% fat. Compared to the NCEP and IOM recommendations, few subjects met the recommended daily intakes for sodium (0%), vitamin E (0%), folate (13%), saturated fat (20%), fiber (26%), and cholesterol (39%). Subjects with PAD and claudication have poor nutrition, with diets particularly high in saturated fat, sodium, and cholesterol, and low in fiber, vitamin E and folate intakes. Subjects should be encouraged to reduce consumption of dietary fat, saturated fat, cholesterol, and sodium, and to increase fiber and vitamin intakes to meet recommendations of the NCEP and IOM. PMID:21406424

  20. Space Station Software Recommendations

    NASA Technical Reports Server (NTRS)

    Voigt, S. (Editor)

    1985-01-01

    Four panels of invited experts and NASA representatives focused on the following topics: software management, software development environment, languages, and software standards. Each panel deliberated in private, held two open sessions with audience participation, and developed recommendations for the NASA Space Station Program. The major thrusts of the recommendations were as follows: (1) The software management plan should establish policies, responsibilities, and decision points for software acquisition; (2) NASA should furnish a uniform modular software support environment and require its use for all space station software acquired (or developed); (3) The language Ada should be selected for space station software, and NASA should begin to address issues related to the effective use of Ada; and (4) The space station software standards should be selected (based upon existing standards where possible), and an organization should be identified to promulgate and enforce them. These and related recommendations are described in detail in the conference proceedings.

  1. Urotherapy recommendations for bedwetting.

    PubMed Central

    Robson, Lane M.; Leung, Alexander K. C.

    2002-01-01

    OBJECTIVE: To assess the efficacy of urotherapy recommendations prior to pharmacological or moisture alarm treatment in the management of bedwetting in children. METHODS: Children assessed for bedwetting at a voiding dysfunction clinic were admitted to a prospective, uncontrolled pilot study. The families were instructed to follow specific urotherapy recommendations. RESULTS: Of the 23 children who completed the study, sixteen (70%) improved with at least one less wet night per week, nine (39%) with at least a 50% reduction, and five (22%) resolved. CONCLUSION: Urotherapy recommendations prior to pharmacological or moisture alarm treatment shows promise and potential for the management of children with bedwetting. Further studies are necessary to determine if the improvement is sustained. PMID:12126283

  2. Order Theoretical Semantic Recommendation

    SciTech Connect

    Joslyn, Cliff A.; Hogan, Emilie A.; Paulson, Patrick R.; Peterson, Elena S.; Stephan, Eric G.; Thomas, Dennis G.

    2013-07-23

    Mathematical concepts of order and ordering relations play multiple roles in semantic technologies. Discrete totally ordered data characterize both input streams and top-k rank-ordered recommendations and query output, while temporal attributes establish numerical total orders, either over time points or in the more complex case of startend temporal intervals. But also of note are the fully partially ordered data, including both lattices and non-lattices, which actually dominate the semantic strcuture of ontological systems. Scalar semantic similarities over partially-ordered semantic data are traditionally used to return rank-ordered recommendations, but these require complementation with true metrics available over partially ordered sets. In this paper we report on our work in the foundations of partial order measurement in ontologies, with application to top-k semantic recommendation in workflows.

  3. Integrating information literacy into the education of public health professionals: roles for librarians and the library.

    PubMed

    Cobus, Laura

    2008-01-01

    The paper reviews the core competencies for public health professionals presented in the Institute of Medicine's (IOM's) report, Who Will Keep the Public Healthy: Educating Public Health Professionals for the 21st Century; describes improving information literacy (IL) as a mechanism for integrating the core competencies in public health education; and showcases IL as an opportunity for solidifying partnerships between academic librarians and public health educators. The IOM competencies, along with explicit examples of library support from a literature review of current IL trends in the health sciences, are analyzed. Librarians can play a fundamental role in implementing the IOM's core competencies in shaping public health education for the twenty-first century. A partnership between public health educators and librarians through a transdisciplinary approach is recommended. IL skills and competencies integrated into public health curricula through a collaborative partnership between public health educators and librarians can help integrate the IOM's core competencies and improve public health education.

  4. Personal medicines storage in New Zealand.

    PubMed

    Hewson, Campbell; Shen, Chong Chi; Strachan, Clare; Norris, Pauline

    2013-06-01

    Poor storage of medicines can reduce their efficacy, yet little is known about how people store medicines in their homes and elsewhere, why these locations are chosen, and whether the conditions are suitable for medicines storage. To investigate where medicines are commonly stored in New Zealand households, why, and the typical conditions-temperature and relative humidity-in those places of storage. Data from a large qualitative study on the meanings of medicines were analysed to explore where people store medicines in their households, and why. A data logger was used to log temperature and relative humidity in common medicine storage places, such as homes and cars. Kitchens and bathrooms were the most commonly reported storage places, with people influenced by convenience, desire to remember to take medicines, and child safety when deciding where to store medicines. High temperatures and humidity were found in kitchens and bathrooms, extreme temperatures in a car and a backpack, and extremely low temperatures in checked-in luggage on a plane. Temperature- and humidity-sensitive medicines should not be stored long-term in common storage locations, such as kitchens and bathrooms. Conditions in these places may not comply with the recommended storage conditions given by the manufacturer. Furthermore, medicines should not be left in backpacks or cars, especially if the vehicle is in the sun. Medicines that may degrade upon freezing and thawing-such as protein-containing medicines, emulsions, suspensions and some solutions-should not be stored in the cargo hold of a plane.

  5. Confidentiality in Sports Medicine.

    PubMed

    Malcolm, Dominic

    2016-04-01

    This article synthesizes existing literature to provide a summary of the ethical issues concerning patient confidentiality in sport. It outlines the medical principle of confidentiality and identifies cross-cultural ethicolegal variations that shape its implementation. Clinicians' multiple obligations, physical environments, and practice and policy contexts are discussed, and research detailing experiences of maintaining patient confidentiality in sport is reviewed. Policy recommendations for enhancing compliance with this ethical principle are summarized. It is argued that the context of sport exacerbates pressures on clinicians to break patient confidentiality, breaches occur regularly, and interventions are required to enhance ethical compliance in sports medicine. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. [Parenteral administration medicines: recommendations of preparation, administration and stability].

    PubMed

    Gaspar Carreño, M; Torrico Martín, F; Novajarque Sala, L; Batista Cruz, M; Ribeiro Gonçalves, P; Porta Oltra, B; Sánchez Santos, J C

    2014-11-03

    Objetivo: Elaborar unas recomendaciones de preparacion de medicamentos de administracion parenteral (MAP) para valorar la posibilidad de transferir su preparacion, desde las unidades de enfermeria en planta de hospitalizacion al servicio de farmacia (SF). Método: Se procede a elaborar una tabla de estabilidades de los medicamentos incluidos en la guia farmacoterapeutica del Hospital, aplicando la Guia USP (Pharmaceutical compounding Sterile Preparations) y la Guia de de buenas practicas de preparacion de medicamentos en los servicios de farmacia hospitalaria. Se recopilo informacion sobre las MAP: metodo de preparacion, compatibilidad, conservacion, periodo de validez, modo de administracion y tipo de envase. Los datos se obtuvieron mediante consulta de las fichas tecnicas, laboratorios, revision bibliografica y otras bases de datos. Resultados: Tras revisar 209 farmacos se elaboro un listado de recomendaciones. Segun los datos obtenidos, las MAP se prepararan de la siguiente forma: 89 seran preparadas desde el SF, 62 en unidad de enfermeria en planta de hospitalizacion pues son medicamentos que requieren administracion inmediata y 58 ya van acondicionados para su administracion por la industria. De los 62 farmacos que se prepararan por enfermeria, en 14 de ellos las dosis siguientes se prepararan desde el SF. Por lo tanto de los 209 farmacos solo 48 se prepararan exclusivamente en la unidad de enfermeria. Conclusiones: Desde el SF se ha establecido un metodo normalizado de preparacion, conservacion, administracion y periodo de validez de MAP. La preparacion de MAP en SF ampliaria su tiempo de conservacion, al tener en cuenta la estabilidad fisicoquimica, el nivel de riesgo y la vulnerabilidad del preparado a la contaminacion microbiologica. La informacion aportada contribuira a una disminucion de errores asociados al proceso de preparacion y administracion de MAP.

  7. The Fukushima accident and travel medicine--analysis and recommendations.

    PubMed

    Scholl, C; Lieberz, W; Jansing, P; Küpper, T

    2013-01-01

    The accident at the nuclear site in Fukushima has fostered a fear of the consequences of radioactive contamination among many, especially regarding travel to Japan and the import of Japanese goods. We give a general overview of the assessment of the effects of ionizing radiation and a summary of the consequences of the Japanese accident. We report the results of the measurement of radionuclide intake among travelers returning from Japan, carried out at the whole-body counter of the Institute for Work Design of North Rhine-Westphalia (LIA.NRW) in Düsseldorf.

  8. Expedition Medicine--Recommendations from Experience in Guatemala.

    ERIC Educational Resources Information Center

    Malison, Michael D.

    1980-01-01

    Eight guidelines to assist health professionals in the preparation of a team field expedition are: (1) assess the activities; (2) consider the environment; (3) know orientation and preventive measures; (4) take food and water precautions; (5) know the team members; (6) prepare the pharmacy; (7) carry out the field operation; and (8) follow up…

  9. Statistical recommendations for papers submitted to Developmental Medicine & Child Neurology.

    PubMed

    Rigby, Alan S

    2010-03-01

    The use of statistics in medical diagnoses and biomedical research may affect whether an individual may live or die, whether their health is protected or jeopardized. Because society depends on sound statistical practice, all practitioners of statistics, whatever their training or occupation, have social obligations to perform their work in a professional, competent, and ethical manner.

  10. Technical Joint Cross Service Group. Analyses and Recommendations. Volume 12

    DTIC Science & Technology

    2005-05-19

    ehicles Sea V ehicles Space Platform s W eapons N uclear T echnology M aterials & Processes B iom edical H um an System s B attlespace...accommodate contingency, mobilization , surge, and future total force requirements, both at existing and potential receiving locations, to support... mobilization , surge, and future total force requirements at both existing and potential receiving locations to support operations and training

  11. [Intensive medicine in Spain].

    PubMed

    2011-03-01

    the future of intensive care medicine in Spain and in Europe, recommendations are made towards specialization in intensive care medicine incorporating in the training program those competences (knowledge, skills and attitudes) that should be present an intensivist in Europe and that are extensively fulfilled by the current Spanish training program. The trajectory followed by intensive care medicine in Europe and recently in China, shows the increasing need of intensive care and the progressive recognition of the specialty in economically growing countries, and emphasizes the need of homogenization in the training of future specialists in intensive care medicine globally.

  12. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics.

    PubMed

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

    2009-09-04

    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

  13. 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

    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

  14. Recommendations for Alternative Credit.

    ERIC Educational Resources Information Center

    Lenderman, Ed; And Others

    Following a review of the mathematics topics taught in accounting, electronics, auto, food and clothing, and metals courses at Linn-Benton Community College, Albany, Oregon, recommendations were made to grant one semester of mathematics credit for completing a two-year sequence of these courses. The other required semester of mathematics should be…

  15. CETA: Assessment and Recommendations.

    ERIC Educational Resources Information Center

    National Academy of Sciences - National Research Council, Washington, DC. Committee on Evaluation of Employment and Training Programs.

    This document presents the principal findings and recommendations of a study conducted by the Committee on Evaluation of Employment and Training Program to assess the impact of CETA (Comprehensive Employment and Training Act) on manpower programs. This report is divided into two parts. Part 1 provides an overview of CETA's history, summarizes…

  16. Personalized Course Sequence Recommendations

    NASA Astrophysics Data System (ADS)

    Xu, Jie; Xing, Tianwei; van der Schaar, Mihaela

    2016-10-01

    Given the variability in student learning it is becoming increasingly important to tailor courses as well as course sequences to student needs. This paper presents a systematic methodology for offering personalized course sequence recommendations to students. First, a forward-search backward-induction algorithm is developed that can optimally select course sequences to decrease the time required for a student to graduate. The algorithm accounts for prerequisite requirements (typically present in higher level education) and course availability. Second, using the tools of multi-armed bandits, an algorithm is developed that can optimally recommend a course sequence that both reduces the time to graduate while also increasing the overall GPA of the student. The algorithm dynamically learns how students with different contextual backgrounds perform for given course sequences and then recommends an optimal course sequence for new students. Using real-world student data from the UCLA Mechanical and Aerospace Engineering department, we illustrate how the proposed algorithms outperform other methods that do not include student contextual information when making course sequence recommendations.

  17. The effects of herbal medicine on epilepsy

    PubMed Central

    Pan, Zhenxiang; Leng, Yashu; Lv, Jiayin; Li, Bingjin

    2017-01-01

    Traditional herbal medicine plays a significant role in the treatment of epilepsy. Though herbal medicine is widely used in antiepileptic treatment, there is a lack of robust evidence for efficacy and toxicity of most herbs. Besides, the herbal medicine should be subject to evidence-based scrutiny. In this context, we present a review to introduce the effects of herbal medicine on epilepsy. However, hundreds of herbal medicines have been investigated in the available studies. Some commonly used herbal medicines for epilepsy have been listed in our study. The overwhelming majority of these data are based on animal experiments. The lack of clinical data places constraints on the clinical recommendation of herbal medicine. Our study may conduct further studies and provide some insight on the development of anti-epileptic drugs. PMID:28423368

  18. The effects of herbal medicine on epilepsy.

    PubMed

    Liu, Wei; Ge, Tongtong; Pan, Zhenxiang; Leng, Yashu; Lv, Jiayin; Li, Bingjin

    2017-07-18

    Traditional herbal medicine plays a significant role in the treatment of epilepsy. Though herbal medicine is widely used in antiepileptic treatment, there is a lack of robust evidence for efficacy and toxicity of most herbs. Besides, the herbal medicine should be subject to evidence-based scrutiny. In this context, we present a review to introduce the effects of herbal medicine on epilepsy. However, hundreds of herbal medicines have been investigated in the available studies. Some commonly used herbal medicines for epilepsy have been listed in our study. The overwhelming majority of these data are based on animal experiments. The lack of clinical data places constraints on the clinical recommendation of herbal medicine. Our study may conduct further studies and provide some insight on the development of anti-epileptic drugs.

  19. Mesopotamian medicine.

    PubMed

    Retief, F P; Cilliers, L

    2007-01-01

    Although the Mesopotamian civilisation is as old as that of Egypt and might even have predated it, we know much less about Mesopotamian medicine, mainly because the cuneiform source material is less well researched. Medical healers existed from the middle of the 3rd millennium. In line with the strong theocratic state culture, healers were closely integrated with the powerful priestly fraternity, and were essentially of three main kinds: barû (seers) who were experts in divination, âshipu (exorcists), and asû (healing priests) who tended directly to the sick. All illness was accepted as sent by gods, demons and other evil spirits, either as retribution for sins or as malevolent visitations. Treatment revolved around identification of the offending supernatural power, appeasement of the angry gods, for example by offering amulets or incantations, exorcism of evil spirits, as well as a measure of empirical therapy aimed against certain recognised symptom complexes. Medical practice was rigidly codified, starting with Hammurabi's Code in the 18th century BC and persisting to the late 1st millennium BC. Works like the so-called Diagnostic Handbook, the Assyrian Herbal and Prescription Texts describe the rationale of Mesopotamian medicine, based predominantly on supernatural concepts, although rudimentary traces of empirical medicine are discernible. There is evidence that Egyptian medicine might have been influenced by Mesopotamian practices, but Greek rational medicine as it evolved in the 5th/4th centuries BC almost certainly had no significant Mesopotamian roots.

  20. Nuclear Medicine

    PubMed Central

    Streek, Penny Vande; Carretta, Robert; Weiland, Frederick L.

    1994-01-01

    The Council on Scientific Affairs of the California Medical Association presents the following epitomes of progress in nuclear medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and clinical importance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of progress in medicine, whether in their own field of special interest or another. The epitomes included here were selected by the Advisory Panel to the Section on Nuclear Medicine of the California Medical Association, and the summaries were prepared under the direction of Dr Lyons and the panel. PMID:7529452

  1. Analysis of French generic medicines retail market: why the use of generic medicines is limited.

    PubMed

    Dylst, Pieter; Vulto, Arnold; Simoens, Steven

    2014-12-01

    The market share of generic medicines in France is low compared to other European countries. This perspective paper provides an overview of the generic medicines retail market in France and how the current policy environment may affect the long-term sustainability. Looking at the French generic medicines retail market and the surrounding regulatory framework, all conditions seem to be in place to create a healthy generic medicines market: the country has well-respected regulatory authorities, generic medicines enter the market in a timely manner and prices of generic medicines are competitive compared with other European countries. Despite the success of the demand-side policies targeted at pharmacists and patients, those targeted at physicians were less successful due to a lack of enforcement and a lack of trust in generic medicines by French physicians. Recommendations to increase the use of generic medicines in France round off this perspective paper.

  2. Wilderness Medicine.

    PubMed

    Alexander, Whitney; Bright, Steven; Burns, Patrick; Townes, David

    2016-03-01

    Wilderness medicine encompasses prevention and treatment of illness and injury, education and training, emergency medical services, and search and rescue in the wilderness. Although traumatic injuries, including minor injuries, outnumber medical illness as the cause of morbidity in the wilderness, basic understanding of the prevention and management of injury and illness, including recognition, identification, treatment, initial management, and stabilization, is essential, in addition to the ability to facilitate evacuation of affected patients. An important theme throughout wilderness medicine is planning and preparation for the best- and worst-case scenarios, and being ready for the unexpected.

  3. [Medicinal cannabis].

    PubMed

    Van der Meersch, H; Verschuere, A P; Bottriaux, F

    2006-01-01

    Pharmaceutical grade cannabis is available to Dutch patients from public pharmacies in the Netherlands. The first part of this paper reviews the pharmaceutical and pharmacological properties of medicinal cannabis. Detailed information about its composition and quality, potential applications, methods of administration, adverse reactions, drug interactions and safety during pregnancy or breastfeeding are given. The second part deals with the legal aspects of dispensing medicinal cannabis through pharmacies in view of the Belgian and Dutch legislation. The last part discusses the present Belgian regulation about the possession of cannabis.

  4. Complementary Therapies and Medicines and Reproductive Medicine.

    PubMed

    Smith, Caroline A; Armour, Mike; Ee, Carolyn

    2016-03-01

    Complementary therapies and medicines are a broad and diverse range of treatments, and are frequently used by women and their partners during the preconception period to assist with infertility, and to address pregnancy-related conditions. Despite frequent use, the evidence examining the efficacy, effectiveness, and safety for many modalities is lacking, with variable study quality. In this article, we provide an overview of research evidence with the aim of examining the evidence to inform clinical practice. During the preconception period, there is mixed evidence for acupuncture to improve ovulation, or increase pregnancy rates. Acupuncture may improve sperm quality, but there is insufficient evidence to determine whether this results in improved pregnancy and live birth rates. Acupuncture can be described as a low-risk intervention. Chinese and Western herbal medicines may increase pregnancy rates; however, study quality is low. The evaluation of efficacy, effectiveness, and safety during the first trimester of pregnancy has most commonly reported on herbs, supplements, and practices such as acupuncture. There is high-quality evidence reporting the benefits of herbal medicines and acupuncture to treat nausea in pregnancy. The benefit from ginger to manage symptoms of nausea in early pregnancy is incorporated in national clinical guidelines, and vitamin B6 is recommended as a first-line treatment for nausea and vomiting in pregnancy. The safety of ginger and vitamin B6 is considered to be well established, and is based on epidemiological studies. Acupuncture has been shown to reduce back pain and improve function for women in early pregnancy. There is little evidence to support the use of cranberries in pregnancy for prevention of urinary tract infections, and chiropractic treatment for back pain. Overall the numbers of studies are small and of low quality, although the modalities appear to be low risk of harm.

  5. Is old medicine new medicine?

    PubMed

    Montaocean, K

    1991-07-01

    By the year 2000, over 90% of cases of acquired immunodeficiency syndrome (AIDS) are expected in Third World countries where Western medicine is often unavailable, unaffordable, or culturally unacceptable. Thus, there is a need for greater attention to the potential role of traditional medicine and healers in the prevention and treatment of AIDS. A US-based nongovernmental organization, Green Cross Inc, is examining cross-cultural healing traditions and seeking areas of convergence between scientific bio-medicine and indigenous traditional healing systems. At a street clinic operated by Green Cross in Washington DC, both Western medicine and traditional Chinese practices such as acupuncture, herbal remedies, and meditation are offered to AIDS patients at those at risk of infection. Although the individualized nature of Chinese medicine makes it difficult to evaluate through use of Western research methods, there is anecdotal evidence that it reduces the stress, anxiety, depression, and fatigue that accompany AIDS. Health care systems in all parts of the world could benefit from the concept that illness cannot be treated in isolation from individuals and communities.

  6. Rheumatologic rehabilitation: towards recommendations.

    PubMed

    Maddali Bongi, S; Del Rosso, A; Matucci Cerinic, M

    2014-11-06

    Rheumatic patients are highly complex and often affected by chronic diseases. Rehabilitation is generally needed for proper management of the underlying disease. This article describes the characteristics of an effective rheumatologic rehabilitation, takes into account data published in international literature, suggests recommendations based on scientific evidence to develop a correct rehabilitation plan for rheumatic patients and proposes the basis to draw up guidelines in the field of rheumatologic rehabilitation.

  7. FELASA Guidelines and Recommendations

    PubMed Central

    Guillen, Javier

    2012-01-01

    The Federation of European Laboratory Animal Science Associations (FELASA) has been releasing guidelines and recommendations on several laboratory animal science disciplines for more than 15 y. The Working Groups producing these documents comprise specialists in each of the addressed topics, are nominated by the FELASA constituent associations, and are elected by the FELASA Board of Management. The FELASA guidelines and recommendations are not regulatory but rather are proposals based on scientific knowledge and the state of the art of laboratory animal science activities. Because they are supported by laboratory animal science associations that represent the vast majority of European professionals, these guidelines and recommendations have influenced the development of various regulatory requirements in Europe, including those related to education and training, routine laboratory animal activities, and animal health monitoring. Some reports fill existing gaps in the European legal framework or complement it. The Working Groups occasionally collaborate with other European organizations, thus enhancing the professional input and effect of the documents produced. The recently established AALAS–FELASA Liaison Body may result in future international cooperation that benefits laboratory animal science and welfare in a global context. PMID:22776188

  8. Medicine Handbook.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Office of the Professions.

    A reference guide to laws, rules, and regulations that govern medical practice in New York State is presented. After an overview of professional regulation in the state, licensing requirements/procedures for medicine are described including education and postgraduate training requirements, state licensing examinations, and application…

  9. Medicine Handbook.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Office of the Professions.

    New York State education law, rules, and regulations concerning the practice of medicine are presented, along with requirements and procedures for obtaining licensure and first registration as a physician. State statutory provisions cover: duration and registration of a license, practice and regulation of the profession, supervision by the Board…

  10. [Disaster medicine].

    PubMed

    Ballesteros, J A; Badosa, A M; Usandizaga, I; Zurita, M; Muñoz, J

    1989-01-01

    The authors have reviewed the concept of catastrophe from the health care stand-point as well as, that concerning medicine in catastrophies. The basic outlines for planning adequate health care when a massive number of victims have to be attended are pointed-out as well as, the prevention means for possible flare ups of transmissible diseases.

  11. Medicinal Plants.

    ERIC Educational Resources Information Center

    Phillipson, J. David

    1997-01-01

    Highlights the demand for medicinal plants as pharmaceuticals and the demand for health care treatments worldwide and the issues that arise from this. Discusses new drugs from plants, anticancer drugs, antiviral drugs, antimalarial drugs, herbal remedies, quality, safety, efficacy, and conservation of plants. Contains 30 references. (JRH)

  12. Maritime Medicine.

    ERIC Educational Resources Information Center

    Estes, J. Worth

    1996-01-01

    Presents a fascinating look at the practice of medicine aboard commercial and military ships in the 18th and early 19th centuries. Contemporary medical practice believed all diseases were created by one of four "humors." In spite of this, and the constant presence of disease, most seamen led relatively healthy lives. (MJP)

  13. Medicine Handbook.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Office of the Professions.

    New York State education law, rules, and regulations concerning the practice of medicine are presented, along with requirements and procedures for obtaining licensure and first registration as a physician. State statutory provisions cover: duration and registration of a license, practice and regulation of the profession, supervision by the Board…

  14. Medicine Handbook.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Office of the Professions.

    A reference guide to laws, rules, and regulations that govern medical practice in New York State is presented. After an overview of professional regulation in the state, licensing requirements/procedures for medicine are described including education and postgraduate training requirements, state licensing examinations, and application…

  15. Nuclear medicine

    SciTech Connect

    Wagner, H.N. Jr.

    1986-10-17

    In 1985 and 1986 nuclear medicine became more and more oriented toward in vov chemistry, chiefly as a result of advances in positron emission tomography (PET). The most important trend was the extension of PET technology into the care of patients with brain tumors, epilepsy, and heart disease. A second trend was the increasing use of single-photon emission computed tomography (SPECT).

  16. Medicinal Plants.

    ERIC Educational Resources Information Center

    Phillipson, J. David

    1997-01-01

    Highlights the demand for medicinal plants as pharmaceuticals and the demand for health care treatments worldwide and the issues that arise from this. Discusses new drugs from plants, anticancer drugs, antiviral drugs, antimalarial drugs, herbal remedies, quality, safety, efficacy, and conservation of plants. Contains 30 references. (JRH)

  17. [Quality management and safety culture in medicine: context and concepts].

    PubMed

    Wischet, Werner; Eitzinger, Claudia

    2009-01-01

    The publication of the IOM report "To err is human: building a safer health system" in 1999 put spotlight on the primacy of the principle of primum non nocere and made patient safety a central topic of quality management. A key conclusion of the report was the need for a well-developed safety culture. While concepts of quality management have evolved along the lines of ISO and Total Quality Management over the last decades patient safety still has not got the same amount of attention (PubMed). Evidence from other safety-critical areas but also from the field of medicine itself suggests that an efficient culture of safety is a conditio sine qua non for the sustainable improvement of patient safety. Considering these arguments the present paper aims at emphasizing the importance of an efficient culture of safety for patient safety and quality management in healthcare. In addition, key instruments of safety culture as well as their limitations will be presented.

  18. Physiopathology of dementia from the perspective of traditional Persian medicine.

    PubMed

    Seifaddini, Rostam; Tajadini, Haleh; Choopani, Rasool

    2015-07-01

    The most common cognitive disorder that is disabling is dementia. During the medieval period, traditional Persian medicine was an outstanding source of medicine that was used as standard references in medical schools of in the West and Middle East. In ancient manuscripts of traditional Persian medicine, a condition has been introduced similar to dementi (raoonat and homgh). In this article, by collecting materials of traditional medicine texts on dementia, we aim to provide theories for further studies on this topics, as there is an obvious difference between traditional Persian medicine and modern medicine with regard to dementia; however, since modern medicine has not found a suitable response to treatment for all diseases, reviewing traditional Persian medicine for finding better treatment strategies is wise. Use of all medical potentials approved by the World Health Organization beside classic medicine like traditional medicine and considering the availability and acceptability among people is recommended. © The Author(s) 2015.

  19. Personalized professional content recommendation

    DOEpatents

    Xu, Songhua

    2015-10-27

    A personalized content recommendation system includes a client interface configured to automatically monitor a user's information data stream transmitted on the Internet. A hybrid contextual behavioral and collaborative personal interest inference engine resident to a non-transient media generates automatic predictions about the interests of individual users of the system. A database server retains the user's personal interest profile based on a plurality of monitored information. The system also includes a server programmed to filter items in an incoming information stream with the personal interest profile and is further programmed to identify only those items of the incoming information stream that substantially match the personal interest profile.

  20. Panel summary of recommendations

    NASA Technical Reports Server (NTRS)

    Dunbar, Bonnie J.; Coleman, Martin E.; Mitchell, Kenneth L.

    1990-01-01

    The following Space Station internal contamination topics were addressed: past flight experience (Skylab and Spacelab missions); present flight activities (Spacelabs and Soviet Space Station Mir); future activities (materials science and life science experiments); Space Station capabilities (PPMS, FMS, ECLSS, and U.S. Laboratory overview); manned systems/crew safety; internal contamination detection; contamination control - stowage and handling; and contamination control - waste gas processing. Space Station design assumptions are discussed. Issues and concerns are discussed as they relate to (1) policy and management, (2) subsystem design, (3) experiment design, and (4) internal contamination detection and control. The recommendations generated are summarized.

  1. Clinical Recommendation: Vulvovaginitis.

    PubMed

    Zuckerman, Andrea; Romano, Mary

    2016-12-01

    Vulvovaginitis is a commonly encountered condition among prepubertal and adolescent females. The objective of this report is to provide the latest evidence regarding the diagnosis and management of vulvovaginitis in prepubertal and adolescent females. In this systematic review we used the Grading of Recommendations Assessment, Development and Evaluation evidence system. Vulvovaginal complaints are common in the pediatric and adolescent age group. The patient's age in conjunction with history and associated complaints will guide evaluation, diagnosis, and treatment. Treatment should include counseling on hygiene and voiding techniques as well as therapy for any specific pathogens identified.

  2. Nuclear medicine and radionuclide imaging: a survey of recruitment issues in the United Kingdom.

    PubMed

    Gray, H W; Prvulovich, E; Nunan, T

    2003-04-01

    This wide ranging survey has highlighted difficulties in recruiting trained and committed individuals into nuclear medicine and radionuclide radiology. Several key factors have been recognised that reduce the attractiveness of the training. Recommendations include the rotation of medical senior house officers through nuclear medicine, reconsideration of dual accreditation in nuclear medicine and medicine, an increase in the number of consultant posts in nuclear medicine, parity of remuneration for nuclear medicine trainees and finally, an appropriate sessional provision for those providing radionuclide radiology services.

  3. [Syndrome of recommended patient].

    PubMed

    Sanz Rubiales, A; del Valle Rivero, M L; Flores Pérez, L A; Hernansanz de la Calle, S; García Recio, C; López-Lara Martín, F

    2002-08-01

    "Syndrome of recommended patient" is manifested as the presence of numerous unexpected and unusual complications in patients that the treating physician is trying to give a better assistance. Even assuming that a few complications may appear by chance, there are several factors from daily clinical practice that facilitate the presence of such a syndrome, and some of them can be corrected in order to reduce its incidence. All of them come from the change on daily clinical practice on these patients, as if they do not fit for the attention provided for other people. These factors favouring the presence of this syndrome come from: patients' attitude, inefficient use of health resources, absence of an adequate register of clinical data and change in usual clinical practice on interpretation of diagnostic tests as well as in the indication of treatment of these patients. The best way to prevent this "syndrome of recommended patient" is to maintain, even within these patients, an attitude based on solid clinical knowledge and to follow up the same clinical rules accepted for other patients.

  4. French recommendations on electroencephalography.

    PubMed

    André-Obadia, N; Lamblin, M D; Sauleau, P

    2015-03-01

    Electroencephalography allows the functional analysis of electrical brain cortical activity and is the gold standard for analyzing electrophysiological processes involved in epilepsy but also in several other dysfunctions of the central nervous system. Morphological imaging yields complementary data, yet it cannot replace the essential functional analysis tool that is EEG. Furthermore, EEG has the great advantage of being non-invasive, easy to perform and allows repeat testing when follow-up is necessary, even at the patient's bedside. Faced with advances in knowledge, techniques and indications, the Société de neurophysiologie clinique de langue française (SNCLF) and the Ligue française contre l'épilepsie (LFCE) found it necessary to provide an update on EEG recommendations. This article will review the methodology applied to this work, refine the various topics detailed in the following chapters. It will go over the summary of recommendations for each of these chapters and highlight proposals for writing an EEG report. Some questions could not be answered by review of the literature; in such cases, in addition to the guidelines the working and reading groups provided their expert opinion.

  5. Wilderness medicine.

    PubMed

    Townes, David Andrew

    2002-12-01

    Wilderness medicine is not a single entity. It encompasses clinical practice, instruction, and research as they pertain to wilderness settings. Clinical practice often takes place in removed settings far from traditional medical resources and facilities. Many of the conditions treated are unique to wilderness medicine. Decisions commonly are based on limited information. Practitioners of wilderness medicine must combine specialized training, resourcefulness, and improvisation. Instruction and research in wilderness medicine often are directed at clinical practice, with the focus on maximizing patient outcome. Preparation and planning are the best methods of reducing illness and injury; these involve conditioning and choosing clothing and equipment, including the medical kit. Conditioning should mimic the type of trip or activity, because choice will depend on the type, complexity, and duration of the trip, the anticipated environmental conditions, and specific needs of the group. Equipment should be designed for the type of activity, in good working condition, and familiar to the members of the group. The medical kit should include basic medical supplies, with additional supplies and equipment depending on the specific trip, the anticipated needs of the group, and their level of medical training and expertise. Once in the wilderness, the focus shifts from preparation and planning to prevention of illness and injury. This includes the use of safety equipment, appropriate shelter, water treatment, and location knowledge. The most common methods of water treatment are mechanical filters, chemicals, and heat. When an injury or illness does occur in the wilderness, proper assessment of the patient is essential to determine both the appropriate treatment and the need for evacuation to definitive care. This is best accomplished with an organized, systematic approach. The decision of what treatment should be initiated and if the patient requires evacuation to definitive

  6. Transfusion medicine

    SciTech Connect

    Murawski, K.; Peetoom, F.

    1986-01-01

    These proceedings contain 24 selections, including papers presented at the conference of American Red Cross held in May 1985, on the Subject of transfusion medicine. Some of the titles are: Fluosol/sup R/-DA in Radiation Therapy; Expression of Cloned Human Factor VIII and the Molecular Basis of Gene Defects that Cause Hemophilia; DNA-Probing Assay in the Detection of Hepatitis B Virus Genome in Human Peripheral Blood Cells; and Monoclonal Antibodies: Convergence of Technology and Application.

  7. [Travel medicine].

    PubMed

    Schubert, S; Grimm, M

    2009-07-01

    Travel medicine deals with travellers' diseases. The target group is therefore distinct from tropical medicine. It has gained in significance due to the increase in tourism and professional work abroad in the last 50 years. Dangerous and widespread diseases in tropical countries, in particular tropical malaria, have come into focus in industrialized countries because of their appearance in travellers. Travel medicine deals not only with infectious or transmittable diseases, but also with the ability of patients with chronic diseases to travel, the medical aspects of flying, as well as the health hazards of professional work or high-risk sports abroad. The risk of disease as a result of travelling can be minimized by advice and prophylactic measures, such as vaccinations and drug prophylaxis against malaria, if indicated. On return, medical symptoms should be investigated promptly to ensure early detection of life-threatening disease courses, particularly tropical malaria, as well as to prevent the occurrence of small-scale epidemics. A small number of diseases can also emerge after several years, such as benign types of malaria, amoebic liver abscess and visceral leishmaniasis (kala-azar). Aids also belongs to these diseases. Therefore, in this era of HIV pandemic travellers concerned should be made aware of the risks.

  8. Medicine safety and children

    MedlinePlus

    ... keep purses or bags containing medicine on a high shelf, out of reach. Get rid of any old or expired medicines. Call your city government and ask where you can drop off unused medicines. DO NOT flush medicines down ...

  9. ADHD Medicines (for Kids)

    MedlinePlus

    ... Room? What Happens in the Operating Room? ADHD Medicines KidsHealth > For Kids > ADHD Medicines A A A ... doctor can decide if ADHD medicine is needed. Medicine and the Mind There are a lot of ...

  10. Chinese medicine and martial arts.

    PubMed

    Koh, T C

    1981-01-01

    Wushu (Martial Arts), mistakenly known in the West as Kung-Fu, is a system of Chinese boxing which is closely linked with the traditional practice of Chinese medicine. Many of the masters (Sifu) are Chinese physicians who often recommend health exercises and the soft form of martial arts to their patients, while the hard form is suitable for sport and self-defense. Martial arts is a great discipline for body and mind, suitable for all who treasure physical and mental health.

  11. Space Medicine

    NASA Technical Reports Server (NTRS)

    Pool, Sam L.

    2000-01-01

    The National Academy of Sciences Committee on Space Biology and Medicine points out that space medicine is unique among space sciences, because in addition to addressing questions of fundamental scientific interest, it must address clinical or human health and safety issues as well. Efforts to identify how microgravity affects human physiology began in earnest by the United States in 1960 with the establishment of the National Aeronautics and Space Administration (NASA's) Life Sciences program. Before the first human space missions, prediction about the physiological effects of microgravity in space ranged from extremely severe to none at all. The understanding that has developed from our experiences in space to date allows us to be guardedly optimistic about the ultimate accommodations of humans to space flight. Only by our travels into the microgravity environment of space have we begun to unravel the mysteries associated with gravity's role in shaping human physiology. Space medicine is still at its very earliest stages. Development of this field has been slow for several reasons, including the limited number of space flights, the small number of research subjects, and the competition within the life sciences community and other disciplines for flight opportunities. The physiological changes incurred during space flight may have a dramatic effect on the course of an injury or illness. These physiological changes present an exciting challenge for the field of space medicine: how to best preserve human health and safety while simultaneously deciphering the effects of microgravity on human performance. As the United States considers the future of humans in long-term space travel, it is essential that the many mysteries as to how microgravity affects human systems be addressed with vigor. Based on the current state of our knowledge, the justification is excellent indeed compelling- for NASA to develop a sophisticated capability in space medicine. Teams of physicians

  12. Wind Farm Recommendation Report

    SciTech Connect

    John Reisenauer

    2011-05-01

    On April 21, 2011, an Idaho National Laboratory (INL) Land Use Committee meeting was convened to develop a wind farm recommendation for the Executive Council and a list of proposed actions for proceeding with the recommendation. In terms of land use, the INL Land Use Committee unanimously agrees that Site 6 is the preferred location of the alternatives presented for an INL wind farm. However, further studies and resolution to questions raised (stated in this report) by the INL Land Use Committee are needed for the preferred location. Studies include, but are not limited to, wind viability (6 months), bats (2 years), and the visual impact of the wind farm. In addition, cultural resource surveys and consultation (1 month) and the National Environmental Policy Act process (9 to 12 months) need to be completed. Furthermore, there is no documented evidence of developers expressing interest in constructing a small wind farm on INL, nor a specific list of expectations or concessions for which a developer might expect INL to cover the cost. To date, INL assumes the National Environmental Policy Act activities will be paid for by the Department of Energy and INL (the environmental assessment has only received partial funding). However, other concessions also may be expected by developers such as roads, fencing, power line installation, tie-ins to substations, annual maintenance, snow removal, access control, down-time, and remediation. These types of concessions have not been documented, as a request, from a developer and INL has not identified the short and long-term cost liabilities for such concessions should a developer expect INL to cover these costs. INL has not identified a go-no-go funding level or the priority this Wind Farm Project might have with respect to other nuclear-related projects, should the wind farm remain an unfunded mandate. The Land Use Committee recommends Legal be consulted to determine what, if any, liabilities exist with the Wind Farm Project and

  13. Exercise and Physical Activity Recommendations for People with Cerebral Palsy

    PubMed Central

    Peterson, Mark D.; Balemans, Astrid C.J.; Hurvitz, Edward A.

    2016-01-01

    Physical activity (PA) and its promotion, as well as the avoidance of sedentary behaviour play important roles in health promotion and prevention of lifestyle-related diseases. Guidelines for typically developing youth and adults published by the World Health Organization and American College of Sports Medicine are available. However, detailed recommendations for PA and sedentary behaviour have not been established for children, adolescents and adults with cerebral palsy (CP). This paper presents the first CP-specific PA and exercise recommendations. The recommendations are based on (1) a comprehensive review and analysis of the literature, (2) expert opinion and (3) extensive clinical experience. The evidence supporting these recommendations are based on randomized controlled trials and observational studies involving children, adolescents and adults with CP, and buttressed by the previous guidelines for the general population. These recommendations may be used to guide healthcare providers on exercise and daily PA prescription for individuals with CP. PMID:26853808

  14. A bottom-up approach to MEDLINE indexing recommendations

    PubMed Central

    Jimeno-Yepes, Antonio; Wilkowski, Bartłomiej; Mork, James G.; Van Lenten, Elizabeth; Demner Fushman, Dina; Aronson, Alan R.

    2011-01-01

    MEDLINE indexing performed by the US National Library of Medicine staff describes the essence of a biomedical publication in about 14 Medical Subject Headings (MeSH). Since 2002, this task is assisted by the Medical Text Indexer (MTI) program. We present a bottom-up approach to MEDLINE indexing in which the abstract is searched for indicators for a specific MeSH recommendation in a two-step process. Supervised machine learning combined with triage rules improves sensitivity of recommendations while keeping the number of recommended terms relatively small. Improvement in recommendations observed in this work warrants further exploration of this approach to MTI recommendations on a larger set of MeSH headings. PMID:22195224

  15. A bottom-up approach to MEDLINE indexing recommendations.

    PubMed

    Jimeno-Yepes, Antonio; Wilkowski, Bartłomiej; Mork, James G; Van Lenten, Elizabeth; Fushman, Dina Demner; Aronson, Alan R

    2011-01-01

    MEDLINE indexing performed by the US National Library of Medicine staff describes the essence of a biomedical publication in about 14 Medical Subject Headings (MeSH). Since 2002, this task is assisted by the Medical Text Indexer (MTI) program. We present a bottom-up approach to MEDLINE indexing in which the abstract is searched for indicators for a specific MeSH recommendation in a two-step process. Supervised machine learning combined with triage rules improves sensitivity of recommendations while keeping the number of recommended terms relatively small. Improvement in recommendations observed in this work warrants further exploration of this approach to MTI recommendations on a larger set of MeSH headings.

  16. Exercise and physical activity recommendations for people with cerebral palsy.

    PubMed

    Verschuren, Olaf; Peterson, Mark D; Balemans, Astrid C J; Hurvitz, Edward A

    2016-08-01

    Physical activity and its promotion, as well as the avoidance of sedentary behaviour, play important roles in health promotion and prevention of lifestyle-related diseases. Guidelines for young people and adults with typical development are available from the World Health Organisation and American College of Sports Medicine. However, detailed recommendations for physical activity and sedentary behaviour have not been established for children, adolescents, and adults with cerebral palsy (CP). This paper presents the first CP-specific physical activity and exercise recommendations. The recommendations are based on (1) a comprehensive review and analysis of the literature, (2) expert opinion, and (3) extensive clinical experience. The evidence supporting these recommendations is based on randomized controlled trials and observational studies involving children, adolescents, and adults with CP, and buttressed by the previous guidelines for the general population. These recommendations may be used to guide healthcare providers on exercise and daily physical activity prescription for individuals with CP. © 2016 Mac Keith Press.

  17. Recommendation in evolving online networks

    NASA Astrophysics Data System (ADS)

    Hu, Xiao; Zeng, An; Shang, Ming-Sheng

    2016-02-01

    Recommender system is an effective tool to find the most relevant information for online users. By analyzing the historical selection records of users, recommender system predicts the most likely future links in the user-item network and accordingly constructs a personalized recommendation list for each user. So far, the recommendation process is mostly investigated in static user-item networks. In this paper, we propose a model which allows us to examine the performance of the state-of-the-art recommendation algorithms in evolving networks. We find that the recommendation accuracy in general decreases with time if the evolution of the online network fully depends on the recommendation. Interestingly, some randomness in users' choice can significantly improve the long-term accuracy of the recommendation algorithm. When a hybrid recommendation algorithm is applied, we find that the optimal parameter gradually shifts towards the diversity-favoring recommendation algorithm, indicating that recommendation diversity is essential to keep a high long-term recommendation accuracy. Finally, we confirm our conclusions by studying the recommendation on networks with the real evolution data.

  18. IRIS Product Recommendations

    NASA Technical Reports Server (NTRS)

    Short, David A.

    2000-01-01

    This report presents the Applied Meteorology Unit's (AMU) evaluation of SIGMET Inc.'s Integrated Radar Information System (IRIS) Product Generator and recommendations for products emphasizing lightning and microburst tools. The IRIS Product Generator processes radar reflectivity data from the Weather Surveillance Radar, model 74C (WSR-74C), located on Patrick Air Force Base. The IRIS System was upgraded from version 6.12 to version 7.05 in late December 1999. A statistical analysis of atmospheric temperature variability over the Cape Canaveral Air Force Station (CCAFS) Weather Station provided guidance for the configuration of radar products that provide information on the mixed-phase (liquid and ice) region of clouds, between 0 C and -20 C. Mixed-phase processes at these temperatures are physically linked to electrification and the genesis of severe weather within convectively generated clouds. Day-to-day variations in the atmospheric temperature profile are of sufficient magnitude to warrant periodic reconfiguration of radar products intended for the interpretation of lightning and microburst potential of convectively generated clouds. The AMU also examined the radar volume-scan strategy to determine the scales of vertical gaps within the altitude range of the 0 C to -20 C isotherms over the Kennedy Space Center (KSC)/CCAFS area. This report present's two objective strategies for designing volume scans and proposes a modified scan strategy that reduces the average vertical gap by 37% as a means for improving radar observations of cloud characteristics in the critical 0 C to -20 C layer. The AMU recommends a total of 18 products, including 11 products that require use of the IRIS programming language and the IRIS User Product Insert feature. Included is a cell trends product and display, modeled after the WSR-88D cell trends display in use by the National Weather Service.

  19. Respiratory medicine

    PubMed Central

    Pinnock, Hilary

    2004-01-01

    The General Medical Services (GMS) contract has focused the attention of United Kingdom (UK) general practitioners (GPs) on the provision of high quality routine care for patients with chronic disease.1 The quality markers defined by the contract endorse the need for objective diagnosis and structured care recommended by the British Thoracic Society/Scottish Intercollegiate Guideline Network (BTS–SIGN) guideline for the management of asthma and the National Institute for Clinical Excellence (NICE) guideline on the management of chronic obstructive pulmonary disease (COPD).2,3 In this paper the key recommendations of these guidelines and their implementation in the pragmatic world of general practice are discussed, with specific focus on diagnosis, monitoring, management, self-management and delivery of care. PMID:15239918

  20. [Psychiatric medicine].

    PubMed

    Ibañez Dominguez, J

    1984-06-01

    The author, after a short historical introduction which shows the Medicine, especially the Neurology, as the predecessor of the Psychiatry, intents to relate in a theorico-practical way the anxiety and the depression within a bio-chemical and endocrinological frame. He presents the hipo and hipercalcemia signals and symptoms demonstrating with a casuistic from his clinical practice the similitude between anxiety and depression respectively. Finally he realizes a theorical analysis about the investigations published over the AMP-ciclic and infers about the hormonal interference and the clinical data linked with the manic-depressive disease.

  1. 78 FR 67169 - Tentative Determination Regarding Partially Hydrogenated Oils; Request for Comments and for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-08

    ... opinions of expert panels and the 2005 recommendation of the Institute of Medicine (IOM) to limit trans fat... common use in food) to be safe under the conditions of its intended use. However, history of use prior to... predecessor of Sec. 170.38)). Further, as stated previously, history of the safe use of a substance in food...

  2. The Inclusion of the Care of the Cancer Survivor in Undergraduate Nursing Curricula

    ERIC Educational Resources Information Center

    Dietmann, Mary E.

    2015-01-01

    As the number of individuals surviving cancer continues to rise, short and long term effects of cancer and its treatment that result in physical, psychosocial, and spiritual needs unique to the care of the cancer survivor has not been addressed in nursing curricula. The Institute of Medicine (IOM, 2005) recommends that all health care providers…

  3. New Idaho Nutrition Standards. Nourishing News. Volume 3, Issue 6

    ERIC Educational Resources Information Center

    Idaho State Department of Education, 2009

    2009-01-01

    The United States Department of Agriculture (USDA) has contracted with the Institute of Medicine (IOM) to examine ways to implement the 2005 Dietary Guidelines for Americans (DGAs) into the school meals programs. In the meantime, USDA has requested that state agencies begin proactively implementing the applicable recommendations for the 2005 DGAs…

  4. The Inclusion of the Care of the Cancer Survivor in Undergraduate Nursing Curricula

    ERIC Educational Resources Information Center

    Dietmann, Mary E.

    2015-01-01

    As the number of individuals surviving cancer continues to rise, short and long term effects of cancer and its treatment that result in physical, psychosocial, and spiritual needs unique to the care of the cancer survivor has not been addressed in nursing curricula. The Institute of Medicine (IOM, 2005) recommends that all health care providers…

  5. Parenteral amino acid intakes in critically ill children

    USDA-ARS?s Scientific Manuscript database

    Parenteral amino acid formulas used in parenteral nutrition have a variable composition. To determine the amino acid intake of parenterally fed, critically ill children, and compare it with recommended dietary allowances (RDA) established by the Institute of Medicine (IOM), we retrospectively review...

  6. Many Young Adults with High Cholesterol Not on Statins as Recommended

    MedlinePlus

    ... as recommended. "This article clearly articulates the under-usage of statins in young people with severe elevations ... federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or ...

  7. Uncertainties and recommendations.

    PubMed

    Callaghan, Terry V; Björn, Lars Olof; Chernov, Yuri; Chapin, Terry; Christensen, Torben R; Huntley, Brian; Ims, Rolf A; Johansson, Margareta; Jolly, Dyanna; Jonasson, Sven; Matveyeva, Nadya; Panikov, Nicolai; Oechel, Walter; Shaver, Gus

    2004-11-01

    An assessment of the impacts of changes in climate and UV-B radiation on Arctic terrestrial ecosystems, made within the Arctic Climate Impacts Assessment (ACIA), highlighted the profound implications of projected warming in particular for future ecosystem services, biodiversity and feedbacks to climate. However, although our current understanding of ecological processes and changes driven by climate and UV-B is strong in some geographical areas and in some disciplines, it is weak in others. Even though recently the strength of our predictions has increased dramatically with increased research effort in the Arctic and the introduction of new technologies, our current understanding is still constrained by various uncertainties. The assessment is based on a range of approaches that each have uncertainties, and on data sets that are often far from complete. Uncertainties arise from methodologies and conceptual frameworks, from unpredictable surprises, from lack of validation of models, and from the use of particular scenarios, rather than predictions, of future greenhouse gas emissions and climates. Recommendations to reduce the uncertainties are wide-ranging and relate to all disciplines within the assessment. However, a repeated theme is the critical importance of achieving an adequate spatial and long-term coverage of experiments, observations and monitoring of environmental changes and their impacts throughout the sparsely populated and remote region that is the Arctic.

  8. Site Recommendation Subsurface Layout

    SciTech Connect

    C.L. Linden

    2000-06-28

    The purpose of this analysis is to develop a Subsurface Facility layout that is capable of accommodating the statutory capacity of 70,000 metric tons of uranium (MTU), as well as an option to expand the inventory capacity, if authorized, to 97,000 MTU. The layout configuration also requires a degree of flexibility to accommodate potential changes in site conditions or program requirements. The objective of this analysis is to provide a conceptual design of the Subsurface Facility sufficient to support the development of the Subsurface Facility System Description Document (CRWMS M&O 2000e) and the ''Emplacement Drift System Description Document'' (CRWMS M&O 2000i). As well, this analysis provides input to the Site Recommendation Consideration Report. The scope of this analysis includes: (1) Evaluation of the existing facilities and their integration into the Subsurface Facility design. (2) Identification and incorporation of factors influencing Subsurface Facility design, such as geological constraints, thermal loading, constructibility, subsurface ventilation, drainage control, radiological considerations, and the Test and Evaluation Facilities. (3) Development of a layout showing an available area in the primary area sufficient to support both the waste inventories and individual layouts showing the emplacement area required for 70,000 MTU and, if authorized, 97,000 MTU.

  9. Nutritional recommendations for divers.

    PubMed

    Benardot, Dan; Zimmermann, Wes; Cox, Gregory R; Marks, Saul

    2014-08-01

    Competitive diving involves grace, power, balance, and flexibility, which all require satisfying daily energy and nutrient needs. Divers are short, well-muscled, and lean, giving them a distinct biomechanical advantage. Although little diving-specific nutrition research on performance and health outcomes exists, there is concern that divers are excessively focused on body weight and composition, which may result in reduced dietary intake to achieve desired physique goals. This will result in low energy availability, which may have a negative impact on their power-to-weight ratio and health risks. Evidence is increasing that restrictive dietary practices leading to low energy availability also result in micronutrient deficiencies, premature fatigue, frequent injuries, and poor athletic performance. On the basis of daily training demands, estimated energy requirements for male and female divers are 3,500 kcal and 2,650 kcal, respectively. Divers should consume a diet that provides 3-8 g/kg/day of carbohydrate, with the higher values accommodating growth and development. Total daily protein intake (1.2-1.7 g/kg) should be spread evenly throughout the day in 20 to 30 g amounts and timed appropriately after training sessions. Divers should consume nutrient-dense foods and fluids and, with medical supervision, certain dietary supplements (i.e., calcium and iron) may be advisable. Although sweat loss during indoor training is relatively low, divers should follow appropriate fluid-intake strategies to accommodate anticipated sweat losses in hot and humid outdoor settings. A multidisciplinary sports medicine team should be integral to the daily training environment, and suitable foods and fluids should be made available during prolonged practices and competitions.

  10. Emergency medicine ultrasonography

    PubMed Central

    Woo, Michael Y.; Nussbaum, Chris; Lee, A. Curtis

    2009-01-01

    ABSTRACT OBJECTIVE To survey program directors of family medicine–emergency medicine (CCFP[EM]) training programs regarding current and future emergency medicine ultrasonography (EMUS) training. DESIGN A Web-based survey using a modified Dillman method. Two academic emergency physicians reviewed the validity and reliability of the survey. SETTING Canada. PARTICIPANTS Program directors of all 17 Canadian CCFP(EM) residency training programs in 2006. MAIN OUTCOME MEASURES Characteristics of EMUS training currently offered and program directors’ perceptions of needs for future EMUS training. RESULTS The survey, performed in 2006, had a response rate of 100% (17/17), although not all respondents answered all questions. At the time of the study, 82.4% of respondents’ programs used EMUS. Although all program directors recommended that residents attend introductory EMUS courses, only 71.4% (10/14) of programs offered such courses; 60.0% (9/15) of those were mandatory. In one-third of the programs, more than 75% of the attending staff used EMUS. A total of 76.5% of program directors thought that introductory courses in EMUS should be mandatory; 62.5% (10/16) believed that residents were able to acquire sufficient experience to use EMUS independently to make practice decisions before completion of their residency; and 88.2% believed that EMUS should be a part of the scope of practice for emergency medicine physicians. Only 58.8% believed that there should be questions about EMUS on the CCFP(EM) Certification examination. Open responses indicated that funding, resources, and standardization were issues that needed to be addressed. CONCLUSION Formal EMUS training for CCFP(EM) programs is being introduced in Canada. Quality assurance needs to be strengthened. Most program directors thought that an introductory course in EMUS should be mandatory. Fewer directors, however, believed EMUS should be on the CCFP(EM) Certification examination until further funding, resources

  11. Updates in perioperative medicine.

    PubMed

    Dutta, Suparna; Cohn, Steven L; Pfeifer, Kurt J; Slawski, Barbara A; Smetana, Gerald W; Jaffer, Amir K

    2016-03-01

    As our surgical population becomes older and more medically complex, knowledge of the most recent perioperative literature is necessary to optimize perioperative care. We aim to summarize and critique literature published over the past year with the highest potential to impact the clinical practice of perioperative medicine. We reviewed articles published between January 2014 and April 2015, identified via MEDLINE search. The final 10 articles selected were determined by consensus among all authors, with criteria for inclusion including scientific rigor and relevance to perioperative medicine practice. Key findings include: long term β-blockade should be continued prior to surgery, routine screening with postoperative troponin is not recommended, initiation/continuation of aspirin or clonidine in the perioperative period is not beneficial and may increase adverse outcomes, preoperative diagnosis and treatment of obstructive sleep apnea may reduce risk of postoperative cardiovascular complications, new pulmonary risk indices are available that accurately estimate postoperative pulmonary complications, postoperative atrial fibrillation is associated with increased long-term stroke risk, risk scores such as the CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes Mellitus, previous stroke or transient ischemic attack) are superior to the Revised Cardiac Risk Index in predicting adverse postoperative outcomes for patients with nonvalvular atrial fibrillation, and utilization of bridging anticoagulation comes with a much higher risk of bleeding compared to patients who are not bridged. The body of literature reviewed provides important information for clinicians caring for surgical patients across multiple fronts, including preoperative risk assessment, medication management, and postoperative medical care. © 2015 Society of Hospital Medicine.

  12. Interpretive Medicine

    PubMed Central

    Reeve, Joanne

    2010-01-01

    Patient-centredness is a core value of general practice; it is defined as the interpersonal processes that support the holistic care of individuals. To date, efforts to demonstrate their relationship to patient outcomes have been disappointing, whilst some studies suggest values may be more rhetoric than reality. Contextual issues influence the quality of patient-centred consultations, impacting on outcomes. The legitimate use of knowledge, or evidence, is a defining aspect of modern practice, and has implications for patient-centredness. Based on a critical review of the literature, on my own empirical research, and on reflections from my clinical practice, I critique current models of the use of knowledge in supporting individualised care. Evidence-Based Medicine (EBM), and its implementation within health policy as Scientific Bureaucratic Medicine (SBM), define best evidence in terms of an epistemological emphasis on scientific knowledge over clinical experience. It provides objective knowledge of disease, including quantitative estimates of the certainty of that knowledge. Whilst arguably appropriate for secondary care, involving episodic care of selected populations referred in for specialist diagnosis and treatment of disease, application to general practice can be questioned given the complex, dynamic and uncertain nature of much of the illness that is treated. I propose that general practice is better described by a model of Interpretive Medicine (IM): the critical, thoughtful, professional use of an appropriate range of knowledges in the dynamic, shared exploration and interpretation of individual illness experience, in order to support the creative capacity of individuals in maintaining their daily lives. Whilst the generation of interpreted knowledge is an essential part of daily general practice, the profession does not have an adequate framework by which this activity can be externally judged to have been done well. Drawing on theory related to the

  13. Nuclear medicine training and practice in Portugal.

    PubMed

    Vieira, Rosário; Costa, Gracinda

    2013-07-01

    Nuclear medicine in Portugal has been an autonomous speciality since 1984. In order to obtain the title of Nuclear Medicine Specialist, 5 years of training are necessary. The curriculum is very similar to the one approved under the auspices of the European Union of Medical Specialists, namely concerning the minimum recommended number of diagnostic and therapeutic procedures. There is a final assessment, and during the training the resident is in an approved continuing education programme. Departments are accredited by the Medical College in order to verify their capacity to host nuclear medicine residencies.

  14. [Recommendations for neonatal transport].

    PubMed

    Moreno Hernando, J; Thió Lluch, M; Salguero García, E; Rite Gracia, S; Fernández Lorenzo, J R; Echaniz Urcelay, I; Botet Mussons, F; Herranz Carrillo, G; Sánchez Luna, M

    2013-08-01

    During pregnancy, it is not always possible to identify maternal or foetal risk factors. Infants requiring specialised medical care are not always born in centres providing intensive care and will need to be transferred to a referral centre where intensive care can be provided. Therefore Neonatal Transport needs to be considered as part of the organisation of perinatal health care. The aim of Neonatal Transport is to transfer a newborn infant requiring intensive care to a centre where specialised resources and experience can be provided for the appropriate assessment and continuing treatment of a sick newborn infant. Intrauterine transfer is the ideal mode of transport when the birth of an infant with risk factors is diagnosed. Unfortunately, not all problems can be detected in advance with enough time to safely transfer a pregnant woman. Around 30- 50% of risk factors will be diagnosed during labour or soon after birth. Therefore, it is important to have the knowledge and resources to resuscitate and stabilise a newborn infant, as well as a specialised neonatal transport system. With this specialised transport it is possible to transfer newly born infants with the same level of care that they would receive if they had been born in a referral hospital, without increasing their risks or affecting the wellbeing of the newborn. The Standards Committee of the Spanish Society of Neonatology reviewed and updated recommendations for intrauterine transport and indications for neonatal transfer. They also reviewed organisational and logistic factors involved with performing neonatal transport. The Committee review included the type of personnel who should be involved; communication between referral and receiving hospitals; documentation; mode of transport; equipment to stabilise newly born infants; management during transfer, and admission at the referral hospital.

  15. Diving medicine.

    PubMed

    Benton, P J; Glover, M A

    2006-01-01

    Recreational diving developed in the late 1940s when self-contained underwater breathing apparatus (SCUBA) first became available for civilian use. At the same time the development of the commercial airliner, in particular the jet airliner, made possible the concept of international travel for pleasure as opposed to business. Over the past 50 years the number of international tourists has increased by over 2500% from a mere 25 million in 1950 to over 700 million in 2002 (Treadwell TL. Trends in travel. In: Zuckerman JN, editor. Principles and practice of travel medicine, 2001; p. 2-6). The popularity of recreational diving has also increased over the same period from an activity experienced by a small number of individuals in the early 1950s to an activity today enjoyed by many millions. The combination of increased international travel and the means by which to enter and explore the underwater world has led to diving becoming increasingly popular as a tourist activity.

  16. Risk Assessment Considerations for Veterinary Medicines in Aquatic Ecosystems

    EPA Science Inventory

    This chapter provides a critical evaluation of prospective and retrospective risk assessment approaches for veterinary medicines in aquatic ecosystems and provides recommendations for possible alternative approaches for hazard characterization.

  17. Risk Assessment Considerations for Veterinary Medicines in Aquatic Ecosystems

    EPA Science Inventory

    This chapter provides a critical evaluation of prospective and retrospective risk assessment approaches for veterinary medicines in aquatic ecosystems and provides recommendations for possible alternative approaches for hazard characterization.

  18. Ayurvedic medicine and anaesthesia

    PubMed Central

    Pradhan, Sameer L; Pradhan, Priya S

    2011-01-01

    The use of herbal medicines has increased dramatically over the past few years. The United States alone noted a 380% increase in the consumption of these products. Although the common practice of taking over-the-counter herbal soups, herbal teas and other such prepacked preparations was not associated with adverse events at large, still, some herbs are known to cause problems, especially when large doses are taken. The American Society of Anaesthesiologist (ASA) has taken a conservative stance and recommended that it is prudent to stop these products at least 2–3 weeks prior to anaesthesia and surgery. This advice may be difficult to implement as most preoperative evaluations occur only a few days prior to surgery. Some of the Ayurvedic preparations have shown to improve the patient outcome when taken during the perioperative period. Hence, the conservative stance by ASA may not always benefit the patient. More scientific studies are needed to have more targeted recommendations. This article puts forward the facts that need to be addressed by researchers in the future. PMID:22013247

  19. Dementia etiologies and remedies in Traditional Persian Medicine; a review of medicinal plants and phytochemistry.

    PubMed

    Shirbeigi, Laila; Dalfardi, Behnam; Abolhasanzade, Zohre; Nejatbakhsh, Fatemeh

    2017-08-10

    Dementia is a chronic neurodegenerative disease causing progressive and gradual impairment of different brain's cognitive functions. The prevalence of dementia is about 3 to 7% in different parts of the world. The aim of this study was to determine the etiologies of dementia according to the Traditional Persian Medicine scientists' viewpoint and introduce their recommended herbal remedies for this disease. The authors explored six main Traditional Persian Medicine textbooks for the disease of dementia, its etiologies and related recommended herbal treatments. Two main keywords of "Lisarghes" and" Nesyan" were searched for this purpose. Medical databases, including PubMed, Scopus, Google Scholar, and Science Direct were searched for related articles published between 1966 and 2016 to review the pharmacological components and active ingredients of suggested herbal medicines. According to the Traditional Persian Medicine, dementia is resulted from brain dystemperament, a condition caused by cold and moist or cold and dry tempers. To treat this disease, Traditional Persian scientists recommended various herbal remedies. Current studies have demonstrated that some of these medicinal plants have beneficial effects for the aforementioned disease, including acetyl cholinesterase inhibitory function, neuroprotective effects, and memory enhancing role. The Traditional Persian Medicine literature suggested different herbal remedies for treating dementia. Modern studies support the usefulness of some of these medicines. However, the effect of a large number of these remedies has remained unexamined, a matter which need to be investigated in future researches. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  20. Redesigning the nuclear medicine reading room.

    PubMed

    Zemariame, Nigist; Knight, Nancy; Siegel, Eliot L

    2011-11-01

    The process of image review and interpretation has become increasingly complex and challenging for today's nuclear medicine physician from many perspectives, especially with regard to workstation integration and reading room ergonomics. With the recent proliferation of hybrid imaging systems, this complexity has increased rapidly, along with the number of studies performed. At the same time, clinicians throughout the health care enterprise are expecting remote access to nuclear medicine images whereas nuclear medicine physicians require reliable access at the point of care to the electronic medical record and to medical images from radiology and cardiology. The authors discuss the background and challenges related to integration of nuclear medicine into the health care enterprise and provide a series of recommendations for advancing successful integration efforts. Also addressed are unique characteristics of the nuclear medicine environment as well as ergonomic, lighting, and environmental considerations in the design and redesign of the modern reading room.

  1. Functional Food in Traditional Persian Medicine.

    PubMed

    Zare, Roghayeh; Hosseinkhani, Ayda

    2016-05-01

    During the last decades, there have been great advancements in the field of preventive medicine. Research has demonstrated that nutrition plays a crucial role in the prevention of chronic diseases. The concept of functional food was first introduced in Japan during the 1980s. It proposes to consider food not only vital to survive, but also a mean for mental and physical well-being, contributing to the prevention and reduction of risk factors for diseases. However, there is evidence that the concept was believed by ancient physicians as well. One of the traditional systems of medicines is traditional Persian medicine (TPM). Rhazes said; "as long as a disease could be treated with food, medicine should be avoided". We carried out a review of Avicenna's Canon of medicine and Rhazes books for the definition of food and drug and similar concepts of functional food. We listed the identified concepts along with their examples. The classification of food and their therapeutic use were explained in Canon of medicine. Rhazes has a book called 'Manafe al-Aghziyeh', in which he writes about the medicinal benefits of different nutrition. Five concepts (food, drug, medicinal food, nutritional medicine and antidote or poison) were noted in these books. There are many recommendations on food for the prevention and treatment of diseases in TPM books, which can be the basis for novel research studies.

  2. Functional Food in Traditional Persian Medicine

    PubMed Central

    Zare, Roghayeh; Hosseinkhani, Ayda

    2016-01-01

    Background: During the last decades, there have been great advancements in the field of preventive medicine. Research has demonstrated that nutrition plays a crucial role in the prevention of chronic diseases. The concept of functional food was first introduced in Japan during the 1980s. It proposes to consider food not only vital to survive, but also a mean for mental and physical well-being, contributing to the prevention and reduction of risk factors for diseases. However, there is evidence that the concept was believed by ancient physicians as well. One of the traditional systems of medicines is traditional Persian medicine (TPM). Rhazes said; “as long as a disease could be treated with food, medicine should be avoided” Methods: We carried out a review of Avicenna’s Canon of medicine and Rhazes books for the definition of food and drug and similar concepts of functional food. We listed the identified concepts along with their examples. Results: The classification of food and their therapeutic use were explained in Canon of medicine. Rhazes has a book called ‘Manafe al-Aghziyeh’, in which he writes about the medicinal benefits of different nutrition. Five concepts (food, drug, medicinal food, nutritional medicine and antidote or poison) were noted in these books. Conclusion: There are many recommendations on food for the prevention and treatment of diseases in TPM books, which can be the basis for novel research studies. PMID:27516666

  3. Functional Food in Traditional Persian Medicine

    PubMed Central

    Zare, Roghayeh; Hosseinkhani, Ayda

    2016-01-01

    Background: During the last decades, there have been great advancements in the field of preventive medicine. Research has demonstrated that nutrition plays a crucial role in the prevention of chronic diseases. The concept of functional food was first introduced in Japan during the 1980s. It proposes to consider food not only vital to survive, but also a mean for mental and physical well-being, contributing to the prevention and reduction of risk factors for diseases. However, there is evidence that the concept was believed by ancient physicians as well. One of the traditional systems of medicines is traditional Persian medicine (TPM). Rhazes said; “as long as a disease could be treated with food, medicine should be avoided” Methods: We carried out a review of Avicenna’s Canon of medicine and Rhazes books for the definition of food and drug and similar concepts of functional food. We listed the identified concepts along with their examples. Results: The classification of food and their therapeutic use were explained in Canon of medicine. Rhazes has a book called ‘Manafe al-Aghziyeh’, in which he writes about the medicinal benefits of different nutrition. Five concepts (food, drug, medicinal food, nutritional medicine and antidote or poison) were noted in these books. Conclusion: There are many recommendations on food for the prevention and treatment of diseases in TPM books, which can be the basis for novel research studies. PMID:27840499

  4. Document of treatment recommendations for non-infectious anterior uveitis.

    PubMed

    Espinosa, Gerard; Muñoz-Fernández, Santiago; García Ruiz de Morales, José M; Herreras, José M; Cordero-Coma, Miguel

    2017-09-11

    To develop recommendations on the use of immunodepressors in patients with non-infectious, non-neoplastic anterior uveitis (AU) based on best evidence and experience. A multidisciplinary panel of five experts was established, who, in the first nominal group meeting defined the scope, users, and chapters of the document. A systematic literature review was performed to assess the efficacy and safety of immunosuppressors in patients with non-infectious, non-neoplastic AU. All the above was discussed in a second nominal group meeting and 33 recommendations were generated. Through the Delphi methodology, the degree of agreement with the recommendations was tested also by 25 more experts. Recommendations were voted on from one (total disagreement) to 10 (total agreement). We defined agreement if at least 70% voted ≥7. The level of evidence and degree of recommendation was assessed using the Oxford Centre for Evidence-based Medicine's Levels of Evidence. The 33 recommendations were accepted. They include specific recommendations on patients with non-infectious, non-neoplastic AU, as well as different treatment lines. In patients with non-infectious, non-neoplastic AU, these recommendations on the use of immunosuppressors might be a guide in order to help in the treatment decision making, due to the lack of robust evidence or other globally accepted algorithms. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  5. Motocross medicine.

    PubMed

    Grange, Jeff T; Bodnar, John A; Corbett, Stephen W

    2009-01-01

    Motocross is an increasingly popular but high-risk sport. This article reviews the history of motocross, the relevant medical literature, the unique medical issues, safety equipment, and the expert recommended approach to providing support for such events. Assessment of an injured rider on or near a track requires a provider to first ensure scene safety, then assess for airway, cervical spine, and head injuries before proceeding. Although extremity injuries are the most common injury, motocross riders frequently sustain significant spine and head trauma as well. Caregivers need to have a complete understanding of the protective gear used in motocross. They also need to be able to understand what injuries can be treated at the scene and which need transport to a hospital for more definitive care.

  6. A Decision Fusion Framework for Treatment Recommendation Systems.

    PubMed

    Mei, Jing; Liu, Haifeng; Li, Xiang; Xie, Guotong; Yu, Yiqin

    2015-01-01

    Treatment recommendation is a nontrivial task--it requires not only domain knowledge from evidence-based medicine, but also data insights from descriptive, predictive and prescriptive analysis. A single treatment recommendation system is usually trained or modeled with a limited (size or quality) source. This paper proposes a decision fusion framework, combining both knowledge-driven and data-driven decision engines for treatment recommendation. End users (e.g. using the clinician workstation or mobile apps) could have a comprehensive view of various engines' opinions, as well as the final decision after fusion. For implementation, we leverage several well-known fusion algorithms, such as decision templates and meta classifiers (of logistic and SVM, etc.). Using an outcome-driven evaluation metric, we compare the fusion engine with base engines, and our experimental results show that decision fusion is a promising way towards a more valuable treatment recommendation.

  7. Weight gain in pregnancy: is less truly more for mother and infant?

    PubMed Central

    Barbour, Linda A

    2012-01-01

    SUMMARY Although more than 50% of women gain weight above the Institute of Medicine (IOM) guidelines for weight gain in pregnancy and excessive weight gain is an independent risk factor for significant maternal and neonatal morbidity and offspring obesity, there is little consensus over the ideal weight gain during pregnancy. Surprisingly, the 2009 IOM guidelines varied minimally from the 1990 IOM guidelines, and many critics advocate lower weight gain recommendations. This review explores the energy costs of pregnancy, the relationship between gestational weight gain and birth weight, and considers what gestational weight gain minimizes both large-for-gestational age as well as small-for-gestational age infants. An extensive examination of the current data leads this author to question whether the current weight gain recommendations are too liberal, especially for obese pregnant women. PMID:27579137

  8. Depression - stopping your medicines

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000570.htm Depression - stopping your medicines To use the sharing features ... prescription medicines you may take to help with depression, anxiety, or pain. Like any medicine, there are ...

  9. Medicines by Design

    MedlinePlus

    ... Search the NIGMS Website NIGMS Home Research Funding Research Training News & Meetings Science Education About NIGMS NIGMS Home > Science Education > Medicines By Design Medicines By Design Spotlight Nature's Medicine Cabinet A ...

  10. Storing your medicines

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000534.htm Storing your medicines To use the sharing features on this page, ... child latch or lock. Do not use Damaged Medicine Damaged medicine may make you sick. DO NOT ...

  11. Taking multiple medicines safely

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000883.htm Taking multiple medicines safely To use the sharing features on this ... directed. Why You May Need More Than One Medicine You may take more than one medicine to ...

  12. Managing Your Medicines

    MedlinePlus

    ... Disease Venous Thromboembolism Aortic Aneurysm More Managing Your Medicines Updated:Oct 27,2016 If you have heart ... Weight • Tools & Resources Heart Insight Supplement: Know Your Medicines Keeping track of your medicines can be overwhelming. ...

  13. Medicines for osteoporosis

    MedlinePlus

    ... Evista); Teriparatide (Forteo); Denosumab (Prolia); Low bone density - medicines; Osteoporosis - medicines ... Your doctor may prescribe certain medicines to help lower your ... make the bones in your hips, spine, and other areas less likely ...

  14. Complementary and Integrative Medicine

    MedlinePlus

    ... medical treatments that are not part of mainstream medicine. When you are using these types of care, it may be called complementary, integrative, or alternative medicine. Complementary medicine is used together with mainstream medical ...

  15. Complementary and Alternative Medicine

    MedlinePlus

    ... use practices like acupuncture in medicine. But until recently, most Western hospitals didn't provide any alternative ... medicine is often used instead of conventional medical techniques. Complementary medicine is used in addition to conventional ...

  16. High blood pressure medicines

    MedlinePlus

    Hypertension - medicines ... blood vessel diseases. You may need to take medicines to lower your blood pressure if lifestyle changes ... blood pressure to the target level. WHEN ARE MEDICINES FOR HIGH BLOOD PRESSURE USED Most of the ...

  17. [The methods of Western medicine in on ancient medicine].

    PubMed

    Ban, Deokjin

    2010-06-30

    The treatise On Ancient Medicine attests that questions of method were being debated both in medicine and in philosophy and is important evidence of cross-discipline methodological controversy. The treatise On Ancient Medicine is the first attempt in the history of Greek thought to provide a detailed account of the development of a science from a starting point in observation and experience. The author of it criticizes philosophical physicians who attempt to systematized medicine by reducing it to the interaction of one or more of the opposites hot, cold, wet, and dry, factors. He regards the theory of his opponents as hypothesis(hypothesis). Medicine has long been in possession of both an archē and a hodos, a principle and a method, which have enabled it to make discoveries over a long period of time. As far as method is concerned, the traditional science of medicine attained the knowledge of the visible by starting from observation and experience, but it recommended the use of reasoning and analogies with familiar objects as a means of learning about the invisible. It also utilized inference from the visible to the visible(epilogismos) and inference from the visible to the invisible(analogismos). The use of analogy as a means of learning about the obscure was also part of the common heritage of early philosophy and medicine. But the author's use of the analogical method distinguishes it from Empedocles' well-known analogy comparisons of the eye to a lantern and the process of respiration to the operations of a clepsydra. According to the author, traditional science of medicine used functional analogy like wine example and cheese example to know the function of humors within the body and utilized structured analogy like a tube example and a cupping instrument example to acknowledge an organ or structure within the body. But the author didn't distinguish between the claim that medicine has a systematic method of making discoveries and very different claim that it

  18. [Disaster medicine].

    PubMed

    Carli, Pierre; Telionri, Caroline

    2015-01-01

    For over 30 years, the French hospital and pre-hospital medical teams are trained in disaster medicine. In fact, they are regularly confronted with the management of multiple casualties in accidents or even terrorist attacks, and more rarely to large-scale disasters. The intervention of physicians of the EMS system (SAMU-SMUR) in the field allows an original healthcare organization: in an advanced medical post, the victims are triaged according to their severity and benefit if needed of initial resuscitation. SAMU medical regulating center then organize their transport and repartition in several hospitals put on alert. To cope with a mass casualty situation, the hospital also has a specific organization, the White Plan. This plan, initiated by the director, assisted by a medico-administrative cell crisis can mobilize all the resources of the institution. Personnel are recalled and the ability of emergency units is increased. Care, less urgent, other patients are postponed. There are many plans for responding to disasters. ORSEC plans of the ministry of Interior articulate with the ORSAN plans of the ministry of Health. This complementarity allows a global mobilization of public services in disasters or exceptional medical situations.

  19. Medicine organizer

    NASA Astrophysics Data System (ADS)

    Martins, Ricardo; Belchior, Ismael

    2015-04-01

    In the last year of secondary school, students studying physics and chemistry are incentivized to do a project where they must put in practice their improvement of scientific knowledge and skills, like observation of phenomena and analysis of data with scientific knowledge. In this project a group of students, tutored by the teacher, wanted to build an instrument that helps people to take their medical drugs at the right time. This instrument must have some compartments with an alarm and an LED light where the people can put their medical drugs. The instrument must be easily programed using an android program that also registers if the medicine has been taken. The students needed to simulate the hardware and software, draw the electronic system and build the final product. At the end of the school year, a public oral presentation was prepared by each group of students and presented to the school community. They are also encouraged to participate in national and international scientific shows and competitions.

  20. Increasing Women's Leadership in Academic Medicine.

    ERIC Educational Resources Information Center

    Academic Medicine, 1996

    1996-01-01

    This position paper of the Association of American Medical Colleges gives an overview of the current situation regarding women's careers in academic medicine; looks at some reasons for disparities between men and women; and makes recommendations concerning development and mentoring of women faculty, administrators, residents, and students as well…

  1. Rehabilitation Medicine Summit: Building Research Capacity

    ERIC Educational Resources Information Center

    Frontera, Walter R.; Fuhrer, Marcus J.; Jette, Alan M.; Chan, Leighton; Cooper, Rory A.; Duncan, Pamela W.; Kemp, John D.; Ottenbacher, Kenneth J.; Peckham, P. Hunter; Roth, Elliot J.; Tate, Denise G.

    2006-01-01

    The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were (a) researchers; (b) research culture, environment, and infrastructure;…

  2. A guide to medicinal plants of Appalachia

    Treesearch

    Arnold Krochmal; Russell S. Walters; Richard M. Doughty

    1969-01-01

    The Medicinal or therapeutic uses of the plants described in this guide are not to be construed in any way as a recommendation by the authors or the U.S. Department of Agriculture. Some of the dried crude drugs, which must be modified considerably before commercial use, can be extremely poisonous when not used properly. Readers are cautioned against using these plant...

  3. Medicinal Herbs in Iranian Traditional Medicine for Learning and Memory

    PubMed Central

    Shojaii, Asie; Ghods, Roshanak; Fard, Mehri Abdollahi

    2016-01-01

    Background: A few factors such as age, stress, and emotions may lead to impaired learning, memory loss, amnesia, and dementia or threats like schizophrenia and Alzheimer’s disease (AD). Iranian traditional medicine (ITM) recommends some herbs and herbal preparations for the treatment or prevention of CNS problems. Methods: In this study, scientific evidence related to the effectiveness of ITM herbal medicine on memory, learning and AD is reviewed. The scientific evidence of plant efficacy was searched in electronic databases including PubMed, Scopus, SID, Science Direct, and Google Scholar by keywords such as memory, Alzheimer, amnesia, learning and scientific plant names from 1969 to 2014. Results: The findings of this study confirmed the effectiveness of certain ITM medicinal plants on enhancing memory and learning or in the treatment/prevention of amnesia and AD. Some ITM plants like Melissa officinalis, Crocus sativus and Nigella sativa showed improving effects on memory and the treatment of AD in clinical trials. In some cases, active principles responsible for the efficacy of these plants on memory were also determined. Discussion: Most of the studies on ITM plants were designed in animal models and a few herbs were evaluated in clinical trials on AD. Furthermore, there are insufficient or no investigations on certain herbal medicines used in ITM to confirm their effectiveness on memory and learning. Therefore, further experimental and clinical studies are necessary to evaluate the effectiveness of these plants on memory and AD as well as determining their active components. PMID:27516676

  4. Medicinal Herbs in Iranian Traditional Medicine for Learning and Memory

    PubMed Central

    Shojaii, Asie; Ghods, Roshanak; Fard, Mehri Abdollahi

    2016-01-01

    Background: A few factors such as age, stress, and emotions may lead to impaired learning, memory loss, amnesia, and dementia or threats like schizophrenia and Alzheimer’s disease (AD). Iranian traditional medicine (ITM) recommends some herbs and herbal preparations for the treatment or prevention of CNS problems. Methods: In this study, scientific evidence related to the effectiveness of ITM herbal medicine on memory, learning and AD is reviewed. The scientific evidence of plant efficacy was searched in electronic databases including PubMed, Scopus, SID, Science Direct, and Google Scholar by keywords such as memory, Alzheimer, amnesia, learning and scientific plant names from 1969 to 2014. Results: The findings of this study confirmed the effectiveness of certain ITM medicinal plants on enhancing memory and learning or in the treatment/prevention of amnesia and AD. Some ITM plants like Melissa officinalis, Crocus sativus and Nigella sativa showed improving effects on memory and the treatment of AD in clinical trials. In some cases, active principles responsible for the efficacy of these plants on memory were also determined. Discussion: Most of the studies on ITM plants were designed in animal models and a few herbs were evaluated in clinical trials on AD. Furthermore, there are insufficient or no investigations on certain herbal medicines used in ITM to confirm their effectiveness on memory and learning. Therefore, further experimental and clinical studies are necessary to evaluate the effectiveness of these plants on memory and AD as well as determining their active components. PMID:27840509

  5. General Nuclear Medicine

    MedlinePlus

    ... Children's (Pediatric) Nuclear Medicine Radioactive Iodine (I-131) Therapy Biopsies - Overview Radioimmunotherapy (RIT) Alzheimer's Disease X-ray, Interventional Radiology and Nuclear Medicine ...

  6. Medicines for sleep

    MedlinePlus

    Benzodiazepines; Sedatives; Hypnotics; Sleeping pills; Insomnia - medicines; Sleep disorder - medicines ... are commonly used to treat allergies. While these sleep aids are not addictive, your body becomes used ...

  7. International recommendations for electrocardiographic interpretation in athletes.

    PubMed

    Sharma, Sanjay; Drezner, Jonathan A; Baggish, Aaron; Papadakis, Michael; Wilson, Mathew G; Prutkin, Jordan M; La Gerche, Andre; Ackerman, Michael J; Borjesson, Mats; Salerno, Jack C; Asif, Irfan M; Owens, David S; Chung, Eugene H; Emery, Michael S; Froelicher, Victor F; Heidbuchel, Hein; Adamuz, Carmen; Asplund, Chad A; Cohen, Gordon; Harmon, Kimberly G; Marek, Joseph C; Molossi, Silvana; Niebauer, Josef; Pelto, Hank F; Perez, Marco V; Riding, Nathan R; Saarel, Tess; Schmied, Christian M; Shipon, David M; Stein, Ricardo; Vetter, Victoria L; Pelliccia, Antonio; Corrado, Domenico

    2017-02-20

    Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD. © The Author 2017. This article has been co-published in the European Heart Journal and the Journal of the American College of Cardiology. An extended version of this article has also

  8. Global patterns of water intake: how intake data affect recommendations.

    PubMed

    Shirreffs, Susan M

    2012-11-01

    Studies to assess water intake have been undertaken in many countries around the world. Some of these have been large-scale studies, whereas others have used a small number of subjects. These studies provide an emerging picture of water and/or fluid consumption in different populations around the world. Studies of this nature have also formed the basis of a number of recommendations published by different organizations, including the US Institute of Medicine and the European Food Safety Authority. The results of these intake studies indicate substantial differences in water and/or fluid intake in different populations, which have translated into different intake recommendations.

  9. [Vaccination schedule of the Spanish Association of Pediatrics: recommendations 2004].

    PubMed

    2004-05-01

    The Vaccine Assessment Committee of the Spanish Association of Pediatrics discusses vaccine developments in 2003 and recommends some modifications to the vaccination schedule. The recommendation of substituting the oral polio vaccine for the inactivated polio vaccine, suppressing the fifth dose, is maintained. The introduction of the conjugate pneumococcal vaccine and the varicella vaccine is stressed. Concerning the meningococcal C vaccine, the improvement introduced by being able to immunize with just two doses is discussed. In agreement with the information received from the European Medicines Agency, there appear to be no well-founded reasons to abandon hexavalent preparations.

  10. National Recommended Water Quality Criteria

    EPA Pesticide Factsheets

    The National Recommended Water Quality Criteria is a compilation of national recommended water quality criteria for the protection of aquatic life and human health in surface water for approximately 150 pollutants. These criteria provide guidance for states and tribes to use in adopting water quality standards.

  11. Teacher Leadership: Federal Policy Recommendations

    ERIC Educational Resources Information Center

    Gran, Jackie; Young, Margaret; Broin, Alexandra

    2015-01-01

    This policy brief was developed specifically for federal policymakers, and builds upon the policy recommendations included in "Leading from Every Seat: Empowering Principals to Cultivate Teacher Leadership for School Improvement." The recommendations in this report include the following: (1) Uncover New Leadership Ideas and Seed…

  12. Recommendations for Constructing Roadside Vegetation ...

    EPA Pesticide Factsheets

    Recommendations for external partners planting roadside vegetation. Intended for broad use, but immediate use will be to provide to project partners on the RESES roadside vegetation project and as an attachment to the RESES project QAPP Provide recommendations on the physical characteristics of roadside vegetation that can provide a local air quality benefit

  13. Context-Aware Recommender Systems

    NASA Astrophysics Data System (ADS)

    Adomavicius, Gediminas; Tuzhilin, Alexander

    The importance of contextual information has been recognized by researchers and practitioners in many disciplines, including e-commerce personalization, information retrieval, ubiquitous and mobile computing, data mining, marketing, and management. While a substantial amount of research has already been performed in the area of recommender systems, most existing approaches focus on recommending the most relevant items to users without taking into account any additional contextual information, such as time, location, or the company of other people (e.g., for watching movies or dining out). In this chapter we argue that relevant contextual information does matter in recommender systems and that it is important to take this information into account when providing recommendations. We discuss the general notion of context and how it can be modeled in recommender systems. Furthermore, we introduce three different algorithmic paradigms - contextual prefiltering, post-filtering, and modeling - for incorporating contextual information into the recommendation process, discuss the possibilities of combining several contextaware recommendation techniques into a single unifying approach, and provide a case study of one such combined approach. Finally, we present additional capabilities for context-aware recommenders and discuss important and promising directions for future research.

  14. Patients' refusal of recommended treatment.

    PubMed

    Dickens, Bernard M; Cook, Rebecca J

    2015-10-01

    When patients require information to decide whether to accept recommended treatments, a question in both law and ethics is whether the same information is adequate whether they consent or refuse, or whether refusal requires more or repeated information. Refusals of recommended treatment can carry increased risks for patients' well-being and so require more emphatic disclosure without imposing pressure. A related question is whether guardians of dependents who would decline recommended treatment for themselves--for instance on religious grounds--can similarly decline it for their dependents. When pregnant women, children, and adolescents are able to give consent for recommended treatment, the question arises whether they are equally competent to refuse it and prevent their decisions being overridden by guardians or courts. Consenting to and refusing medical treatments recommended in one's own or dependents' best interests might not be the same sorts of decisions and could require different levels of disclosure and capacity. Copyright © 2015. Published by Elsevier Ireland Ltd.

  15. Internal Medicine Training in the Inpatient Setting

    PubMed Central

    Lorenzo, Di Francesco; Pistoria, Michael J; Auerbach, Andrew D; Nardino, Robert J; Holmboe, Eric S

    2005-01-01

    PURPOSE Although the inpatient setting has served as the predominant educational site of internal medicine training programs, many changes and factors are currently affecting education in this setting. As a result, many educational organizations are calling for reforms in inpatient training. This report reviews the available literature on specific internal medicine inpatient educational interventions and proposes recommendations for improving internal medicine training in this setting. METHOD We searched Medline for articles published between 1966 and August 2004 which focused on internal medicine training interventions in the inpatient setting; bibliographies of Medline-identified articles, as well as articles suggested by experts in the field provided additional citations. We then reviewed, classified, and abstracted only articles where an assessment of learner outcomes was included. RESULTS Thirteen studies of inpatient internal medicine educational interventions were found that included an outcome assessment. All were single institution studies. The majority of these studies was of poor methodological quality and focused on specific content areas of internal medicine. None assessed the effectiveness or impact of internal medicine core inpatient experiences or curriculum. CONCLUSION This review identifies significant gaps in our understanding of what constitutes effective inpatient education. The paucity of high quality research in the internal medicine inpatient setting highlights the urgent need to formally define and study what constitutes an effective “core” inpatient curriculum. PMID:16423111

  16. Perspectives on the future of geriatric medicine.

    PubMed

    Elon, Rebecca D

    2006-03-01

    The following comments were presented to the 20th anniversary celebration of the geriatric medicine fellowship training program at the Baylor College of Medicine in the Texas Medical Center, Houston, Texas, on June 24, 2005. The author, who was the first graduate of the geriatric medicine training program at Baylor, proposes that geriatrics is at a critical juncture and that the voice and identity of geriatric medicine should be that of advocacy for our patients, and that in such a role geriatric medicine is well suited to become the "soul of medicine." She encourages all geriatricians to read the report of the Task Force on the Future of Geriatric Medicine and to look for opportunities to personally be involved in implementing the recommendations. She suggests that since our visions of the future are often only caricatures of our past, we must be creative and dream big dreams of what the future may hold. She challenges each of us to get involved in actively creating the future of geriatric medicine.

  17. The Need for a College of Veterinary Medicine to Serve New England and New Jersey.

    ERIC Educational Resources Information Center

    New England Board of Higher Education, Wellesley, MA. New England Library Information Network.

    This report documents the need for and presents well-founded recommendations for the establishment of a college of veterinary medicine to serve New England and New Jersey. The need for a veterinary medicine college is discussed in relation to today's veterinarians, and future shortage estimations. Major recommendations suggest that (1) a regional…

  18. Alternative Medicine and Alzheimer's Disease

    PubMed Central

    Kelley, Brendan J.; Knopman, David S.

    2009-01-01

    Background Alternative medicine has an extensive worldwide history and is commonly used by older patients. A number of different alternative medicines are used by patients having Alzheimer's disease. It is both desirable and expected for clinicians to be acquainted with these medications. Review Summary This paper discusses the available clinical trial evidence regarding eight agents commonly used by people having Alzheimer's disease. We provide an overview of the history and basic scientific evidence available for each agent, followed by a critical analysis of the evidence available from clinical trials, including the number of participants, trial duration and specific outcomes evaluated. Conclusion While many of these compounds have been associated with interesting basic science, none has shown clear clinical benefit to date. Data available for some, such as ginkgo biloba, curcumin and huperzine A, suggest that further evaluation is warranted. Familiarity with this literature will allow clinicians to provide meaningful recommendations to patients who wish to use these agents. PMID:18784599

  19. Antiretroviral treatment of HIV infection: Swedish recommendations 2005.

    PubMed

    Gisslén, Magnus; Ahlqvist-Rastad, Jane; Albert, Jan; Blaxhult, Anders; Hamberg, Anna-Karin; Lindbäck, Stefan; Sandström, Eric; Uhnoo, Ingrid

    2006-01-01

    On 2 earlier occasions, in 2002 and 2003, the Swedish Medical Products Agency (MPA) and the Swedish Reference Group for Antiviral Therapy (RAV) have jointly publicized recommendations for the treatment of HIV infection. A working group from the same expert team that produced the 2002 report has now revised the text again. Since the publication of the last treatment recommendations, 4 new medicines have become available: emtricitabine, atazanavir, fosamprenavir, and enfuvirtid. The last-mentioned belongs to a new class of HIV medications called fusion inhibitors (Box 1). It is likely that tipranavir will also be on the market soon. Simultaneously, the drug zalcitabin has been deregistered. The following updated recommendations parallel the earlier ones, but increased knowledge allows us to be more specific in our recommendations. Thus, it is now suggested that the initial treatment for HIV infection consist of 2 nucleoside reverse transcriptase inhibitors (NRTIs) and 1 non-nucleoside reverse transcriptase inhibitor (NNRTI); or 2 NRTIs and 1 protease inhibitor (PI). In the group of the NRTIs, stavudine is no longer recommended for this purpose. In the NNRTI group, efavirenz should be preferred to nevirapine, except under special circumstances. Finally, PIs ought to be boosted with ritonavir (PI/r). Also new are recommendations regarding treatment choices for patients co-infected with hepatitis B virus (HBV) or tuberculosis (TB). As in the case of the previous publication, recommendations are evidence-graded in accordance with the Oxford Centre for Evidence Based Medicine, 2001 (see http://www.cebm.net/levels_of_evidence.asp#levels), and have been supplemented with references to newly-added sections and data not referred to in earlier background documentation.

  20. Avoiding congestion in recommender systems

    NASA Astrophysics Data System (ADS)

    Ren, Xiaolong; Lü, Linyuan; Liu, Runran; Zhang, Jianlin

    2014-06-01

    Recommender systems use the historical activities and personal profiles of users to uncover their preferences and recommend objects. Most of the previous methods are based on objects’ (and/or users’) similarity rather than on their difference. Such approaches are subject to a high risk of increasingly exposing users to a narrowing band of popular objects. As a result, a few objects may be recommended to an enormous number of users, resulting in the problem of recommendation congestion, which is to be avoided, especially when the recommended objects are limited resources. In order to quantitatively measure a recommendation algorithm's ability to avoid congestion, we proposed a new metric inspired by the Gini index, which is used to measure the inequality of the individual wealth distribution in an economy. Besides this, a new recommendation method called directed weighted conduction (DWC) was developed by considering the heat conduction process on a user-object bipartite network with different thermal conductivities. Experimental results obtained for three benchmark data sets showed that the DWC algorithm can effectively avoid system congestion, and greatly improve the novelty and diversity, while retaining relatively high accuracy, in comparison with the state-of-the-art methods.

  1. Recommended for release on recognizance: factors affecting pretrial release recommendations.

    PubMed

    Petee, T A

    1994-06-01

    Researchers have acknowledged the influence of pretrial release agencies in judicial decision making regarding bail; however, few researchers have focused on the process used by the pretrial release agencies to make bail-bond recommendations. In this study I sought to establish which factors were most salient in making the decision to recommend a defendant for release on recognizance. I found that both officially sanctioned release criteria and "extralegal" variables were predictive of this decision.

  2. 76 FR 81 - Adoption of Recommendation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-03

    ...; ] ADMINISTRATIVE CONFERENCE OF THE UNITED STATES Adoption of Recommendation AGENCY: Administrative Conference of... the attached recommendation at its Fifty-third Plenary Session. The recommendation addresses issues... makes recommendations for improvements to the agencies, collectively or individually, and to...

  3. Persian Medicine in the World of Research; Review of Articles on Iranian Traditional Medicine.

    PubMed

    Moeini, Reihaneh; Gorji, Narjes

    2016-05-01

    Due to negligence, Persian (Iranian) traditional medicine has had a weak presence in the world of research for a long time. However, in recent years, a variety of activates by research and faculty centers have created awareness and a platform to introduce and promote Persian medicine to the world. The aim of this study is to present and analyze scientific achievements of Persian medicine in the world of research. Articles were collected from PubMed database using keywords such as "Persian medicine", "Persian traditional medicine", "Iranian medicine", and "Iranian traditional medicine". All data were classified based on the type of research (review, intervention, case reports, etc.), the field of study (neurology, cardiovascular, metabolic, historical studies, etc.), publication year, and journal type. A total of 501 articles were identified until the end of 2015, comprising of 222 reviews and 219 interventional (108 animal, 57 clinical and 54 cellular). Most studies were on neurology (20.1%), gastroenterology (14.5%), and cardiovascular diseases (10.4%). The publications in 2015 and 2014 had the highest hit rate with 139 and 132 articles, respectively, with 1:2 publication ratio between foreign and Iranian journals. The most published articles, both foreign and Iranian, were in "Evidence-Based Complementary and Alternative Medicine" and "Iranian Red Crescent Medicine" journals. The contribution of foreign authors was 5%. The primary focus of the articles was on "Basic concepts of Persian medicine", "Healthy lifestyle according to Persian medicine", and "Historical aspects", by 3.1%, 2.9%, and 6.7%, respectively. During the last 2 years, the number of articles published in Persian (Iranian) medicine, particularly clinical studies had significant growth in comparison with the years before. The tendency of foreign researchers to use the keywords "Iranian" or "Persian" medicine is notable. This research was only based on the designated keyword and other keywords were

  4. Practice parameters and strength of recommendation data: a variable compass.

    PubMed

    Banks, Taylor; Savitz, Julia; Nelson, Michael R

    2014-08-01

    Practice parameters and guidelines shape and influence the method and manner in which medicine is practiced. With more than 121 scales and methods of assessing and rating evidence, a comparison of practice parameters can appear daunting. An evaluation of the evidence engenders a sense of the evolution of a specialty and a roadmap for the future. To assess the level of evidence underlying recommendations in allergy-immunology (AI) practice parameters. We analyzed the practice parameters that guide AI (n = 15), otolaryngology (n = 8), pediatrics (n = 13), and internal medicine (n = 10) as they appeared on August 30, 2012. Strength of recommendation data was compared after making adjustments for differences in rating scales. The strength of recommendation calculated from strong to weak for the AI practice parameters using a standardized format yielded the following grades: A in 195 (13.9%), B in 342 (24.4%), C in 606 (43.2%), D in 231 (16.4%), and E in 29 (2.1%). Controlled trial-based evidence (A and B) demonstrated considerable variability among individual AI practice parameters (range, 1.3%-100%). Evidence from controlled trials was lower in the subspecialty fields (38.3% in AI and 38.2% in otolaryngology) compared with the primary care fields (55.6% in pediatrics and 86.1% in internal medicine). Considerable variability exists in the strength of recommendations within the AI practice parameters. The guidelines created by the primary care fields rest on a larger base of evidence collected from controlled trials. These findings likely reflect the adopted approach of making recommendations for less well-studied conditions and practices in AI to assist practitioners and patients and at the same time highlight the myriad opportunities for future research. Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  5. Integrative Medicine in Preventive Medicine Education

    PubMed Central

    Jani, Asim A.; Trask, Jennifer; Ali, Ather

    2016-01-01

    During 2012, the USDHHS’s Health Resources and Services Administration funded 12 accredited preventive medicine residencies to incorporate an evidence-based integrative medicine curriculum into their training programs. It also funded a national coordinating center at the American College of Preventive Medicine, known as the Integrative Medicine in Preventive Medicine Education (IMPriME) Center, to provide technical assistance to the 12 grantees. To help with this task, the IMPriME Center established a multidisciplinary steering committee, versed in integrative medicine, whose primary aim was to develop integrative medicine core competencies for incorporation into preventive medicine graduate medical education training. The competency development process was informed by central integrative medicine definitions and principles, preventive medicine’s dual role in clinical and population-based prevention, and the burgeoning evidence base of integrative medicine. The steering committee considered an interdisciplinary integrative medicine contextual framework guided by several themes related to workforce development and population health. A list of nine competencies, mapped to the six general domains of competence approved by the Accreditation Council of Graduate Medical Education, was operationalized through an iterative exercise with the 12 grantees in a process that included mapping each site’s competency and curriculum products to the core competencies. The competencies, along with central curricular components informed by grantees’ work presented elsewhere in this supplement, are outlined as a roadmap for residency programs aiming to incorporate integrative medicine content into their curricula. This set of competencies adds to the larger efforts of the IMPriME initiative to facilitate and enhance further curriculum development and implementation by not only the current grantees but other stakeholders in graduate medical education around integrative medicine

  6. Introducing complementary medicine into the medical curriculum.

    PubMed Central

    Rampes, H; Sharples, F; Maragh, S; Fisher, P

    1997-01-01

    We surveyed the deans of British medical schools to determine the provision of complementary medicine in the undergraduate curriculum. We also sampled medical students at one British medical school to determine their knowledge of, and views on instruction in, complementary medicine. There is little education in complementary medicine at British medical schools, but it is an area of active curriculum development. Students' levels of knowledge vary widely between different therapies. Most medical students would like to learn about acupuncture, hypnosis, homoeopathy and osteopathy. We conclude that complementary medicine should be included in the medical undergraduate curriculum. This could be done without a great increase in teaching of facts, and could serve as a vehicle to introduce broader issues, as recommended by the General Medical Council. PMID:9059376

  7. How Do Asthma Medicines Work?

    MedlinePlus

    ... Lifesaver Kids Talk About: Coaches How Do Asthma Medicines Work? KidsHealth > For Kids > How Do Asthma Medicines ... long-term control medicines . What Are Quick-Relief Medicines? Quick-relief medicines (also called rescue or fast- ...

  8. How Do Asthma Medicines Work?

    MedlinePlus

    ... Happens in the Operating Room? How Do Asthma Medicines Work? KidsHealth > For Kids > How Do Asthma Medicines ... of medicines for treating asthma: 1. Quick-relief Medicines Quick-relief medicines (also called rescue or fast- ...

  9. New IOM report underscores ongoing threat of med errors.

    PubMed

    2006-10-01

    Technology may improve the error rate, but careful implementation is absolutely critical. Health care provider groups should actively monitor their progress in improving medication safety. Medication reconciliation is a worthy goal, but implementation is proving more difficult than anticipated.

  10. Primary Care Physicians Practicing Preventive Medicine in the Outpatient Setting.

    PubMed

    Snipelisky, David; Carter, Kimberly; Sundsted, Karna; Burton, M Caroline

    2016-01-01

    Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians' perspectives of practicing preventive medicine and evaluate which topics are deemed most important. All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians' perception of the role of preventive medicine during both acute/routine and yearly visits, physicians' perception of patients' response to preventive medicine topics, and which preventive medicine topics are commonly practiced. Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1-5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1-5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force. Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations.

  11. Primary Care Physicians Practicing Preventive Medicine in the Outpatient Setting

    PubMed Central

    Snipelisky, David; Carter, Kimberly; Sundsted, Karna; Burton, M. Caroline

    2016-01-01

    Background: Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians’ perspectives of practicing preventive medicine and evaluate which topics are deemed most important. Methods: All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians’ perception of the role of preventive medicine during both acute/routine and yearly visits, physicians’ perception of patients’ response to preventive medicine topics, and which preventive medicine topics are commonly practiced. Results: Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1–5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1–5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force. Conclusions: Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations. PMID:26941906

  12. Recommended Immunizations for Adults 50+

    MedlinePlus

    ... page please turn Javascript on. Health Screenings and Immunizations Recommended Immunizations For Adults 50+ The content in this section ... out more, visit How Vaccines Prevent Disease . Vaccines, Vaccinations, and Immunizations Understanding the difference between vaccines, vaccinations, ...

  13. Preparing for an epidemic: cancer care in an aging population.

    PubMed

    Shih, Ya-Chen Tina; Hurria, Arti

    2014-01-01

    The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer.

  14. NUCLEAR DATA EVALUATIONS AND RECOMMENDATIONS

    SciTech Connect

    HOLDEN, N.E.

    2005-05-08

    The published scientific literature is scanned and periodically evaluated for neutron and non-neutron nuclear data and the resulting recommendations are published [1,2]. After the literature has been scanned and appropriate data collected, there are often problems with regard to the treatment of the various types of data during this evaluation process and with regard to the method by which the recommendations are drawn from the assessment of the collection of individual measurements. Some-problems with uncertainties are presented.

  15. Comparing physicians personal prevention practices and their recommendations to patients.

    PubMed

    Atanasov, Pavel; Anderson, Britta L; Cain, Joanna; Schulkin, Jay; Dana, Jason

    2015-01-01

    Hypothetical choice studies suggest that physicians often take more risk for themselves than on their patient's behalf. To examine if physicians recommend more screening tests than they personally undergo in the real-world context of breast cancer screening. Within-subjects survey. A national sample of female obstetricians and gynecologists (N = 135, response rate 54%) from the United States. In total, they provided breast care to approximately 2,800 patients per week. Personal usage history and patient recommendations regarding mammography screening and breast self-examination, a measure of defensive medicine practices. Across age groups, female physicians were more likely to recommend mammography screening than to have performed the procedure in the past 5 years (86% vs. 81%, p = .10). In respondents aged 40-49 this difference was significant (91% vs. 82%, p < .05), whereas no differences were detected for younger or older physicians. Among respondents in their 40s, 18% had undergone annual screenings in the past 5 years, compared to 48% of their colleagues above 50. Respondents were as likely to practice breast self-examination (98%) as to recommend it (93%), a pattern that was consistent across age groups. A logistic regression model of personal use of mammography significantly predicted recommending the procedure to patients (OR = 15.29, p = .001). Similarly, number of breast self-examinations performed over the past 2 years positively predicted patient recommendations of the procedure (OR = 1.31, p < .001). Obstetricians and gynecologists tended to recommend early mammography screening to their patients, though their personal practices indicated later start than their own recommendations and lower frequency of screening than peers in recent studies have recommended.

  16. Introduction on health recommender systems.

    PubMed

    Sanchez-Bocanegra, C L; Sanchez-Laguna, F; Sevillano, J L

    2015-01-01

    People are looking for appropriate health information which they are concerned about. The Internet is a great resource of this kind of information, but we have to be careful if we don't want to get harmful info. Health recommender systems are becoming a new wave for apt health information as systems suggest the best data according to the patients' needs.The main goals of health recommender systems are to retrieve trusted health information from the Internet, to analyse which is suitable for the user profile and select the best that can be recommended, to adapt their selection methods according to the knowledge domain and to learn from the best recommendations.A brief definition of recommender systems will be given and an explanation of how are they incorporated in the health sector. A description of the main elementary recommender methods as well as their most important problems will also be made. And, to finish, the state of the art will be described.

  17. Herbal medicine use in pregnancy: results of a multinational study.

    PubMed

    Kennedy, Deborah A; Lupattelli, Angela; Koren, Gideon; Nordeng, Hedvig

    2013-12-12

    The use of complementary and alternative medicines (CAM) is growing in the general population. Herbal medicines are used in all countries of the world and are included in the top CAM therapies used. A multinational study on how women treat disease and pregnancy-related health ailments was conducted between October 2011 and February 2012 in Europe, North and South America and Australia. In this study, the primary aim was to determine the prevalence of herbal medicine use in pregnancy and factors related to such use across participating countries and regions. The secondary aim was to investigate who recommended the use of herbal medication in pregnancy. There were 9,459 women from 23 countries participating in the study. Of these, 28.9% reported the use of herbal medicines in pregnancy. Most herbal medicines were used for pregnancy-related health ailments such as cold and nausea. Ginger, cranberry, valerian and raspberry were the most commonly used herbs in pregnancy. The highest reported rate of herbal use medicines was in Russia (69%). Women from Eastern Europe (51.8%) and Australia (43.8%) were twice as likely to use an herbal medicine versus other regions. Women using herbal medicines were characteristically having their first child, non-smokers, using folic acid and consuming some alcohol in pregnancy. Also, women who were currently students and women with an education other than a high school degree were more likely to use herbal medicines than other women. Although 1 out of 5 women stated that a physician had recommended the herbal use, most women used herbal medicine in pregnancy on their own initiative. In this multinational study herbal medicine use in pregnancy was high although there were distinct differences in the herbs and users of herbal medicines across regions. Most commonly the women self-medicated with herbal medicine to treat pregnancy-related health ailments. More knowledge regarding the efficacy and safety of herbal medicines in pregnancy is

  18. Managing medicinal risks in self-medication.

    PubMed

    Fainzang, Sylvie

    2014-05-01

    and minimising the former. This either leads patients to limit the consumption of medicines because of their adverse effects, or, on the contrary, to consume them precisely for these effects. Risk reduction strategies often consist of verifying, experimenting with, and personalising treatments. Although users sometimes resort to practices that do not comply with biomedical recommendations, they do so in order to attain the values and exigencies of biomedicine as regards the validation or personalisation of treatments. However irrational and peculiar these practices may appear, the mechanisms on which they are based do not necessarily break away from medical recommendations. Therefore, anthropologically speaking, we cannot oppose good and bad practices in terms of medicinal uses, since what health professionals would consider to be bad practices are thought by patients to be in keeping with good use.

  19. [Recommendation on temperature management after cardiopulmonary arrest and severe traumatic brain injury in childhood beyond the neonatal period : Statement of the German Society for Neonatology and Pediatric Intensive Care Medicine (GNPI) and the scientific Working Group for Paediatric Anaesthesia (WAKKA) of the German Society of Anaesthesiology and Intensive Care (DGAI)].

    PubMed

    Brenner, S; Eich, C; Rellensmann, G; Schuhmann, M U; Nicolai, T; Hoffmann, F

    2017-02-01

    The available data on the effectiveness of therapeutic hypothermia in different patient groups are heterogeneous. Although the benefits have been proven for some collectives, recommendations for the use of hypothermia treatment in other groups are based on less robust data and conclusions by analogy. This article gives a review of the current evidence of temperature management in all age groups and based on this state of knowledge, recommends active temperature management with the primary aim of strict normothermia (36-36.5 °C) for 72 hours after cardiopulmonary arrest or severe traumatic brain injury for children beyond the neonatal period.

  20. Teaching pediatric laboratory medicine to pathology residents.

    PubMed

    Pysher, Theodore J; Bach, Philip R; Geaghan, Sharon M; Hamilton, Marilyn S; Laposata, Michael; Lockitch, Gillian; Brugnara, Carlo; Coffin, Cheryl M; Pasquali, Marzia; Rinaldo, Piero; Roberts, William L; Rutledge, Joe C; Ashwood, Edward R; Blaylock, Robert C; Campos, Joseph M; Goldsmith, Barbara; Jones, Patricia M; Lim, Megan; Meikle, A Wayne; Perkins, Sherrie L; Perry, Deborah A; Petti, Cathy A; Rogers, Beverly B; Steele, Paul E; Weiss, Ronald L; Woods, Gail

    2006-07-01

    Laboratory data are essential to the medical care of fetuses, infants, children, and adolescents. However, the performance and interpretation of laboratory tests on specimens from these patients, which may constitute a significant component of the workload in general hospitals and integrated health care systems as well as specialized perinatal or pediatric centers, present unique challenges to the clinical pathologist and the laboratory. Therefore, pathology residents should receive training in pediatric laboratory medicine. Children's Health Improvement through Laboratory Diagnostics, a group of pathologists and laboratory scientists with interest and expertise in pediatric laboratory medicine, convened a task force to develop a list of curriculum topics, key resources, and training experiences in pediatric laboratory medicine for trainees in anatomic and clinical pathology or straight clinical pathology residency programs and in pediatric pathology fellowship programs. Based on the experiences of 11 training programs, we have compiled a comprehensive list of pediatric topics in the areas of clinical chemistry, endocrinology, hematology, urinalysis, coagulation medicine, transfusion medicine, immunology, microbiology and virology, biochemical genetics, cytogenetics and molecular diagnostics, point of care testing, and laboratory management. This report also includes recommendations for training experiences and a list of key texts and other resources in pediatric laboratory medicine. Clinical pathologists should be trained to meet the laboratory medicine needs of pediatric patients and to assist the clinicians caring for these patients with the selection and interpretation of laboratory studies. This review helps program directors tailor their curricula to more effectively provide this training.

  1. Balancing personalized medicine and personalized care.

    PubMed

    Cornetta, Kenneth; Brown, Candy Gunther

    2013-03-01

    The current description of personalized medicine by the National Institutes of Health is "the science of individualized prevention and therapy." Although physicians are beginning to see the promise of genetic medicine coming to fruition, the rapid pace of sequencing technology, informatics, and computer science predict a revolution in the ability to care for patients in the near future. The enthusiasm expressed by researchers is well founded, but the expectations voiced by the public do not center on advancing technology. Rather, patients are asking for personalized care: a holistic approach that considers physical, mental, and spiritual well-being. This perspective considers psychological, religious, and ethical challenges that may arise as the precision of preventive medicine improves. Psychological studies already highlight the barriers to single gene testing and suggest significant barriers to the predictive testing envisioned by personalized medicine. Certain religious groups will likely mount opposition if they believe personalized medicine encourages embryo selection. If the technology prompts cost-containment discussions, those concerned about the sanctity of life may raise ethical objections. Consequently, the availability of new scientific developments does not guarantee advances in treatment because patients may prove unwilling to receive and act on personalized genetic information. This perspective highlights current efforts to incorporate personalized medicine and personalized care into the medical curriculum, genetic counseling, and other aspects of clinical practice. Because these efforts are generally independent, the authors offer recommendations for physicians and educators so that personalized medicine can be implemented in a manner that meets patient expectations for personalized care.

  2. Medicines for cancers in children: The WHO model for selection of essential medicines

    PubMed Central

    Robertson, Jane; Barr, Ronald; Forte, Gilles; Ondari, Clive

    2015-01-01

    Pressures to include more cancer medicines in the WHO Model List of Essential Medicines (EML) pose challenges for the Expert Committee responsible for recommending changes to the list. How do medicines for cancer fit within a definition of essential medicines as those meeting the priority health needs of the population? Will identifying a medicine as “essential” offer some leverage to improve access to effective cancer medicines in low and middle‐income countries (LMICs)? The addition of a number of medicines for the treatment of cancers in children to the Model List of Essential Medicines for Children (EMLc) in 2011 provides important insights into previous Expert Committee decision‐making and offers a platform for future deliberations. As combination chemotherapy is required for effective treatment of many malignancies, a disease‐based approach makes more sense than an agent‐based approach. Inadequate financing to purchase essential medicines is a reality in many LMICs, thus a consideration of health impact is central to decisions on the selection and procurement of medicines. Inclusion in national EMLs should identify medicines that have priority for procurement in the public sector. This article will discuss some of the factors taken into account by the Expert Committee in developing the WHO EMLc. We argue that the disease‐based approach coupled with the assessment of the magnitude of the clinical benefit provides an appropriate approach for considering further additions of medicines for pediatric cancers and for the review of the adult cancer section of the Model List. Pediatr Blood Cancer 2015;62:1689–1693. © 2015 Wiley Periodicals, Inc. PMID:25929524

  3. Reflections on preventive medicine.

    PubMed

    Miettinen, Olli S

    2014-10-01

    Having thought much about medicine in my career-long effort to understand it and the research for its advancement, I have come to views rather different form the now-prevailing ones in respect to what preventive medicine is about; what epidemiology is in relation to preventive medicine; what distinguishes preventive medicine in preventive healthcare at large; the relation of preventive medicine to public health; the concept of health promotion; and also the core principles of preventive medicine. All of these views I set forth in this article, for the readers' critical reflection. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Economics and lighting level recommendations

    SciTech Connect

    Clear, R.; Berman, S.

    1992-04-01

    The Illuminating Engineering Society of North America develops light level recommendations for tasks where visual performance is important. The 1959 and 1972 recommendations for illumination levels were based on the principle of delivering a fixed level of performance as predicted by the visual performance models of the time. This same principle is being considered for future revisions to the recommendations. There is currently no explicit method for determining whether a given fixed performance level is in any sense optimal or best. Visual performance increases with lighting levels, but so do economic and environmental costs. These costs lessen the economic benefits of the improved visual performance. A formal method for including these factors in light level recommendations is to restate the problem in terms of net benefits (benefits minus costs). The resulting equations have well defined optima versus light level, and thus give an explicit estimate of what the best lighting levels are in terms of current visual performance models, and current economic conditions. A simple net-benefit procedure is described, and sample calculations are shown for two current visual performance models. Fixed performance levels do not provide economically optimal recommendations with either model. There are also differences between models, but they are less significant than the large differences between the principles of fixed performance levels and economic optimization.

  5. Interview with quality leaders: Dr. Donna E. Shalala and Dr. Linda Burnes Bolton on the committee on the Robert Wood Johnson Foundation initiative on The Future of Nursing at the Institute of Medicine. Interviewed by Diane Storer Brown.

    PubMed

    Shalala, Donna E; Bolton, Linda Burnes

    2012-01-01

    The Institute of Medicine released a consensus report in October 2010, titled The Future of Nursing (FON): Leading Change, Advancing Health, which concluded significant change was needed in nurses' roles, responsibilities, and education to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system (http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx). Dr. Donna Shalala, Chair of the study, and Dr. Linda Burnes Bolton, Vice Chair of the study, spoke about the Future of Nursing (FON) at the Collaborative Alliance for Nursing Outcomes (CALNOC) conference to a predominately nursing and quality professional audience. This follow-up interview expands the discussion specifically for quality professionals, many of whom are nurses.

  6. Paradigm lost: race, ethnicity, and the search for a new population taxonomy.

    PubMed Central

    Oppenheimer, G M

    2001-01-01

    The Institute of Medicine (IOM) recently recommended that the National Institutes of Health (NIH) reevaluate its employment of "race," a concept lacking scientific or anthropological justification, in cancer surveillance and other population research. The IOM advised the NIH to use a different population classification, that of "ethnic group," instead of "race." A relatively new term, according to the IOM, "ethnic group" would turn research attention away from biological determinism and toward a focus on culture and behavior. This article examines the historically central role of racial categorization and its relationship to racism in the United States and questions whether dropping "race" from population taxonomies is either possible or, at least in the short run, preferable. In addition, a historical examination of "ethnicity" and "ethnic group" finds that these concepts, as used in the United States, derive in part from race and immigration and are not neutral terms; instead, they carry their own burden of political, social, and ideological meaning. PMID:11441730

  7. Enhancing collaborative leadership in palliative social work in oncology.

    PubMed

    Jones, Barbara; Phillips, Farya; Head, Barbara Anderson; Hedlund, Susan; Kalisiak, Angela; Zebrack, Brad; Kilburn, Lisa; Otis-Green, Shirley

    2014-01-01

    The Institute of Medicine (IOM) Report-Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs-provided recommendations for meeting the palliative care needs of our growing population of older Americans. The IOM report highlights the demand for social work leadership across all aspects of the health care delivery system. Social workers are core interdisciplinary members of the health care team and it is important for them to be well prepared for collaborative leadership roles across health care settings. The ExCEL in Social Work: Excellence in Cancer Education & Leadership education project was created as a direct response to the 2008 IOM Report. This article highlights a sampling of palliative care projects initiated by outstanding oncology social work participants in the ExCEL program. These projects demonstrate the leadership of social workers in palliative care oncology.

  8. [2013 Ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension-associated risk, and attainment of therapeutic goals (summary). Joint recommendations from the International Society for Chronobiology (ISC), American Association of Medical Chronobiology and Chronotherapeutics (AAMCC), Spanish Society of Applied Chronobiology, Chronotherapy, and Vascular Risk (SECAC), Spanish Society of Atherosclerosis (SEA), and Romanian Society of Internal Medicine (RSIM)].

    PubMed

    Hermida, Ramón C; Smolensky, Michael H; Ayala, Diana E; Portaluppi, Francesco; Crespo, Juan J; Fabbian, Fabio; Haus, Erhard; Manfredini, Roberto; Mojón, Artemio; Moyá, Ana; Piñeiro, Luis; Ríos, María T; Otero, Alfonso; Balan, Horia; Fernández, José R

    2013-01-01

    Correlation between systolic (SBP) and diastolic (DBP) blood pressure (BP) level and target organ damage, cardiovascular disease (CVD) risk, and long-term prognosis is much greater for ambulatory BP monitoring (ABPM) than daytime office measurements. The 2013 ABPM guidelines specified herein are based on ABPM patient outcomes studies and constitute a substantial revision of current knowledge. The asleep SBP mean and sleep-time relative SBP decline are the most significant predictors of CVD events, both individually as well as jointly when combined with other ABPM-derived prognostic markers. Thus, they should be preferably used to diagnose hypertension and assess CVD and other associated risks. Progressive decrease by therapeutic intervention in the asleep BP mean is the most significant predictor of CVD event-free interval. The 24 h BP mean is not recommended to diagnose hypertension because it disregards the more valuable clinical information pertaining to the features of the 24 h BP pattern. Persons with the same 24 h BP mean may display radically different 24 h BP patterns, ranging from extreme-dipper to riser types, representative of markedly different risk states. Classification of individuals by comparing office with either the 24 h or awake BP mean as "masked normotensives" (elevated clinic BP but normal ABPM), which should replace the terms of "isolated office" or "white-coat hypertension", and "masked hypertensives" (normal clinic BP but elevated ABPM) is misleading and should be avoided because it disregards the clinical significance of the asleep BP mean. Outcome-based ABPM reference thresholds for men, which in the absence of compelling clinical conditions are 135/85 mmHg for the awake and 120/70 mmHg for the asleep SBP/DBP means, are lower by 10/5 mmHg for SBP/DBP in uncomplicated, low-CVD risk, women and lower by 15/10 mmHg for SBP/DBP in male and female high-risk patients, e.g., with diabetes, chronic kidney disease (CKD), and/or past CVD events. In

  9. Marijuana and medicine: assessing the science base: a summary of the 1999 Institute of Medicine report.

    PubMed

    Watson, S J; Benson, J A; Joy, J E

    2000-06-01

    In response to public pressure to allow the medical use of marijuana, the Office of National Drug Control Policy, Washington, DC, funded a study by the Institute of Medicine evaluating the scientific evidence for benefits and risks of using marijuana as a medicine. The report used scientific reviews, public hearings, and reports from other agencies, and was evaluated by knowledgeable advisors and reviewers. It called for heavier investment in research on the biology of cannabinoid systems, careful clinical studies of cannabinoids in clinical syndromes, analysis of cannabinoids' psychological effects on symptoms, and evaluations of the health consequences of heavy marijuana use; recommends against the use of smoked marijuana in medicine and for the development of a medical cannabinoid inhaler; and recommends that compassionate use of marijuana be considered under carefully reviewed protocols. Finally, the report evaluates the abuse potential, tolerance, withdrawal, and gateway risks of medical use of cannabinoid drugs.

  10. Some Medicinal Plants Used in Chinese Medicine.

    DTIC Science & Technology

    1960-09-27

    consisting of the following^plants: Panax ginseng C.A.ivio, Lycium chinense Mill«, Cornus officinalis Sieb, et Zucc, Rehmannia glutinosa (Gaertn.) Libosch...medicine. As an example of combined therapy with drugs from modern and Chinese popular medicine we might cite the use of ginseng as a factor which

  11. The purpose of occupational medicine.

    PubMed Central

    Raffle, P A

    1975-01-01

    The purposes of occupational medicine are described in terms of its clinical medical, environmental medical, research, and administrative content. Each of these components is essential in different proportions in comprehensive occupational health services for different industries, and can only be satisfactorily provided by occupational physicians and occupational health nurses who are an integral part of their organizations. Two-thirds of the working population in the United Kingdom are without the benefits of occupational medicine. The reorganization of the National Health Service and of local government presents the opportunity to extend occupational health services to many more workers who need them. It is suggested that area health authorities should provide occupational health services for all National Health Service staff and, on an agency basis, for local government and associated services, eventually extending to local industry. Such area health authority based services, merged with the Employment Medical Advisory Service, could conveniently then be part of the National Health Service, as recommended by the British Medical Association, the Society of Occupational Medicine, and the Medical Services Review Committee. PMID:1131336

  12. Plan for early action: Recommendations

    SciTech Connect

    1998-12-31

    This report contains recommendations on the implementation of an action plan to reduce or recapture greenhouse gas (GHG) emissions in British Columbia. The report includes the consensus recommendations of the BC Greenhouse Gas Forum, as well as those items on which Forum participants have agreed to disagree, plus the reasons for those differences. The recommendations include: Umbrella actions which may affect several or all sectors of the economy, or support the success of other actions; actions to reduce vehicle kilometers travelled; actions to increase vehicle efficiency or increase the use of alternative fuels or technologies; actions to decrease GHG emissions from energy production; actions to increase end-use energy efficiency; and actions to reduce non-energy-related emissions. Appendices include work sheets on each action, with a description of the action and information on the action`s rationale, experience elsewhere, related policy initiatives, and key issues regarding feasibility and implementation.

  13. Recommended Practices in Thrust Measurements

    NASA Technical Reports Server (NTRS)

    Polk, James E.; Pancotti, Anthony; Haag, Thomas; King, Scott; Walker, Mitchell; Blakely, Joseph; Ziemer, John

    2013-01-01

    Accurate, direct measurement of thrust or impulse is one of the most critical elements of electric thruster characterization, and one of the most difficult measurements to make. The American Institute of Aeronautics and Astronautics has started an initiative to develop standards for many important measurement processes in electric propulsion, including thrust measurements. This paper summarizes recommended practices for the design, calibration, and operation of pendulum thrust stands, which are widely recognized as the best approach for measuring micro N- to mN-level thrust and micro Ns-level impulse bits. The fundamentals of pendulum thrust stand operation are reviewed, along with its implementation in hanging pendulum, inverted pendulum, and torsional balance configurations. Methods of calibration and recommendations for calibration processes are presented. Sources of error are identified and methods for data processing and uncertainty analysis are discussed. This review is intended to be the first step toward a recommended practices document to help the community produce high quality thrust measurements.

  14. Publication recommendations for electrodermal measurements.

    PubMed

    Boucsein, Wolfram; Fowles, Don C; Grimnes, Sverre; Ben-Shakhar, Gershon; roth, Walton T; Dawson, Michael E; Filion, Diane L

    2012-08-01

    This committee was appointed by the SPR Board to provide recommendations for publishing data on electrodermal activity (EDA). They are intended to be a stand-alone source for newcomers and experienced users. A short outline of principles for electrodermal measurement is given, and recommendations from an earlier report (Fowles et al., ) are incorporated. Three fundamental techniques of EDA recording are described: (1) endosomatic recording without the application of an external current, (2) exosomatic recording with direct current (the most widely applied methodology), and (3) exosomatic recording with alternating current-to date infrequently used but a promising future methodology. In addition to EDA recording in laboratories, ambulatory recording has become an emerging technique. Specific problems that come with this recording of EDA in the field are discussed, as are those emerging from recording EDA within a magnetic field (e.g., fMRI). Recommendations for the details that should be mentioned in publications of EDA methods and results are provided.

  15. Empowering Recommendation Technologies Through Argumentation

    NASA Astrophysics Data System (ADS)

    Chesñevar, Carlosiván; Maguitman, Ana Gabriela; González, María Paula

    User support systems have evolved in the last years as specialized tools to assist users in a plethora of computer-mediated tasks by providing guidelines or hints 19. Recommender systems are a special class of user support tools that act in cooperation with users, complementing their abilities and augmenting their performance by offering proactive or on-demand, context-sensitive support. Recommender systems are mostly based on machine learning and information retrieval algorithms, providing typically suggestions based on quantitative evidence (i.e. measures of similarity between objects or users). The inference process which led to such suggestions is mostly unknown (i.e. ‘black-box’ metaphor). Although the effectiveness of existing recommenders is remarkable, they still have some serious limitations.

  16. Recommended Practices in Thrust Measurements

    NASA Technical Reports Server (NTRS)

    Polk, James E.; Pancotti, Anthony; Haag, Thomas; King, Scott; Walker, Mitchell; Blakely, Joseph; Ziemer, John

    2013-01-01

    Accurate, direct measurement of thrust or impulse is one of the most critical elements of electric thruster characterization, and one of the most difficult measurements to make. The American Institute of Aeronautics and Astronautics has started an initiative to develop standards for many important measurement processes in electric propulsion, including thrust measurements. This paper summarizes recommended practices for the design, calibration, and operation of pendulum thrust stands, which are widely recognized as the best approach for measuring micro N- to mN-level thrust and micro Ns-level impulse bits. The fundamentals of pendulum thrust stand operation are reviewed, along with its implementation in hanging pendulum, inverted pendulum, and torsional balance configurations. Methods of calibration and recommendations for calibration processes are presented. Sources of error are identified and methods for data processing and uncertainty analysis are discussed. This review is intended to be the first step toward a recommended practices document to help the community produce high quality thrust measurements.

  17. Action Recommendation for Cyber Resilience

    SciTech Connect

    Choudhury, Sutanay; Rodriguez, Luke R.; Curtis, Darren S.; Oler, Kiri J.; Nordquist, Peter L.; Chen, Pin-Yu; Ray, Indrajit

    2015-09-01

    This paper presents an unifying graph-based model for representing the infrastructure, behavior and missions of an enterprise. We describe how the model can be used to achieve resiliency against a wide class of failures and attacks. We introduce an algorithm for recommending resilience establishing actions based on dynamic updates to the models. Without loss of generality, we show the effectiveness of the algorithm for preserving latency based quality of service (QoS). Our models and the recommendation algorithms are implemented in a software framework that we seek to release as an open source framework for simulating resilient cyber systems.

  18. Herbal medicinal oils in traditional Persian medicine.

    PubMed

    Hamedi, Azadeh; Zarshenas, Mohammad M; Sohrabpour, Maryam; Zargaran, Arman

    2013-09-01

    In Iran, conventional production methods of herbal oils are widely used by local practitioners. Administration of oils is rooted in traditional knowledge with a history of more than 3000 years. Scientific evaluation of these historical documents can be valuable for finding new potential use in current medicine. The current study (i) compiled an inventory of herbal oils used in ancient and medieval Persia and (ii) compared the preparation methods and therapeutic applications of ancient times to current findings of medicinal properties in the same plant species. Information on oils, preparation methods and related clinical administration was obtained from ancient Persian documents and selected manuscripts describing traditional Persian medicine. Moreover, we investigated the efficacy of medicinal plant species used for herbal oils through a search of the PubMed, Scopus and Google Scholar databases. In Iran, the application of medicinal oils date back to ancient times. In medieval Persian documents, 51 medicinal oils produced from 31 plant species, along with specific preparation methods, were identified. Flowers, fruits and leaves were most often used. Herbal oils have been traditionally administered via oral, topical and nasal routes for gastrointestinal, musculoskeletal, and neural diseases, respectively. According to current investigations, most of the cited medicinal plant species were used for their anti-inflammatory and analgesic properties. Medicinal oils are currently available in Iranian medicinal plant markets and are prepared using traditional procedures for desirable clinical outcomes. Other than historical clarification, the present study provides data on clinical applications of the oils that should lead to future opportunities to investigate their potential medicinal use.

  19. [Innovation guidelines and strategies for pharmaceutical engineering of Chinese medicine and their industrial translation].

    PubMed

    Cheng, Yi-Yu; Qu, Hai-Bin; Zhang, Bo-Li

    2013-01-01

    This paper briefly analyzes the bottlenecks and major technical requirements for pharmaceutical industry of Chinese medicine, providing current status of pharmaceutical engineering of Chinese medicine. The innovation directions and strategies of the pharmaceutical engineering for manufacturing Chinese medicine are proposed along with the framework of their core technology. As a consequence, the development of the third-generation pharmaceutical technology for Chinese medicine, featured as "precision, digital and intelligent", is recommended. The prospects of the pharmaceutical technology are also forecasted.

  20. Individualized medicine, health medicine, and constitutional theory in Chinese medicine.

    PubMed

    Wang, Qi

    2012-03-01

    The patterns of modern science and changes in the medical model can result in the transformation of the current state of individualized and health medicines into being the primary trend in medical development. Chinese and Western medical systems are dissimilar in terms of value orientations, thinking style, and research directions because of their different historical and cultural backgrounds. Individualized treatment in modern medicine is mainly established based on individual genome information and the differences in mononucleotide polymorphisms. However, such treatment method is expensive, creates an uncertain genetic marker, and leads to different result interpretations, among other problems. The Chinese constitutional theory developed in the 1970s expresses the principle behind Chinese health medicine and individual treatment and provides the corresponding methods. The Chinese constitutional theory divides the constitution of the Chinese population into nine categories based on established classification criteria. It promotes the study of the relationship of each constitution to diseases and Chinese medicine preparation toward adjusting the constitution and preventing diseases. The theory also provides methods and tools for individualized treatment. Constitution identification shows the direction and provides the core technology for the evaluation of the health status. By combining the developments in modern biotechnology, new diagnostic techniques and treatment models of constitution-differentiation, disease-differentiation, and syndrome-differentiation can be established for the development of individualized Chinese medicine treatment and health medicine for the international medical community.

  1. Veterinary medicines: product update.

    PubMed

    2014-04-05

    The following information has been produced for Veterinary Record by the Veterinary Medicines Directorate (VMD) to provide an update for veterinary surgeons on recent changes to marketing authorisations for veterinary medicines in the UK and on other relevant issues.

  2. Veterinary medicines: product update.

    PubMed

    2014-03-01

    The following information has been produced for Veterinary Record by the Veterinary Medicines Directorate (VMD) to provide an update for veterinary surgeons on recent changes to marketing authorisations for veterinary medicines in the UK and on other relevant issues.

  3. Veterinary medicines: product update.

    PubMed

    2014-08-02

    The following information has been produced for Veterinary Record by the Veterinary Medicines Directorate (VMD) to provide an update for veterinary surgeons on recent changes to marketing authorisations for veterinary medicines in the UK and on other relevant issues.

  4. Veterinary medicines: product update.

    PubMed

    2014-11-01

    The following information has been produced for Veterinary Record by the Veterinary Medicines Directorate (VMD) to provide an update for veterinary surgeons on recent changes to marketing authorisations for veterinary medicines in the UK and on other relevant issues.

  5. Veterinary medicines: product update.

    PubMed

    2014-09-06

    The following information has been produced for Veterinary Record by the Veterinary Medicines Directorate (VMD) to provide an update for veterinary surgeons on recent changes to marketing authorisations for veterinary medicines in the UK, and on other relevant issues.

  6. Veterinary medicines update.

    PubMed

    2017-03-11

    The following information has been produced for Veterinary Record by the Veterinary Medicines Directorate (VMD) to provide an update for veterinary surgeons on recent changes to marketing authorisations for veterinary medicines in the UK and on other relevant issues.

  7. Cough & Cold Medicine Abuse

    MedlinePlus

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Cough & Cold Medicine Abuse KidsHealth > For Teens > Cough & Cold ... tos y el resfriado Why Do People Use Cough and Cold Medicines to Get High? There's an ...

  8. Cold and Cough Medicines

    MedlinePlus

    ... What can you do for your cold or cough symptoms? Besides drinking lots of fluids and getting ... medicines. There are lots of different cold and cough medicines, and they do different things. Nasal decongestants - ...

  9. Sports Medicine Today

    ERIC Educational Resources Information Center

    Ryan, Allan J.

    1978-01-01

    Includes a general discussion of sports medicine including exercise and conditioning techniques, prevention of illness and injury, treatment of and rehabilitation after sports injury, and the future of sports medicine. (BB)

  10. Using Medicines Wisely

    MedlinePlus

    ... Consumers Consumer Information by Audience For Women Use Medicines Wisely Share Tweet Linkedin Pin it More sharing ... or foods should I avoid? 2. Keep a Medicine List Write down the important facts about each ...

  11. Medicines for ADHD

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/007592.htm Medicines for ADHD To use the sharing features on ... that the treatment plan is successful. TYPES OF MEDICINES Stimulants are the most commonly used type of ...

  12. Pregnancy and Medicines

    MedlinePlus

    Not all medicines are safe to take when you are pregnant. Some medicines can harm your baby. That includes over-the-counter or prescription drugs, herbs, and supplements. Always speak with your health ...

  13. Cough & Cold Medicine Abuse

    MedlinePlus

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Cough & Cold Medicine Abuse KidsHealth > For Teens > Cough & Cold ... Someone Quit? Avoiding DXM Why Do People Use Cough and Cold Medicines to Get High? There's an ...

  14. Giving Medicine to Children

    MedlinePlus

    ... Products For Consumers Home For Consumers Consumer Updates Articulos en Espanol Giving Medicine to Children Share Tweet ... right medicine and the right amount More in Articulos en Espanol Alimentos y Bebidas Cosméticos Dispositivos Médicos ...

  15. Society for Vascular Medicine

    MedlinePlus

    ... Certification with this new online course from the Society for Vascular Medicine. Learn more. Looking for a ... jobs are listed right now. Copyright © 2016 The Society for Vascular Medicine. All Rights Reserved.

  16. Sports Medicine Today

    ERIC Educational Resources Information Center

    Ryan, Allan J.

    1978-01-01

    Includes a general discussion of sports medicine including exercise and conditioning techniques, prevention of illness and injury, treatment of and rehabilitation after sports injury, and the future of sports medicine. (BB)

  17. Traveling Safely with Medicines

    MedlinePlus

    ... means taking a trip. To be sure that you can stay healthy on your trip, ask your pharmacist about how to travel safely with your medicines. Make sure that you always carry a list of all the medicines ...

  18. Operational and Research Musculoskeletal Summit: Summit Recommendations

    NASA Technical Reports Server (NTRS)

    Scheuring, Richard A.; Walton, Marlei; Davis-Street, Janis; Smaka, Todd J.; Griffin, DeVon

    2006-01-01

    The Medical Informatics and Health Care Systems group in the Office of Space Medicine at NASA Johnson Space Center (JSC) has been tasked by NASA with improving overall medical care on the International Space Station (ISS) and providing insights for medical care for future exploration missions. To accomplish this task, a three day Operational and Research Musculoskeletal Summit was held on August 23-25th, 2005 at Space Center Houston. The purpose of the summit was to review NASA#s a) current strategy for preflight health maintenance and injury screening, b) current treatment methods in-flight, and c) risk mitigation strategy for musculoskeletal injuries or syndromes that could occur or impact the mission. Additionally, summit participants provided a list of research topics NASA should consider to mitigate risks to astronaut health. Prior to the summit, participants participated in a web-based pre-summit forum to review the NASA Space Medical Conditions List (SMCL) of musculoskeletal conditions that may occur on ISS as well as the resources currently available to treat them. Data from the participants were compiled and integrated with the summit proceedings. Summit participants included experts from the extramural physician and researcher communities, and representatives from NASA Headquarters, the astronaut corps, JSC Medical Operations and Human Adaptations and Countermeasures Offices, Glenn Research Center Human Research Office, and the Astronaut Strength, Conditioning, and Reconditioning (ASCR) group. The recommendations in this document are based on a summary of summit discussions and the best possible evidence-based recommendations for musculoskeletal care for astronauts while on the ISS, and include recommendati ons for exploration class missions.

  19. A review on the elemental contents of Pakistani medicinal plants: Implications for folk medicines.

    PubMed

    Aziz, Muhammad Abdul; Adnan, Muhammad; Begum, Shaheen; Azizullah, Azizullah; Nazir, Ruqia; Iram, Shazia

    2016-07-21

    Substantially, plants produce chemicals such as primary and secondary metabolites, which have significant applications in modern therapy. Indigenous people mostly rely on traditional medicines derived from medicinal plants. These plants have the capacity to absorb a variety of toxic elements. The ingestion of such plants for medicinal purpose can have imperative side effects. Hence, with regard to the toxicological consideration of medicinal plants, an effort has been made to review the elemental contents of ethno medicinally important plants of Pakistan and to highlight the existing gaps in knowledge of the safety and efficacy of traditional herbal medications. Literature related to the elemental contents of ethno medicinal plants was acquired by utilizing electronic databases. We reviewed only macro-elemental and trace elemental contents of 69 medicinal plant taxa, which are traditionally used in Pakistan for the treatment of sundry ailments, including anemia, jaundice, cancer, piles, diarrhea, dysentery, headache, diabetes, asthma, blood purification, sedative and ulcer. A majority of plants showed elemental contents above the permissible levels as recommended by the World health organization (WHO). As an example, the concentrations of Cadmium (Cd) and Lead (Pb) were reportedly found higher than the WHO permissible levels in 43 and 42 medicinal plants, respectively. More specifically, the concentrations of Pb (54ppm: Silybum marianum) and Cd (5.25ppm: Artemisia herba-alba) were found highest in the Asteraceae family. The reported medicinal plants contain a higher amount of trace and toxic elements. Intake of these plants as traditional medicines may trigger the accumulation of trace and toxic elements in human bodies, which can cause different types of diseases. Thus, a clear understanding about the nature of toxic substances and factors affecting their concentrations in traditional medicines are essential prerequisites for efficacious herbal therapeutics with

  20. Observational studies often make clinical practice recommendations: an empirical evaluation of authors' attitudes.

    PubMed

    Prasad, Vinay; Jorgenson, Joel; Ioannidis, John P A; Cifu, Adam

    2013-04-01

    Although observational studies provide useful descriptive and correlative information, their role in the evaluation of medical interventions remains contentious. There has been no systematic evaluation of authors' attitudes toward their own nonrandomized studies and how often they recommend specific medical practices. We reviewed all original articles of nonrandomized studies published in 2010 in New England Journal of Medicine, Lancet, Journal of the American Medical Association, and Annals of Internal Medicine. We classified articles based on whether authors recommend a medical practice and whether they state that a randomized trial is needed to support their recommendation. We also examined the types of logical extrapolations used by authors who did advance recommendations. Of the 631 original articles published in 2010, 298 (47%) articles were eligible observational studies. In 167 (56%) of 298 studies, authors recommended a medical practice based on their results. Only 24 (14%) of 167 studies stated that a randomized controlled trial (RCT) should be done to validate the recommendation, whereas the other 143 articles made a total of 149 logical extrapolations to recommend specific medical practices. Recommendations without a call for a randomized trial were most common in studies of modifiable factors (59%), but they were also common in studies reporting incidence or prevalence (51%), studies examining novel tests (41%), and association studies of nonmodifiable factors (32%). The authors of observational studies often extrapolate their results to make recommendations concerning a medical practice, typically without first calling for a RCT. Published by Elsevier Inc.